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Panulo M, Lamb J, Chidziwisano K, White B, Dreibelbis R, Morse T. Assessment of infrastructure, behaviours, and user satisfaction of guardian waiting shelters for secondary level hospitals in southern Malawi. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002642. [PMID: 39046968 PMCID: PMC11268604 DOI: 10.1371/journal.pgph.0002642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 06/20/2024] [Indexed: 07/27/2024]
Abstract
Guardian Waiting Shelters (GWSs) are an essential component of the Malawi's health care system as they serve as a temporary home for patient guardians while taking care of their relatives admitted to the hospital, and expectant mothers. Although GWSs play a crucial role in Malawi's healthcare system, past studies have primarily concentrated on maternity waiting homes, neglecting the role and importance of GWSs. The study examines GWS management structures and conditions, as well as guardian satisfaction and perception of health risks related to GWS use. In this explanatory sequential mixed methods design, we assessed 12 GWSs from southern region of Malawi. Qualitative data included interviews (n = 149) and focus group discussions with patient guardians (n = 72), interviews with GWS caretakers (n = 5), representatives from Hospital Management (n = 12) and Hospital Advisory Committees (n = 11). Lack of guidelines and standards for GWSs resulted in creating a customized facility checklist to quantitatively assess infrastructure present at GWSs (n = 12). Descriptive statistics and qualitative thematic analysis were utilized for data analysis, and a problem tree analysis was used to triangulate and summarize the findings. A total of 249 participants participated in the study. Each GWS had an average of 100 users daily, primarily adult females (71%). No one was accountable for GWS operation and maintenance due to the lack of a management hierarchy. GWS infrastructure conditions were poor, with inadequate functional sleeping rooms, insufficient access to water, sanitation and hygiene facilities. Notably, 50% of the GWSs lacked water access, and a quarter had non-functional toilets. Guardians felt unsafe and at risk of disease transmission when staying within GWS. Study findings highlight lack of clear, consistent GWS ownership as a root cause of challenges in GWSs. Clear policy and operational standards must be established for effective management and smooth functioning of GWSs.
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Affiliation(s)
- Mindy Panulo
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Blantyre, Malawi
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, Scotland
| | - Jennifer Lamb
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kondwani Chidziwisano
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Blantyre, Malawi
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, Scotland
- Department of Public and Environmental Health, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Blessings White
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tracy Morse
- Department of Civil and Environmental Engineering, University of Strathclyde, Glasgow, Scotland
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Boru TM, Tefera EG, Bulto GA, Doba YS, Wakgari N, Roga EY, Ganfure G, Geda GM, Erena MM. Maternity waiting home utilization among women who gave birth in the pastoralist communities of Borana Zone, Ethiopia: A community-based mixed-method study design. Heliyon 2024; 10:e32925. [PMID: 38988556 PMCID: PMC11234036 DOI: 10.1016/j.heliyon.2024.e32925] [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: 04/10/2023] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/12/2024] Open
Abstract
Background Maternity Waiting Home (MWH) utilization is valuable for enhancing maternal and neonatal health service utilization. Although few studies have been conducted in non-pastoral areas, more evidence is needed from pastoralist communities. Hence, the study aimed to assess the utilization of MWH and its associated factors among women in pastoralist communities in Ethiopia. Methods A concurrent mixed-method design was conducted from 10 Augustto15 September 2021. The cluster sampling technique was used to select the study participants. Qualitative data was collected through focus group discussions and in-depth interviews. Multivariable logistic regression analysis is used to identify significant factors. Qualitative data were thematically analyzed and triangulated with quantitative findings. Results Only 13 % (95%CI:10.5-15.6) of women had utilized MWHs. Husbands participation in antenatal care (AOR = 5.54, 95%CI: 2.14-14.35), having caregivers at home (AOR = 2.59, 95%CI: 1.14-4.86), attending pregnant-women conferences (AOR = 5.01, 95%CI: 2.17-11.49), the husband received information about MWH (AOR = 3.6, 95%CI: 1.54-8.49), favorable attitude towards MWH (AOR = 3.15, 95%CI:1.47-6.77), birth during the rainy season (AOR = 0.35, 95%CI: 0.15-0.81) and residing within 10 km of a health center (AOR = 0.15,95%CI:0.04-0.58) were significantly associated with MWH utilization. The main themes that emerged as barriers to MWH utilization were lack of awareness, availability and accessibility of the services, norms and perceptions, lack of decision-making power, family support and women's workload. Conclusion The study found low utilization of MWHs. Husbands' involvement, having information about MWHs, a favorable attitude, the season of birth, and distance were significantly associated. Lack of transportation access, norms, and limited awareness of MWH were also found to be barriers to service utilization. Health education to raise awareness about the importance of MWHs, enabling transportation access, husbands' involvement, and encouraging women to take an active role in household decision-making are crucial to boosting MWH utilization.
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Affiliation(s)
| | - Eden Girmaye Tefera
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Yonas Sagni Doba
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hosana, Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Ephrem Yohannes Roga
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gemechu Ganfure
- Department of Pediatrics and Child Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Gonfa Moti Geda
- Department of Medicine, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Maru Mossisa Erena
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Petros Y, Assegid S, Shaweno T, Markos M. Utilization of pregnant women waiting area and associated factors among mothers at Damboya District, Kembata Tembaro Zone, Southern Ethiopia. Pan Afr Med J 2023; 46:89. [PMID: 38314233 PMCID: PMC10837281 DOI: 10.11604/pamj.2023.46.89.33071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 10/31/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction pregnant women waiting areas are residential facilities where women who live remotely can wait before giving birth at a hospital or health center. About 80% of people in developing countries live in rural areas, where poor access to maternity services accounts for many maternal and perinatal deaths. Although, pregnant women waiting areas are recommended to reduce maternal and infant deaths data on the utilization of pregnant women waiting areas limited in Ethiopia and the study area. Thus, this study assessed the utilization of pregnant mothers waiting area and associated factors among pregnant mothers at Damboya district Kembata Tembaro Zone south, Ethiopia in 2020. Methods community-based cross-sectional study was conducted from March 16 to April 15/2020 at Damboya district Kembata Tembaro Zone Southern Ethiopia. Data were collected using a structured interviewer-administered questionnaire. Data were coded, edited, and cleaned then double entered into epi data version 3.1 and exported to SPSS version 20 for analysis. Descriptive, bivariate, and multivariable logistic regression analyses were done. Finally, variables with p-value < 0.05 by multivariate logistic regression analysis were reported as independently associated factors for utilization status of pregnant mothers waiting area. Results this study shows pregnant women waiting area utilization was 28.1% at 95%CI (24-32). A distance greater than 30 minutes [AOR: 2.29, 95%CI (1.38-3.62)], wealth fourth quintile [AOR: 3.66, 95%CI (1.73-7.73)], awareness for PWWAs [AOR: 2.30, 95%cCI (1.12,4.74)], Good attitude [AOR: 3.0, 95%CI (1.8-5.0)], Favorable subjective norm [AOR: 2.40, 95%CI (1.50-4.0)] and low perceived barrier [AOR: 2.10, 95%CI (1.30-3.3)] were factors associated with utilization of Pregnant women waiting areas. Conclusion utilization of pregnant women waiting areas in the study area was low. A distance greater than 30 minutes, wealthy family, good awareness of pregnant women waiting areas, favorable subjective norm, good attitude, and low perceived barriers were predictors of utilization. To increase their utilization, we need to focus on; improving the economic status of mothers, awareness creation, and work on attitude, subjective norm, and the barriers to utilize pregnant women waiting areas.
