A Mini-review on the Determinants and Risk Factors of Adolescent Pregnancy in Developing Countries

@#Pregnant adolescents have been shown to have a higher incidence of health and non-health-related complications that affect both mothers and infants. These include increased risk of pregnancy-related diseases such as anemia and pre-eclampsia, preterm and low-birth-weight babies, as well as other social consequences such as educational and financial difficulties. This mini review evaluates selected articles which explain the attitudes, knowledge, behavior and other risk factors associated with pregnancy among adolescents in developing countries. It also revealed that inadequate knowledge among adolescents about reproductive and sexual health, other social, cultural and peer influences, parenting values, and poor financial and educational status were factors that contribute to adolescent pregnancy. Likewise, a lack of support from parents, educators and healthcare workers had negative impacts on healthy sexual behavior among adolescents, which may ultimately lead to adolescent pregnancy. We conclude that the factors discussed in this review need to be evaluated and taken into consideration by policymakers and healthcare workers when formulating strategies to prevent pregnancies among adolescents.

Factores de riesgo para cesáreas en indígenas adolescentes en un departamento de Colombia período 2020 ­ 2021 / Risk factors for cesarean sections in indigenous adolescents in a department of Colombia in the period 2020 - 2021

Objetivo Determinar los factores de riesgo que afectan el embarazo en adolescentes entre los 12 y 17 años de las comunidades indígenas, atendidas en un hospital del Departamento de La Guajira durante el periodo 2020- 2021. Materiales y métodos Estudio de tipo descriptivo con el fin de determinar, los principales factores de riesgo que pueden afectar el embarazo y que son motivo de consultas o causas de remisión para ser atendidas oportunamente en un hospital de la región, se tuvieron en cuenta 100 historias clínicas que cumplían con la información solicitada empleando las categorías de; edad de la gestante, asistencia a control de embarazo, enfermedades presentadas relacionadas con el embarazo y remisión. Resultados Se destacan que al comparar los años se encuentra que la anemia no especificada se mantiene y se incrementan de un año al otro las infecciones urinarias y la vaginitis lo anterior se acompaña de poca asistencia a los controles prenatales. Conclusiones El embarazo en la adolescencia sigue siendo uno de los principales factores que contribuyen a la mortalidad materna infantil y aumenta el círculo de enfermedad y pobreza, con mayor énfasis en los grupos indígenas. Este es un aspecto crucial por su importancia en los ámbitos de salud materna y reproductiva. Por lo cual, en estudios recientes se muestran altas tasas de mortalidad infantil, así como brechas sistemáticas entre grupos étnicos.

Objective To determine the risk factors that affect pregnancy in adolescents between 12 and 17 years of age from indigenous communities, treated at a hospital in the Department of La Guajira during the period 2020-2021. Materials and methods Descriptive study in order to determine the main risk factors that can affect pregnancy and that are the reason for consultations or causes of referral to be treated promptly in a hospital in the region, 100 were taken into account. medical records that met the requested information using the categories of; age of the pregnant woman, assistance to pregnancy control, presented diseases related to pregnancy and remission Results It is highlighted that when comparing the years it is found that unspecified anemia is maintained and urinary infections and vaginitis increase from one year to the next, the above is accompanied by little attendance at prenatal controls. Conclusions Pregnancy in adolescence continues to be one of the main factors that contribute to maternal and child mortality and increases the cycle of disease and poverty, with greater emphasis on indigenous groups. This is a crucial aspect due to its importance in the areas of maternal and reproductive health. Therefore, recent studies show high infant mortality rates, as well as systematic gaps between ethnic groups.

Características sociodemográficas que influyen en el embarazo en la adolescencia / Sociodemographic characteristics that influence pregnancy in adolescence

