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Aman M, Bekele A, Abamecha F, Lemu YK, Gizaw AT. Husband's intention to support during pregnancy for the use of maternity waiting home in Jimma Zone, Southwest, Ethiopia: a community-based cross-sectional study. Front Glob Womens Health 2024; 5:1342687. [PMID: 38952839 PMCID: PMC11215070 DOI: 10.3389/fgwh.2024.1342687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/29/2024] [Indexed: 07/03/2024] Open
Abstract
Background Husbands are the primary decision-makers about the place of childbirth. Lack of husbands' support for maternal health care is associated with low maternal waiting home utilization and less is known about the husbands' intention to support their wife's use of maternal waiting homes (MWHs) and underlying beliefs in Ethiopia. This community-based cross-sectional survey aimed to study husbands' intention to support during pregnancy through the use of maternity waiting homes in Jimma Zone, Southwest Ethiopia. Method A cross-sectional study was conducted among 396 randomly selected husbands whose wives were pregnant. Interviewer-administered, a structured questionnaire developed based on the Theory of Planned Behavior (TPB) was used to collect the data. Multivariable logistic regression analyses were used to examine the association between behavioral intention and constructs of the theory of planned behavior. Results Of the 396 husbands who took part in the study, 42.7% intend to support their partner's use of a maternity waiting home. Intention to support a wife to use a maternity waiting home was associated with subjective norm [AOR = 1.303, 95% CI (1.054, 1.611)] and perceived behavioral control [AOR = 1.446, 95% CI (1.234, 1.695)]. Among the control beliefs, "having childcare"; "having a person who stays with a wife at a maternity waiting home"; and "availability of quality service provided to a wife in the maternity waiting home" significantly separated intenders and non-intenders. Conclusion The findings suggest that husbands who perceived more social pressure and felt in control of barriers were more likely to intend to support their partner in using a maternity waiting home. Intervention should focus on underlying normative and control beliefs to improve the husband's intention.
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Affiliation(s)
- Mamusha Aman
- Department of Health, Behavior, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Adisu Bekele
- Mana District Health Department, Oromia, Ethiopia
| | - Fira Abamecha
- Department of Health, Behavior, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Yohannes Kebede Lemu
- Department of Health, Behavior, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abraham Tamirat Gizaw
- Department of Health, Behavior, and Society, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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van Braam EJ, McRae DN, Portela AG, Stekelenburg J, Penn-Kekana L. Stakeholders' perspectives on the acceptability and feasibility of maternity waiting homes: a qualitative synthesis. Reprod Health 2023; 20:101. [PMID: 37407983 PMCID: PMC10324180 DOI: 10.1186/s12978-023-01615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of stakeholders' perspectives (women, families, communities and health workers) on the acceptability and feasibility of MWHs. METHODS A qualitative evidence synthesis was conducted. Studies that were published between January 1990 and July 2020, containing qualitative data on the perspectives of the stakeholder groups were included. A combination of inductive and deductive coding and thematic synthesis was used to capture the main perspectives in a thematic framework. RESULTS Out of 4,532 papers that were found in the initial search, a total of 38 studies were included for the thematic analysis. Six themes emerged: (1) individual factors, such as perceived benefits, awareness and knowledge of the MWH; (2) interpersonal factors and domestic responsibilities, such as household and childcare responsibilities, decision-making processes and social support; (3) MWH characteristics, such as basic services and food provision, state of MWH infrastructure; (4) financial and geographical accessibility, such as transport availability, costs for MWH attendance and loss of income opportunity; (5) perceived quality of care in the MWH and the adjacent health facility, including regular check-ups by health workers and respectful care; and (6) Organization and advocacy, for example funding, community engagement, governmental involvement. The decision-making process of women and their families for using an MWH involves balancing out the gains and losses, associated with all six themes. CONCLUSION This systematic synthesis of qualitative literature provides in-depth insights of interrelating factors that influence acceptability and feasibility of MWHs according to different stakeholders. The findings highlight the potential of MWHs as important links in the maternal and neonatal health (MNH) care delivery system. The complexity and scope of these determinants of utilization underlines the need for MWH implementation strategy to be guided by context. Better documentation of MWH implementation, is needed to understand which type of MWH is most effective in which setting, and to ensure that those who most need the MWH will use it and receive quality services. These results can be of interest for stakeholders, implementers of health interventions, and governmental parties that are responsible for MNH policy development to implement acceptable and feasible MWHs that provide the greatest benefits for its users. Trial registration Systematic review registration number: PROSPERO 2020, CRD42020192219.
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Affiliation(s)
| | - Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anayda G Portela
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
- Department Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Loveday Penn-Kekana
- Department of Maternal Health and Health Systems, London School of Hygiene and Tropical Medicine, London, UK
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Yarinbab TE, Harrison MS, Belachew T. Women's experiences of maternity waiting homes in sub-Saharan Africa: a qualitative systematic review protocol. JBI Evid Synth 2022; 20:2528-2535. [PMID: 35946906 PMCID: PMC10137323 DOI: 10.11124/jbies-22-00102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to synthesize women's experiences related to the use of maternity waiting homes in sub-Saharan Africa. INTRODUCTION Most maternal deaths occur within resource-limited settings. Sub-Saharan Africa and Southern Asia account for around 86% of all maternal deaths worldwide, with sub-Saharan Africa alone contributing roughly two-thirds of all maternal deaths. The long distances that women must travel to reach health facilities has been highlighted as the main cause of maternal death. Maternity waiting homes have been recognized as a strategy to enhance maternal health outcomes by bringing women living in geographically isolated locations closer to health facilities. However, maternity waiting home utilization rates are low and vary across different settings. INCLUSION CRITERIA The study population will be women (15 to 49 years of age) living in sub-Saharan Africa who have experiences related to maternity waiting home use. This may include experiences with service provisions during the final weeks of pregnancy and 2 weeks after childbirth. Stays of at least 1 day will be considered for inclusion. METHODS Databases including MEDLINE, Web of Science, Scopus, and Hinari will be searched. Gray literature sources will include Google Scholar and MedNar. Studies published in English from January 2000 onward will be included. Two independent reviewers will screen the titles and abstracts, followed by an examination of full-text papers. Any disagreements will be handled through discussion or consultation with a third reviewer. Two reviewers will independently assess the methodological quality of included studies and extract the data. The articles will be meta-aggregated and presented in tabular or narrative format. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42022306003.
