Fertility trends by HIV status in a health and demographic surveillance study in Magu District, Tanzania, 1994-2018.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2023
2023
Historique:
received:
21
11
2021
accepted:
04
02
2023
entrez:
21
2
2023
pubmed:
22
2
2023
medline:
25
2
2023
Statut:
epublish
Résumé
Sub-Saharan Africa (SSA) has the highest fertility rates and highest HIV disease burden globally. However, it is not clear how the rapid expansion of anti-retroviral therapy (ART) for HIV has impacted the fertility gap between HIV-infected and uninfected women. We used data from a Health and Demographic Surveillance System (HDSS) in north-western Tanzania to explore trends in fertility rates and the relationship between HIV and fertility over the 25-year period. From 1994 to 2018, births and population denominators from the HDSS population were used to obtain age-specific fertility rates (ASFRs) and total fertility rates (TFRs). HIV status was extracted from eight rounds of epidemiologic serological surveillances (1994-2017). Fertility rates by HIV status and in different levels of ART availability were compared over time. Independent risk factors for fertility changes were examined using Cox proportional hazard models. There were 24,662 births from 36,814 women (15-49) who contributed a total of 145,452.5 Person-Years of follow-ups. The TFR declined from 6.5 births per woman in 1994-1998 to 4.3 births per woman in 2014-2018. The number of births per woman was 40% lower in women living with HIV than in HIV-uninfected women (4.4 vs. 6.7), although this difference narrowed over time. The fertility rate in HIV-uninfected women was 36% lower in 2013-2018 than in 1994-1998(age-adjusted HR = 0.641; 95% CI 0.613-0.673). In contrast, the fertility rate in women living with HIV was relatively unchanged over the same follow up period (age-adjusted HR = 1.099; 95% CI 0.870-1.387). There was a notable fertility decline among women in the study area from 1994 to 2018. Fertility remained lower in women living with HIV than in HIV-uninfected women, but the difference continued to narrow over time. These results highlight the need for more research into fertility changes, fertility desire and family planning use in Tanzanian rural communities.
Sections du résumé
BACKGROUND
Sub-Saharan Africa (SSA) has the highest fertility rates and highest HIV disease burden globally. However, it is not clear how the rapid expansion of anti-retroviral therapy (ART) for HIV has impacted the fertility gap between HIV-infected and uninfected women. We used data from a Health and Demographic Surveillance System (HDSS) in north-western Tanzania to explore trends in fertility rates and the relationship between HIV and fertility over the 25-year period.
METHODS
From 1994 to 2018, births and population denominators from the HDSS population were used to obtain age-specific fertility rates (ASFRs) and total fertility rates (TFRs). HIV status was extracted from eight rounds of epidemiologic serological surveillances (1994-2017). Fertility rates by HIV status and in different levels of ART availability were compared over time. Independent risk factors for fertility changes were examined using Cox proportional hazard models.
RESULTS
There were 24,662 births from 36,814 women (15-49) who contributed a total of 145,452.5 Person-Years of follow-ups. The TFR declined from 6.5 births per woman in 1994-1998 to 4.3 births per woman in 2014-2018. The number of births per woman was 40% lower in women living with HIV than in HIV-uninfected women (4.4 vs. 6.7), although this difference narrowed over time. The fertility rate in HIV-uninfected women was 36% lower in 2013-2018 than in 1994-1998(age-adjusted HR = 0.641; 95% CI 0.613-0.673). In contrast, the fertility rate in women living with HIV was relatively unchanged over the same follow up period (age-adjusted HR = 1.099; 95% CI 0.870-1.387).
CONCLUSIONS
There was a notable fertility decline among women in the study area from 1994 to 2018. Fertility remained lower in women living with HIV than in HIV-uninfected women, but the difference continued to narrow over time. These results highlight the need for more research into fertility changes, fertility desire and family planning use in Tanzanian rural communities.
Identifiants
pubmed: 36802408
doi: 10.1371/journal.pone.0281914
pii: PONE-D-21-36924
pmc: PMC9942988
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0281914Subventions
Organisme : Wellcome Trust
ID : 107742/Z/15/Z
Pays : United Kingdom
Informations de copyright
Copyright: © 2023 Mkwashapi 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.
Déclaration de conflit d'intérêts
No - The aurthors have declared that no competing interest exist.
Références
Int J Epidemiol. 2015 Dec;44(6):1851-61
pubmed: 26403815
Trop Med Int Health. 2006 Feb;11(2):182-7
pubmed: 16451342
Int J Gynaecol Obstet. 2015 Dec;131(3):255-9
pubmed: 26387468
AIDS. 1999 Jul 9;13(10):1233-40
pubmed: 10416528
AIDS. 1999 Mar 11;13(4):517-21
pubmed: 10197381
Afr J Reprod Health. 2018 Dec;22(4):44-53
pubmed: 30632721
Proc Natl Acad Sci U S A. 2019 Feb 19;116(8):2891-2896
pubmed: 30718411
BMJ Open. 2018 Apr 24;8(4):e019818
pubmed: 29691244
Reprod Health. 2014 Dec 06;11:81
pubmed: 25480367
J Biosoc Sci. 2003 Apr;35(2):189-99
pubmed: 12664957
Popul Dev Rev. 2020 Sep;46(3):409-441
pubmed: 33132461
J Acquir Immune Defic Syndr. 2017 Aug 1;75(4):391-398
pubmed: 28653969
AIDS. 2004 Jun;18 Suppl 2:S35-43
pubmed: 15319742
J Acquir Immune Defic Syndr. 2014 Oct 1;67(2):e45-54
pubmed: 25216079
J Acquir Immune Defic Syndr. 2007 Dec 15;46(5):616-23
pubmed: 18043316
Lancet. 2005 Oct 1;366(9492):1182-8
pubmed: 16198767
Trop Med Int Health. 2016 Sep;21(9):1071-85
pubmed: 27371942
J Acquir Immune Defic Syndr. 2016 Jul 1;72(3):324-32
pubmed: 26910499
PLoS One. 2019 Sep 6;14(9):e0222173
pubmed: 31491017
AIDS. 2004 Mar 26;18(5):799-804
pubmed: 15075516
AIDS. 2017 Apr;31 Suppl 1:S69-S76
pubmed: 28296802
AIDS Care. 2019 Jul;31(7):908-911
pubmed: 30712359
PLoS One. 2016 Mar 25;11(3):e0151877
pubmed: 27015522
Trop Med Int Health. 2017 Dec;22(12):1542-1550
pubmed: 28986949
Lancet. 1993 Nov 13;342(8881):1241-2
pubmed: 7901561
Sex Transm Infect. 1999 Feb;75(1):3-17
pubmed: 10448335
Contracept Reprod Med. 2019 Nov 13;4:18
pubmed: 31754451