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      Unintended Pregnancy and Associated Factors Among HIV Positive Women in Ilu Aba Bora zone, South Western Ethiopia: A Facility-Based Cross-Sectional Study

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          Abstract

          Background

          Unintended pregnancy reflects the existence of unprotected sex. Understanding factors associated with unintended pregnancy among HIV-positive women is very important to design strategies for the prevention of further transmission and infection with the virus. However, there is scarce information in this regard. Given the degree of HIV prevalence among women and the current antiretroviral therapy scale up in Ethiopia, it is important to understand factors associated with un-intended pregnancy in order to prevent mother to child HIV transmission (MTCT).

          Methods

          An institution-based cross-sectional study design was employed. The sample size was 353; all HIV/AIDS sero-positive reproductive age group (15–49) women having any pregnancy history after their diagnosis and having started HAART were included and simple random sampling was used to select study participants. Data collection period was from March 9 to April 13, 2019.

          Results

          The prevalence of unintended pregnancy among the participants was 40.9%. In the multivariate logistic regression, unemployment (AOR, 3.36; 95% CI: 1.55–7.26), not being knowledgeable on MTCT and prevention of MTCT (PMTCT) (AOR, 3.18; 95% CI: 1.92–5.24), and having had no discussion on reproductive health issues (AOR, 1.83; 95% CI: 1.09–3.07) are factors significantly associated with unintended pregnancy occurrence among HIV-positive women on antiretroviral therapy.

          Conclusion and Recommendation

          The prevalence of unintended pregnancy among the women in the study is high. To avoid unintended pregnancies, HIV-infected women need access to effective family planning services and risk reduction discussions during routine care visits.

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          Most cited references16

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          Saving the lives of South Africa's mothers, babies, and children: can the health system deliver?

          South Africa is one of only 12 countries in which mortality rates for children have increased since the baseline for the Millennium Development Goals (MDGs) in 1990. Continuing poverty and the HIV/AIDS epidemic are important factors. Additionally, suboptimum implementation of high-impact interventions limits programme effectiveness; between a quarter and half of maternal, neonatal, and child deaths in national audits have an avoidable health-system factor contributing to the death. Using the LiST model, we estimate that 11,500 infants' lives could be saved by effective implementation of basic neonatal care at 95% coverage. Similar coverage of dual-therapy prevention of mother-to-child transmission with appropriate feeding choices could save 37,200 children's lives in South Africa per year in 2015 compared with 2008. These interventions would also avert many maternal deaths and stillbirths. The total cost of such a target package is US$1.5 billion per year, 24% of the public-sector health expenditure; the incremental cost is $220 million per year. Such progress would put South Africa squarely on track to meet MDG 4 and probably also MDG 5. The costs are affordable and the key gap is leadership and effective implementation at every level of the health system, including national and local accountability for service provision.
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            Daily consumption of ready-to-use peanut-based therapeutic food increased fat free mass, improved anemic status but has no impact on the zinc status of people living with HIV/AIDS: a randomized controlled trial

            Background Food insecurity in sub-Saharan Africa and malnutrition constitute the main obstacles for successful treatment of people living with HIV/AIDS (PLWH). The aim of this study was to assess the effect of consuming daily 100 g RUTF (ready-to-use therapeutic food) as supplement, on body composition, anemia and zinc status of hospitalized PLWH in Senegal. Methods A Controlled clinical trial was conducted in 65 PLWH randomly allocated to receive either standard hospital diet alone (Control group: n = 33), or the standard diet supplemented with 100 g RUTF/day (RUTF group: n = 32). Supplementation was continued at home during 9 weeks. Individual dietary intakes were measured and compared to the Recommended Dietary Allowances. Body composition was determined using Bio-Impedance Analysis. Hemoglobin was measured by HemoCue and plasma zinc (PZ) concentration by atomic absorption spectrometry. PZ was adjusted to infection (CRP and α1-AGP). All measures were conducted on admission, discharge and after 9 weeks home-based follow up. Results 34 and 24 % of the patients in RUTF and Control groups were suffering from severe malnutrition (BMI < 16 kg/m2), respectively. In both groups, more than 90 % were anemic and zinc deficiency affected over 50 % of the patients. Food consumed by the Control group represented 75, 14 and 55 % of their daily recommended intake (DRI) of energy, iron and zinc, respectively. When 100 g of RUTF was consumed with the standard diet, the DRI of energy and zinc were 100 % covered (2147 kcal, 10.4 mg, respectively), but not iron (2.9 mg). After 9 weeks of supplementation, body weight, and fat-free mass increased significantly by +11 % (p = 0.033), and +11.8 % (p = 0.033) in the RUTF group, but not in the Control group, while percentage body fat was comparable between groups (p = 0.888). In the RUTF group, fat free mass gain is higher in the patients on ART (+11.7 %, n = 14; p = 0.0001) than in those without ART (+6.2 %, n = 6; p = 0.032). Anemia decreased significantly with the supplementation, but zinc status, measured using plasma zinc concentration, remained unchanged. Conclusion Improving PLWH’ diet with 100 g RUTF for a long period has a positive impact on muscle mass and anemia but not on the zinc status of the patients. Trial number NCT02433743, registered 29 April 2015.
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              Unmet Need for Family Planning, Contraceptive Failure, and Unintended Pregnancy among HIV-Infected and HIV-Uninfected Women in Zimbabwe