Introducción: el embarazo en la adolescencia constituye un alarmante problema de salud; describir las características que influyen en su aparición permite desarrollar actividades de promoción de salud encaminadas a mejorar dicha situación. Objetivo: describir las características sociodemográficas que influyen el embarazo en la adolescencia. Métodos: estudio observacional, descriptivo, de corte transversal en gestantes adolescentes pertenecientes al Policlínico Docente "7 de noviembre" del municipio Majibacoa durante el año 2020. El universo estuvo constituido por 34 gestantes adolescentes; se trabajó con la totalidad de estas. Se analizaron las variables: edad materna, características sociodemográficas, factores de riesgo familiares, factores de riesgo sociales y económicos y deserción escolar. Resultados: el 55,9% de las gestantes tenía entre 18 y 19 años. El 47% tenían nivel preuniversitario, el 52,9% eran estudiantes; el 67,6% se encontraban en unión y la mayoría tuvo su primera relación sexual después de los 14 años (58,8%). El 32,4% de las gestantes adolescentes eran hijas de madres con algún embarazo en la adolescencia. Se observó con mayor preponderancia el per cápita familiar bajo como factor de riesgo socioeconómico (43,8%). El 58,8% abandonaron sus estudios. Conclusiones: el inicio precoz de las relaciones sexuales, el antecedente de madres con embarazos en la adolescencia, el per cápita familiar bajo favorecen la aparición de una gestación en la adolescencia, donde la mayoría de las veces estas deciden abandonar sus estudios.

Introduction: teenage pregnancy constitutes an alarming health problem; Describing the characteristics that influence its appearance allows the development of health promotion activities aimed at improving this situation. Objective: to describe the sociodemographic characteristics that influence pregnancy in adolescence. Methods:observational, descriptive, cross-sectional study in pregnant teenagers belonging to the Teaching Polyclinic "7 de Noviembre" of the Majibacoa municipality during the year 2020. The universe consisted of 34 pregnant teenagers; all of these were worked on. The variables were analyzed: maternal age, sociodemographic characteristics, family risk factors, social and economic risk factors, and school dropout. Results: 55,9% of the pregnant women were between 18 and 19 years old. 47% had a pre-university level, 52,9% were students; 67,6% were in union and the majority had their first sexual intercourse after the age of 14 (58,8%). 32,4% of the adolescent pregnant women were the daughters of mothers with some pregnancy in adolescence. Low family per capita is exhibited with greater preponderance as a socio-economic risk factor (43,8%). 58,8% dropped out of their studies. Conclusions: the early initiation of sexual relations, the antecedent of mothers with teenage pregnancies, the low family per capita favor the appearance of a pregnancy in adolescence, where most of the time they decide to abandon their studies

Relación entre anemia del primer trimestre y bajo peso al nacer en cuatro Centros de Salud Materno-Infantiles de Lima Sur durante el 2019 / Relationship between first trimester anemia and low birth weight in four mother-and-child health centers in Lima Sur during 2019

RESUMEN Objetivo: Determinar la relación entre la anemia materna del primer trimestre y el bajo peso al nacer de cuatro centros de salud maternos de Lima-Sur durante el 2019. Materiales y métodos: Se realizó un estudio cohorte retrospectivo de una base de datos secundaria donde se incluyeron gestantes atendidas en cuatro Centros de Salud con nivel de complejidad I-4 de Lima-Sur; cuyos partos se registraron durante el 2019, excluyendo a los recién nacidos pretérmino. Una hemoglobina del primer trimestre <11 g/dl se definió como anemia y un peso <2500 g como bajo peso al nacer. Se calculó la incidencia acumulada según anemia y se halló el riesgo relativo (RR) ajustado a potenciales confusores. Resultados: Se incluyó 221 gestantes y el 76 % tuvo una edad entre 18 a 35 años. Un 42 % fue primigesta, un 52 % presentó exceso de peso y el 60 % realizó 6 o más controles prenatales. Un 23,5 % de gestantes presentó anemia en el primer trimestre y se halló una incidencia de 2,7 % casos con bajo peso al nacer. La anemia del primer trimestre elevó en 11 veces la incidencia de recién nacidos con bajo peso, independiente de la edad, índice de masa corporal y paridad (RR ajustado = 11,1; IC 95 % 1,3 - 97,2; p=0,029). Conclusiones: De la muestra estudiada, una de cada cuatro gestantes presenta anemia durante el primer trimestre incrementando la incidencia acumulada de tener un neonato con bajo peso hasta en 11 veces.