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Affiliation(s)
- Teklemariam Ergat Yarinbab
- Institute of Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia.,Department of Epidemiology and Biostatistics, College of Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Margo Shawn Harrison
- Department of Gynecology and Obstetrics, School of Medicine, University of Colorado, Denver, CO, USA
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
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Uwamahoro NS, McRae D, Zibrowski E, Victor-Uadiale I, Gilmore B, Bergen N, Muhajarine N. Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis. BMJ Glob Health 2022; 7:bmjgh-2022-009605. [PMID: 36180098 PMCID: PMC9528638 DOI: 10.1136/bmjgh-2022-009605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number CRD42020173595.
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Affiliation(s)
- Nadege Sandrine Uwamahoro
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Faculty of Medical Sciences, Newcastle University, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Daphne McRae
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Chilliwack Division of Family Practice, Chilliwack General Hospital, Chiliwack, British Colombia, Canada
| | - Elaine Zibrowski
- Best Care COPD, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ify Victor-Uadiale
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Ireland
| | - Nicole Bergen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Population Health and Evaluation Research Unit, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Smith S, Henrikson H, Thapa R, Tamang S, Rajbhandari R. Maternity Waiting Home Interventions as a Strategy for Improving Birth Outcomes: A Scoping Review and Meta-Analysis. Ann Glob Health 2022; 88:8. [PMID: 35087708 PMCID: PMC8782095 DOI: 10.5334/aogh.3496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Over 300 000 women worldwide die due to pregnancy-related complications annually, with most occurring in developing countries where access to skilled obstetric care is limited. Maternity waiting homes (MWHs) are one intervention designed to increase access to skilled prenatal care in resource-limited settings. MWHs are defined as accommodations at or near a health facility where pregnant women can stay in the final weeks of their pregnancy so they can be easily transferred to the health facility to give birth. While MWHs have existed for decades, evidence regarding their effectiveness in reducing adverse birth outcomes has been mixed. The objective of this study is to comprehensively assess all available MWH research reporting quantitative maternal and childbirth data to determine whether MWHs are an effective maternal health strategy in resource-limited settings. METHODOLOGY We conducted a scoping review and meta-analysis of existing literature on MWHs according to PRISMA guidelines. Descriptive statistics and odds ratios were calculated for the following birth outcomes: maternal mortality, perinatal mortality, and caesarian section. Quantitative analysis was conducted in RStudio and Stata Version 16. RESULTS One hundred seventy-one records were retrieved from our initial database search, of which 66 were identified as relevant. Only 15 of these records reported quantitative data on the health outcomes of interest and therefore met inclusion criteria for our meta-analysis. All studies reporting maternal mortality demonstrated a protective effect of MWHs (aggregate OR: 0.19 [0.10, 0.40]), as did all studies reporting perinatal mortality (aggregate OR: 0.29 [0.16, 0.53]). Studies reporting caesarian section were more varied and indicated less of a protective effect (aggregate OR: 1.80 [1.18, 2.75]). CONCLUSIONS There is some indication that MWHs are an effective strategy for reducing maternal and perinatal mortality in resource-limited settings. However, our analysis was constrained by the observational design of most prior MWH studies. More rigorous MWH evaluations, ideally in the form of randomized-control trials, are needed to better determine MWH effectiveness.
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Affiliation(s)
- Samantha Smith
- Brigham and Women’s Hospital, Department of Medicine, Division of Global Health Equity, Boston, Massachusetts, USA
| | - Hannah Henrikson
- Brigham and Women’s Hospital, Department of Medicine, Division of Global Health Equity, Boston, Massachusetts, USA
| | - Rita Thapa
- Nick Simons Institute, Sanepa, Lalitpur, Nepal
| | | | - Ruma Rajbhandari
- Brigham and Women’s Hospital, Department of Medicine, Division of Global Health Equity, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Mount Auburn Hospital, Department of Medicine, Division of Gastroenterology, Cambridge, Massachusetts, USA
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Yoon HS, Kim CS. Maternity waiting home as a potential intervention for reducing the maternal mortality ratio in El Salvador: an observational case study. Arch Public Health 2021; 79:228. [PMID: 34930447 PMCID: PMC8690890 DOI: 10.1186/s13690-021-00752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background El Salvador is recognized as a country that has effectively reduced its Maternal Mortality Ratio (MMR). While health indicators, such as total fertility rate, adolescent fertility rate, skilled birth attendance, and health expenditures, have improved in El Salvador, this improvement was unremarkable compared to advancements in other developing countries. How El Salvador could achieve an outstanding decrease in MMR despite unexceptional improvements in health and non-health indicators is a question that deserves deep research. We used quantitative methods and an observational case study to show that El Salvador could reduce its MMR more than expected by instituting health policies that not only aimed to reduce the (adolescent) fertility rate, but also provide safe birthing conditions and medical services to pregnant women through maternity waiting homes. Methods We ran pooled ordinary least squares regression and panel regression with fixed effects using MMR as the dependent variable and health and non-health factors as the independent variables. We conducted residual analysis, calculated the predicted value of MMR, and compared it with the observed value in El Salvador. To explain the change in MMR in El Salvador, we carried out an observational case study of maternity waiting homes in that country. Results El Salvador could reduce MMR by improving health factors such as fertility rate skilled birth attendance and non-health factors, such as gross domestic product (GDP) per capita and female empowerment. However, even while considering these factors, the MMR of El Salvador decreased by more than expected. We confirmed this by analyzing the residuals of the regression model. This improvement in MMR, which is larger than expected from the regression results, can be attributed partly to government measures such as maternity waiting homes. Conclusions The reason for the unexplained reduction in El Salvador’s MMR seems to be attributed in part to health policies that not only aim to reduce the fertility rate but also to provide safe birthing conditions and medical services to pregnant women through maternity waiting homes. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00752-8.
