PARITY PROGRESSION AND BIRTH INTERVAL ANALYSIS AMONG WOMEN RECEIVING HIV CARE IN UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

Abstract

Childbearing remains a major concern for women living with HIV/AIDS (WLHA) worldwide because of the risk of HIV transmission not only to their uninfected partner but to their children as well, which results to childhood and maternal mortality. Understanding parity progression and patterns of birth spacing will play a vital role in reducing child mortality and adverse maternal outcome among women living with HIV. This study therefore investigated parity progression and birth spacing among women living with HIV in Nigeria. This study utilized data set from a cross-sectional study on childbearing progression among 933 women living with HIV (age 15years and above) and receiving care at University College Hospital, Ibadan, Nigeria. Brass P/F ratio method, Cox regression model, Chi-square test and Parity progression ratio method were employed for the analysis. Most women (92.8%) were educated and the common educational level was secondary education (47%). The average age of the women was 38.1 (± SD = 6.1) and most of the women had their first sex at mean age of 20.4 (± SD = 3.7) with 24.3 (± SD = 4.6) as their age at first birth. The study revealed that 35% of the women have had at least 4 children while others have had at most 3 children as at the time of the study. Most (64%) had birth interval of 36 months and above, about 13% had a birth interval of less than 24 months, and 23% had a birth interval of 24-35 months. The median birth interval was 42 months. Parity progression ratio method revealed that probability of childbearing progression was significantly higher among women who have reached their end of childbearing age (45 – 49 years). Brass P/F ratio method exposed total fertility rate of 4.3 children per woman. Cox-proportional hazard multivariate model revealed that age group 30-34 years (HR = 0.17*, 95%CI: 0.07-0.38), 35-39 years (HR = 0.09*, 95%CI: 0.04-0.25), 40-44 years (HR = 0.06*, 95%CI: 0.02-0.19), 45-49 years(HR = 0.09*, 95%CI: 0.03-0.34), age at first birth (HR = 0.21*,95%CI: 0.07-0.62), educational level (secondary) (HR = 4.45*, 95%CI: 3.41-4.50), child death (HR = 0.25*, 95%CI: 0.09-0.68) and age at first intercourse (HR = 2.26*, 95%CI: 1.04-4.91) were significantly associated with childbearing progression from first birth to second birth, to third birth, to fourth birth and to fifth birth among women living with HIV. Also, chi-square test revealed significant association exist between age group of women, religious affiliation, age at first birth, ethnicity, partner’s age, child death and birth interval at p < 0.05. Based on this result, child spacing can be said to be improving among women living with HIV in Ibadan, as majority had birth interval of at least 36 months. Health intervention programmes on the need for limiting birth should be improved and made accessible to women living with HIV. This may lower fertility and reduce rate at which women living with HIV progress childbearing in Ibadan, Nigeria.