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Affiliation(s)
- Yonas Petros
- Public Health expert at Damboya Health Office, Damboya Woreda, Kembata Tembaro Zone, Southern Ethiopia
| | - Sahilu Assegid
- Department of Epidemiology, Faculty of Public Health, Institute of Health, Jimma University, Jimma Ethiopia
| | - Tamrat Shaweno
- African Centers of Diseases Control and Prevention (African CDC), Addis Ababa, Ethiopia
- African Union, Addis Ababa, Ethiopia
| | - Melese Markos
- Department of Public Health, College of Health and Medicine Science, Wachamo University, Durame, Ethiopia
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Hasen H, Arage G, Mulusew M, Delil R, Endale A, Mosa H, Ahmed R. Pregnant women's intentions to use maternity waiting homes and its associated factors in rural districts of Hadiya Zone, Southern Ethiopia. PLoS One 2023; 18:e0281652. [PMID: 37267304 DOI: 10.1371/journal.pone.0281652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 01/29/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND As part of a strategy to reduce maternal and perinatal mortality, Ethiopia's government has made a significant effort to expand the number of Maternity Waiting Homes (MWHs). However, worldwide there is a substantial regional variation in pregnant women's intention to use MWHs. Therefore, the aim of this study is to assess pregnant women's intention to use maternity waiting home and its associated factors in the rural district of Hadiya Zone, Southern Ethiopia. METHODS This was a cross-sectional study carried out on 385 pregnant women from March 1-28, 2020. A systematic random sampling technique was used to recruit the study participants. SPSS software (version 24.0) was used to enter and analyze the data. Bivariate and multivariate logistic regression analyses were used to determine an association between each independent and dependent variables. Odds ratio with their 95% confidence intervals was computed to ascertain the existence and strength of an association, and statistical significance was affirmed at a p-value of < 0.05. RESULTS The prevalence of pregnant women's intension to use MWHs was observed to be 55.6%. A poor wealth status (AOR = 2.52; 95% CI:1.05-6.05), having a previous history of institutional delivery (AOR = 4.78; 95% CI:1.16-9.64), attending four or more antenatal care visits (AOR = 3.34; 95%CI:1.35-8.29), having obstetric complications during previous pregnancy (AOR = 3.76; 95% CI:1.45-9.77), and having favourable attitude towards MWHs (AOR = 13.51; 95% CI: 5.85-9.54) had a significant association with an intention to use MWHs. CONCLUSIONS According to the findings of this study, more than half of pregnant women have been intended to use MWHs. Therefore, boosting the uptake of the antenatal care visit, raising awareness about the risk and consequences of obstetric complications, and strengthening behavioral modification strategies is very crucial to increase pregnant women's intention to use MWHs.
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Affiliation(s)
- Habtamu Hasen
- Department of Emergency Medical Care, Hossana College of Health Sciences, Hossana, Ethiopia
| | - Getachew Arage
- Department of Nutrition and Dietetics, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Manayeh Mulusew
- Department of Clinical Nursing, Hossana College of Health Sciences, Hossana, Ethiopia
| | - Romedan Delil
- Department of Clinical Nursing, Hossana College of Health Sciences, Hossana, Ethiopia
| | - Ashebir Endale
- Department of Health Extension, Hossana College of Health Sciences, Hossana, Ethiopia
| | - Hassen Mosa
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
- Department of Midwifery, College of Medicine and Health Sciences, Werabe University, Werabe, Ethiopia
| | - Ritbano Ahmed
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
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Yismaw W, Teklu T, Fantahun A, Dugassa B, Merid R, Bizuwork K. Intention to Use Maternal Waiting Homes and Related Factors among Pregnant Women in Metu Woreda, Western Ethiopia. Ethiop J Health Sci 2022; 32:875-884. [PMID: 36262698 PMCID: PMC9554769 DOI: 10.4314/ejhs.v32i5.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
Background Maternity Waiting Homes are houses built in the healthcare settings that lodge pregnant women in their term state of pregnancy to prevent labor and delivery-related complication. This study aimed to estimate the extent of pregnant women's intention to use Maternal Waiting Homes and identify its associated factors in Metu Woreda, Western Ethiopia. Methods A community-based cross-sectional study was conducted from March 1-30, 2018. We used a systematic sampling method to select the study participants and Binary logistic regression analysis was used to identify factors associated with the intention of the women to use Maternal Waiting Homes. Results A total of (97%) of respondents' questionnaires were found complete and analyzed for this study. Almost half (48.8%) of the pregnant women who participated in the study were planned to use Maternal Waiting Homes in their prospective delivery. Based on multivariate logistic regression analysis; being illiterate and/or less educated in their educational status, having a history of using Maternal Waiting homes, and receiving a number of times antenatal care services were found statistically significantly associated with intention of the women to use Maternal Waiting Homes. Conclusions It is trivial that more than half of the pregnant women who participated in the study were unintended to use Maternal Waiting Homes. Educational status, a number of times attending antenatal care services and experience of using Maternal Waiting Homes were found statistically significantly associated with women's intention to use Maternal Waiting Homes.
