Distribution of maternity waiting homes and their correlation with perinatal mortality and direct obstetric complication rates in Ethiopia

Determinants of feto-maternal outcomes of antepartum hemorrhage among women who gave birth in Awi zone public hospitals, Ethiopia. A case-control study

BACKGROUND

Antepartum hemorrhage continues to be a major cause of maternal and perinatal morbidity and mortality in developing countries including Ethiopia and it complicates 2-5% of all pregnancies with an increased rate of maternal and perinatal morbidity and even mortality. Despite many activities, still, poor fetomaternal outcomes of antepartum hemorrhage are still there. Moreover, studies around the current study area emphasize the magnitude and associated factors for antepartum hemorrhage rather than its feto-maternal outcomes. Thus, there is a need to identify the determinants associated with the fetomaternal outcomes of antepartum hemorrhage to guide midwives and obstetricians in the early diagnosis and treatment.

METHOD

An institution-based case-control study was conducted in four-year delivery charts diagnosed with antepartum hemorrhage from April 2, 2022, to May 12, 2022, at Awi Zone public hospitals. To see the association between dependent and independent variables logistic regression model along with a 95% confidence interval (CI) and a p-value of <0.05 were used.

RESULT

No antenatal care follow-up (AOR: 2.5, 95% CI 1.49-4.2), rural residence (AOR: 1.706, 95%CI 1.09-2.66), delay to seek care >12 hours (AOR: 2.57, 95% CI: 1.57-4.23) and advanced maternal age (AOR: 3.43, 95% CI 1.784-6.59) were significant factors associated with feto-maternal outcomes of antepartum Hemorrhage.

CONCLUSION

This study revealed that rural residence, delay in seeking the care of more than 12 hours, not having antenatal care follow up and advanced maternal age were significant factors associated with feto-maternal outcomes of Antepartum hemorrhage.

RECOMMENDATION

The findings of our study suggest the need for health education about the importance of antenatal care follow-up which is the ideal entry point for health promotion and early detection of complications, especially for rural residents.

Maternity waiting home utilization among women who gave birth in the pastoralist communities of Borana Zone, Ethiopia: A community-based mixed-method study design

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.

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

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.

Delay in Seeking Institutional Delivery Services and Associated Factors Among Immediate Postpartum Mothers in Public Health Facilities in Gondar Town, Northwest Ethiopia, 2022

Background

Maternal and neonatal mortality is a global problem that is highly prevalent in low- and middle-income countries, including Ethiopia. Maternal delay in seeking institutional delivery services utilization plays a significant role in determining maternal and neonatal health outcomes. Although studies have been conducted on institutional delivery service utilization in Ethiopia, little is known about factors for delays in seeking care for institutional delivery services.

Objective

This study aimed to assess the delay in seeking institutional delivery services and associated factors among immediate postpartum mothers in public health facilities in Gondar, northwest Ethiopia.

Methods

A facility-based cross-sectional study was conducted from July 15 to September 10, 2022. A total of 391 participants were selected using systematic random sampling. Data were collected through face-to-face interviews using structured, pretested, and interviewer-administered questionnaires. Data were entered into EpiData version 4.6, and the analysis was conducted using Statistical Package for Social Science version 26. The multivariable logistic regression model was fitted and the level of significance was set at p ≤ 0.05.

Result

The prevalence of delay in seeking institutional delivery was 49.10% (95% confidence interval [CI]: 44.13, 54.08). Rural residence (adjusted odds ratio [AOR] = 2.51; 95% CI: 1.43-4.41), no antenatal care visits (AOR: 2.87; 95% CI: 1.34-6.13), unplanned pregnancy (AOR: 2.98; 95% CI: 1.78-5.01), poor decision-making autonomy in maternity care services (AOR: 1.98; 95% CI: 1.15-3.40), and poor birth preparedness plan (AOR: 4.88; 95% CI: 2.79-8.53) were significantly associated with delays in seeking institutional delivery.

Conclusion

Delays in seeking institutional delivery services were high. It is better to promote women's decision-making power in their own health care. In addition, it is better to arrange programs that will improve maternal and child health service utilization.

Stakeholders' perspectives on the acceptability and feasibility of maternity waiting homes: a qualitative synthesis

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.

Magnitude and factors influencing pastoralist women's maternity waiting home utilization in Teltelle district, Ethiopia: A cross-sectional study

Background and Aims

Pastoralists in Ethiopia benefit the least from health-sector advances compared to the country's agrarian population. Maternity waiting homes (MWHs) have been established to provide mothers living in remote regions with access to skilled healthcare services during pregnancy, delivery, and postpartum periods. However, there is a dearth of data on the utilization of MWHs in pastoralist areas.