              Background Prevention of unintended pregnancies among women living with HIV infection is a strategy recommended by the World Health Organization for prevention of mother-to-child transmission of HIV (PMTCT). We assessed pregnancy intentions and contraceptive use among HIV-positive and HIV-negative women with a recent pregnancy in Zimbabwe. Methods We analyzed baseline data from the evaluation of Zimbabwe’s Accelerated National PMTCT Program. Eligible women were randomly sampled from the catchment areas of 157 health facilities offering PMTCT services in five provinces. Eligible women were ≥16 years old and mothers of infants (alive or deceased) born 9 to 18 months prior to the interview. Participants were interviewed about their HIV status, intendedness of the birth, and contraceptive use. Results Of 8,797 women, the mean age was 26.7 years, 92.8% were married or had a regular sexual partner, and they had an average of 2.7 lifetime births. Overall, 3,090 (35.1%) reported that their births were unintended; of these women, 1,477 (47.8%) and 1,613 (52.2%) were and were not using a contraceptive method prior to learning that they were pregnant, respectively. Twelve percent of women reported that they were HIV-positive at the time of the survey; women who reported that they were HIV-infected were significantly more likely to report that their pregnancy was unintended compared to women who reported that they were HIV-uninfected (44.9% vs. 33.8%, p<0.01). After adjustment for covariates, among women with unintended births, there was no association between self-reported HIV status and lack of contraception use prior to pregnancy. Conclusions Unmet need for family planning and contraceptive failure contribute to unintended pregnancies among women in Zimbabwe. Both HIV-infected and HIV-uninfected women reported unintended pregnancies despite intending to avoid or delay pregnancy, highlighting the need for effective contraceptive methods that align with pregnancy intentions.
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                Author and article information

                Journal
                HIV AIDS (Auckl)
                HIV AIDS (Auckl)
                hiv
                hiv
                HIV/AIDS (Auckland, N.Z.)
                Dove
                1179-1373
                16 February 2021
                2021
                : 13
                : 197-203
                Affiliations
                [1 ]Nursing Department, Mettu University , Mettu, Oromia, Ethiopia
                [2 ]Institute of Health, Jimma University , Jimma, Oromia, Ethiopia
                Author notes
                Correspondence: Tigist Teklu Department of Nursing, Mettu University Public Health and Medical Science Faculty , Mettu, Oromia, EthiopiaTel +25910091307 Email tigist16teklu@gmail.com
                Author information
                http://orcid.org/0000-0003-4651-9644
                http://orcid.org/0000-0003-1913-110X
                http://orcid.org/0000-0002-1123-7121
                http://orcid.org/0000-0002-7277-8490
                Article
                288373
                10.2147/HIV.S288373
                7896757
                5bc9ecf0-146e-4ff5-a039-63bc7b00af73
                © 2021 Teklu et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 23 October 2020
                : 14 January 2021
                Page count
                Figures: 1, Tables: 5, References: 17, Pages: 7
                Funding
                Funded by: Jimma University, open-funder-registry 10.13039/501100005068;
                This research was funded by Jimma University.
                Categories
                Original Research

                Infectious disease & Microbiology
                unintended pregnancy,women on art,ilu aba bora zone,southwest ethiopia

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