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Affiliation(s)
- Hee Sang Yoon
- Institution: Nursing Department, Seoul Women's College of Nursing, Seoul, Korea.
| | - Chong-Sup Kim
- Graduate School of International Studies, Seoul National University, Seoul, Korea
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Lori JR, Munro-Kramer ML, Liu H, McGlasson KL, Zhang X, Lee H, Ngoma T, Kaiser JL, Bwalya M, Musonda G, Sakala I, Perosky JE, Fong RM, Boyd CJ, Chastain P, Rockers PC, Hamer DH, Biemba G, Vian T, Bonawitz R, Lockhart N, Scott NA. Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study. BJOG 2021; 128:1804-1812. [PMID: 33993600 PMCID: PMC8518771 DOI: 10.1111/1471-0528.16755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility. DESIGN Quasi-experimental design with partial randomisation at the cluster level. SETTING Seven rural districts in Zambia. POPULATION Women delivering at 40 health facilities between June 2016 and August 2018. METHODS Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes. MAIN OUTCOME MEASURES Differences in the change from baseline to study period in the percentage of women living >10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group. RESULTS We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10 km away (DID 4.2%, 95% CI 0.6-7.6, P = 0.03), adolescent women (<18 years) living >10 km away (DID 18.1%, 95% CI 6.3-29.8, P = 0.002) and primigravida women living >10 km away (DID 9.3%, 95% CI 2.4-16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7-28, P < 0.001). CONCLUSION The core MWH model was successful in increasing rates of facility delivery for women living >10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit. TWEETABLE ABSTRACT A core MWH model increased facility delivery for women living >10 km from a health facility including adolescents and primigravidas in Zambia.
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Affiliation(s)
- J R Lori
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | | | - H Liu
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - K L McGlasson
- Boston University School of Public Health, Boston, MA, USA
| | - X Zhang
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - H Lee
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - T Ngoma
- Zambia Centre for Applied Health Research and Development, Lusaka, Zambia
| | - J L Kaiser
- Boston University School of Public Health, Boston, MA, USA
| | - M Bwalya
- Zambia Centre for Applied Health Research and Development, Lusaka, Zambia
| | | | | | - J E Perosky
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - R M Fong
- Boston University School of Public Health, Boston, MA, USA
| | - C J Boyd
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - P Chastain
- Boston University School of Public Health, Boston, MA, USA
| | - P C Rockers
- Boston University School of Public Health, Boston, MA, USA
| | - D H Hamer
- Boston University School of Public Health, Boston, MA, USA
| | - G Biemba
- Paediatric Centre of Excellence, National Health Research Authority, Lusaka, Zambia
| | - T Vian
- Boston University School of Public Health, Boston, MA, USA
| | - R Bonawitz
- Boston University School of Public Health, Boston, MA, USA
| | - N Lockhart
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - N A Scott
- Boston University School of Public Health, Boston, MA, USA
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McRae DN, Portela A, Waldron T, Bergen N, Muhajarine N. Understanding the implementation (including women's use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol. BMJ Open 2021; 11:e039531. [PMID: 33658257 PMCID: PMC7931758 DOI: 10.1136/bmjopen-2020-039531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Maternity waiting homes in low-income and middle-income countries provide accommodation near health facilities for pregnant women close to the time of birth to promote facility-based birth and birth with a skilled professional and to enable timely access to emergency obstetric services when needed. To date, no studies have provided a systematic, comprehensive synthesis explaining facilitators and barriers to successful maternity waiting home implementation and whether and how implementation strategies and recommendations vary by context. This synthesis will systematically consolidate the evidence, answering the question, 'How, why, for whom, and in what context are maternity waiting homes successfully implemented in low-income and middle-income countries?'. METHODS AND ANALYSIS Methods include standard steps for realist synthesis: determining the scope of the review, searching for evidence, appraising and extracting data, synthesising and analysing the data and developing recommendations for dissemination. Steps are iterative, repeating until theoretical saturation is achieved. Searching will be conducted in 13 electronic databases with results managed in Eppi-Reviewer V.4. There will be no language, study-type or document-type restrictions. Items documented prior to 1990 will be excluded. To ensure our initial and revised programme theories accurately reflect the experiences and knowledge of key stakeholders, most notably the beneficiaries, interviews will be conducted with maternity waiting home users/nonusers, healthcare staff, policymakers and programme designers. All data will be analysed using context-mechanism-outcome configurations, refined and synthesised to produce a final programme theory. ETHICS AND DISSEMINATION Ethics approval for the project will be obtained from the Mozambican National Bioethical Commission, Jimma University College of Health Sciences Institutional Review Board and the University of Saskatchewan Bioethical Research Ethics Board. To ensure results of the evaluation are available for uptake by a wide range of stakeholders, dissemination will include peer-reviewed journal publication, a plain-language brief, and conference presentations to stakeholders' practice audiences. PROSPERO REGISTRATION NUMBER CRD42020173595.