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Affiliation(s)
- Worke Yismaw
- Metu University College of Health Sciences, Metu, Ethiopia
| | - Tigist Teklu
- Metu University College of Health Sciences, Metu, Ethiopia
| | | | - Boka Dugassa
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Rodas Merid
- St. Paul Millennium Medical College, Addis Ababa, Ethiopia
| | - Ketema Bizuwork
- Addis Ababa University College of Health Sciences, Addis Ababa, 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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Aden M, Azale T, Tadie C. Intention to Use and Predictors of Use of Maternity Waiting Home among Pregnant Women in Hargeisa City Health Centers, Somaliland. Patient Prefer Adherence 2022; 16:1595-1603. [PMID: 35795009 PMCID: PMC9252294 DOI: 10.2147/ppa.s358952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/20/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Maternity waiting homes (MWHs) can help women receive the necessary obstetric care and referral if needed. However, there is a lack of evidence on whether women have the desire to stay away from their homes and the sociocultural predictors of their decision in Somaliland. OBJECTIVE The purpose of this study was to measure predictors of the intention of women to stay in MWHs using the theory of planned behavior in Hargeisa city, Somaliland. METHODS A facility-based cross-sectional study was conducted from in April 2021 in Hargeisa health facilities among 422 randomly selected participants using an interviewer-administered and structured questionnaire. Data were transferred to Epi Data 4.6 and exported to SPSS 20 for further analysis. Descriptive, bivariate, and multivariate binary logistic regression analyses were used. ORs with 95% CIs were used to assess associations, and statistical significance was set at P<0.05. RESULTS A total of 245 (58%, 95% CI 53.1%-62.8%) pregnant women intended to use an MWH. Multivariate analysis revealed that education (AOR 5.40, 95% CI 3.01-9.69), experience of using an MWH (AOR 3.80, 95% CI 2.32-6.27), multigravidity (AOR 2.2, 95% CI 1.16-4.29), subjective norms (AOR 1.8, 95% CI 1.05-3.11), indirect attitudes toward use of MWHs (AOR 1.9, 95% CI 1.01-3.92), and indirect subjective norms (AOR 2.0, 95% CI 1.16-3.60) were significantly associated with intention to use an MWH. CONCLUSION Using an MWH is not the preference of many women. Personal characteristics, such as education, multigravidity, and perceived social pressure are important predictors of intention to use MWHs. It is important to raise the awareness of women and the community about the benefits of using MWHs in the early management of obstetric complications.
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Affiliation(s)
- Mohamed Aden
- Ministry of Plan and National Development, Hargeisa, Somaliland
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Telake Azale, Email
| | - Chalie Tadie
- Department of Health Systems and Policy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lee H, Maffioli EM, Veliz PT, Sakala I, Chiboola NM, Lori JR. Direct and opportunity costs related to utilizing maternity waiting homes in rural Zambia. Midwifery 2021; 105:103211. [PMID: 34894428 PMCID: PMC8811481 DOI: 10.1016/j.midw.2021.103211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/13/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Lack of financial resources is a critical barrier to utilising Maternity Waiting Homes (MWHs) in low-income countries (LICs). Food and user fees are most frequent expenditures for women utilising MWHs in rural Zambia. Being away from various household chores, the loss of income generating activities (IGAs), may also be a financial constraint in utilising MWHs.
Aim To assess the direct and opportunity costs involved in utilising maternity waiting homes. Method A cross-sectional admission survey administered to women who used ten maternity waiting homes across two rural districts in Zambia. A total of 3,796 women participated in the survey. Descriptive analysis was conducted on three domains of the data: demographic characteristics of women, direct costs, and opportunity costs. Findings Waiting to deliver (86.3%), safe birth (70.8%), and distance (56.0%) were the most frequent reasons women reported for using a maternity waiting home. In terms of direct costs, roughly 65% of the women brought seven days or fewer days' worth of food to the maternity waiting homes, with salt, mealie meals, and vegetables being the most frequently brought items. Only 5.8% of the women spent money on transport. More than half of the women reported paying user fees that ranged from 1 to 5 or more kwacha (US$0.10- 0.52). In terms of opportunity costs, 52% of the women participated in some form of income generating activities (IGAs) when at home. Approximately 35% of the women reported they lost earned income (1 to 50 or more kwacha) by staying at a maternity waiting home. Conclusion A large proportion of women paid for food and user fees to access a maternity waiting home, while a low number of women paid for transport. Even though it is difficult to assign monetary value to women's household chores, being away from these responsibilities and the potential loss of earned income appear to remain a cost to accessing maternity waiting homes. More research is needed to understand how to overcome these financial constraints and assist women in utilising a maternity waiting home.
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Affiliation(s)
- HaEun Lee
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States.
| | - Elisa M Maffioli
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Philip T Veliz
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States
| | - Isaac Sakala
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Box 33921 Lusaka, Zambia
| | - Nchimunya M Chiboola
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Box 33921 Lusaka, Zambia
| | - Jody R Lori
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States
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Tayebwa E, Kalisa R, Ndibaza AF, Cornelissen L, Teeselink EK, Kim YM, van Dillen J, Stekelenburg J. Maternal and Perinatal Outcomes among Maternity Waiting Home Users and Non-Users in Rural Rwanda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111211. [PMID: 34769730 PMCID: PMC8583170 DOI: 10.3390/ijerph182111211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022]
Abstract
Most maternal and perinatal deaths could be prevented through timely access to skilled birth attendants. Women should access appropriate obstetric care during pregnancy, labor, and puerperium. Maternity waiting homes (MWHs) permit access to emergency obstetric care when labor starts. This study compared maternal and perinatal outcomes among MWH users and non-users through a retrospective cohort study. Data were collected through obstetric chart reviews and analyzed using STATA version 15. Of the 8144 deliveries reported between 2015 and 2019, 1305 women had high-risk pregnancies and were included in the study. MWH users had more spontaneous vaginal deliveries compared to non-users (38.6% versus 16.8%) and less cesarean sections (57.7% versus 76.7%). Maternal morbidities such as postpartum hemorrhage occurred less frequently among users than non-users (2.13% versus 5.64%). Four women died among non-users while there was no death among users. Non-users had more stillbirths than users (7.68% versus 0.91%). The MWH may have contributed to the observed differences in outcomes. However, many women with high risk pregnancies did not use the MWH, indicating a probable gap in awareness, usefulness, or their inability to stay due to other responsibilities at home. Use of MWHs at scale could improve maternal and perinatal outcomes in Rwanda.