Objectives

To assess maternity waiting home utilization and its associated factors among pastoralist women who gave birth in the last 12 months in Teltelle district, Southeastern Ethiopia; 2021.

Methods

A community-based cross-sectional study was undertaken from March 1 to June 20, 2021. A multistage sampling technique was used to select the 458 study subjects. A pretested structured questionnaire was used to gather the data. For data entry and analysis, Epi-data version 4.4.3.1 and SPSS version 25.0 were utilized respectively. Models of bivariate and multivariate logistic regression were utilized to identify associated factors. In the multivariable analysis, variables with p < 0.05 were declared significantly associated with maternity waiting home utilization.

Result

A total of 458 pastoralist women participated in the study. From the total participants, 26.64% [95% confidence interval: 22.57%-30.70%] of women utilized MWHs. Women's husband education status, complications during their last pregnancy, family support to MWHs, and community involvement and support were found to be significantly associated with the utilization of MWHs.

Conclusion and Recommendation

This study found that utilization of MWHs was significantly lower in pastoralist areas of Ethiopia than in agrarian areas. Previous pregnancy complications, family support, husband's literacy, and community support were all significantly associated with improved maternity waiting home utilization. Encouraging community participation and family support are recommended to improve its utilization. Moreover, increasing community involvement in MWHs establishment and sustainability will be expected from the stakeholders.

Epidemiology of neonatal mortality: a spatial and multilevel analysis of the 2019 mini-Ethiopian demographic and health survey data

BACKGROUND

Sub-Saharan African countries are a high-burden region of neonatal mortality and showed slow progress in its reduction. In developing countries, as long as the current trend of mortality persists, achieving a sustainable development target for neonatal mortality would be challenging. The aim of this study was to detect significant geographic areas and identify community and individual-level predictors of neonatal mortality in Ethiopia to draw attention to a policy.

METHODS

A weighted total sample of 24,136 mothers from the 2019 mini-Ethiopian demographic and health survey data were included in the analysis. Global Moran's I statistics was run to check the clustering of neonatal mortality and then kriging interpolation was done to predict the magnitude of neonatal mortality in Ethiopia. In addition, SaTScan analysis was also executed to identify hot spot clusters of neonatal mortality. Finally, a multilevel mixed-effect logistic regression model was used to identify community and individual-level predictors of early neonatal and neonatal mortality.

RESULTS

The lifetime early neonatal and neonatal mortality among mothers in Ethiopia was 5.08 (95% CI: 4.13-6.03) and 6.54 (5.55, 7.52) per 1000 births respectively. Neonatal mortality was spatially clustered in the country and the SaTScan analysis identified significant hotspot areas of neonatal mortality in the Amhara and Afar regions and some areas of the Somali and Oromia regions. Its predicted magnitude was > 8 per 1000 births in wide areas of the Amhara and Benishangul regions. A multilevel mixed-effect logistics regression analysis identified that a lower level of maternal education, being a twin neonate, and being a male neonate were predictors of both early neonatal and neonatal mortality. Whereas, the younger age of mothers predicted neonatal mortality.

CONCLUSIONS

Neonatal mortality in Ethiopia is geographically clustered and sociodemographic and obstetric factors played a significant role. Policy direction should focus on evidence-based practices like midwives-led community and facility-based continuum of care from preconception to postnatal periods to possibly reduce neonatal mortality.

Maternal Mortality in Africa: Regional Trends (2000-2017)

BACKGROUND

United Nations Sustainable Development Goals state that by 2030, the global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. The leading causes of maternal mortality in Africa are hemorrhage and eclampsia. This research aims to study regional trends in maternal mortality (MM) in Africa.

METHODS

We extracted data for maternal mortality rates per 100,000 births from the United Nations Children's Fund (UNICEF) databank from 2000 to 2017, 2017 being the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC).

RESULTS

Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9; -3,2%). All regions showed significant downward trends, with the greatest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining Sub-Saharan African regions are still far from achieving the goals.

CONCLUSIONS

Maternal mortality has decreased in Africa, especially in the South African region. The only region close to the United Nations' target is the North African region. The remaining Sub-Saharan African regions are still far from achieving the goals. The West African region needs more extraordinary efforts to achieve the goals of the United Nations. Policies should ensure that all pregnant women have antenatal visits and give birth in a health facility staffed by specialized personnel.