ABSTRACT Objective: To determine the relationship between maternal anemia in the first trimester of pregnancy and low birth weight in four mother-and-child-health centers in Southern Lima during 2019. Material and methods: A retrospective cohort study from a secondary database was performed, where pregnant women from 4 middle-complexity Health Centers from Southern Lima were included. Deliveries took place during 2019, excluding preterm newborns. First trimester hemoglobin concentration <11 g/dL was defined as anemia and birth weight <2500 g was defined as low birth weight. Cumulative incidence for anemia was calculated, and relative risk (RR) adjusted for potential confounders was also calculated. Results: Two hundred and twenty one pregnant women were included. Seventy-six per cent were between 18 and 35 years old. Forty-two percent were primigravida, fifty-two percent had excess body weight, and sixty percent had six or more prenatal control visits. Nearly one quarter (23,5%) of all pregnant women had anemia during the first trimester, and there were 2,7% cases of low birth weight. Anemia during the first trimester of pregnancy increased 11 times the frequency of newborns with low birth weight, independently of age, body mass index, and parity (adjusted RR = 11,1; 95% CI: 1,3-97,2; p= 0,029). Conclusions: In the studied sample, one out of four pregnant women had anemia during the first trimester of pregnancy, increasing up to 11 times the cumulative incidence for having a neonate with low birth weight.

Factores familiares que predisponen el embarazo adolescente en América Latina y El Caribe 2009-2019: revisión sistemática / Family Factors Predisposing to Adolescent Pregnancy in Latin America and the Caribbean 2009-2019: A Systematic Review / Fatores familiares que predispõem à gravidez na adolescência na América Latina e no Caribe 2009-2019: revisão sistemática

Introducción: el embarazo adolescente, problema de salud pública mundial, requiere un abordaje integral y multidisciplinario de los factores condicionantes; sin embargo, el reconocimiento que se da a la familia frente a este problema es débil, a pesar del rol importante que cumple. Objetivo: analizar la información basada en evidencias acerca de los factores familiares que predisponen el embarazo adolescente en América Latina y El Caribe, para fortalecer el cuidado de enfermería al identicar oportunamente factores de riesgo y diseñar estrategias que reduzcan el impacto. Método: revisión sistemática realizada de mayo a octubre del 2020, se utilizaron descriptores Decs y Mesh en la identificación de palabras clave, los operadores booleanos "AND" y "OR" para generar ecuaciones de búsqueda en las bases de datos SciELO, LILACS, PubMed y los repositorios de Alicia y Latinoamericano. Resultados: el 73 % (1-11) identificó la disfuncionalidad familiar, el 53 % (8) la familia desestructurada y el 47 % (7) el antecedente familiar y escasa o inadecuada educación sexual-reproductiva, respectivamente. Conclusiones: la importancia de la familia en el cuidado de la salud integral del adolescente radica en la identicación oportuna de riesgos como la disfuncionalidad familiar, tener una familia desestructurada, el antecedente de embarazo precoz en la familia y la escasa o inadecuada educación sexual y reproductiva del adolescente que, de mantenerse, afectarían el desarrollo óptimo, el futuro de estas adolescentes y de sus próximas generaciones.

Introduction: adolescent pregnancy, a global public health problem, requires a comprehensive and multidisciplinary approach to conditioning factors; however, the recognition given to the family in the face of this problem is weak, despite the critical role it plays. Objective: analyze evidence-based information about family factors that predispose adolescent pregnancy in Latin America and the Caribbean to strengthen nursing care by identifying risk factors promptly and designing strategies that reduce the impact. Method: systematic review carried out from May to October 2020. Decs and Mesh descriptors were used to identify keywords, the Boolean operators "AND" and "OR" to generate search equations in the SciELO, LILACS, PubMed databases, and the Alicia and Latinoamericano repositories. Results: 73% (1-11) identified family dysfunction, 53% (8) the unstructured family, and 47% (7) the family history and scarce or inadequate sexual-reproductive education, respectively. Conclusions: the importance of the family in the comprehensive health care of adolescents lies in the timely identication of risks such as family dysfunction, having an unstructured family, the history of early pregnancy in the family, and the scarce or inadequate sexual and reproductive education of the adolescent that, if maintained, would affect the optimal development, their future, and their next generations.