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Affiliation(s)
- Edwin Tayebwa
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, 9700 RB Groningen, The Netherlands;
- Correspondence: (E.T.); (R.K.)
| | - Richard Kalisa
- IntraHealth International, Kigali 6639, Rwanda;
- School of Public Health, University of Rwanda, Kigali 3286, Rwanda
- Correspondence: (E.T.); (R.K.)
| | | | - Lisa Cornelissen
- Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands;
| | - Eefje Klein Teeselink
- Amalia Children’s Hospital, Radboudumc Nijmegen, 6500 HB Nijmegen, The Netherlands; (E.K.T.); (J.v.D.)
| | - Young-Mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, MD 21231, USA;
| | - Jeroen van Dillen
- Amalia Children’s Hospital, Radboudumc Nijmegen, 6500 HB Nijmegen, The Netherlands; (E.K.T.); (J.v.D.)
| | - Jelle Stekelenburg
- University Medical Centre Groningen, Department of Health Sciences, Global Health, University of Groningen, 9700 RB Groningen, The Netherlands;
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, 8934 AD Leeuwarden, The Netherlands
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11
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Utilisation of maternity waiting homes and its associated factors in Ethiopia: Systematic reviews and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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McRae DN, Bergen N, Portela AG, Muhajarine N. A systematic review and meta-analysis of the effectiveness of maternity waiting homes in low- and middle-income countries. Health Policy Plan 2021; 36:1215-1235. [PMID: 34179952 DOI: 10.1093/heapol/czab010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Abstract
Maternity waiting homes (MWHs) in low- and middle-income countries (LMICs) provide women with accommodation close to a health facility to enable timely access to skilled care at birth. We examined whether MWH use and availability compared with non-use/unavailability were associated with facility birth, birth with a skilled health professional, attendance at postnatal visit(s) and/or improved maternal and newborn health, in LMICs. We included (non-)randomized controlled, interrupted time series, controlled before-after, cohort and case-control studies published since 1990. Thirteen databases were searched with no language restrictions. Included studies (1991-2020) were assessed as either moderate (n = 9) or weak (n = 10) on individual quality using the Effective Public Health Practice Project tool. Quality was most frequently compromised by selection bias, confounding and blinding. Only moderate quality studies were analyzed; no studies examining maternal morbidity/mortality met this criterion. MWH users had less relative risk (RR) of perinatal mortality [RR 0.65, 95% confidence intervals (CIs): 0.48, 0.87] (3 studies) and low birthweight (RR 0.34, 95% CI: 0.20, 0.59) (2 studies) compared with non-users. There were no significant differences between MWH use and non-use for stillbirth (RR 0.75, 95% CI: 0.47, 1.18) (3 studies) or neonatal mortality (RR 0.51, 95% CI: 0.25, 1.02) (2 studies). Single study results demonstrated higher adjusted odds ratios (aOR) for facility birth (aOR 5.8, 95% CI: 2.6, 13.0) and attendance at all recommended postnatal visits within 6 weeks of birth (aOR 1.99, 95% CI: 1.30, 3.07) for MWH users vs. non-users. The presence vs. absence of an MWH was associated with a 19% increase in facility birth (aOR 1.19, 95% CI: 1.10, 1.29). The presence vs. absence of a hospital-affiliated MWH predicted a 47% lower perinatal mortality rate (P < 0.01), but at a healthcare centre-level a 13 higher perinatal mortality rate (P < 0.01). Currently, there remains a lack of robust evidence supporting MWH effectiveness. We outline a six-point strategy for strengthening the evidence base.
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Affiliation(s)
- Daphne N McRae
- Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, 104 Clinic Place, Saskatoon SK, S7N 2Z4, Canada
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Montpetit Hall, 125 University, Ottawa ON, K1N 6N5, Canada
| | - Anayda G Portela
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Avenue Appia 20, 1202 Genève, Switzerland
| | - Nazeem Muhajarine
- Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, 104 Clinic Place, Saskatoon SK, S7N 2Z4, Canada.,Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon SK, S7N 5E5, Canada
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13
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Intention to use maternity waiting home and associated factors among pregnant women in Gamo Gofa zone, Southern Ethiopia, 2019. PLoS One 2021; 16:e0251196. [PMID: 33983992 PMCID: PMC8118329 DOI: 10.1371/journal.pone.0251196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background A maternity waiting home is a temporary residence in which pregnant women from remote areas wait for their childbirth. It is an approach targeted to advance access to emergency obstetric care services especially, in hard-to-reach areas to escalate institutional delivery to reduce complications that occur during childbirth. Apart from the availability of this service, the intention of pregnant women to utilize the existing service is very important to achieve its goals. Thus, this study aimed to assess the intention to use maternity waiting homes and associated factors among pregnant women. Methods Community-based cross-sectional study was conducted among 605 pregnant women using a multistage sampling technique from March 10 to April 10, 2019, by using a structured questionnaire through a face-to-face interview. The collected data was entered into Epi-Data version 3.1 and analyzed using the SPSS version 24 statistical package. Logistic regression analysis was used to test the association. All variables at p-value < 0.25 in bivariate analysis were entered into multivariate analysis. Lastly, a significant association was declared at a P-value of < 0.05 with 95% CI. Results In this study, the intention to use maternity waiting homes was 295(48.8%, 95%CI: 47%-55%)). Occupation (government employee) (AOR:2.87,95%CI: 1.54–5.36), previous childbirth history (AOR:2.1,95%CI:1.22–3.57), past experience in maternity waiting home use AOR:4.35,95%CI:2.63–7.18), direct (AOR:1.57,95%CI:1.01–2.47) and indirect (AOR: 2.18, 1.38,3.44) subject norms and direct (AOR:3.00,95%CI:2.03–4.43), and indirect (AOR = 1.84,95%CI:1.25–2.71) perceived behavioral control of respondents were significantly associated variables with intention to use maternity waiting home. Conclusion The magnitude of intention to use maternity waiting homes among pregnant women is low. Community disapproval, low self-efficacy, maternal employment, history of previous birth, and past experiences of MWHs utilization are predictors of intention to use MWHs, and intervention programs, such as health education, strengthening and integration of community in health system programs need to be provided.