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Affiliation(s)
- Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Tamara Waldron
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Nicole Bergen
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
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Lori JR, Perosky JE, Rominski S, Munro-Kramer ML, Cooper F, Kofa A, Nyanplu A, James KH, Cole GG, Coley K, Liu H, Moyer CA. Maternity waiting homes in Liberia: Results of a countrywide multi-sector scale-up. PLoS One 2020; 15:e0234785. [PMID: 32574182 PMCID: PMC7310707 DOI: 10.1371/journal.pone.0234785] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 06/02/2020] [Indexed: 12/04/2022] Open
Abstract
Objective Descriptions of maternity waiting homes (MWHs) as an intervention to increase facility delivery for women living in remote geographic areas dates back to the 1950s, yet there is limited information on the scale-up and sustainability of MWHs. The objective of this study was to describe the evolutionary scale-up of MWHs as a component of health system strengthening efforts and document the successes, challenges, and barriers to sustainability in Liberia. Methods Data were collected from a national sample of 119 MWHs in Liberia established between 2010–2018. The study used a mixed method design that included focus group discussions, individual interviews, logbook reviews, and geographic information systems. Qualitative data were grouped into themes using Glaser’s constant comparative method. Quantitative data were analyzed using negative binomial regression to measure the differences in the counts of monthly stays at facilities with different funding sources and presence of advisory committee. Additionally, each MWH was geo-located for purposes of geo-visualization. Results In the years since the original construction of five MWHs, an additional 114 MWHs were constructed in 14 of the 15 counties in Liberia. Monthly stays at facilities funded by community were 2·5 times those funded by NGOs (IRR, 2·46, 95% CI 1·33–4·54). Attributes of sustainability included strong local leadership/active community engagement and community ownership and governance. Conclusion Success factors for scale-up and sustainability included strong government support through development of public policy, local and county leadership, early and sustained engagement with communities, and self-governance. A multi-pronged approach with strong community engagement is key to the scale-up and sustainability of MWHs as an intervention to increase facility delivery for women living the farthest from a healthcare facility.
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Affiliation(s)
- Jody R. Lori
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
- * E-mail:
| | - Joseph E. Perosky
- College of Human Medicine, Michigan State University, East Lansing, MI, United States of America
| | - Sarah Rominski
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, United States of America
| | | | - Faith Cooper
- International Rescue Committee, Sophie’s Junction, Monrovia, Liberia
| | | | | | - Katherine H. James
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States of America
| | | | - Katrina Coley
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Haiyin Liu
- School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Cheryl A. Moyer
- Department of Learning Health Sciences, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, United States of America
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Olaniran A, Madaj B, Bar-Zev S, van den Broek N. The roles of community health workers who provide maternal and newborn health services: case studies from Africa and Asia. BMJ Glob Health 2019; 4:e001388. [PMID: 31478012 PMCID: PMC6703286 DOI: 10.1136/bmjgh-2019-001388] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/25/2019] [Accepted: 05/25/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A variety of community health workers (CHWs) provide maternal and newborn health (MNH) services in low-income and middle-income settings. However, there is a need for a better understanding of the diversity in type of CHW in each setting and responsibility, role, training duration and type of remuneration. METHODS We identified CHWs providing MNH services in Bangladesh, India, Kenya, Malawi and Nigeria by reviewing 23 policy documents and conducting 36 focus group discussions and 131 key informant interviews. We analysed the data using thematic analysis. RESULTS Irrespective of training duration (8 days to 3 years), all CHWs identify pregnant women, provide health education and screen for health conditions that require a referral to a higher level of care. Therapeutic care, antenatal care and skilled birth attendance, and provision of long-acting reversible contraceptives are within the exclusive remit of CHWs with training greater than 3 months. In contrast, community mobilisation and patient tracking are often done by CHWs with training shorter than 3 months. Challenges CHWs face include pressure to provide MNH services beyond their scope of practice during emergencies, and a tendency in some settings to focus CHWs on facility-based roles at the expense of their traditional community-based roles. CONCLUSION CHWs are well positioned geographically and socially to deliver some aspects of MNH care. However, there is a need to review and revise their scope of practice to reflect the varied duration of training and in-country legislation.
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Affiliation(s)
- Abimbola Olaniran
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Barbara Madaj
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Sarah Bar-Zev
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK
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Sakanga VIR, Chastain PS, McGlasson KL, Kaiser JL, Bwalya M, Mwansa M, Mataka K, Kalaba D, Scott NA, Vian T. Building financial management capacity for community ownership of development initiatives in rural Zambia. Int J Health Plann Manage 2019; 35:36-51. [PMID: 31120153 PMCID: PMC7043374 DOI: 10.1002/hpm.2810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Building financial management capacity is increasingly important in low- and middle-income countries to help communities take ownership of development activities. Yet, many community members lack financial knowledge and skills. METHODS We designed and conducted financial management trainings for 83 members from 10 community groups in rural Zambia. We conducted pre-training and post-training tests and elicited participant feedback. We conducted 28 in-depth interviews over 18 months and reviewed financial records to assess practical application of skills. RESULTS The training significantly improved knowledge of financial concepts, especially among participants with secondary education. Participants appreciated exercises to contextualize financial concepts within daily life and liked opportunities to learn from peers in small groups. Language barriers were a particular challenge. After trainings, sites successfully adhered to the principles of financial management, discussing the benefits they experienced from practicing accountability, transparency, and accurate recordkeeping. CONCLUSION Financial management trainings need to be tailored to the background and education level of participants. Trainings should relate financial concepts to more tangible applications and provide time for active learning. On-site mentorship should be considered for a considerable time. This training approach could be used in similar settings to improve community oversight of resources intended to strengthen developmental initiatives.
