Reviewer's report
Title:Fertility Desire among HIV-Positive Women in Tigray Region, Ethiopia:
Implications for the provision of Reproductive Health and Prevention of
Mother-to-Child HIV Transmission Services
Version:3Date:3 August 2014
Reviewer: Risa Hoffman
Reviewer's report:
Major Compulsory Revisions
Overall, this study replicates others that look cross sectionally at fertility desires.
The main issue with the study is the limitations of the design (cross sectional, no
comparison with HIV negative women, lack of power to look at differences in
those on ART versus not on ART), and most importantly, a lack of information
about what this study adds to the existing literature. There are actually several
similar studies published from Ethiopia yet almost none of these are
acknowledged in the background. I would suggest that to be published, the
authors think about what their study adds to the state of knowledge about the
topic in the context first of what is known in Ethiopia, and then what is known in
other resource limited settings that are similar. What does there study add? Why
is it important? Is there something about this particular region of Ethiopia that is
unique and hasn’t been represented by other studies? The strength of the study
is the broad number of clinics included, which makes data potentially
generalizable to a large population.
The manuscript is too long and includes a lot of extraneous information. The
background should be shortened as above, as can the methods which includes
too much detail about IRB review and topics related to staff training and data
collection.
The Discussion needs to be framed in the context of what this study adds to the
literature, including in relation to what is already known about HIV-infected
women in Ethiopia (see abstracts below).
The tables do not convey the data in an easily interpretable manner. It would be
better to combine tables 1-3 and include only most important and relevant data,
and then look at those with versus without fertility desire for each variable with a
p value so one can really see all these variables as they differ between the two
groups of interest.
Minor Essential Revisions
• Perception of improving health status is unclear. Improving from what-from the
time of HIV diagnosis? Is this just a proxy for ART?
• Likewise, the majority of women were on ART, so what can really be said about
the role of ART and fertility desire? Did the authors do any power calculations to
know that they had sufficient power to detect differences in fertility desire
between those on and off ART? The authors need to be careful about drawing
conclusions on the role of ART without appropriate power to detect differences.
• As above, background should be shortened by several paragraphs with
clarification of what the study is adding to the known literature from Ethiopia on
this topic
• There is a lot of discussion of contraception need and unmet need. It feels a bit
unfocused when the focus is fertility desire. I agree with acknowledging that
those without fertility desire may have an unmet need for contraception, but the
data collected was not about whether contraception was obtained or not or
whether women had health seeking behavior or difficulty accessing this. You do
not show data to suggest that women without fertility desire were not on
contraception (do you have that data?). You are assuming they are not. The
paper should really focus on fertility desire draw conclusions only from the data
collected. The other thing that isn’t overtly said but should be mentioned is the
need for safer conception counseling to address the desires of those women who
want more children
• Methods, under eligibility, paper states they were considered ART users if they
were taking ART at the time of the interview ‘or had taken it before’. I would not
consider someone off ART or who had received ARVs for PMTCT an ‘ART user’
and think the analysis should be adjusted to reflect that change.
• Data collection section, first section. If you included every female patient then
how could you have used a random sampling technique? Too much detail in that
paragraph about number of women interviewed per day and how patient client
flow was determined. These should be deleted.
• Definition of HIV-positive women receiving chronic care doesn’t make sense.
How can they be receiving chronic care if they’ve ever only had one visit? If you
really included people with only one visit then would edit to say women who had
engaged in care at least once, including the current visit.
• Methods are too long. Do not need to mention how you cleaned data. Ethics
section can be limited to a few sentences that state IRB approval was obtained
and by whom
• Results section- how many screened… can you clarify that 100% of those
screened were eligible and enrolled?
• Paragraph 1 of results. Television and Radio should not be capitalized unless
they are the first word of a sentence.
• 3.5% of women were pregnant at the time of the study. How did you ask them
about fertility desire. It seems strange to include these women. Did they respond
to the question in regard to a future pregnancy after the current one? The
discussion of planned versus unplanned pregnancy in this group seems out of
place and I wonder if you should just exclude them to be more focused and clear.
• TABLES- The data provided in tables 1-3 is not informative. What the reader
really wants to know for each variable is the N(%) who did versus did not desire
children and the p-value for that comparison. Would merge those 3 tables and
include only most relevant and important variables, and have column 1 be
variable, column 2 the N(%) who desired a child, column 3 the N(%) who did not
desire a child, and column 4 a p-value for that comparison.