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14
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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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15
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Gurara MK, Van Geertruyden JP, Gutema BT, Draulans V, Jacquemyn Y. Maternity waiting homes as component of birth preparedness and complication readiness for rural women in hard-to-reach areas in Ethiopia. Reprod Health 2021; 18:27. [PMID: 33531033 PMCID: PMC7856798 DOI: 10.1186/s12978-021-01086-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background In rural areas of Ethiopia, 57% of births occur at home without the assistance of skilled birth attendants, geographical inaccessibility being one of the main factors that hinder skilled birth attendance. Establishment of maternity waiting homes (MWH) is part of a strategy to improve access to skilled care by bringing pregnant women physically close to health facilities. This study assessed barriers to MWHs in Arba Minch Zuria District, Southern Ethiopia. Methods A community-based cross-sectional study was undertaken from February 01 to 28, 2019. Study participants were selected by computer-generated random numbers from a list of women who gave birth from 2017 to 2018 in Arba Minch Health and Demographic Surveillance System site. Data were collected using a pre-tested and interviewer-administered questionnaire. Stata software version-15 was used for data management and analysis, and variables with p-values ≤ 0.2 in bivariate analysis were considered for multivariable logistic regression analysis. Level of statistical significance was declared at a p-value < 0.05. Qualitative data were analyzed manually based on thematic areas. Results MWH utilization was found to be 8.4%. Wealth index (lowest wealth quintile aOR 7.3; 95% CI 1.2, 42), decisions made jointly with male partners (husbands) for obstetric emergencies (aOR 3.6; 95% CI 1.0, 12), birth preparedness plan practice (aOR 6.5; 95% CI 2.3, 18.2), complications in previous childbirth (aOR 3; 95% 1.0, 9), history of previous institutional childbirth (aOR 12; 95% CI 3.8, 40), residence in areas within two hours walking distance to the nearest health facility (aOR 3.3; 95% CI: 1.4, 7.7), and ease of access to transport in obstetric emergencies (aOR 8.8; 95% CI: 3.9, 19) were factors that showed significant associations with MWH utilization. Conclusions A low proportion of women has ever used MWHs in the study area. To increase MWH utilization, promoting birth preparedness practices, incorporating MWH as part of a personalized birth plan, improving access to health institutions for women living far away and upgrading existing MWHs are highly recommended.
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Affiliation(s)
- Mekdes Kondale Gurara
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia. .,Global Health Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | | | - Befikadu Tariku Gutema
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, P.O. Box 21, Arba Minch, Ethiopia
| | - Veerle Draulans
- Faculty of Social Sciences, Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Yves Jacquemyn
- Global Health Institute, Faculty of Medicine & Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Obstetrics and Gynecology, Antwerp University Hospital, Edegem, Belgium
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16
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How maternity waiting home use influences attendance of antenatal and postnatal care. PLoS One 2021; 16:e0245893. [PMID: 33481942 PMCID: PMC7822518 DOI: 10.1371/journal.pone.0245893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
As highlighted in the International Year of the Nurse and the Midwife, access to quality nursing and midwifery care is essential to promote maternal-newborn health and improve survival. One intervention aimed at improving maternal-newborn health and reducing underutilization of pregnancy services is the construction of maternity waiting homes (MWHs). The purpose of this study was to assess whether there was a significant change in antenatal care (ANC) and postnatal care (PNC) attendance, family planning use, and vaccination rates before and after implementation of the Core MWH Model in rural Zambia. A quasi-experimental controlled before-and-after design was used to evaluate the impact of the Core MWH Model by assessing associations between ANC and PNC attendance, family planning use, and vaccination rates for mothers who gave birth to a child in the past 13 months. Twenty health care facilities received the Core MWH Model and 20 were identified as comparison facilities. Before-and-after community surveys were carried out. Multivariable logistic regression were used to assess the association between Core MWH Model use and ANC and PNC attendance. The total sample includes 4711 mothers. Mothers who used the Core MWH Model had better ANC and PNC attendance, family planning use, and vaccination rates than mothers who did not use a MWH. All mothers appeared to fare better across these outcomes at endline. We found an association between Core MWH Model use and better ANC and PNC attendance, family planning use, and newborn vaccination outcomes. Maternity waiting homes may serve as a catalyst to improve use of facility services for vulnerable mothers.
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Kurji J, Gebretsadik LA, Wordofa MA, Morankar S, Bedru KH, Bulcha G, Bergen N, Kiros G, Asefa Y, Asfaw S, Mamo A, Endale E, Thavorn K, Labonte R, Taljaard M, Kulkarni MA. Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia. BMC Public Health 2020; 20:1593. [PMID: 33092565 PMCID: PMC7583173 DOI: 10.1186/s12889-020-09692-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website (https://clinicaltrials.gov) on 3rd October 2017. The trial identifier is NCT03299491.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Lakew Abebe Gebretsadik
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | - Sudhakar Morankar
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | | | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Getachew Kiros
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Yisalemush Asefa
- Department of Health Economics, Management & Policy, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Shifera Asfaw
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Erko Endale
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute General Campus, University of Ottawa, Ottawa, Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute Civic Campus, University of Ottawa, Ottawa, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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18
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Kebede KM, Mihrete KM. Factors influencing women's access to the maternity waiting home in rural Southwest Ethiopia: a qualitative exploration. BMC Pregnancy Childbirth 2020; 20:296. [PMID: 32408875 PMCID: PMC7226938 DOI: 10.1186/s12884-020-02988-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Maternity Waiting Homes (MWHs) have been advocated to improve the utilization of skilled birth attendants. Nevertheless, delivery attended by skilled personnel is low in Ethiopia and may indicate that the utilization of MWH is also low. The aim of this study is to explore the factors influencing women’s access to the MWHs in rural Southwest Ethiopia. Methods Qualitative data were collected through focus group discussions with MWHs users and in-depth interviews with MWHs non-users, health extension workers and the clinicians. Four focus group discussions and 18 in-depth interviews were conducted between May 1 and June 1, 2017. Furthermore, observations were made to assess the availability of basic facilities at selected MWHs. Data were thematically analyzed using NVivo version 7. The concept of access defined by Thiede et al was applied to guide the analysis. Results Women had interest on MWHs and are aware of the existence of MWHs in their immediate vicinity. Health information disseminations and referral linkages by frontline health workers enabled women to timely access the MWHs. However, Women didn’t understand the aims and benefits of MWHs. At the facility level, there were attempts to improve the acceptability of MWHs by allowing women to choose their delivery positions. But, participants claimed lack of privacy and presence of disrespectful care. Physical barriers (long distance, unavailability of transport options & unfavorable roads) were considered as potential problems for women residing in remote areas. MWH users mentioned absences of sufficient basic facilities, poor quality and varieties of food. Because of insufficient facilities, the cost of living was high for most users. The communities try to overcome the indirect costs through contributions in-kind and in-cash. Conclusions The factors influencing women’s access to the MWHs were structural and individual and resonate with Thiede et al. dimensions of access. A better understanding of which factors are most influential in preventing women’s access to the MWHs in rural Southwest Ethiopia is needed to appropriately target interventions.
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Affiliation(s)
- Kindie Mitiku Kebede
- Department of Public Health, College of Health Sciences, Mizan -Tepi University, PO. Box 260, Tepi, Ethiopia.