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Affiliation(s)
| | | | - Kathleen L McGlasson
- Biostatistics and Epidemiology Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Misheck Bwalya
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Melvin Mwansa
- Department of Research, Monitoring and Evaluation, Society for Family Health, Lusaka, Zambia
| | - Kaluba Mataka
- Department of Production, Akros, Inc., Lusaka, Zambia
| | - David Kalaba
- Department of Finance and Administration, Eastern and Southern African Management Institute, Arusha, Tanzania
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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12
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Getachew B, Liabsuetrakul T. Health care expenditure for delivery care between maternity waiting home users and nonusers in Ethiopia. Int J Health Plann Manage 2019; 34:e1334-e1345. [PMID: 30924204 DOI: 10.1002/hpm.2782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To compare the health care expenditures between maternity waiting home (MWH) users and nonusers in Ethiopia. METHODS A cross-sectional study was done in Ethiopia between December 2017 and June 2018. The study setting included eight health facilities in the Gurage zone of Ethiopia. Health expenditure for delivery care was the outcome variable that was then classified into out-of-pocket (OOP) payments, women's costs, total costs, and overall costs. Those health expenditures were then compared among MWH users and nonusers. OOP payments were further analyzed using quantile regression to explore associated factors. RESULTS A total of 812 postpartum women were included in this study of whom half were MWH users. Significantly higher OOP payment, women's costs, total costs, and overall cost were found among MWH users compared with nonusers regardless of duration of MWH stay. The MWH users were more likely to have higher OOP payment compared with MWH nonusers in linear and quantile regressions for both unadjusted and adjusted analyses. Higher OOP payments were observed for longer distance traveled and cesarean section (CS) delivery women at the 75th and 90th quantiles of expenditure. Using public transportation was significantly associated with higher OOP payment in all quantile levels. CONCLUSION Utilization of MWH incurred higher OOP payments, total costs, women's costs, and overall costs compared with MWH nonusers. Higher OOP payments for delivery care among MWH users were observed in all quantiles of expenditure.
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Affiliation(s)
- Biniam Getachew
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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13
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Bekele BB, Dadi TL, Tesfaye T. The significant association between maternity waiting homes utilization and perinatal mortality in Africa: systematic review and meta-analysis. BMC Res Notes 2019; 12:13. [PMID: 30642355 PMCID: PMC6332606 DOI: 10.1186/s13104-019-4056-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/08/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE A proper uptake of maternity waiting homes (MWHs) is important to improve maternal and child health (MCH). The aim of this review is to generate the best existing evidences concerning the MWHs utilization and its impact on perinatal mortality (PNM) among pregnant mothers in Africa. Both relevant quantitative and qualitative studies, investigated and reported from databases were explored. Meta-analysis of the studies was displayed by tables and forest plots. The Stata version 14 was used with the fixed effect model and 95% confidence interval. RESULTS In this review, a total of 68,805 births were recorded in this review. About 1.6% and 7.2% PNM occurred among non-exposed and exposed mothers respectively. Fifty percent of the studies showed there is a significant association between MWHs use and PNM. Meta-analysis revealed that utilizing MWHs have a significant effect in a reducing PNM by 82.5% (80.4%-84.5%), I2 = 96.5%. Therefore, use of MWHs has a potential to reduce PNM among pregnant mothers. The review revealed that MWHs relevance to achieving sustainable development goals (SDGs) concerning reducing newborn mortality. Therefore, the utilization rate of MWHs must be enhanced to achieve SDGs.
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Affiliation(s)
- Bayu Begashaw Bekele
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman Street, 260, Mizan Aman, Ethiopia
| | - Tegene Legese Dadi
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Aman Street, 260, Mizan Aman, Ethiopia
| | - Thomas Tesfaye
- Arba Minch College of Health Sciences, Arba Minch, Ethiopia
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14
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Vermeiden T, Schiffer R, Langhorst J, Klappe N, Asera W, Getnet G, Stekelenburg J, van den Akker T. Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed-methods study based on 45 years of experience. Trop Med Int Health 2018; 23:1332-1341. [PMID: 30286267 DOI: 10.1111/tmi.13158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff. METHODS Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed-methods design. This included seven in-depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2-week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation. RESULTS The MWH at Attat Hospital has become a well-established intervention for high-risk pregnant women (1987-2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142-832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy-related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby. CONCLUSIONS Facilitators for MWH utilisation according to users and staff were perceived high-quality EmONC, integrated health services, awareness of pregnancy-related complications and the husband's support in overcoming barriers. If providing high-quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC.
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Affiliation(s)
- Tienke Vermeiden
- Butajira General Hospital, Butajira, Southern Nations, Nationalities, and Peoples' Region, Ethiopia.,Department of Health Sciences, Global Health, University Medical Centre/University of Groningen, Groningen, The Netherlands
| | - Rita Schiffer
- Attat Our Lady of Lourdes Catholic Primary Hospital, Welkite, Southern Nations, Nationalities, and Peoples' Region, Ethiopia
| | - Jorine Langhorst
- Faculty of Medical Sciences, University Medical Centre/University of Groningen, Groningen, The Netherlands
| | - Neel Klappe
- Faculty of Medical Sciences, University Medical Centre/University of Groningen, Groningen, The Netherlands
| | - Wolde Asera
- Attat Our Lady of Lourdes Catholic Primary Hospital, Welkite, Southern Nations, Nationalities, and Peoples' Region, Ethiopia
| | - Gashaw Getnet
- Butajira General Hospital, Butajira, Southern Nations, Nationalities, and Peoples' Region, Ethiopia
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre/University of Groningen, Groningen, The Netherlands.,Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
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15
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Scott NA, Kaiser JL, Vian T, Bonawitz R, Fong RM, Ngoma T, Biemba G, Boyd CJ, Lori JR, Hamer DH, Rockers PC. Impact of maternity waiting homes on facility delivery among remote households in Zambia: protocol for a quasiexperimental, mixed-methods study. BMJ Open 2018; 8:e022224. [PMID: 30099401 PMCID: PMC6089313 DOI: 10.1136/bmjopen-2018-022224] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Maternity waiting homes (MWHs) aim to improve access to facility delivery in rural areas. However, there is limited rigorous evidence of their effectiveness. Using formative research, we developed an MWH intervention model with three components: infrastructure, management and linkage to services. This protocol describes a study to measure the impact of the MWH model on facility delivery among women living farthest (≥10 km) from their designated health facility in rural Zambia. This study will generate key new evidence to inform decision-making for MWH policy in Zambia and globally. METHODS AND ANALYSIS We are conducting a mixed-methods quasiexperimental impact evaluation of the MWH model using a controlled before-and-after design in 40 health facility clusters. Clusters were assigned to the intervention or control group using two methods: 20 clusters were randomly assigned using a matched-pair design; the other 20 were assigned without randomisation due to local political constraints. Overall, 20 study clusters receive the MWH model intervention while 20 control clusters continue to implement the 'standard of care' for waiting mothers. We recruit a repeated cross section of 2400 randomly sampled recently delivered women at baseline (2016) and endline (2018); all participants are administered a household survey and a 10% subsample also participates in an in-depth interview. We will calculate descriptive statistics and adjusted ORs; qualitative data will be analysed using content analysis. The primary outcome is the probability of delivery at a health facility; secondary outcomes include utilisation of MWHs and maternal and neonatal health outcomes. ETHICS AND DISSEMINATION Ethical approvals were obtained from the Boston University Institutional Review Board (IRB), University of Michigan IRB (deidentified data only) and the ERES Converge IRB in Zambia. Written informed consent is obtained prior to data collection. Results will be disseminated to key stakeholders in Zambia, then through open-access journals, websites and international conferences. TRIAL REGISTRATION NUMBER NCT02620436; Pre-results.