Introdução: a gravidez na adolescência, um problema de saúde pública global, requer uma abordagem abrangente e multidisciplinar dos fatores condicionantes; entretanto, o reconhecimento dado à família diante dessa problemática é fraco, apesar do importante papel que desempenha. Objetivo: analisar informações baseadas em evidências sobre os fatores familiares que predispõem à gravidez na adolescência na América Latina e no Caribe, para fortalecer a assistência de enfermagem, identificando os fatores de risco em tempo hábil e traçando estratégias que reduzam o impacto. Método: revisão sistemática realizada de maio a outubro de 2020, foram utilizados os descritores Decs e Mesh na identificação das palavras-chave, os operadores booleanos "AND" e "OR" para gerar as equações de busca nas bases de dados SciELO, LILACS, PubMed e os Repositórios Alicia e Latinoamericano. Resultados: 73% (1-11) identificaram disfunção familiar, 53% (8) a família desestruturada e 47% (7) a história familiar e educação sexual reprodutiva escassa ou inadequada, respectivamente. Conclusões: a importância da família na atenção integral à saúde do adolescente reside na identificação oportuna de riscos como disfunção familiar, ter família desestruturada, história de gravidez precoce na família e a escassa ou inadequada educação sexual e reprodutiva de o adolescente que, se mantido, afetaria o desenvolvimento ótimo, o futuro dessas adolescentes e das suas próximas gerações.

Pregnancy complicated with severe special diseases in 2014-2016 in Shanghai:its risk management study / 上海预防医学

Objective To study the risk management of pregnancy with severe special diseases. Methods The relevant data on 181 women (< 28 weeks gestation) with severe special diseases reported from 2014 to 2016 in Shanghai city were analyzed retrospectively. Results The incidence of pregnancy with severe special diseases rose from 2014-2016, the incidence of 2016 was significantly higher than that of 2014 (P < 0.01).The average age of 181 pregnant women with severe special diseases was (29.06±5.41) years old, and pregnant women over 35 years of age accounted for 16.02%.The proportion of pregnant women (over 35) with severe special diseases in 2016 increased compared with the previous two years.Among 181 pregnant women with severe special diseases, the proportion of non-household registration people(76.80%) was higher than that of Shanghai household registered women(23.20%), the pregnant women who temporarily lived in Shanghai(residence time < 6 months) accounted for 35.91%.The top three diseases of 181 pregnant women with severe special diseases were pregnancy with cardiopathy, pregnancy with blood diseases and pregnancy with diseases of the immune system.Among the 181 pregnant women with severe special diseases, 47 cases received rescue of severe pregnant (259.67‰), which was significantly higher than the incidence of critically ill pregnant women in Shanghai during 2014-2016 (2.31‰, 3.12‰, 3.31‰ for three years respectively, and the average 2.89‰).The hospitalization expenses were lower if pregnancy terminated within 13 weeks gestation (P < 0.05). Conclusion To strengthen early intervention for pregnancy with severe specific diseases, for the purpose of ensuring the safety of mothers and infants, improving the quality of life for the pregnant women, reducing the burden on pregnancy and saving medical and health costs.To increase the risk awareness and intervention compliance of pregnant women with severe special diseases for the purpose of reducing maternal mortality.

Pregnancy complicated with severe special diseases in 2014-2016 in Shanghai:its risk management study / 上海预防医学

Objective To study the risk management of pregnancy with severe special diseases. Methods The relevant data on 181 women (< 28 weeks gestation) with severe special diseases reported from 2014 to 2016 in Shanghai city were analyzed retrospectively. Results The incidence of pregnancy with severe special diseases rose from 2014-2016, the incidence of 2016 was significantly higher than that of 2014 (P < 0.01).The average age of 181 pregnant women with severe special diseases was (29.06±5.41) years old, and pregnant women over 35 years of age accounted for 16.02%.The proportion of pregnant women (over 35) with severe special diseases in 2016 increased compared with the previous two years.Among 181 pregnant women with severe special diseases, the proportion of non-household registration people(76.80%) was higher than that of Shanghai household registered women(23.20%), the pregnant women who temporarily lived in Shanghai(residence time < 6 months) accounted for 35.91%.The top three diseases of 181 pregnant women with severe special diseases were pregnancy with cardiopathy, pregnancy with blood diseases and pregnancy with diseases of the immune system.Among the 181 pregnant women with severe special diseases, 47 cases received rescue of severe pregnant (259.67‰), which was significantly higher than the incidence of critically ill pregnant women in Shanghai during 2014-2016 (2.31‰, 3.12‰, 3.31‰ for three years respectively, and the average 2.89‰).The hospitalization expenses were lower if pregnancy terminated within 13 weeks gestation (P < 0.05). Conclusion To strengthen early intervention for pregnancy with severe specific diseases, for the purpose of ensuring the safety of mothers and infants, improving the quality of life for the pregnant women, reducing the burden on pregnancy and saving medical and health costs.To increase the risk awareness and intervention compliance of pregnant women with severe special diseases for the purpose of reducing maternal mortality.