• Table 4. Would change title to Associations of fertility Desire” and avoid use of
‘predictors’ which implies cause effect which cannot be determined from this type
of research although I know statistically this term is often used. Would also
include % in the Yes No columns to help reader
• Discussion, as above needs to be re-framed to highlight data from Ethiopia and
how this study informs that data. Would delete extended discussions of family
planning and contraceptive desire (you don’t have data to support it). Delete
‘translating’ demographic survey data on contraception to your population.
Careful drawing conclusions about ART not being associated with fertility desire
given most were on ART so may not have been able to detect differences.
• Statement in discussion: “We believe that age was confounded with the number
of children that the women had, which was treated as a predictor in our logistic
regression model?” Can you clarify this? The multivariate model is adjusting for
number of children unless you are saying there collinearity and all the older
women had many children and all the younger ones none or few?
• Study Limitations- limited to those engaged in care and fertility desire could be
very different among women who do not engage. Limited by high number of
women on ART, limited by cross sectional design, lack of comparison to HIV
negative subgroup
Discretionary Revisions
• Methods-would be careful of the use of word ‘predictor’ and use the word
association (page 8 topic paragraph).
• I’m not clear on why whether they wanted a boy or girl is important however I
can see asking the question about whether they wanted a specific gender infant
was the reason they desire another child. For example, if they have 3 girls and
want a boy. Do the authors have that type of information?
• Consider deleting Figure 2. It can be easily described in the text.
• Was the survey validated for the specific population in which it was used for this
study. It sounds like ‘pre-testing’ was done but this was more for staff training
then ensuring the tool was appropriate for the popln and setting
Selected Abstracts from Ethiopia below: The authors should perform a thorough
literature search for additional studies
Fertility intentions among HIV positive women aged 18–49 years in Addis Ababa
Ethiopia: a cross sectional study
Hussen Mekonnen Asfaw* and Fikre Enquselassie Gashe
• * Corresponding author: Hussen M Asfaw hussen_mk@yahoo.com
Author Affiliations
Department of preventive medicine, School of Public Health, Addis Ababa
University, Addis Ababa, Ethiopia
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Reproductive Health 2014, 11:36 doi:10.1186/1742-4755-11-36
The electronic version of this article is the complete one and can be found online
at: http://www.reproductive-health-journal.com/content/11/1/36
Received: 3 January 2014
Accepted: 12 May 2014
Published: 20 May 2014
© 2014 Asfaw and Gashe; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly credited. The Creative Commons Public
Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/)
applies to the data made available in this article, unless otherwise stated.
Abstract
Background
Given the degree of HIV epidemic among women and the current antiretroviral
therapy (ART) scale up in Ethiopia; considering the issue of fertility is vital to
ensure the delivery of integrated reproductive health along with prevention
services provided to positive women. This study was aimed to assess fertility
intentions of women living with HIV attending public health institutions (hospitals
& health centers) in Addis Ababa, Ethiopia.
Methods
Institution based cross sectional survey was conducted, among 1855 HIV
positive, women aged 18–49 years selected from different public health facilities
in Addis Ababa; from June to October 2012. Information was gathered by using
interviewer administered questionnaires. Data were double entered in EPI Info
version 3.5.2 software, cleaned finally exported to IBM SPSS statistics version 20
for analysis. Logistic regression models were used to predict the association of
study variables and adjusted for possible confounders.
Result
Overall, 44% of women reported fertility intention. ART users had higher fertility
intention (AOR; 1.26, 95%CI; 1.01 to 1.60) than ART naïve. In addition to this,
having partner being on sexual relationship, young age, being single and having
fewer or no children were found to be predictors of fertility intentions. The
presence of ART, improvement of health condition and the influence of husband
were the main reasons for childbearing intentions of women in the study area.
Conclusion
A considerable proportion of women reported fertility intention. There was an
association between fertility intentions and ART use. It is important for health
care providers and policy makers to strengthen the fertility need of HIV positive
women along with HIV care so that women may decide freely and responsibly on
their fertility issues.