Area of focus to handle delays related to maternal death in Ethiopia

Background

Maternal delay factors, together with medical factors, have a substantial role in determining maternity outcomes. Although several studies were conducted on delay factors that contribute to maternal death in Ethiopia, the studies were mostly focused either on an individual or at a provincial level factor with a limited number of study participants. In response to this gap, this study is aimed at exploring the magnitude and factors related to delay factors that contribute to maternal death in Ethiopia.

Methods

The study used maternal death surveillance data collected from different regions of Ethiopia, compiled between 2013 and 2021. A total of 4530 maternal deaths were reviewed during the study period. A Multilevel multinomial logistic regression model was applied to examine factors associated with delays related to maternal death. An adjusted relative risk ratio with a 95% confidence interval was stated and variables with p-values less than 0.05 were declared as significant predictors of maternal delay.

Result

Delay three (delay in receiving adequate and appropriate care once reached a health facility) has contributed to 36.3% of maternal deaths followed by delay one (delay in deciding to seek care when experiencing an obstetric emergency) and delay two (delay in reaching to an appropriate obstetric facility) where each of them contributed to 36.1% and 27.6% of maternal deaths respectively. In the multivariate multilevel multinomial model, maternal age, education status, and place of death were among the individual level factors associated with both delay two and delay three. Conversely, marital status and ANC follow-up were associated with delay two alone, while the timing of maternal death was associated with delay three. Residence and type of facility were provincial-level factors linked with both delay two and delay three, while the type of region was related to delay three of maternal death.

Conclusion

Both delay one and three have a major contribution to maternal death in Ethiopia. Individual and provincial level factors played an important role in determining delays related to maternal death. Therefore, it is crucial to account for measures that provide emphasis on the area of raising awareness on the utilization of Antenatal care (ANC) service, improving facility readiness to handle obstetrics emergencies, and narrowing down inequality among regions in service provision.

Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis

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.

Utilization of maternal waiting home and associated factors among women who gave birth in the last one year, Dabat district, Northwest Ethiopia

Background

Maternal mortality and adverse pregnancy outcomes are still challenges in developing countries. In Ethiopia, long distances and lack of transportation are the main geographic barriers for pregnant women to utilize a skilled birth attendant. To alleviate this problem, maternity waiting homes are a gateway for women to deliver at the health facilities, thereby helping towards the reduction of the alarming maternal mortality trend and negative pregnancy outcomes. However, there is a paucity of evidence regarding the utilization of maternity waiting homes in the study area. Therefore, this study aimed to assess utilization of maternity waiting home services and associated factors among mothers who gave birth in the last year in Dabat district, northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted from January 5 to February 30, 2019. A total of 402 eligible women were selected using a simple random sampling technique. Data were collected using a structured, pre-tested, and interviewer-administered questionnaire through face-to-face interviews. Data were entered into EPI info version 7.1.2 and exported to SPSS version 20 for analysis. Both bivariable and multivariable logistic regression models were fitted. Statistically significant associations between variables were determined based on the adjusted odds ratio (AOR) with its 95% confidence interval and p-value of ≤ 0.05.

Results

Maternity waiting home utilization by pregnant women was found to be 16.2% (95% CI: 13, 20). The mothers’ age (26–30 years) (AOR = 0.24; 95% CI: 0.08,0.69), primary level of education (AOR = 9.05; 95% CI: 3.83, 21.43), accepted length of stay in maternity waiting homes (AOR = 3.15; 95% CI: 1.54, 6.43), adequate knowledge of pregnancy danger signs (AOR = 7.88; 95% CI: 3.72,16.69), jointly decision on the mother’s health (AOR = 2.76; 95% CI: 1.08,7.05), and getting people for household activities (AOR = 2.59, 95% CI: 1.21, 5.52) had significant association with maternity waiting home utilization.

Conclusion

In this study, maternity waiting home utilization was low. Thus, expanding a strategy to improve women’s educational status, health education communication regarding danger signs of pregnancy, empowering women’s decision-making power, and shortening the length of stay at maternity waiting homes may enhance maternity waiting home utilization.

