Study design and setting
An institution-based cross-sectional study was conducted from October 2020 to December 2020 to determine the proportion of HIV plus its associated factors amongst pregnant women attending ANC at referral hospitals associated with the Amhara Regional Condition, Ethiopia. There were six recommendation hospitals in the region serving 3. 5 in order to 5 million people [ 25 ]. In this study, three hospitals (University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Comprehensive Specialized Hospital, and Debre Tabor Referral Hospital) were selected as the study sites out of the six referral hospitals. University associated with Gondar Extensive Specialized Hospital is located in Gondar town, Central Gondar Zone, North West Ethiopia, 727 km away from Addis Ababa [ 26 ]. Felege Hiwot Comprehensive Specific Hospital is located in Bahir Dar; the capital city of the particular Amhara Regional State. And Debre Tabor Referral Hospital is found in Debre Tabor town, 665 km far from Addis Ababa. All Recommendation Hospitals of the Amhara Regional State offer focused ANC services, and have a separate ART as well as PMTCT clinic. The Ethiopian government began implementing Option B + (initiation of antiretroviral medication for all expectant mothers) in 2013. Since then, the service has been made available in all health facilities at no cost.
Source and study population
Pregnant women attending ANC services in the referral private hospitals of the Amhara Local State had been the source population. The study population was pregnant women going to ANC solutions during the particular study period within the selected referral hospitals from the region.
Sample size determination
Sample size has been determined using single populace proportion formula [ n = (Za/2) 2 p (1 − p)/d 2 ], considering, 6. 1% associated with HIV prevalence among expecting women in the Amhara Regional State from the 2014 antenatal sentinel surveillance report of Ethiopia [ 11 ], 95% level associated with confidence, 3% margin of error, design effect of 2, and 10% non-response rate. The final sample size had been 538.
Sampling technique and procedure
The particular study participants were drawn from the three chosen referral private hospitals of the Amhara Regional Condition after proportional allocation was done. We assigned the particular sample dimension for each associated with the hospitals based on the number of pregnant ladies attending ANC in those referral private hospitals. The research individuals were chosen based on daily flow records of expectant women seeking ANC at these hospitals. The average daily attendance at the ANC clinics were 30, 20 and 15 in University of Gondar Comprehensive Specialized Hospital, Felege Hiwot Comprehensive Specialized Medical center, and Debre Tabor Referral Hospital, respectively. During the research period, about 1600, 1200 and 900 women that are pregnant attended ANC in University of Gondar Extensive Specialized Hospital, Felege Hiwot Comprehensive Specific Hospital, plus Debre Tabor Referral Medical center, respectively. Consequently, we included 233 through University associated with Gondar Comprehensive Specialized Hospital, 174 from Felege Hiwot Comprehensive Specialized Hospital, and 131 through Debre Tabor Referral Medical center from a total of a few, 700 participants.
Systematic random sampling technique was employed to select the individual study participant. Sample interval (k) was calculated as k = 3700/538 = 7. Based upon this sampling interval, research participants had been selected from seven intervals until the required sample has been attained.
Data collection procedures and quality assurance
The data had been collected making use of interviewer-administered, structured as nicely as standardized questionnaires. The particular tool consists of items on socio-demographic, obstetric, medical, plus behavioral conditions of the particular study individuals. Besides, some clinical data were collected from your charts from the participants. The tool was first developed in English and then translated to the local language, Amharic, which is the participants’ mother tongue, to avoid difficulty within communication and finally translated back to English to verify consistency. In addition, face and content validity were checked and found valid. Specifically, food insecurity was measured using the three-item household hunger score with 3-point Likert scale along with Cronbach’s Alpha of 0. 74 in the present study. Social support was measured utilizing the Maternity Social Support Scale (MSSS) developed by Webster et al. 2000, with Cronbach’s Alpha of 0. 55 in the current study . The data were collected simply by three BSc nurses working in the 3 referral private hospitals and supervised by three MSc Nurses.
To maintain the particular quality associated with the data different measures had been taken. Firstly, face plus content validity of the tool were performed. A range of experts such as gynaecologist, midwives, reproductive health professionals and infectious disease experts participated in the face plus content validation process. Accordingly, adjustments were made based on their expertise. Secondly, a pre-test was conducted in Gondar Poly Health Centre among 50 (10%) pregnant females to check clarity and reliability from the tool. Overall, the tool has been found in order to be valid and reliable. Thirdly, training was given towards the data collectors and the supervisors on the particular objective plus content of the questionnaire, on how to approach a patient and conduct interviews, as well because on ethical aspects associated with the study such as how to maintain confidentiality of the information obtained from the research, and how to respect autonomy of the individuals. Finally, every day supervision had been done throughout the data collection time to maintain the high quality from the information.
Variables associated with the research
The dependent variable was HIV sero-status of pregnant women. The independent variables include socio-demographic factors (i. e. age of the mother, marital status, maternal educational status, paternal educational status, residency, maternal occupational status, paternal occupational standing, family monthly income) obstetric and related factors (i. e. plan of pregnancy, parity, gravidity, gestational age, abortion history, syphilis status), behavioral aspects (i. electronic. alcohol consumption, cigarette smoking) and other elements including level of social support and house hold food security position.
Operational definitions
HIV positive sero- status: positive HIV antibody test result which is confirmed by the second HIV antibody check, and/or good virological test [ 27 ].
Social support: is a perception of communication of love, caring, trust, or concern of family plus friends for an individual. It was measured using the Maternity Support Scale (MSSS). The scale contains 6-items with 5-point Likert level. The total possible score for the scale is 30, and the cut-off points for the scale were set at 0 – 18 (low support), 19 – 24 (medium support), and > 24 (adequate support) [ 28 ].
Food security: is defined as a state in which almost all people at all times have both physical and economic access to sufficient meals to meet their dietary needs with regard to a productive and healthy life [ 29 ]. In the current study, foods insecurity has been measured utilizing the three items scale known as Household Hunger Score with 3-point Likert scale. The total possible rating for the scale will be 6 along with cutoff points ranging from 0 – 1 (little in order to no hunger), 2 – 3 (moderate hunger), plus 4 – 6 (severe hunger) [ 30 ].
Alcohol use: It was assessed with the particular question “Have you been drinking alcohol during your current pregnancy? ” If the answer had been “yes” and took any unit associated with alcohol throughout the present pregnancy, then the mother was considered to have alcohol exposure while pregnant.
Cigarette smoking: It was assessed with the question “Have you been smoking since your pregnancy? ” If the answer for this question was a “yes” even regarding once the mother was considered to have a tobacco exposure during pregnancy.
Information processing plus analysis
The data was cleaned, coded and entered in to EpiData Manager V4. 6. 0. 0 and exported in order to STATA version 14 intended for recoding plus analysis. Descriptive and summary statistics had been computed to summarize the characteristics of the particular participants. The particular association between HIV sero-status and selected independent variables like socio-demographic, obstetric, medical and behavioral variables were tested using a binary logistic regression model. Independent factors with p -value ≤ 0. 2 within the bi-variable analysis were potential candidates for that multivariable logistic regression analysis to control confounders. Variables with g -value less than 0. 05 within the multivariable binary logistic regression model were considered to be statistically significant at 95% CI. Hosmer and Lemeshow’s goodness of fit test was used to check the model fitness (Prob value = 0. 3202).