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Affiliation(s)
- Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Carol J Boyd
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Jody R Lori
- Center for Global Affairs and PAHO/WHO Collaborating Center, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Davidson H Hamer
- Section of Infectious Diseases, Department of Medicine, Boston University, Boston, Massachusetts, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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16
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Newborn Outcomes and Maternity Waiting Homes in Low and Middle-Income Countries: A Scoping Review. Matern Child Health J 2018; 21:760-769. [PMID: 27475822 DOI: 10.1007/s10995-016-2162-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives Decreasing neonatal morbidity and mortality remains a challenge in low resource settings. Maternity waiting homes (MWHs) may offer a way to better provide perinatal obstetric care and improve newborn outcomes. The purpose of this scoping review is to examine the impact of MWHs on newborn outcomes and to inform the development of targeted interventions and services to decrease neonatal mortality. Methods A literature search of four databases in the fields of nursing, medicine and global health was conducted yielding a total of 11 articles included for the review. Results Results indicate studies with extremely limited qualitative or quantitative measures of the impact of MWHs on neonatal health. Conclusions An exceptionally wide gap in knowledge on the outcomes of neonates born at MWHs was identified through this scoping review of the scientific literature. The review illustrates the need for more research to understand the effectiveness of MWHs on newborn morbidity and mortality. An increased focus on the study of MWHs for improving newborn outcomes in low resource settings merits immediate attention.
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17
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Penn-Kekana L, Pereira S, Hussein J, Bontogon H, Chersich M, Munjanja S, Portela A. Understanding the implementation of maternity waiting homes in low- and middle-income countries: a qualitative thematic synthesis. BMC Pregnancy Childbirth 2017; 17:269. [PMID: 28854880 PMCID: PMC5577673 DOI: 10.1186/s12884-017-1444-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background Maternity waiting homes (MWHs) are accommodations located near a health facility where women can stay towards the end of pregnancy and/or after birth to enable timely access to essential childbirth care or care for complications. Although MWHs have been implemented for over four decades, different operational models exist. This secondary thematic +analysis explores factors related to their implementation. Methods A qualitative thematic analysis was conducted using 29 studies across 17 countries. The papers were identified through an existing Cochrane review and a mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and barriers and facilitators for implementation. The influence of contextual factors, the design of the MWHs, and the conditions under which they operated were examined. Results Key problems of MWH implementation included challenges in MWH maintenance and utilization by pregnant women. Poor utilization was due to lack of knowledge and acceptance of the MWH among women and communities, long distances to reach the MWH, and culturally inappropriate care. Poor MWH structures were identified by almost all studies as a major barrier, and included poor toilets and kitchens, and a lack of space for family and companions. Facilitators included reduced or removal of costs associated with using a MWH, community involvement in the design and upkeep of the MWHs, activities to raise awareness and acceptance among family and community members, and integrating culturally-appropriate practices into the provision of maternal and newborn care at the MWHs and the health facilities to which they are linked. Conclusion MWHs should not be designed as an isolated intervention but using a health systems perspective, taking account of women and community perspectives, the quality of the MWH structure and the care provided at the health facility. Careful tailoring of the MWH to women’s accommodation, social and dietary needs; low direct and indirect costs; and a functioning health system are key considerations when implementing MWH. Improved and harmonized documentation of implementation experiences would provide a better understanding of the factors that impact on successful implementation.