Critical factors associated with postpartum maternal death in Ethiopia

BACKGROUND

Globally most maternal deaths occur during the postpartum period; however, the burden is disproportionately higher in some Sub-Saharan African countries including Ethiopia. According to Ethiopian Ministry of Health's annual report, in 2019 alone, nearly 70% of maternal deaths happen during the postpartum period. Although several studies have been conducted on postpartum maternal deaths in Ethiopia, most of the studies were focused either on individual-level or district-level determinants with limited emphasis on the timing of death and in relatively small and localized areas. Therefore, this study aimed at identifying the determinants of postpartum death both at an individual and districts level, which could shed light on designing pragmatic policies to reduce postpartum maternal death.

METHODS

The study utilized secondary data obtained from the Ethiopian maternal death surveillance system. A total of 4316 reviewed maternal death from 645 districts of Ethiopia were included in the analysis. A multilevel multinomial logistic regression model was applied to examine factors significantly associated with postpartum maternal death in Ethiopia.

RESULT

The findings revealed that 65.1% of maternal deaths occurred during the postpartum period. The factors associated with postpartum death included previous medical history (history of ANC follow up and party), medical causes (obstetrics haemorrhage, hypertensive disorder of pregnancy, pregnancy-related infection, and non-obstetrics complication), personal factors (poor knowledge of obstetrics complication), and facility-level barriers (shortage of life-saving maternal commodities and delay in receiving treatment).

CONCLUSION

Almost seven in ten maternal deaths happen during the postpartum period. The rate was even higher for some women based on their previous medical history, level of awareness about obstetrics complication, medical conditions, as well as the readiness of the health facility at which the women was served. Since the postpartum period is identified as a critical time for reducing maternal death, policies and actions must be directed towards improving health education, ANC service utilization, and facility-level readiness.

Maternity waiting homes utilization and associated factors among childbearing women in rural settings of Finfinnee special zone, central Ethiopia: A community based cross-sectional study

Background

Maternity waiting home (MWH) is one of the strategies designed for improved access to comprehensive obstetric care for pregnant women living far from health facilities. Hence, it is vital to promote MWHs for pregnant women in Ethiopia, where most people reside in rural settings and have a high mortality rate. Therefore, this study aimed to assess MWHs utilization and associated factors among women who gave birth in the rural settings of Finfinnee special zone, central Ethiopia.

Methods

A community-based cross-sectional study was conducted from 15^th October to 20^th November 2019 among women who gave birth in the last six months before data collection. Multistage random sampling was employed among 636 women from six rural kebeles to collect data through a face-to-face interview. Multivariable logistic regression analysis was fitted, and a 95% confidence level with a p-value <0.05 was used to determine the level and significance of the association.

Results

Overall, MWHs utilization was 34.0% (30.3% - 37.7%). The higher age (AOR: 4.77; 95% CI: 2.76–8.24), career women (AOR: 0.39 95% CI: 0.20–0.74), non-farmer husband (AOR: 0.28; 95% CI: 0.14–0.55), rich women (AOR:1.84; 95% CI: 1.12–3.02), living greater than 60 minutes far from a health facility (AOR: 1.80; 95% CI: 1.16–2.80), and four and more livebirths (AOR: 5.72; 95% CI: 1.53–21.35) significantly associated with MWHs utilization. The common services provided were latrine, bedding, and health professional checkups with 98.2%, 96.8%, and 75.4%, respectively. Besides, feeding service was provided by 39.8%. The primary reason not to use MWHs was the absence of enough information on MWHs.

Conclusion

One-third of the women who delivered within the last six months utilized MWHs in the Finfinnee special zone. Our results support the primary purpose of MWHs, that women far from the health facility are more likely to utilize MWHs, but lack of adequate information is the reason not to use MWHs. Therefore, it is better to promote MWHs to fill the information gap among women with geographical barriers to reach health facilities.

Factors affecting men's involvement in maternity waiting home utilization in North Achefer district, Northwest Ethiopia: A cross-sectional study

Background

Maternity waiting home (MWH) is a direct strategy to improve newborn and maternal survival. The utilization of MWH, however, remains very low in Ethiopia. Men involvement in maternal health programs is a key strategy to increase utilization of maternal health services, including MWH. This study defines men involvement in-terms of men’s participation in deciding to admit their spouse to an MWH, accompanying their spouse to an MWH, providing financial support, availing food at an MWH, and taking care of the home or children. Thus, the current study aims to identify factors affecting men’s involvement in MWH utilization.

