Factores Associados ao Parto Domiciliar e à Não Adesão ao Teste de VIH em Luanda, Angola: Estudo caso-controlo
Factors Associated with Home Birth and Non-Adherence to HIV Testing in Luanda, Angola: A Case-Control Study
DOI:
https://doi.org/10.70360/rccse.v.170Palavras-chave:
Parto domiciliar, Prevenção da transmissão vertical do VIH, AceAcesso aos serviços de saúdeResumo
Introdução: O parto domiciliar persiste como uma prática comum em Angola, levantando preocupações sobre a perda de oportunidades na prevenção da transmissão vertical do VIH (PTV). Este estudo caso-controlo investigou os factores associados ao parto domiciliar em Luanda e sua relação com a não adesão ao teste de VIH durante a gravidez, parto ou pós-parto.
Métodos: Realizou-se um estudo caso-controlo com 139 mães que tiveram parto domiciliar e 278 mães que tiveram parto institucional em Luanda. Dados sociodemográficos, obstétricos e relacionados ao conhecimento e práticas de PTV foram coletados por meio de questionários. A análise estatística incluiu testes qui-quadrado e regressão logística multivariada para identificar fatores associados ao parto domiciliar.
Resultados: A análise multivariada revelou que o parto noturno (OR=2.34; IC95%: 1.35-4.05), baixa literacia materna (OR=2.11; IC95%: 1.22-3.65), residir no município de Icolo e Bengo (OR=3.57; IC95%: 1.98-6.43) e a influência de familiares/amigas/vizinhas com histórico de parto domiciliar (OR=2.88; IC95%: 1.68-4.95) foram preditores independentes de parto domiciliar. Uma proporção significativa de mulheres com parto domiciliar não realizou o teste de VIH durante o seguimento (38.1%) e, entre as seropositivas, apenas 11.1% estavam inscritas no PTV desde o pré-natal.
Conclusão: O parto domiciliar em Luanda está associado a factores geográficos, socioeconómicos e influências sociais, representando uma perda considerável de oportunidades para a testagem do VIH e a implementação de medidas de PTV. Intervenções direccionadas para melhorar o acesso aos serviços de saúde, aumentar a literacia em saúde materna e envolver as comunidades são cruciais para promover o parto institucional seguro e fortalecer a cascata de prevenção da transmissão vertical do VIH.
Palavras-chave: Parto domiciliar, Prevenção da transmissão vertical do VIH, Acesso aos serviços de saúde.
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Abstract
Introduction: Home birth remains a common practice in Angola, raising concerns regarding missed opportunities for the prevention of mother-to-child transmission of HIV (PMTCT). This case-control study investigated the factors associated with home birth in Luanda and its relationship with non-adherence to HIV testing during pregnancy, childbirth, or the postnatal period.
Methods: A case-control study was conducted involving 139 mothers who had a home birth and 278 mothers who had an institutional birth in Luanda. Sociodemographic and obstetric data, along with information related to PMTCT knowledge and practices, were collected via questionnaires. Statistical analysis included chi-squared tests and multivariable logistic regression to identify factors associated with home birth.
Results: Multivariable analysis revealed that night-time birth (OR=2.34; 95% CI: 1.35-4.05), low maternal literacy (OR=2.11; 95% CI: 1.22-3.65), residing in the municipality of Icolo e Bengo (OR=3.57; 95% CI: 1.98-6.43), and the influence of family members/friends/neighbours with a history of home birth (OR=2.88; 95% CI: 1.68-4.95) were independent predictors of home birth. A significant proportion of women who had a home birth did not undergo HIV testing during follow-up (38.1%), and among those who were HIV-positive, only 11.1% were enrolled in PMTCT services from the antenatal period.
Conclusion: Home birth in Luanda is associated with geographical and socioeconomic factors, as well as social influences, representing a considerable loss of opportunities for HIV testing and the implementation of PMTCT measures. Targeted interventions to improve access to healthcare services, increase maternal health literacy, and engage communities are crucial to promote safe institutional birth and strengthen the cascade for the prevention of mother-to-child transmission of HIV.
Keywords: Home birth, Prevention of mother-to-child transmission of HIV, Access to healthcare services.
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