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Affiliation(s)
- Loveday Penn-Kekana
- School of Public Health, Faculty of Health Sciences, Centre for Health Policy/MRC Health Policy Research Group, Private Bag X3, University of the Witwatersrand, Johannesburg, 2050, Gauteng, South Africa.,Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Shreya Pereira
- Department of Global Health and Development, London School Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Julia Hussein
- Immpact, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - Hannah Bontogon
- Department of Maternal, Newborn, Child, Adolescent Health, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Matthew Chersich
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen Munjanja
- Department of Obstetrics and Gynaecology, College of Health Sciences, University of Zimbabwe, Mazowe Street, Harare, Zimbabwe
| | - Anayda Portela
- Department of Maternal, Newborn, Child, Adolescent Health, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
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18
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Lori JR, Munro-Kramer ML, Shifman J, Amarah PNM, Williams G. Patient Satisfaction With Maternity Waiting Homes in Liberia: A Case Study During the Ebola Outbreak. J Midwifery Womens Health 2017; 62:163-171. [PMID: 28376559 DOI: 10.1111/jmwh.12600] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/26/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Liberia in West Africa has one of the highest maternal mortality ratios in the world (990/100,000 live births). Many women in Liberia live in rural, remote villages with little access to safe maternity services. The World Health Organization has identified maternity waiting homes (MWHs) as one strategy to minimize the barrier of distance in accessing a skilled birth attendant. However, limited data exist on satisfaction with MWHs or maternal health care in Liberia. METHODS This mixed-methods case study examines women's satisfaction with their stay at a MWH and compares utilization rates before and during the Ebola outbreak. From 2012 to 2014, 650 women who stayed at one of 6 MWHs in rural Liberia during the perinatal or postnatal period were surveyed. Additionally, 60 semi-structured interviews were conducted with traditional providers, skilled birth attendants, and women utilizing the MWHs. Quantitative analyses assessed satisfaction rates before and during the Ebola outbreak. Content analysis of semi-structured interviews supplemented the quantitative data and provided a lens into the elements of satisfaction with the MWHs. RESULTS The majority of women who utilized the MWHs stated they would suggest the MWH to a friend or relative who was pregnant (99.5%), and nearly all would utilize the home again (98.8%). Although satisfaction with the MWHs significantly decreased during the Ebola outbreak (P < .001), participants were satisfied overall with the MWHs. Content analysis identified areas of satisfaction that encompassed the themes of restful and supportive environment as well as areas for improvement such as lacking necessary resources and loneliness. DISCUSSION This case study demonstrated that women using MWHs in Bong County, Liberia are generally satisfied with their experience and plan to use an MWH again during future pregnancies to access a skilled birth attendant for birth. Women are also willing to encourage family and friends to use MWHs.
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19
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Lori JR, Munro-Kramer ML, Mdluli EA, Musonda (Mrs.) GK, Boyd CJ. Developing a community driven sustainable model of maternity waiting homes for rural Zambia. Midwifery 2016; 41:89-95. [DOI: 10.1016/j.midw.2016.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022]
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20
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Kyokan M, Whitney-Long M, Kuteh M, Raven J. Community-based birth waiting homes in Northern Sierra Leone: Factors influencing women's use. Midwifery 2016; 39:49-56. [PMID: 27321720 DOI: 10.1016/j.midw.2016.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE to explore the factors influencing women's use of birth waiting homes in the Northern Bombali district, Sierra Leone. DESIGN this was a descriptive exploratory study using qualitative research methodology, which included in depth interviews, key informant interviews, focus group discussions, document review and observations. SETTING two chiefdoms in the Northern Bombali district, Sierra Leone. PARTICIPANT eight interviews were conducted with women who had delivered in the past one year and used birth waiting homes; eight key informant interviews with a project manager, birth waiting homes hosts, and community members; thirteen women who delivered in the past year without using birth waiting homes (four interviews and two focus group discussions). FINDINGS there are several factors influencing the use of birth waiting homes (BWHs) including: past experience of childbirth, promotion of the birth waiting homes by traditional birth attendance, distance and costs of transport to the homes, child care and other family commitments, family's views of the importance of the homes, the costs of food during women's stay, and information given to women and families about when and how to use the homes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE some barriers, especially those related to family commitments and costs of food, are challenging to solve. In order to make a BWH a user-friendly and viable option, it may be necessary to adjust ways in which BWHs are used. Good linkage with the health system is strength of the programme. However, further strengthening of community participation in monitoring and managing the BWHs is needed for the long term success and sustainability of the BWHs.
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Affiliation(s)
- Michiko Kyokan
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
| | - Melissa Whitney-Long
- Health Poverty Action Sierra Leone, 25 Barracks Road, Murray Town, Freetown, Sierra Leone.
| | - Mabel Kuteh
- Health Poverty Action Sierra Leone, 25 Barracks Road, Murray Town, Freetown, Sierra Leone.
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK.
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Lunze K, Higgins-Steele A, Simen-Kapeu A, Vesel L, Kim J, Dickson K. Innovative approaches for improving maternal and newborn health--A landscape analysis. BMC Pregnancy Childbirth 2015; 15:337. [PMID: 26679709 PMCID: PMC4683742 DOI: 10.1186/s12884-015-0784-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 12/09/2015] [Indexed: 12/31/2022] Open
Abstract
Background Essential interventions can improve maternal and newborn health (MNH) outcomes in low- and middle-income countries, but their implementation has been challenging. Innovative MNH approaches have the potential to accelerate progress and to lead to better health outcomes for women and newborns, but their added value to health systems remains incompletely understood. This study’s aim was to analyze the landscape of innovative MNH approaches and related published evidence. Methods Systematic literature review and descriptive analysis based on the MNH continuum of care framework and the World Health Organization health system building blocks, analyzing the range and nature of currently published MNH approaches that are considered innovative. We used 11 databases (MedLine, Web of Science, CINAHL, Cochrane, Popline, BLDS, ELDIS, 3ie, CAB direct, WHO Global Health Library and WHOLIS) as data source and extracted data according to our study protocol. Results Most innovative approaches in MNH are iterations of existing interventions, modified for contexts in which they had not been applied previously. Many aim at the direct organization and delivery of maternal and newborn health services or are primarily health workforce interventions. Innovative approaches also include health technologies, interventions based on community ownership and participation, and novel models of financing and policy making. Rigorous randomized trials to assess innovative MNH approaches are rare; most evaluations are smaller pilot studies. Few studies assessed intervention effects on health outcomes or focused on equity in health care delivery. Conclusions Future implementation and evaluation efforts need to assess innovations’ effects on health outcomes and provide evidence on potential for scale-up, considering cost, feasibility, appropriateness, and acceptability. Measuring equity is an important aspect to identify and target population groups at risk of service inequity. Innovative MNH interventions will need innovative implementation, evaluation and scale-up strategies for their sustainable integration into health systems. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0784-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karsten Lunze
- Department of Medicine Boston, Boston University, Boston, MA, USA. .,Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Ariel Higgins-Steele
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Aline Simen-Kapeu
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
| | - Linda Vesel
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,Concern Worldwide, 355 Lexington Avenue, New York, NY, 10017, USA.
| | - Julia Kim
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA. .,GNH Centre Bhutan, Jaffa's Commercial Building, Room 302, Thimphu, Bhutan.
| | - Kim Dickson
- Health Section, UNICEF, 3 United Nations Plaza, New York, NY, 10017, USA.