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19
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Bonawitz R, McGlasson KL, Kaiser JL, Ngoma T, Fong RM, Biemba G, Bwalya M, Hamer DH, Scott NA. Quality and utilization patterns of maternity waiting homes at referral facilities in rural Zambia: A mixed-methods multiple case analysis of intervention and standard of care sites. PLoS One 2019; 14:e0225523. [PMID: 31774838 PMCID: PMC6881034 DOI: 10.1371/journal.pone.0225523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Maternity waiting homes, defined as residential lodging near a health facility, are recommended by the WHO. An improved MWH model, responsive to community standards for functionality and comfort, was implemented at two purposively selected health facilities in rural Zambia providing comprehensive emergency obstetric and neonatal care (CEmONC) services (intervention MWHs), and compared to three existing standard-of-care MWHs (comparison MWHs) at other CEmONC sites in the same districts. METHODS We used a mixed-methods time-series design for this analysis. Quantitative data including MWH quality, MWH utilization, and demographics of women utilizing MWHs were collected from September 2016 through May 2018 to capture pre-post intervention trends. Qualitative data were obtained from two focus group discussions conducted with pregnant women at intervention MWHs in August 2017 and May 2018. The primary outcomes were quality scoring of the MWHs and maternal utilization of the MWHs. RESULTS MWH quality was similar at all sites during the pre-intervention time period, with a significant change in overall quality scores between intervention (mean score 83.8, SD 12) and comparison (mean score 43.1, SD 10.2) sites after the intervention (p <0.0001). Women utilizing intervention and comparison MWHs at all time points had very similar demographics. After implementation of the intervention, there were marked increases in MWH utilization at both intervention and comparison sites, with a greater percentage increase at one of two intervention sites. CONCLUSIONS An improved MWH model can result in measurably improved quality scores for MWHs, and can result in increased utilization of MWHs at rural CEmONC facilities. MWHs are part of the infrastructure that might be needed for health systems to provide high quality "right place" maternal care in rural settings.
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Affiliation(s)
- Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- Division of Hospital Medicine, Saint Christopher’s Hospital for Children, Philadelphia PA, United States of America
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, United States of America
- * E-mail: , ,
| | - Kathleen L. McGlasson
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Jeanette L. Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Rachel M. Fong
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Misheck Bwalya
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Nancy A. Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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Getachew B, Liabsuetrakul T, Gebrehiwot Y. Association of maternity waiting home utilization with women's perceived geographic barriers and delivery complications in Ethiopia. Int J Health Plann Manage 2019; 35:e96-e107. [PMID: 31691379 DOI: 10.1002/hpm.2940] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/10/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study is to identify the influence of perceived geographic barriers to the utilization of maternity waiting homes (MWHs) and to explore factors associated with current delivery complications among MWH users and nonusers. METHODS An observational cross-sectional study was conducted between December 2017 and June 2018 in eight health facilities with MWH in the Gurage zone of Ethiopia. The associated factors were identified by using the combination of a directed acyclic graph (DAG) concept and multiple logistic regression for data analysis. RESULTS A total of 716 women were included in the study, of whom 358 were MWH users. MWH users had lower odds of having delivery complications. Lower odds of delivery complications were found among women who gave birth in non-cesarean section (CS) facilities. Women with pregnancy complications and did not used MWH were more likely to develop delivery complications. Women with delivery complications had higher odds of undergoing cesarean delivery and neonatal death. CONCLUSIONS Geographic barriers influenced the utilization of MWH. The women who used MWH had lower delivery complications. This study strengthens the evidence of MWH utilization as a useful strategy to overcome geographic barriers and lower delivery complications.
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Affiliation(s)
- Biniam Getachew
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | | | - Yirgu Gebrehiwot
- Obstetrics and Gynecology Department, Addis Ababa University, Addis Ababa, Ethiopia
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Cavallin F, Maziku D, Mkolomi R, Azzimonti G, Manenti F, Putoto G, Trevisanuto D. Changes in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting. J Matern Fetal Neonatal Med 2019; 33:4076-4082. [PMID: 30880512 DOI: 10.1080/14767058.2019.1594768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aim: Quality improvement approaches have been integrated into routine health care in high-resource settings, but not in low-resource settings. We aimed to report the achievements in maternal and neonatal care after a quality improvement intervention in a sub-Saharan setting.Methods: After a first quality assessment in 2012 at Tosamaganga hospital in Tanzania, main areas of intervention were identified and a quality improvement program was implemented. In 2016, a second quality assessment was conducted by the same assessment team by using the World Health Organization's maternal and neonatal quality of hospital care assessment tool. Some hospital indicators were also collected during the same period.Results: Access to hospital care, maternity ward and management of maternal complications improved from inadequate to substandard care, alongside with an increment of deliveries from 2145 to 2838 and a substantially stable rate of complicated deliveries (21-26%). The improvements in the maternity ward, maternal complications and emergency care coupled with the reduction of direct obstetric case fatality rate obstetric mortality that dropped from 2.9 to 0.27%. Some neonatal areas (neonatal ward, routine neonatal care, sick newborn care, monitoring, and follow-up) improved from poor to substandard care, while others (infection control and supportive care, emergency care, guidelines protocols, and audit) showed only limited improvements. These changes coupled with a decrease in the perinatal mortality rate from 5.8 to 2.9%.Conclusion: The quality improvement program resulted in substantial progress in most aspects of quality care, which coupled with a decrease in obstetric and perinatal mortality. Nevertheless, the overall quality of care remained substandard with the limited effect of the intervention on some areas, which require further efforts in order to achieve an acceptable level of care.