Methods

A community-based cross-sectional study was conducted from October 1st to December 30th, 2018. Four hundred three men were involved in the study. Data were analyzed by the statistical package for social science (SPSS) version 23. Independent predictors were identified by a multivariable logistic regression model. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

Results

Men’s involvement in MWH was 55.6% (50.71, 60.45). Age (AOR = 0.86, 95% CI = 0.82–0.94), knowledge about MWH (AOR = 4.74, 95% CI = 2.65–8.49), decision-making power (AOR = 4.00, 95% CI = 1.38–11.57), and receiving counseling about MWH during spousal antenatal care visits (AOR = 9.15, 95% CI = 3.34–25.03) had statistically significant associations with men’s involvement in MWH utilization.

Conclusions

Nearly, half of the male partners were involved in MWH utilization. Men’s age, MWH knowledge, decision-making power, and receiving counseling were factors affecting their involvement in MWH utilization. Interventions targeting to improve male involvement in MWH utilization should focus on building men’s knowledge about MWH, increasing male involvement in ANC with an appropriate level of counseling about MWH, and changing patriarchal thinking in society with appropriate behavioral interventions such as community-based health education.

Predictors of maternal and newborn health service utilization across the continuum of care in Ethiopia: A multilevel analysis

Background

The continuum of care for maternal and newborn health is a systematic approach for delivery of an integrated effective package of life-saving interventions throughout pregnancy, childbirth, and postpartum as well as across levels of service delivery to women and newborns. Nonetheless, in low-income countries, coverage of these interventions across the life cycle continuum is low. This study examined the predictors of utilization of maternal and newborn health care services along the continuum of care in Ethiopia.

Methods

This was a cross-sectional population-based study. We measured maternal and newborn health care utilization practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions of Ethiopia. We fitted multilevel random-effects logistic regression models to examine the predictors of the continuum of care accounting for the survey design, and individual, and contextual characteristics of the respondents.

Results

Our analysis revealed that only one-fifth of women utilized maternal and newborn health services across the antepartum, intrapartum, and postpartum continuum; most women discontinued at the postpartum stage. Continued use of services varied significantly across wealth, model family, prenatal stay at maternity waiting homes, antenatal care in the first trimester, complete antenatal care service, and the administrative region at all antepartum, intrapartum, and postpartum stages. Moreover, family conversation during pregnancy [AOR: 2.12; 95% CI: 1.56–2.88], delivery by cesarean [AOR: 2.70; 95% CI: 1.82–4.02] and birth notified to health extension workers [AOR: 1.95; 95% CI: 1.56–2.43] were found to be predictors of the continuum of care at the postpartum stage.

Conclusion

In Ethiopia, despite good access to antepartum care, compliance with continuity of care across the pathway decreased with significant inequitable distributions, the poorest segment of the population being at most disadvantage. The main modifiable program factors connected to the continued uptake of maternal health services include family conversation, pregnant women conference, complete antenatal care, antenatal care in the first trimester, and birth notification.

Maternity Waiting Home Interventions as a Strategy for Improving Birth Outcomes: A Scoping Review and Meta-Analysis

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.

Facility level factors that determine consistent delivery of essential newborn care at health centers in Ethiopia

BACKGROUND

Essential newborn care (ENC) is a package of interventions which should be provided for every newborn baby regardless of body size or place of delivery immediately after birth and should be continued for at least the seven days that follows. Even though Ethiopia has endorsed the implementation of ENC, as other many counties, it has been challenged. This study was conducted to measure the level of essential newborn care practice and identify health facility level attributes for consistent delivery of ENC services by health care providers.

METHODS

This study employed a retrospective cross-sectional study design in 425 facilities. Descriptive statistics were formulated and presented in tables. Binary logistic regression was employed to assess the statistical association between the outcome variable and the independent variables. All variables with p < 0.2 in the bivariate analysis were identified as candidate variables. Then, multiple logistic regression analysis was performed using candidate variables to determine statistically significant predictors of the consistent delivery of ENC by adjusting for possible confounders.

RESULTS

A total of 273, (64.2%), of facilities demonstrated consistent delivery of ENC. Five factors-availability of essential obstetrics drugs in delivery rooms, high community score card (CSC) performances, availability of maternity waiting homes, consistent partograph use, and availability of women-friendly delivery services were included in the model. The strongest predictor of consistent delivery of essential newborn care (CD-ENC) was consistent partograph use, recording an odds ratio of 2.66 (AOR = 2.66, 95%CI: 1.71, 4.13). Similarly, providing women-friendly services was strongly associated with increased likelihood of exhibiting CD-ENC. Furthermore, facilities with essential obstetric drugs had 1.88 (AOR = 1.88, 95%CI: 1.15, 3.08) times higher odds of exhibiting consistent delivery of ENC.

