|Year : 2015 | Volume
| Issue : 1 | Page : 14-19
Predictors of fertility desire among people living with HIV attending anti-retroviral clinic in a tertiary health facility in Sokoto, Northern Nigeria
AU Kaoje1, M.T.O. Ibrahim1, CH Njoku2, GA Gusau3, A Saad4, MO Raji1
1 Department of Community Health, UDU, Sokoto, Nigeria
2 Department of Medicine, UDU, Sokoto, Nigeria
3 Department of Sociology, UDU, Sokoto, Nigeria
4 Department of Centre for Communication Program, John Hopkins School of Public Health, Baltimore, USA
|Date of Web Publication||26-Feb-2015|
A U Kaoje
Department of Community Health, Usmanu Danfodiyo University, Sokoto
Introduction: The pressure on couples and particularly women to have children is strong in developing countries where a childless woman is considered a social pariah. This study aimed to determine the predictors of fertility desire among people living with HIV.
Materials and Methods : This is a descriptive cross-sectional study conducted among 400 HIV-positive clients receiving follow-up care at anti-retroviral (ART) clinic in a tertiary health facility in Sokoto. A list of clients that came to the clinic was compiled and served as sampling frame. A two stage sampling method was used to select study respondents from the sampling frame. Interviewer- administered closed-ended questionnaire was used to collect the required data from the respondents. Ethical approval was granted for the conduct of the study and informed consent was obtained from the respondents. Descriptive, bivariate and multivariate analyses were carried out.
Results : Majority (56.2%) of the respondents were females. The overall mean age was 34.5 ± 0.4 years (male 38.4 ± 0.5 years), and (females, 31.4 ± 0.4 years). A large proportion of the respondents (67.7%) reported desire to have children in future. Using logistic regression analysis, younger age (adjusted odd ratio [aOR] = 2.0, P = 0.023), marital status (aOR = 1.9, P < 0.001) and number of living children (aOR = 0.7, P < 0.001) were the key factors influencing respondents desire for children.
Conclusion : Many HIV-positive clients in the clinic reported desire to have children. It is recommended that full reproductive health services be provided in the clinic to help them achieve their reproductive goal without risk to their partners and new born.
Keywords: HIV/AIDS, fertility desire, Sokoto
|How to cite this article:|
Kaoje A U, Ibrahim M, Njoku C H, Gusau G A, Saad A, Raji M O. Predictors of fertility desire among people living with HIV attending anti-retroviral clinic in a tertiary health facility in Sokoto, Northern Nigeria. Sahel Med J 2015;18:14-9
|How to cite this URL:|
Kaoje A U, Ibrahim M, Njoku C H, Gusau G A, Saad A, Raji M O. Predictors of fertility desire among people living with HIV attending anti-retroviral clinic in a tertiary health facility in Sokoto, Northern Nigeria. Sahel Med J [serial online] 2015 [cited 2019 Dec 15];18:14-9. Available from: http://www.smjonline.org/text.asp?2015/18/1/14/152153
| Introduction|| |
The level of fertility of a population is partly influenced by demographic, health status, prevailing social-economic conditions and cultural factors.  Fertility desires are the most proximate determinants of actual childbearing behaviour of a population.  The fertility issues of people living with HIV (PLHIV) are becoming increasingly important. Advances in medical care have decreased mother-to-child-transmission and also have improved the prognosis for the PLHIV who are now considering childbearing.  Number of studies indicated PLHIV who felt healthier were more likely to be more inclined to having more children in Nigeria  , India  and the United States.  More than half of the PLHIV worldwide are women who are mostly in their reproductive age. ,, The level at which HIV positive couples desire for children is currently approaching that among the general population.  A study in Sagamu, Nigeria showed that 63.3% of PLHIV expressed desire for child bearing with 71.5% of men and 93.8% of women who desired children intending to have an average of 2 children in the near future.  In Rwandan, a study among HIV-infected and uninfected women, showed that both groups expressed equally the desire for more children after HIV testing.  People living with HIV, like general population are under serious pressure from family, spouses and friends to reproduce. ,,
Little is known of the fertility desires of PLHIV in northern Nigeria with a relatively distinct culture. This is why the study aimed to determine their fertility desires and identify its socio-demographic correlates.
| Materials and Methods|| |
The study was conducted in a tertiary health facility in Sokoto, Northern Nigeria. An average of 10-15 new cases are registered weekly, with an overall average of about 120-150 old cases seen per week. The study population comprised of all PLHIV attending ART clinic in the study Centre. Eligible respondents were those aged 15 years and above, present at the study Centre during data collection and not in any critical health condition.
The study was a descriptive and cross sectional in design. Sample size formula for determining required sample size in population less than 10,000 for descriptive study was used. Using a 63.3% proportion of PLHIV who desired for children from a study in Sagamu, Nigeria  and an adjustment for attrition factor due to non-response to some questions/loss of entire questionnaire,  a sample size of four hundred was estimated. Thus, a total of four hundred people living with HIV were recruited in the study.
A two stage sampling method was used to select study respondents. First, respondents were stratified into male and female using a stratified sampling method. The total number of the study population was 2059 out of which males were 903 and females were 1156. A proportional allocation was made for each of the strata where 175 males and 225 females were selected. Secondly, a systematic sampling method was used. A list of clients that came to the clinic was obtained and listed to form the sampling frame. Sampling interval was calculated by dividing the total sample size required by the number of clients at the clinic. A number was randomly selected between 1 and the sampling interval calculated using simple random sampling method. It was from the selected number and corresponding client that sampling was started. Subsequently, the sampling interval was added to the selected number and each resulting number to sample other client from the sampling frame who participated in the study. Selected respondents who were absent were substituted by selecting the next eligible person on the sampling frame. This was repeated on each clinic days until required sample size was obtained.