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Affiliation(s)
| | - Donald Maziku
- Department of Pediatrics, Tosamaganga Council Designated Hospital, Iringa, Tanzania
| | - Rosalia Mkolomi
- Department of Pediatrics, Tosamaganga Council Designated Hospital, Iringa, Tanzania
| | - Gaetano Azzimonti
- Doctors with Africa CUAMM, Tosamaganga Council Designated Hospital, Iringa, Tanzania
| | - Fabio Manenti
- Department of Pediatrics, Doctors with Africa CUAMM, Padova, Italy
| | - Giovanni Putoto
- Department of Pediatrics, Doctors with Africa CUAMM, Padova, Italy
| | - Daniele Trevisanuto
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
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22
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Bonawitz R, McGlasson KL, Kaiser JL, Ngoma T, Lori J, Boyd C, Biemba G, Hamer DH, Scott NA. Maternity Waiting Home Use by HIV-positive Pregnant Women in Zambia: Opportunity for Improved Prevention of Maternal to Child Transmission of HIV. Int J MCH AIDS 2019; 8:1-10. [PMID: 30899603 PMCID: PMC6423550 DOI: 10.21106/ijma.267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Maternity waiting homes (MWHs), defined as residential lodging near health facilities, are an intervention to improve access to maternal care recommended by the World Health Organization. Little is known about utilization of MWHs by HIV-positive women. This paper describes: 1) maternal awareness and utilization of MWHs in rural Zambia among HIV-positive women, and 2) health outcomes for HIV-positive women and their infants with regards to utilization of MWHs. METHODS Data were collected from recently delivered women (delivered after 35 weeks in the previous 12 months) living >9.5 km from 40 health facilities in rural Zambia. For our analysis, primary outcomes were compared between self-identified HIV-positive and HIV-negative women in the sample. Primary outcomes include: 1) awareness of MWHs and 2) utilization of MWHs. We summarized simple descriptive statistics, stratified by maternal self-reported HIV status. We conducted bivariate analyses using chi-square tests, t-tests and Wilcoxon rank sum test. RESULTS Among 2,381 women, 50 (2.4%) self-identified as HIV-positive. HIV-positive women were older and had more pregnancies and children than HIV-negative women (p<0.001). There was no difference in awareness of MWHs, but HIV-positive women were more likely to use a MWH than HIV-negative women. There was no difference in receipt of infant antiretroviral prophylaxis between women who did or did not stay at a MWH. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Though HIV prevalence in this sample was lower than expected, MWHs may represent a useful strategy to improve prevention of mother to child transmission of HIV in high prevalence, low-resource settings.
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Affiliation(s)
- Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA.,Department of Pediatrics, Drexel University College of Medicine, 160 East Erie Avenue, Philadelphia, PA, USA
| | - Kathleen Lucy McGlasson
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA
| | - Thandiwe Ngoma
- Right to Care, 11059, Off Brentwood Road Mikwala House, Longacres, Lusaka, ZAMBIA
| | - Jody Lori
- Center for Global Affairs & PAHO/WHO Collaborating Center, University of Michigan School of Nursing, 426 N Ingalls St, Ann Arbor, MI, USA
| | - Carol Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, 426 N Ingalls St, Ann Arbor, MI, USA
| | - Godfrey Biemba
- National Health Research Authority, University Teaching Hospital Pediatric Centre of Excellence, P.O. Box 30075, Lusaka, ZAMBIA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, 1 Boston Medical Center Place, Boston, MA, USA
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center 3 Floor, Boston, MA, USA
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Singh K, Speizer IS, Kim ET, Lemani C, Tang JH, Phoya A. Evaluation of a maternity waiting home and community education program in two districts of Malawi. BMC Pregnancy Childbirth 2018; 18:457. [PMID: 30470256 PMCID: PMC6251123 DOI: 10.1186/s12884-018-2084-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/07/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The implementation of Maternity Waiting Homes (MWHs) is a strategy to bring vulnerable women close to a health facility towards the end of their pregnancies. To date, while MWHs are a popular strategy, there is limited evidence on the role that MWHs play in reaching women most in need. This paper contributes to this topic by examining whether two program-supported MWHs in Malawi are reaching women in need and if there are changes in women reached over time. METHODS Two rounds of exit interviews (2015 and 2017) were conducted with women within 3 months of delivery and included both MWH users and non-MWH users. These exit interviews included questions on sociodemographic factors, obstetric risk factors and use of health services. Bivariate statistics were used to compare MWH users and non-MWH users at baseline and endline and over time. Multivariable logistic regression was used to determine what factors were associated with MWH use, and Poisson regression was used to study factors associated with HIV knowledge. Descriptive data from discharge surveys were used to examine satisfaction with the MWH structure and environment over time. RESULTS Primiparous women were more likely to use a MWH compared to women of parity 2 (p < 0.05). Women who were told they were at risk of a complication were more likely to use a MWH compared to those who were not told they were at risk (p < 0.05). There were also significant findings for wealth and time to a facility, with poorer women and those who lived further from a facility being more likely to use a MWH. Attendance at a community event was associated with greater knowledge of HIV (p < 0.05). CONCLUSIONS MWHs have a role to play in efforts to improve maternal health and reduce maternal mortality. Education provided within the MWHs and through community outreach can improve knowledge of important health topics. Malawi and other low and middle income countries must ensure that health facilities affiliated with the MWHs offer high quality services.
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Affiliation(s)
- Kavita Singh
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Ilene S. Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Eunsoo Timothy Kim
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Clara Lemani
- UNC Project-Malawi, c/o Kamuzu Central Hospital, 100 Mzimba Road, Private Bag, A-104 Lilongwe, Malawi
| | - Jennifer H. Tang
- UNC Project-Malawi, c/o Kamuzu Central Hospital, 100 Mzimba Road, Private Bag, A-104 Lilongwe, Malawi
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Ann Phoya
- UNC Project-Malawi, c/o Kamuzu Central Hospital, 100 Mzimba Road, Private Bag, A-104 Lilongwe, Malawi
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Jacobs C, Michelo C, Moshabela M. Why do rural women in the most remote and poorest areas of Zambia predominantly attend only one antenatal care visit with a skilled provider? A qualitative inquiry. BMC Health Serv Res 2018; 18:409. [PMID: 29871624 PMCID: PMC5989442 DOI: 10.1186/s12913-018-3212-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 05/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While focused antenatal care (ANC) has served as an entry point in the continuum of care for both mothers and children, fewer than a third of pregnant women in the most remote and poorest communities of Zambia achieve the four ANC visits recommended by the World Health Organization. Current evidence suggests that attending ANC provided by a skilled healthcare worker at least once is common and associated with skilled birth attendance. The aim of this study was to explain why one ANC visit with a skilled provider seemed more common than four ANC visits among women in the remote and poorest districts of Zambia. METHODS A qualitative case study design was conducted in 2012 among 84 participants in the selected remote and poorest districts of Zambia. Focus group discussions were conducted with mothers and community health volunteers, while key informant interviews were conducted with healthcare providers. Thematic analysis was conducted. RESULTS Most women delayed starting antenatal care visits due to uncertainties about the timing for initiation of ANC and due to waiting for confirmation of the pregnancy by an elderly woman. Attendance of ANC once with a skilled provider was due to the need to assess their health status and that of their baby. In some facilities, attendance of ANC at least once was enforced by financial charges imposed on women for late ANC initiation, and/or incentives provided by nongovernmental organisations. Unavailability of services at health posts closest to these remote communities led to failure to return for subsequent ANC visits. Women's livelihoods such as nomadic lifestyles made it harder for them to initiate and make additional ANC visits. CONCLUSION The popularity of ANC attendance once by a skilled provider among the remote and poorest women of Zambia was explained through perceived unavoidable social and economic barriers to care, and the punitive and incentive procedures implemented by health services. Maximising comprehensive care by skilled healthcare workers in the one visit a woman makes at the health facility, may lead to optimal utilisation of quality focused ANC. Enhancing community-based interventions may increase the potential to reach the vulnerable populations.