CONCLUSION

The delivery of essential newborn care depends on both health provider and facility manager actions and availability of platforms to streamline relationships between the clients and health facility management.

Prevalence and factors affecting the utilization of antenatal care in rural areas of Southwestern Ethiopia

BACKGROUND

Antenatal care (ANC) is a health care intervention intended to ensure the safety of pregnancy. According to the World Health Organization, at least four ANC visits are recommended for a healthy pregnancy. However, whether this recommended number of visits was followed or not in the rural areas of Southwestern Ethiopia is not known. Therefore, the study aimed to investigate the prevalence of, and the associated factors of ANC utilization by pregnant women in the rural areas of Southwestern Ethiopia.

METHODS

A community-based cross-sectional study design was used in three rural zones. The data were collected from n = 978 women through a structured questionnaire with face-to-face interview. The collected data were analyzed using descriptive statistics and a multiple binary logistic regression model.

RESULTS

The results showed that 56% of women made the recommended minimum number of ANC visits and the remaining 44% of them underutilized the ANC service. The multiple binary logistic regression model identified zone, marital status of the woman, educational level of the husband, occupation of the husband, knowledge of danger signs of pregnancy, birth interval, source of information, timely visits, and transportation problem to be statistically significant factors affecting the prevalence of ANC visit utilization of women. Bench Maji zone had smaller odds ratio of ANC visit prevalence as compared to Kaffa zone. Women who lived in the rural area of Sheko zone are 2.67 times less likely to utilize ANC visit than those who lived in the rural area of Kaffa zone keeping other variables constant.

CONCLUSION

The study results highlight the need to increase the number of ANC visits, and the importance of using an appropriate model to determine the important socio-demographic factors that ANC service providers shall focus on to improve the health of the unborn baby and the mother during pregnancy.

Lived Experiences and Perceptions of Childbirth among Pastoralist Women in North-Eastern Ethiopia: A Multimethod Qualitative Analysis to the WHO Health Systems Responsiveness Framework

Maternity should be a time of hope and joy. However, for women in pastoralist communities in Ethiopia, the reality of motherhood is often grim. This problem is creating striking disparities of skilled birth uptake among the agrarian and pastoral communities in Ethiopia. So far, the depth and effects of the problem are not well understood. This study is intended to fill this research gap by exploring mothers’ lived experiences and perceptions during skilled birthing care in hard-to-reach communities of Ethiopia. An Interpretive Phenomenological approach was employed to analyse the exploratory data. Four key informant interviews, six in-depth interviews, six focus group discussions, and twelve focused observations were held. WHO responsiveness domains formed the basis for coding and analysis: dignity, autonomy, choice of provider, prompt attention, communication, social support, confidentiality, and quality of basic amenities. The skilled birthing experience of nomadic mothers is permeated by a deep-rooted and hidden perceived neglect, which constitutes serious challenges to the health system. Mothers’ experiences reflect not only the poor skilled delivery uptake, but also how health system practitioners are ignorant of Afar women’s way of life, their living contexts, and their values and beliefs regarding giving birth. Three major themes emerged from data analysis: bad staff attitude, lack of culturally acceptable care, and absence of social support. Nomadic mothers require health systems that are responsive and adaptable to their needs, beliefs, and values. The abuse and disrespect they experience from providers deter nomadic women from seeking skilled birthing care. Women’s right to dignified, respectful, skilled delivery care requires the promotion of woman-centred care in a culturally appropriate manner. Skilled birthing care providers should be cognizant of the WHO responsiveness domains to ensure the provision of culturally sensitive birthing care.

Why Women in Ethiopia Give Birth at Home? A Systematic Review of Literature

Objective

This study aimed at reviewing identifying reasons for home delivery preference, determining the status of homebirth in Ethiopia, and identifying socio-demographic factors predicting home delivery in Ethiopia.

Methods

A systematic literature review regarding the status of homebirth, reasons why women preferred homebirth and socio-demographic determinants of home deliveries was performed using CINAHL, MEDLINE, Google Scholar and Maternity and Infant Care. Keywords and phrases such as home birth, home delivery, childbirth, prevalence, determinants, predictors, women and Ethiopia were included in the search.

Results

A total of 10 studies were included in this review. The mean proportion of homebirth was 73.5%. Maternal age, ANC visits, maternal level of education, distance to facilities, and previous facility birth were significantly associated with homebirth. Perceived poor quality of service, distant location of facilities, homebirth as customary in the society and perceived normalness of labour were identified as reasons for choosing homebirth.