Current status and future prospects of serological prenatal screening / 中华检验医学杂志

Prenatal screening has undergone from simple age screening, serological prenatal screening, multiple serological screening, to combined screening with cell-free fetal DNA in maternal blood (non-invasive prenatal testing, NIPT). prenatal screening plays an important role in the detection and prevention of birth defects, such as chromosomal abnormalities and open neural tube defects(ONTD). With the emergence of NIPT technology, serological test result in prenatal screening has been outgrowth from the functional surrogate of the development status of fetus and placenta to the predictors of pre-eclampsia and fetal growth retardation(FGR). Therefore, large scale screening program will further improve maternal safety and reduce birth defects.

Pregnancy risk and mode of delivery in pregnant women with heart disease / 中国实用妇科与产科杂志

Pregnancy with heart disease is one of the important causes of maternal mortality.Assessment and management of such patients before pregnancy,during pregnancy and during childbirth play an important role in reducing maternal mortality and improving maternal and infant outcomes.This article summarizes the risk assessment of pregnancy with heart disease and the choice of delivery mode at home and abroad in order to provide reference for clinical workers in diagnosis,treatment and management of pregnancy with heart disease.

DETERMINATION OF THE RISK FACTORS AND TREATMENT OF ECTOPIC PREGNANCY / Шинэ санаа Шинэ нээлт

Ectopic pregnancy (EP) is a life – threatening emergency, and a significant cause of maternal morbidity and mortality in Ulan – Bator. The aim of this research was to determine and evaluate the incidence, risk factors and treatment of ectopic pregnancies at The First Maternity Hospital in Ulan – Bator.This was a retrospective, descriptive study of EP’s managed in The First Maternity Hospital during the study period 2013, 2014.The medical records of the patients managed for ectopic pregnancy as well as the total birth record and gynecological admission records during the period under review were retrieved, and data were collected with the aid of data-entry forms designed for this purpose. There were 46.147 gynecological admissions and 28.744 deliveries, with 870 cases of ectopic pregnancies. A total 863 cases were suitable for analysis. The relevant collected data were analyzed with SPSS Version 20.0 for windows.Ectopic pregnancies constituted in 3.9% of all gynecological admissions.Majority of patients were in 25-29years age group (64.1%). The average age of patients was 30 +/- 6 years. In 83.8% of patients had previous abortions, inflammatory disease was the most frequent risk factors.521(60.3%) patients were treated surgically while the 342(39.6%) remain patients received conservative treatment.The incidence of ectopic pregnancy increased by 0.8%, which is comparable between 2013(2.5%), 2014(3.3%). In our study the number percentage of organ preserving treatment, such as tubostomy and conservative – treatment by methotrexate increased significantly.

Medications use among pregnant women in Ethiopia: A cross sectional study.

Despite lack of scientific evidence about the safety of some medications, the reported use of medications during pregnancies has increased. This may lead to adverse reproductive outcomes, due to potential risk to the mother and the fetus. In contexts of most developing countries including Ethiopia, it is difficult to elucidate medications use prevalence during pregnancy and their relative contributions to birth defects for several reasons. Institutionbased cross sectional study was conducted in Tertiary care hospital Ethiopia. Current medication use data were collected by reviewing patients' charts in the antenatal care follow up clinic, chronic care (internal medicine) as well as psychiatry clinic and by interviewing pregnant women using semi-structured questionnaire. Medications were classified using the United States Food and Drug Administration pregnancy risk classification system. A total of 339 women were included in the study; of which 187 (55.2%) had used at least one prescription and 162(52.2%) had used over the counter medications during pregnancy. The majority of the medications were antibiotics (42.5%) and analgesics (40.1%). 57(16.8%) and 24(7.1%) of medications were prescribed from category D and X respectively. Out of 187 (55.2%) prescription medications used, 51 (15.0%) were obtained without prescribers order. Majority (70.8%) of the women did not have awareness regarding risks associated with self medication. Prescription medications use was 0.08 times less among women with a co-morbidities (AOR 0.08(.05, 0.13), p=0.001) and 2.5 times higher among women from rural areas (AOR 2.53 (1.15, 5.56); P=0.02). Compared to employed women, over the counter medications use were 1.9 times more among house wife women (AOR1.87 (1.12, 3.09), p= 0.02) and about thrice higher among merchant women (AOR 2.88(1.10, 7.55), p= 0.03). Likewise, presence of medical problems was found to have 60% protective against OTC medications use (AOR 0.40 (.26, 0.64), p=0.01). The overall medications use during pregnancy was found to be high. Medications use without prescribers order was common and potentially harmful medications (category-D and X) use appeared to be higher in all trimesters. The findings of this study argue in favor of prescribing some potentially harmful medications which could have been avoided during pregnancy. Majority of the women lacked awareness about the potential risks associated with medications use in pregnancy without prescribers order.