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Affiliation(s)
- Choolwe Jacobs
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,School of Public Health, Department of Epidemiology & Biostatistics, Section for Surveillance & Disease Control, University of Zambia, Lusaka, Zambia. .,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Charles Michelo
- School of Public Health, Department of Epidemiology & Biostatistics, Section for Surveillance & Disease Control, University of Zambia, Lusaka, Zambia.,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute, Durban, Kwa-Zulu Natal, South Africa
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25
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Jacobs C, Michelo C, Moshabela M. Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups. Implement Sci 2018; 13:74. [PMID: 29855324 PMCID: PMC5984469 DOI: 10.1186/s13012-018-0766-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A community-based intervention known as Safe Motherhood Action Groups (SMAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations in Zambia. While the outcome evaluation demonstrated statistically significant improvement in the MNH indicators, targets for key indicators were not achieved, and reasons for this shortfall were not known. This study was aimed at understanding why the targeted key indicators for MNH services were not achieved. METHODS A process evaluation, in accordance with the Medical Research Council (MRC) framework, was conducted in two selected rural districts of Zambia using qualitative approaches. Focus group discussions were conducted with SMAGs, volunteer community health workers, and mothers and in-depth interviews with healthcare providers. Content analysis was done. RESULTS We found that SMAGs implemented much of the intervention as was intended, particularly in the area of women's education and referral to health facilities for skilled MNH services. The SMAGs went beyond their prescribed roles to assist women with household chores and personal problems and used their own resources to enhance the success of the intervention. Deficiencies in the intervention were reported and included poor ongoing support, inadequate supplies and lack of effective transportation such as bicycles needed for the SMAGs to facilitate their work. Factors external to the intervention, such as inadequacy of health services and skilled healthcare providers in facilities where SMAGs referred mothers and poor geographical access, may have led SMAGs to engage in the unintended role of conducting deliveries, thus compromising the outcome of the intervention. CONCLUSION We found evidence suggesting that although SMAGs continue to play pivotal roles in contribution towards accelerated coverage of MNH services among hard-to-reach populations, they are unable to meet some of the critical sets of MNH service-targeted indicators. The complexities of the implementation mechanisms coupled with the presence of setting specific socio-cultural and geographical contextual factors could partially explain this failure. This suggests a need for innovating existing implementation strategies so as to help SMAGs and any other community health system champions to effectively respond to MNH needs of most-at-risk women and promote universal health coverage targeting hard-to-reach groups.
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Affiliation(s)
- Choolwe Jacobs
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa. .,School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia. .,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia.
| | - Charles Michelo
- School of Public Health, Department of Epidemiology and Biostatistics, University of Zambia, Lusaka, Zambia.,Strategic Centre for Health Systems Metrics and Evaluations (SCHEME), School of Public Health, University of Zambia, Lusaka, Zambia
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Africa Health Research Institute, KwaZulu Natal, South Africa
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McIntosh N, Gruits P, Oppel E, Shao A. Built spaces and features associated with user satisfaction in maternity waiting homes in Malawi. Midwifery 2018; 62:96-103. [PMID: 29660576 DOI: 10.1016/j.midw.2018.03.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess satisfaction with maternity waiting home built spaces and features in women who are at risk for underutilizing maternity waiting homes (i.e. residential facilities that temporarily house near-term pregnant mothers close to healthcare facilities that provide obstetrical care). Specifically we wanted to answer the questions: (1) Are built spaces and features associated with maternity waiting home user satisfaction? (2) Can built spaces and features designed to improve hygiene, comfort, privacy and function improve maternity waiting home user satisfaction? And (3) Which built spaces and features are most important for maternity waiting home user satisfaction? DESIGN A cross-sectional study comparing satisfaction with standard and non-standard maternity waiting home designs. Between December 2016 and February 2017 we surveyed expectant mothers at two maternity waiting homes that differed in their design of built spaces and features. We used bivariate analyses to assess if built spaces and features were associated with satisfaction. We compared ratings of built spaces and features between the two maternity waiting homes using chi-squares and t-tests to assess if design features to improve hygiene, comfort, privacy and function were associated with higher satisfaction. We used exploratory robust regression analysis to examine the relationship between built spaces and features and maternity waiting home satisfaction. SETTING Two maternity waiting homes in Malawi, one that incorporated non-standardized design features to improve hygiene, comfort, privacy, and function (Kasungu maternity waiting home) and the other that had a standard maternity waiting home design (Dowa maternity waiting home). PARTICIPANTS 322 expectant mothers at risk for underutilizing maternity waiting homes (i.e. first-time mothers and those with no pregnancy risk factors) who had stayed at the Kasungu or Dowa maternity waiting homes. FINDINGS There were significant differences in ratings of built spaces and features between the two differently designed maternity waiting homes, with the non-standard design having higher ratings for: adequacy of toilets, and ratings of heating/cooling, air and water quality, sanitation, toilets/showers and kitchen facilities, building maintenance, sleep area, private storage space, comfort level, outdoor spaces and overall satisfaction (p = <.0001 for all). The final regression model showed that built spaces and features that are most important for maternity waiting home user satisfaction are toilets/showers, guardian spaces, safety, building maintenance, sleep area and private storage space (R2 = 0.28). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The design of maternity waiting home built spaces and features is associated with user satisfaction in women at risk for underutilizing maternity waiting homes, especially related to toilets/showers, guardian spaces, safety, building maintenance, sleep area and private storage space. Improving maternity waiting home built spaces and features may offer a promising area for improving maternity waiting home satisfaction and reducing barriers to maternity waiting home use.
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Affiliation(s)
- Nathalie McIntosh
- Massachusetts Health Quality Partners, 42 Pleasant Street, Suite 3, Watertown, MA 02472, United States; MASS Design Group, 334 Boylston St., Suite 400, Boston, MA 02116, United States.
| | - Patricia Gruits
- MASS Design Group, 334 Boylston St., Suite 400, Boston, MA 02116, United States.
| | - Eva Oppel
- Department of Health Care Management, University of Hamburg, Hamburg, Germany; Hamburg Center for Health Economics (HCHE), Esplanade 36, 20354 Hamburg, Germany.
| | - Amie Shao
- MASS Design Group, 334 Boylston St., Suite 400, Boston, MA 02116, United States.
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