A structured close-ended interviewer-administered questionnaire was used to collect data on socio- demographics and fertility characteristics amongst the respondents. The questionnaires were administered by three social workers working in the clinic that were trained on the study protocol. Data collected was entered and analysed using SPSS (IBM, New York). Mean and standard deviation were determined for continuous variables while frequencies and percentages were carried out on categorical variables.
Chi square test was used to compare categorical variables. Multivariate logistic regression was used to examine the association of independent variables and outcome. The adjusted odd ratio was calculated to determine association and identify key determining factors influencing desire for children among the study respondents. During the multivariate analyses, a forced entry regression model was used where all the independent variables were simultaneously entered into regression equation at once to examine the relationship between whole set of predictors and outcome variable. Significant level α, for the bivariate and multivariate analysis was set at 5% (0.05) at 95% confidence level.
Ethical approval was obtained from the Research Ethics Committee of Usmanu Danfodiyo University Teaching Hospital, Sokoto. Oral informed consent was obtained.
| Results|| |
[Table 1] below shows the overall mean age of the respondents was 34.5 ± 0.4 years (males, 38.4 ± 0.5 years; female, 31.4 ± 0.4 years) with those aged below and above 35 years being almost equally represented (50.1 vs 49.9%). Majority of the respondents were Hausa/Fulani (48.2%) and Muslims, 62% while the remaining 38% Christians. Most of the respondents (36%) had tertiary education and 14.7% had Quranic education only. Majority (64.2%) of the respondents was married. Only 3.3% of respondents were full time house wife, while majority (43.3%) were traders.
[Figure 1] below shows that majority (85%) of respondents' had no preference for the sex of their potential children.
Reasons given for desire for child bearing included love for children (27.1%), pressure to have child (13.8), fear that older child may die (22.6%), avoid suspicion about HIV status (7.8%), apprehension about disclosing status (3.3%) and support at old age (25.3%).
[Figure 2] below shows the reasons why the respondents desire for children in future and these included love for children (27.3%), fear of older child may die (22.7%), pressure by in-laws (13.8%), to avoid suspicion of HIV infection (11.1%) and support at old age (25.3%).
[Figure 3] shows that those who indicated no desire for children were because of attained desired family size (43.2.9%), concerned about their health (17.6%), fear of transmitting HIV to their children (31.2%), anxiety about leaving orphan (8.0%).
[Table 2] shows association between desire for children and age group (P = 0.001), gender (P = 0.05), ethnicity (P = 0.001), religion (P = 0.001), educational status (P = 0.029) marital status (P = 0.025), and number of living children (P = 0.001).
|Table 2: Relationship between Socio-demographic characteristics and desire for children |
Click here to view
[Table 3] below shows that young age group below 35 years, marital status and number of living children as the key determinants of respondents' desire for children in future.
| Discussion|| |
This study has shown that majority of the respondents reported having living one or more children (64.4% of men and 70.2% of women). In spite of this, majority (67.7%) of the respondents reported a desire for more children. Parenthood is an important component of married couple's identity and societal status A study by Iliyasu et al., (2009) among PLHIV in Kano, Nigeria had the same observations with the current report with desire to have more children of 65.5% and 52 61.2% among females and males, respectively.  Both study populations share common socio-cultural and religious background. In Sagamu, South West Nigeria with different ethnic, cultural and religious background, 50.4% of PLHIV desired to have more children despite the fact that they had an average of living two children.  Culture of desire for child bearing seems uniform among indigenous Africans irrespective of ethnicity and religion.
However, our findings differ from studies Brazil and America where fewer proportion of PLHIV had desire for child bearing. Fertility level of population has been found to be influenced by level of country's socio-economic development. ,
This study have identified younger age, being married and number of living children as the key determining factors of the reported fertility intentions. This showed that respondents were largely influenced by demographic factors rather than health-related in making their reproductive decisions.
A study conducted in Brazil showed that the desire to have children was more frequent among men than women. Male gender, younger age, having no children, living with 1-2 children, and being married were independently associated with desire to have children. 
Eluid, (2012) demonstrated that age, gender and number of living children were demographic factors that were found to influence fertility desire among PLHIV.  Studies in Nigeria,  Uganda,  South Africa,  Brazil  and the United States,  have shown that younger PLHIV are more likely to desire (more) children than older PLHIV. Gender has been reported by number of studies to influence fertility desires, with men being more likely than women to desire children. ,,, However, our findings did not indicate gender as a factor, which is in agreement with finding of study in Nigeria by Iliyasu et al. (2009).  The number of living children has been shown to be a consistent predictor of fertility desires and thus in conformity with this study. The study showed that PLHIV having living children are less likely to express fertility desire. This observed negative association between fertility desire and number of living children among PLHIV were in conformity with study in Nigeria,  Uganda,  Malawi,  South Africa, ,, Brazil,  and the United States.  The earlier studies in Kenya and Tanzania observed that an increase in child mortality can be expected to increase fertility, while an increase in adult mortality or concerns about AIDS would reduce fertility. ,
Marital status has been identified as one key predictor of fertility desire among the PLHIV. Majority of the PLHIV were married and this finding conforms to a study in Brazil by Vera et al., (2007) that being married was independently associated with desire to have children. 
ART use and subjective health status were health-related factors found to affect future fertility among PLHIV.  Some studies have indicated that PLHIV who felt healthier were more likely to be inclined to having more children in Nigeria,  India,  and United States.  This is in contrast with findings of this study in which religious and cultural factors dictate the reproductive decision making.
In conclusion, our data demonstrated strong desires for child bearing among PLHIV. The determinants of this desire were identified.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]