Conclusion

Despite the significance of skilled birth attendants in reducing maternal and newborn morbidity and mortality, unattended homebirth remains high. By identifying and addressing socio-demographic enablers of home deliveries, maternal health service uptake can be improved.

Maternal and Perinatal Outcomes among Maternity Waiting Home Users and Non-Users in Rural Rwanda

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.

Cesarean delivery rates, hospital readiness and quality of clinical management in Ethiopia: national results from two cross-sectional emergency obstetric and newborn care assessments

Background

Cesarean delivery (CD) rates have reached epidemic levels in many high and middle income countries while increasingly, low income countries are challenged both by high urban CD rates and high unmet need in rural areas. The managing authority of health care institutions often plays a role in these disparities. This paper shows changes between 2008 and 2016 in Ethiopian CD rates, readiness of hospitals to provide CD and quality of clinical care, while highlighting the role of hospital management authority.

Methods

This secondary data analysis draws from two national cross-sectional studies to assess emergency obstetric and newborn care. The sample includes 111 hospitals in 2008 and 316 hospitals in 2016, and 275 women whose CD chart was reviewed in 2008 and 568 in 2016. Descriptive statistics are used to describe our primary outcome measures: population- and institutional-based CD rates; hospital readiness to perform CD; quality of clinical management, including the relative size of Robson classification groups.

Results

The national population CD rate increased from 2008 to 2016 (< 1 to 2.7%) as did all regional rates. Rates in 2016 ranged from 24% in urban settings to less than 1% in several rural regions. The institutional rate was 54% in private for-profit hospitals in 2016, up from 46% in 2008. Hospital readiness to perform CDs increased in public and private for-profit hospitals. Only half of the women whose charts were reviewed received uterotonics after delivery of the baby, but use of prophylactic antibiotics was high. Partograph use increased from 9 to 42% in public hospitals, but was negligible or declined elsewhere. In 2016, 40% of chart reviews from public hospitals were among low-risk nulliparous women (Robson groups 1&2).

Conclusions

Between 2008 and 2016, government increased the availability of CD services, improved public hospital readiness and some aspects of clinical quality. Strategies tailored to further reduce the high unmet need for CD and what appears to be an increasing number of unnecessary cesareans are discussed. Adherence to best practices and universal coverage of water and electricity will improve the quality of hospital services while the use of the Robson classification system may serve as a useful quality improvement tool.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04008-9.

Association between maternity waiting home stay and obstetric outcomes in Yetebon, Ethiopia: a mixed-methods observational cohort study

Background

A strategy for reducing adverse pregnancy outcomes is the expanded implementation of maternity waiting homes (MWHs). We assessed factors influencing MWH use, as well as the association between MWH stay and obstetric outcomes in a hospital in rural Ethiopia.

Methods

Data from medical records of the Glenn C. Olson Memorial Primary Hospital obstetric ward were cross matched with records from the affiliated MWH between 1 and 2011 to 31 March 2014. Poisson regression with robust variance was conducted to estimate the relative risk (RR) of childbirth complications associated with MWH use vs. non-use. Five key informant interviews of a convenience sample of three MWH staff and two users were conducted and a thematic analysis performed of social, cultural, and economic factors underlying MWH use.

Results

During the study period, 489 women gave birth at the hospital, 93 of whom were MWH users. Common reasons for using the MWH were post-term status, previous caesarean section/myomectomy, malposition/malpresentation, and low-lying placenta, placenta previa, or antepartum hemorrhage, and hypertension or preeclampsia. MWH users were more likely than non-users to have had a previous caesarean Sec. (15.1 % vs. 5.3 %, p < 0.001) and to be post-term (21.5 % vs. 3.8 %, p < 0.001). MWH users were also more likely to undergo a caesarean Sec. (51.0 % vs. 35.4 %, p < 0.05) and less likely (p < 0.05) to have a spontaneous vaginal delivery (49.0 % vs. 63.6 %), obstructed labor (6.5 % vs. 14.4 %) or stillbirth (1.1 % vs. 8.6 %). MWH use (N = 93) was associated with a 77 % (adjusted RR = 0.23, 95 % Confidence Interval (CI) 0.12–0.46, p < 0.001) lower risk of childbirth complications, a 94 % (adjusted RR = 0.06, 95 % CI 0.01–0.43, p = 0.005) lower risk of fetal and newborn complications, and a 73 % (adjusted RR = 0.27, 95 % CI 0.13–0.56, p < 0.001) lower risk of maternal complications compared to MWH non-users (N = 396). Birth weight [median 3.5 kg (interquartile range 3.0-3.8) vs. 3.2 kg (2.8–3.5), p < 0.001] and 5-min Apgar scores (adjusted difference = 0.25, 95 % CI 0.06–0.44, p < 0.001) were also higher in offspring of MWH users. Opportunity costs due to missed work and need to arrange for care of children at home, long travel times, and lack of entertainment were suggested as key barriers to MWH utilization.

