2025/09/05 by Eyob Shitie LakeID1*, Mulat Ayele1
paper · doi:10.20372/nadre:17288
Abstract<br> Introduction<br> An unintended pregnancy refers to a situation where a pregnancy occurs either when there<br> is no desire for a child (unwanted) or when it takes place at a time that was not anticipated<br> (mistimed). Pregnant women infected with HIV face a two to tenfold increased risk of mortality during both pregnancy and the postpartum period compared to those who are not<br> infected. A national level cohort study has identified that about 70 babies born HIV positive,<br> 60% of them were from unplanned pregnancy. In pregnant women living with HIV and on<br> antiretroviral therapy, preterm birth and low birth weight have been reported. A systematic<br> review and meta-analysis were conducted on the rate of vertical transmission of HIV in East<br> Africa and revealed the pooled prevalence of 7.68% (ranges from 1.58–32.1%), which is far<br> from the desired target of WHO, which is below 5%.<br> Methods<br> Appropriate and comprehensive searches of PubMed, MEDLINE, EMBASE, Google<br> Scholar, HINARI, and Scopus have been performed. The electronic literature search was<br> last performed on December 28/2023. All observational study designs were eligible in this<br> SRMA (systematic review and meta-analysis). Primary studies lacking the outcome of interest, were excluded from the SRMA. The extracted Microsoft Excel spreadsheet data were<br> imported into the STATA software version 17 (STATA Corporation, Texas, USA) for analysis. A random-effects model was used to estimate the pooled prevalence of unintended<br> pregnancy among women living with HIV in East Africa. The Cochrane Q-test and I2 statistics were computed to assess the heterogeneity among the studies included in the SRMA.<br> Result<br> A total of 2140 articles were found by using our search strategies and finally ten studies<br> were included in the SRMA, comprised of 4319 participants. The pooled prevalence of<br> unintended pregnancy among women living with HIV in East Africa was 40.98% (95% CI:<br> 28.75, 53.20%). The finding of this subgroup analysis by study country showed that the<br> pooled prevalence of unintended pregnancy among women living with HIV was lower in<br> Ethiopia (28.38%; 95% CI: 15.54, 41.21%) and higher in Rwanda (62.7%; 95% CI: 58.71,<br> 66.69%). Unemployment (AOR = 2.75, 95% CI: 1.82, 4.16), high parity (AOR = 3.16, 95%<br> CI: 2.34, 4.36) and no formal education (AOR = 2.04, 95% CI: 1.23, 3.38) were significantly<br> associated with unintended pregnancy among women living with HIV in East Africa.<br> Conclusion<br> The findings of this SRMA suggest a substantial need for concerted efforts to reduce unintended pregnancies among women living with HIV. It underscores the importance of continuous and rigorous initiatives to enhance women’s empowerment, focusing on improving<br> both employment and educational status. Additionally, all stakeholders are urged to diligently implement the WHO recommendations, particularly emphasizing a four-pronged<br> approach to a comprehensive PMTCT strategy and the prevention of unintended<br> pregnancies.<br>