Keywords:
Fertility intension; HIV; ART use; Women; Addis ababa; Ethiopia
Sexual life and fertility desire in long-term HIV serodiscordant couples in Addis
Ababa, Ethiopia: a grounded theory study
Tewodros G Hailemariam1*, Getnet M Kassie2 and Mitike M Sisay2
• * Corresponding author: Tewodros G Hailemariam tedrigecho@gmail.com
Author Affiliations
1 Department of Public Health, Faculty of Health Sciences, Wolaita Sodo
University, Wolaita Sodo, Ethiopia
2 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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BMC Public Health 2012, 12:900 doi:10.1186/1471-2458-12-900
The electronic version of this article is the complete one and can be found online
at: http://www.biomedcentral.com/1471-2458/12/900
Received: 27 July 2012
Accepted: 19 October 2012
Published: 24 October 2012
© 2012 Hailemariam et al.; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Abstract
Background
Even though remarkable progress has been achieved, HIV/AIDS continues to be
a major global health priority. HIV discordant relationship is one of the emerging
issues in HIV prevention endeavour. In Ethiopia, very little is known about
HIV-serodiscordant couples particularly how they manage their sexual
relationship and fertility desire. Therefore, we conduct this study with the aim of
exploring the experiences of HIV discordant couples about their sexual life, and
fertility desire in the context of long-term relationships in Addis Ababa, Ethiopia.
Methods
A grounded theory approach was employed using in-depth interviews among 36
informants in ART/PMTCT centers of three public hospitals, a health center and
one PLHIV association in Addis Ababa. Theoretical sampling was used to recruit
28 clients who lived in a discordant relationship and eight health care providers
as key informants. Data collection and analysis were undertaken simultaneously
using a constant comparison. The analysis was facilitated using OpenCode
software.
Results
A grounded theory pertaining to sexual life and desire to have a child among HIV
discordant couples emerged as “maintaining the relationship” as a core category.
Couples pass through a social process of struggle to maintain their relationship.
The causal conditions for couples to enter into the process of struggle to maintain
their relationship were collectively categorized as “Entering in-to a transition”
(knowing HIV serostatus) and this includes mismatch of desire to have a child,
controversy on safe sex versus desire to have a child, and undeniable change in
sexual desire and practice through time were the features in entering
into-transition. Then after the transition, couples engaged in certain
actions/strategies that are categorized as “dealing with discordancy” such as
entertaining partner’s interest by scarifying once self interest to maintain their
relationship.
Conclusions
HIV discordant couples’ relationship is filled with controversies of maintaining
relationship versus fear of getting infected. The findings of this study have
suggested the need to view discordant couple’s actions as a process of
maintaining their relationship in the context of eminent risks. Further study should
be done among HIV discordant couples to assess the fitness of the current
model in different setups and population. In addition, a study could begin to test
the hypotheses proposed in this study.
Ethiop Med J. 2013 Jan;51(1):1-11.
Fertility desires predictors among people living with HIV/AIDS at art care centers
of two teaching hospitals in Addis Ababa.
Negash S1, Yusuf L, Tefera M.
Author information
Abstract
BACKGROUND:
Studies from different contexts worldwide in both developed and developing
countries in the era of wide access to antiretroviral drugs indicate that many HIV
positive individuals continue to exhibit high risk sexual behaviors, fertility
intentions being one of the many characteristics.
OBJECTIVE:
Identify the level and determinants of fertility desire among people living with
HIV/AIDS (PLWHAs) at antiretroviral treatment (ART) centers.
METHODS:
A cross-sectional study was conducted on randomly sampled, 396 PLWHAs.
Odds ratio along with 95% confidence intervals were used to measure the
association of the study variables with the outcome variable.
RESULTS:
The majority of respondents were females, 330 (83.3%), and 224 (56.6%) were
in the age category of 25-35 years with the mean age of 33.5 +/- 6.61 years.
From a total of 396 study subjects interviewed, 172 (43.3%) desired to have
children in the future, out of which 123 (71.5%) stated positively that they
intended to give birth in the near future, and of these 33 (26.8%) had taken action
and are currently pregnant. CD4 count above 350/mm3, partner's desire to have
a child, life time history of not having live births and number of alive children are
the most important predictors of fertility desire reported in this survey.
CONCLUSION:
Fertility desire remains to be high. This will pose serious challenges in areas of
high HIV prevalence, like Ethiopia, on the implementation of the PMTCT
programs. The strong predictors of fertility desire found in our study on the other
hand can be used by policy makers, planners, and health service providers in the
planning and implementation of the PMTCT programs. We suggest a large scale
studies to be undertaken in the future.
