Socioeconomic Vulnerability and Sexually Transmitted Infection Among Pregnant Haitian Women.

BACKGROUND: Despite evidence that education and poverty act through distinct pathways to influence sexually transmitted infection (STI), few studies have examined the unique, independent associations of these socioeconomic vulnerabilities with sexual risk behaviors and STI among women. METHODS: From August to October 2013, women at an antenatal clinic in Gressier, Haiti, were interviewed and tested for chlamydial infection, gonorrhea, and trichomoniasis (N = 200). We measured low educational attainment as less than 9 years of schooling and currently living in poverty based on crowding, defined as more than 2 people sleeping in one room. We used logistic regression to estimate independent associations between each socioeconomic indicator and outcomes of sexual behaviors and STI. RESULTS: Approximately 29% of the sample had a current STI (chlamydia, 8.0%; gonorrhea, 3.0%; trichomoniasis, 20.5%), with 2.5% testing positive for more than 1 STI. Forty percent of the sample reported low educational attainment and 40% reported current poverty. Low educational attainment was associated with early risk behaviors, including twice the odds of earlier sexual debut (adjusted odds ratio [AOR], 2.09; 95% confidence interval [CI],: 1.14-3.84). Poverty was associated with reporting the current main sexual partner to be nonmonogamous (AOR, 2.01; 95% CI, 1.00-4.01) and current STI (AOR, 2.50; 95% CI, 1.26-4.98). CONCLUSIONS: Education and poverty seem to independently influence STI behaviors and infection, with low education associated with early sexual risk and poverty associated with current risk and infection. Improving women's educational attainment may be important in improving risk awareness, thereby reducing risky sexual behaviors and preventing a trajectory of STI risk.

Determinants of institutional delivery among women of childbearing age in rural Haiti.

Institutional delivery is an important factor associated with reduced maternal mortality rate (MMR). MMR in Haiti is high (350 per 100,000) and institutional delivery is low-just over 25 % of women delivered at a health facility in 2010. There also exists substantial rural-urban disparity in delivery with more hospital deliveries in urban than in rural areas. We aimed to study the prevalence and determinants of institutional delivery in a sample of women of childbearing age in rural Haiti. The study took place in Fond des Blancs and Villa, as part of a baseline assessment undertaken prior to implementation of a maternal, child health, nutrition, and water and sanitation program. From October to November 2011, women 15-49 years old (N = 575) were selected using a cross-sectional two-stage sampling strategy. We used descriptive and multivariate logistic regression analyses to assess the prevalence of and factors associated with institutional delivery. The prevalence of institutional delivery was 45.4 %; a rate higher than the national average of 25 %. In adjusted analyses, correlates of institutional delivery were younger maternal age (25 years and younger) (OR 1.82; CI 1.15, 2.90; P = 0.0112), antenatal care receipt (OR 3.70; CI 1.84, 7.43; P = 0.0003) and those who were poor according to our poverty index score classification (OR 2.04; CI 1.13, 3.69; P = 0.0187). This study shows that increased hospital delivery is likely explained by accessibility to antenatal care. Programs that improve access to antenatal care, with concurrent efforts to address structural inequalities that drive socio-economic deprivation, are likely critical to increasing institutional delivery.