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22
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Benova L, Macleod D, Footman K, Cavallaro F, Lynch CA, Campbell OMR. Role of the private sector in childbirth care: cross-sectional survey evidence from 57 low- and middle-income countries using Demographic and Health Surveys. Trop Med Int Health 2015; 20:1657-73. [PMID: 26412496 DOI: 10.1111/tmi.12598] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Maternal mortality rates have decreased globally but remain off track for Millennium Development Goals. Good-quality delivery care is one recognised strategy to address this gap. This study examines the role of the private (non-public) sector in providing delivery care and compares the equity and quality of the sectors. METHODS The most recent Demographic and Health Survey (2000-2013) for 57 countries was used to analyse delivery care for most recent birth among >330 000 women. Wealth quintiles were used for equity analysis; skilled birth attendant (SBA) and Caesarean section rates served as proxies for quality of care in cross-sectoral comparisons. RESULTS The proportion of women who used appropriate delivery care (non-facility with a SBA or facility-based births) varied across regions (49-84%), but wealth-related inequalities were seen in both sectors in all regions. One-fifth of all deliveries occurred in the private sector. Overall, 36% of deliveries with appropriate care occurred in the private sector, ranging from 9% to 46% across regions. The presence of a SBA was comparable between sectors (≥93%) in all regions. In every region, Caesarean section rate was higher in the private compared to public sector. The private sector provided between 13% (Latin America) and 66% (Asia) of Caesarean section deliveries. CONCLUSION This study is the most comprehensive assessment to date of coverage, equity and quality indicators of delivery care by sector. The private sector provided a substantial proportion of delivery care in low- and middle-income countries. Further research is necessary to better understand this heterogeneous group of providers and their potential to equitably increase the coverage of good-quality intrapartum care.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David Macleod
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Katharine Footman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesca Cavallaro
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline A Lynch
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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23
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Footman K, Benova L, Goodman C, Macleod D, Lynch CA, Penn-Kekana L, Campbell OMR. Using multi-country household surveys to understand who provides reproductive and maternal health services in low- and middle-income countries: a critical appraisal of the Demographic and Health Surveys. Trop Med Int Health 2015; 20:589-606. [PMID: 25641212 PMCID: PMC4409817 DOI: 10.1111/tmi.12471] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Demographic and Health Surveys (DHS) are a vital data resource for cross-country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross-country comparisons of healthcare provision. METHODS We used the most recent DHS surveys between 2000 and 2012; 57 countries had data on family planning and delivery care providers and 47 countries had data on antenatal care. Every possible response option across the 57 countries was listed and categorised. We then developed a classification to group provider response options according to two key dimensions: clinical nature and profit motive. RESULTS We classified the different types of maternal and reproductive healthcare providers, and the individuals providing care. Documented challenges encountered during this process were limitations inherent in household survey data based on respondents' self-report; conflation of response options in the questionnaire or at the data processing stage; category errors of the place vs. professional for delivery; inability to determine whether care received at home is from the public or private sector; a large number of negligible response options; inconsistencies in coding and analysis of data sets; and the use of inconsistent headings. CONCLUSIONS To improve clarity, we recommend addressing issues such as conflation of response options, data on public vs. private provider, inconsistent coding and obtaining metadata. More systematic and standardised collection of data would aid international comparisons of progress towards improved financial protection, and allow us to better characterise the incentives and commercial nature of different providers.
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Affiliation(s)
- K Footman
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L Benova
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C Goodman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D Macleod
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - C A Lynch
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L Penn-Kekana
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
| | - O M R Campbell
- Faculty of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK
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24
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Lori JR, Wadsworth AC, Munro ML, Rominski S. Promoting access: the use of maternity waiting homes to achieve safe motherhood. Midwifery 2013; 29:1095-102. [PMID: 24012018 DOI: 10.1016/j.midw.2013.07.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 06/27/2013] [Accepted: 07/20/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to examine the structural and sociocultural factors influencing maternity waiting home (MWH) use through the lens of women, families, and communities in one rural county in postconflict Liberia. DESIGN an exploratory, qualitative descriptive design using focus groups and in-depth, individual interviews was employed. Content analysis of data was performed using Penchansky and Thomas's (1981) five A's of access as a guiding framework. SETTING rural communities in north-central Liberia. PARTICIPANTS a convenience sampling was used to recruit participants. Eight focus groups were held with 75 participants from congruent groups of (1) MWH users, (2) MWH non-users, (3) family members of MWH users, and (4) family members of MWH non-users. Eleven individual interviews were conducted with clinic staff or community leaders. FINDINGS the availability of MWHs decreased the barrier of distance for women to access skilled care around the time of childbirth. Food insecurity while staying at a MWH was identified as a potential barrier by participants. KEY CONCLUSIONS examining access as a general concept within the specific dimensions of availability, accessibility, accommodation, affordability, and acceptability provides a way to describe the structural and sociocultural factors that influence access to a MWH and skilled attendance for birth. IMPLICATIONS FOR PRACTICE MWHs can address the barrier of distance in accessing skilled care for childbirth in a rural setting with long distances to a facility.
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Affiliation(s)
- Jody R Lori
- Division of Health Promotion and Risk Reduction, University of Michigan, School of Nursing, 400 N. Ingalls, Room 3352, Ann Arbor, MI 48109, USA.
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