Fertility Desire and Associated Factors among People Living with HIV on ART, In
Harari Regional State, Eastern Ethiopia
Fisaha Haile1*, Nesredine Isahak2 and Awrajaw Dessie1
1 Mekelle University, College of Health Science, Department of Public Health,
Mekelle, Ethiopia
2 Harari Regional Health Bureau, Harar-Ethiopia
Corresponding Author : Fisaha Haile
Mekelle University
College of Health Science
Department of Public Health
Mekelle, Ethiopia
Tel: 251913340013
Fax: 2513444166775
E-mail: fisaha.1999@yahoo.com
Received April 04, 2014; Accepted May 02, 2014; Published May 5, 2014
Citation: Haile F, Isahak N, Dessie A (2014) Fertility Desire and Associated
Factors among People Living with HIV on ART, In Harari Regional State, Eastern
Ethiopia. J Trop Dis 2:137. doi: 10.4172/2329-891X.1000137
Copyright: © 2014 Haile F, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Related article at
AIDS Care. 2012;24(11):1407-15. doi: 10.1080/09540121.2011.650679. Epub
2012 Jan 31.
HIV diagnosis and fertility intentions among couple VCT clients in Ethiopia.
Bonnenfant YT1, Hindin MJ, Gillespie D.
Author information
Abstract
In Ethiopia, most HIV-affected couples are in serodiscordant relationships and
must weigh any childbearing desires against the risk of transmitting the virus to a
partner or child. This analysis investigates the relationship between HIV
diagnosis and fertility intentions among couple voluntary counseling and testing
(VCT) clients in Ethiopia and whether this relationship differs between men and
women. Data come from the Ethiopia Voluntary Counseling and Testing
Integrated with Contraceptive Services (VICS) study, which collected information
from men and women attending VCT at eight public sector health facilities in the
Oromia region of Ethiopia. VCT clients were asked about their fertility intentions
before (pre-test) and after (post-test) receiving their HIV test results.
Sex-stratified logistic regression was used to find characteristics, such as the
couple's HIV status, associated with ceasing to desire children between pre-test
and post-test versus desiring children at both time points. Women belonging to
serodiscordant couples were much more likely to cease desiring children than
women in HIV-concordant couples, regardless of whether the woman
(aOR=11.08, p<0.001) or her partner (aOR=9.97, p=0.001) was HIV+. Only HIV+
men in serodiscordant relationships were more likely to stop desiring children
than men in HIV-concordant couples (aOR=12.10, p<0.001). Serodiscordant
couples would benefit from family planning services or referrals during VCT to
help meet their reproductive needs.
1
Engender Health Ethiopia, Dessie Satellite Office, E
-
mail
meene97@yahoo.com
,
menberugetachew@gmail.com
,
Tel 251912948599, P.O. Box 1035, Dessie, Ethiopia;
2
Deparmtn of Epidemiology, Jimma University, Jimma, Ethiopia;
3
Poul
ation and Family Health Department, College of Public Health and Medical
Sciences, P.O. Box 5093 Jimma
University, Jimma, Ethiopia;
4
Department of Epidemiology, Jimma University, Jimma, Ethiopia
Original article
Factors affecting fertility decisions of married men and
women living with HIV in South Wollo Zone, Northeast
Ethiopia
Menberu Getachew
1
, F
essehaye Alemseged
2
, M
ulumebet Abera
3
, A
mare Deribew
4
Abstract
Background
: In a setting with high
HIV prevalence and high fertility rates, addressing fertility issues of People Living
with HIV/AIDS (PLWHA) is crucial. However, understanding of the factors
associated with fertility decisions of
PLWHA in Ethiopia is remarkably low.
Objective
: The study
was conducted to assess factors associated with fertility decisions of PLWHA in
South Wollo
Zone, Northeast Ethiopia.
Methods
: The study was conducted from February 1 to March 30, 2008 using cross
-
sectional design. Quantitative data
were collected from a
sample of 458 men and 458 women using structured questionnaire. Qualitative
data were also
collected from six health care providers. Logistic regression was used to analyze
the quantitative data.
Results
: The study showed that 18.3% of currently married P
LWHA have decided to have a child.
The factors found
to be independently associated with current decision to have a child were higher
family income [OR (95% CI) = 2.29
(1.23, 4.26)], partner’s decision to have a child [OR (95% CI) = 36.4 (17.0, 77.5)],
hav
ing knowledge on PMTCT [OR
(95% CI) = 2.26 (1.44, 3.54)] and having partner with negative HIV test result
[OR (95% CI) = 0.408 (0.219, 0.759)].
During in
-
depth interview the health care providers indicated the fertility related counseling
service to be low
.
Conclusion
: In spite of the fact that significant proportion of married PLWHA had decided to
have a child, the fertility
related counseling service is low. Improving fertility related counseling services to
enable clients make informed
fertility decision
is mandatory. The factors identified to be associated with fertility decision could
be of major
importance and as such should be investigated further. [
Ethiop. J. Health Dev.
2010;24(
3
):
2
14
-
220
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests'