Incidence and Predictors of Pregnancy among HIV Positive Women on ART in North West Ethiopia, a Retrospective Cohort Study

  

    
Covariate
    
Category
    
B
    
S.E.
    
Wald
    
df
    
Sig.
    
Exp(B)
    
95.% CI EXP(B)
  
  

    
Lower
    
Upper
  
  

    
WHO clinical stage
    
Stage I (ref.)
    
 
    
 
    
16.320
    
3
    
.001*
    
 
    
 
    
 
  
  

    
Stage II
    
-1.285
    
.760
    
2.857
    
1
    
.091
    
.277
    
.062
    
1.228
  
  

    
Stage III
    
-5.085
    
1.310
    
15.065
    
1
    
.000*
    
.006
    
.000
    
.081
  
  

    
Stage IV
    
-3.745
    
1.846
    
4.114
    
1
    
.043*
    
.024
    
.001
    
.882
  
  

    
Spouse's HIV status
    
Negative (ref.)
    
 
    
 
    
6.871
    
2
    
.032*
    
 
    
 
    
 
  
  

    
Positive
    
1.614
    
.742
    
4.725
    
1
    
.030*
    
5.023
    
1.172
    
21.526
  
  

    
Unknown
    
-.464
    
.761
    
.371
    
1
    
.542
    
.629
    
.141
    
2.797
  
  

    
Marital status
    
Married (ref.)
    
 
    
 
    
25.368
    
3
    
.000*
    
 
    
 
    
 
  
  

    
Unmarried
    
-4.326
    
1.040
    
17.315
    
1
    
.000*
    
.013
    
.002
    
.101
  
  

    
Divorced
    
-4.904
    
1.111
    
19.485
    
1
    
.000*
    
.007
    
.001
    
.065
  
  

    
Widowed
    
-3.920
    
1.328
    
8.715
    
1
    
.003*
    
.020
    
.001
    
.268
  
  

    
Contraception use
    
Never(ref.)
    
 
    
 
    
19.940
    
3
    
.000*
    
 
    
 
    
 
  
  

    
Rarely
    
-.1.026
    
.978
    
1.102
    
1
    
.294
    
.358
    
.053
    
2.435
  
  

    
Mostly
    
-4.100
    
1.105
    
13.774
    
1
    
.000*
    
.017
    
.002
    
.144
  
  

    
Always
    
-3.671
    
1.106
    
11.019
    
1
    
.001*
    
.025
    
.003
    
.222
  
  

    
CD4 cell count
    
<250 (ref.)
    
 
    
 
    
22.550
    
3
    
.000*
    
 
    
 
    
 
  
  

    
250-350
    
-2.700
    
1.286
    
4.410
    
1
    
.036*
    
.067
    
.005
    
.835
  
  

    
351-500
    
1.594
    
1.060
    
2.263
    
1
    
.133
    
4.925
    
.617
    
39.322
  
  

    
>500
    
2.254
    
1.030
    
4.789
    
1
    
.029*
    
9.522
    
1.265
    
71.674
  
  

    
Time on ART follow up
    
>=24 months
    
 
    
 
    
11.978
    
2
    
.003*
    
 
    
 
    
 
  
  

    
25-48 months
    
3.062
    
.888
    
11.897
    
1
    
.001*
    
21.363
    
3.750
    
121.681
  
  

    
>48 months
    
2.135
    
.926
    
5.315
    
1
    
.021*
    
8.460
    
1.377
    
51.973
  
  

    
Body weight of women
    
<50 kg (ref.)
    
 
    
 
    
6.284
    
2
    
.043*
    
 
    
 
    
 
  
  

    
50-60 kg
    
.438
    
.797
    
.303
    
1
    
.582
    
1.550
    
.325
    
7.387
  
  

    
>60 kg
    
1.949
    
.907
    
4.616
    
1
    
.032*
    
7.018
    
1.186
    
41.515
  
  

    
Occupation
    
Employed(ref.)
    
 
    
 
    
10.108
    
2
    
.006*
    
 
    
 
    
 
  
  

    
Unemployed
    
-2.334
    
.827
    
7.976
    
1
    
.005*
    
.097
    
.019
    
.490
  
  

    
Housewife
    
-2.636
    
.904
    
8.499
    
1
    
.004*
    
.072
    
.012
    
.422
  
  

    
Age
    
15-24 (ref.)
    
 
    
 
    
16.401
    
3
    
.001*
    
 
    
 
    
 
  
  

    
25-29
    
.166
    
.761
    
.048
    
1
    
.827
    
1.181
    
.266
    
5.249
  
  

    
30-35
    
-2.423
    
1.030
    
5.538
    
1
    
.019*
    
.089
    
.012
    
.667
  
  

    
>35
    
-5.035
    
1.333
    
14.255
    
1
    
.000*
    
.007
    
.000
    
.089
  
  

    
Child alive
    
Have a child
    
-1.892
    
.664
    
8.111
    
1
    
.004*
    
.151
    
.041
    
.554
  
  

    
Constant
    
 
    
1.569
    
2.442
    
.413
    
1
    
.520
    
4.804
    
 
    
 
  
  

    
ref.=Reference category which    is the first category; *=significant at 5% significance level
  

Table 2: Result of Multiple Logistic Regression Analysis of incidence of pregnancy among HIV positive women on ART in Finote Selam general hospital, Oct. 2016
to Sep. 2019.

Discussions

The objective of this study was to assess the prevalence and to identify the important predictors of incidence of pregnancy of HIV positive women on ART follow up. As per the result of descriptive analysis, out of 429 samples about 91 (21.2%) of women had pregnancy during the follow up. From multiple logistic regression analysis, WHO clinical stage, spouse’s HIV status, marital status, contraception use, body weight, child alive before ART, occupation, CD4 cell count, age and time of ART follow-up were significant predictors at 5% level of significance.

The study has shown that WHO clinical stage was an important significant variable of incidence of pregnancy. According to the result of this study, women who are under advanced WHO clinical stage were less likely to become pregnant. That is, incidence of pregnancy was negatively related with WHO clinical stage, when the stages become increase, the incidence of pregnancy decrease. This implies that women who had WHO clinical stage I were more likely to be pregnant and this result is supported by the studies [7,9]. This difference might be due to those women in stage I at initiation of ART have a better health.

Marital status of women was also significant predictor for the incidence of pregnancy of HIV positive women. The result indicates that married women were more likely to be pregnant than other category. This finding is similar with the study in Ethiopia, Uganda and Brazil [7,8,11,13,14]. The possible reason for the explanation might be differences in the size of records reviewed, the study period, and marital status is the clear indicator of sexual activity of an individual.

From the result contraception use of women was a significant predictor of incidence of pregnancy. Women who ever-used contraception (mostly, always) were less likely to became pregnant than women who never use contraception and this is supported by the study of [8,11].

As shown from the result, CD4 cell count was strong significant predictors and positively related with incidence of pregnancy. The incidence of pregnancy during ART follow-up was highest among women with CD4 count greater than 500 cell/mm3. The incidence of pregnancy of women was increased with increasing of CD4 cell count. The result is consistent with the study of [10,13] and inconsistent with the study of [11]. The possible justification might be due to that fertility desire increases when CD4 cells count are higher, which subsequently increases the possibility of HIV infected women to become pregnant.

Time of ART follow-up was important predictor and positively related with incidence of pregnancy. Women on ART for 25-48 months were 21.363 times more likely to become pregnant than women on ART less than 25 months and women on ART for more than 48 months were 8.46 times more likely to become pregnant than women less than 25 months. This indicate that longer time on ART follow-up were associated with increasing probability of becoming pregnant. This finding was in line with the study in Malawi and Uganda [9,12].

Body weight of women was significant predictor for incidence of pregnancy. From the output, women who had body weight between 50 and 60 kilogram were more likely to be pregnant than women who had body weight less than 50 kilogram. Additionally, women who had body weight greater than 60 kilogram were more likely to be pregnant compared with the reference group and this study was similar with the studies of [7, 11].

Based on the result, occupation of women was significant predictor of incidence of pregnancy. Both unemployed and housewife women were less likely to be pregnant compared to employed women. This implies that incidence of pregnancy was higher in employed patient women than other groups on ART follow-up. This result was consistent with the study in sub-Saharan Africa and Ethiopia [14] and inconsistent with the study by [9] in Malawi. The possible explanation of this finding might be due to the fact that in most circumstances in Ethiopia employed women are those with better educational status and they could be financially secured.

The study revealed that age of women was a significantly and negatively related with incidence of pregnancy on ART followup. The prevalence of pregnancy during the follow-up was higher among younger women aged 15-24 and 25-29, than older women. This indicate that there was decreasing the probability of incidence of pregnancy with increasing age of women. These results are expected because women are generally most fertile between the ages of 20 and 24 years and as they get older the likelihood of getting pregnant decreases. This finding was supported by similar findings in sub- Saharan Africa, Malawi, Uganda and Brazil [7-11,13]. The explanation is probably that it is more common for women in having children at a younger age in Ethiopia and the fact that younger women are generally more fertile.

The result of our study indicates that number of child alive before ART follow-up was another important significant variable for incidence of pregnancy. Women who have no child were more likely to become pregnant compared to women who had child. Likewise, women who had fewer children were more likely to become pregnant compared to women who had more. This result was consistent with the finding of [11,14] and inconsistent with the study of [13].

Conclusions

The aim of the study was to assess the prevalence and to identify the important predictors of incidence of pregnancy among HIV positive women under ART follow-up of reproductive ages in Finote Selam general Hospital. Both chi-square test and binary logistic regression analysis were employed. Out of total sample about 21.2% of women had pregnancy during ART follow up. From logistic regression result, the significant predictors of incidence of pregnancy on HIV positive women under ART follow up were WHO clinical stage, spouse’s HIV status, marital status, use of contraception, CD4 count, time of ART follow-up, body weight, occupation, age and child alive. Women with advance WHO clinical stage were less likely to be pregnant. Women being married, being employed, never use contraceptive, had HIV positive spouse, had child were more likely to have pregnancy on the follow up. When CD4 cell count and body weight increase, incidence of pregnancy also increases and women who had longer time on ART follow up were more likely to be pregnant.

Based on the findings of this study, the following recommendations were made:

• Zonal Health Department and health institutions should be cautious when the patients have faced advanced WHO clinical stage and low CD4 count.

• Effective counseling strategies have to be designed focusing on unemployed, housewife mothers and mothers with no children at enrollment to encourage pregnancy.

• We would like to put remarks of increasing employment of HIV Positive women, providing effective services of ART health care, and studying further investigation for the general wellbeing of mothers and their respective potentially born children.

Availability of Data And Materials

The primary data set collected from households and analyzed during the current study is available from the corresponding author.

Funding

We declare that we did not receive any funding for this work.

Competing Interests

The authors declare that they have no competing interests.

Acknowledgements

I would like to acknowledge all the study participants and data collectors for their willingness to take in this study. I would like to express our heartfelt gratitude to those who have helped us substantiate our research.

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