Conclusions

This observational, non-randomized study suggests that MWH usage was associated with significantly improved childbirth outcomes. Increasing facility quality, expanding services, and providing educational opportunities should be considered to increase MWH use.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03913-3.

A systematic review and meta-analysis of the effectiveness of maternity waiting homes in low- and middle-income countries

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.

Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study

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.

The effect of maternity waiting homes on perinatal mortality is inconclusive: a critical appraisal of existing evidence from Sub-Saharan Africa

OBJECTIVES

To assess the appropriateness of the statistical methodology used in a recent meta-analysis investigating the effect of maternity waiting homes (MWHs) on perinatal mortality in Sub-Saharan Africa.

RESULTS

A recent meta-analysis published in BMC Research Notes used a fixed-effect model to generate an unadjusted summary estimate of the effectiveness of MWHs in reducing perinatal mortality in Africa using ten observational studies (pooled odds ratio 0.15, 95% confidence interval 0.14-0.17). The authors concluded that MWHs reduce perinatal mortality by over 80% and should be incorporated into routine maternal health care services. In the present article, we illustrate that due to the contextual and methodological heterogeneity present in existing studies, the authors' conclusions about the effectiveness of MWHs in reducing perinatal mortality were likely overstated. Additionally, we argue that because of the selection bias and confounding inherent in observational studies, unadjusted pooled estimates provide little causal evidence for effectiveness. Additional studies with robust designs are required before an appropriately designed meta-analysis can be conducted; until then, the ability to draw causal inferences regarding the effectiveness of MWHs in reducing perinatal mortality is limited.

Status of institutional-level respectful maternity care: Results from the national Ethiopia EmONC assessment

Objective

To assess the availability of an institutional‐level respectful maternity care (RMC) index, its components, and associated factors.

Methods

A cross‐sectional study design was applied to a 2016 census of 3804 health facilities in Ethiopia. The availability of an institutional‐level RMC index was computed as the availability of all nine items identified as important aspects of institutional‐level RMC during childbirth. Logistic regression analysis was used to identify factors associated with availability of the index.

Results

Three components of the institutional‐level RMC index were identified: “RMC policy,” “RMC experience,” and “facility for provision of RMC.” Overall, 28% of facilities (hospitals, 29.9%; health centers, 27.8%) reported availability of the institutional‐level RMC index. Facility location urbanization (urban region), percentage of maternal and newborn health workers trained in basic emergency obstetric and newborn care, and availability of maternity waiting homes in health facilities were positively associated with availability of the institutional‐level RMC index.

Conclusion

Only one in three facilities reported availability of the institutional‐level RMC index. The Ethiopian government should consider strengthening support mechanisms in different administrative regions (urban, pastoralist, and agrarian), implementing the provision training for health workers that incorporates RMC components, and increasing the availability of maternity waiting homes.

In Ethiopia, only one in three facilities reported availability of an institutional‐level respectful maternity care index. Factors associated with availability of the index were identified.

Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap

Large disparities in maternal and neonatal mortality exist between low- and high-income countries. Mothers and babies continue to die at high rates in many countries despite substantial increases in facility birth. One reason for this may be the current design of health systems in most low-income countries where, unlike in high-income countries, a substantial proportion of births occur in primary care facilities that cannot offer definitive care for complications. We argue that the current inequity in care for childbirth is a global double standard that limits progress on maternal and newborn survival. We propose that health systems need to be redesigned to shift all deliveries to hospitals or other advanced care facilities to bring care in line with global best practice. Health system redesign will require investing in high-quality hospitals with excellent midwifery and obstetric care, boosting quality of primary care clinics for antenatal, postnatal, and newborn care, decreasing access and financial barriers, and mobilizing populations to demand high-quality care. Redesign is a structural reform that is contingent on political leadership that envisions a health system designed to deliver high-quality, respectful care to all women giving birth. Getting redesign right will require focused investments, local design and adaptation, and robust evaluation.