HIV risk factors among pregnant women in a Rural Nigerian Hospital / Factores de riesgo de VIH entre las mujeres embarazadas en un Hospital Rural Nigeriano

OBJECTIVE: Specific risk behaviours and practices promote the spread of HIV/AIDS. Identification of those at risk of the Human Immunodeficiency Virus (HIV) infection is an important step toward prevention of both vertical and horizontal transmission of HIV. This study sought to identify risk factors for HIV infection in pregnant women attending a rural antenatal clinic in Northern Nigerian. METHODS: A cross-sectional descriptive study of pregnant women attending antenatal clinic at a rural mission hospital in Northern Nigeria between June and October 2005 was conducted. Data were collected with a structured questionnaire. HIV screening and confirmation were done for the pregnant women after voluntary counselling. RESULTS: The study enrolled 350 pregnant women with a mean (± SD) age of 26.8 ±6.4 years. HIV infection was not associated with smoking habits in women, alcohol intake in the women or their partners, prior blood transfusion, history of sexually transmitted infection or history ofscarification. In multiple logistic regression, HIV infection was independently associated with suspecting their partner of extramarital sex (adjusted odds ratio 3.8, 95% CI 1.6, 9.0), post-primary education (AOR 2.4, 95% CI 1.1, 5.3), multiple sexual partners (AOR 2.4, 95% CI 0.97, 6.2) and cigarette smoking by a partner (AOR 3.0, 95% CI 0.95, 9.4). CONCLUSION: Multiple partners and extramarital sex remain a hindrance to the fight against HIV infection. Promoting the ABC approach (abstinence, be faithful, condom) may reduce risky behaviour as it has in other parts of Africa.

OBJETIVO: Las prácticas y los comportamientos de riesgo específicos promueven la propagación del VIH/SIDA. La identificación de quienes se encuentran en riesgo de infección por el virus de la inmunodeficiencia humana (VIH) es un paso importante hacia la prevención de la transmisión vertical y horizontal del VIH. Este estudio buscó identificar los factores de riesgo de infección de VIH en las mujeres embarazadas que asisten a una clínica prenatal rural en el norte de Nigeria. MÉTODOS: Se llevó a cabo un estudio descriptivo transversal de mujeres embarazadas que asisten a la clínica prenatal en un hospital rural misionero en Nigeria Norte, entre junio y octubre de 2005. Los datos fueron recogidos mediante un cuestionario estructurado. El pesquisaje y confirmación del virus de la inmunodeficiencia humana fueron realizados para las mujeres embarazadas tras recibir aconsejamiento voluntario. RESULTADOS: El estudio enroló a 350 mujeres embarazadas con una edadpromedio (± SD) de 26.8 ± 6.4 anos. La infección por VIH no estuvo asociada con el hábito defumar entre las mujeres, la ingestión de alcohol por las mujeres o sus companeros, las transfusiones de sangre previas, una historia de infecciones de transmisión sexual, o una historia de escarificación. En la regresión logística múltiple, la infección por VIH estuvo independientemente asociada con sospechas de relaciones sexuales extramaritales por parte de sus companeros (odds ratio ajustado 3.8, 95% CI 1.6, 9.0), educación postprimaria (AOR 2.4, 95% CI 1.1, 5.3), parejas sexuales múltiples (AOR 2.4, 95% CI0.97, 6.2) y el hábito defumar cigarrillos por parte del companero (AOR 3.0, 95% CI 0.95, 9.4). CONCLUSIÓN: Las parejas múltiples y el sexo extramarital siguen siendo un estorbo para la lucha contra la infección por VIH. Promover el enfoque ABC puede reducir el comportamiento riesgoso, como ha ocurrido en otras partes de Africa.