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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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Dereje S, Yenus H, Amare G, Amare T. 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. PLoS One 2022; 17:e0265182. [PMID: 35298504 PMCID: PMC8929623 DOI: 10.1371/journal.pone.0265182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
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 15th October to 20th 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.
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Affiliation(s)
- Surafel Dereje
- Maternal and child health office, Finfinnee special zone health department, Addis Ababa, Ethiopia
| | - Hedija Yenus
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getasew Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
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Solomon H, Henry EG, Herlihy J, Yeboah-Antwi K, Biemba G, Musokotwane K, Bhutta A, Hamer DH, Semrau KEA. Intended versus actual delivery location and factors associated with change in delivery location among pregnant women in Southern Province, Zambia: a prespecified secondary observational analysis of the ZamCAT. BMJ Open 2022; 12:e055288. [PMID: 35256443 PMCID: PMC8905985 DOI: 10.1136/bmjopen-2021-055288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This prespecified, secondary analysis of the Zambia Chlorhexidine Application Trial (ZamCAT) aimed to determine the proportion of women who did not deliver where they intended, to understand the underlying reasons for the discordance between planned and actual delivery locations; and to assess sociodemographic characteristics associated with concordance of intention and practice. DESIGN Prespecified, secondary analysis from randomised controlled trial. SETTING Recruitment occurred in 90 primary health facilities (HFs) with follow-up in the community in Southern Province, Zambia. PARTICIPANTS Between 15 February 2011 and 30 January 2013, 39 679 pregnant women enrolled in ZamCAT. SECONDARY OUTCOME MEASURES The location where mothers gave birth (home vs HF) was compared with their planned delivery location. RESULTS When interviewed antepartum, 92% of respondents intended to deliver at an HF, 6.1% at home and 1.2% had no plan. However, of those who intended to deliver at an HF, 61% did; of those who intended to deliver at home, only 4% did; and of those who intended to deliver at home, 2% delivered instead at an HF. Among women who delivered at home, women who were aged 25-34 and ≥35 years were more likely to deliver where they intended than women aged 20-24 years (adjusted OR (aOR)=1.31, 95% CI=1.11 to 1.50 and aOR=1.32, 95% CI=1.12 to 1.57, respectively). Women who delivered at HFs had greater odds of delivering where they intended if they received any primary schooling (aOR=1.34, 95% CI=1.09 to 1.72) or more than a primary school education (aOR=1.54, 95% CI=1.17 to 2.02), were literate (aOR=1.33, 95% CI=1.119 to 1.58), and were not in the lowest quintile of the wealth index. CONCLUSION Discrepancies between intended and actual delivery locations highlight the need to go beyond the development of birth plans and exposure to birth planning messaging. More research is required to address barriers to achieving intentions of a facility-based childbirth. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT01241318).
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Affiliation(s)
- Hiwote Solomon
- Doctor of Public Health Program, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Henry
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie Herlihy
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kojo Yeboah-Antwi
- Public Health Unit, Fr Thomas Alan Rooney Memorial Hospital, Kumasi, Asankrangwa, Ghana
| | - Godfrey Biemba
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Zambia National Health Research Authority, Lusaka, Zambia
| | | | - Afsah Bhutta
- MBBS Department, Dow University of Health Sciences, Karachi, Pakistan
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katherine E A Semrau
- Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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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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Horton R, Lee H, Perosky JE, Kofa A, Lori JR. Comparison of quality, birth outcomes, and service utilization between health facilities with and without maternity waiting homes in Liberia. Midwifery 2021; 105:103235. [PMID: 34959000 PMCID: PMC8811480 DOI: 10.1016/j.midw.2021.103235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/29/2021] [Accepted: 12/19/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE 1) To assess the quality of health facilities associated with functional Maternity Waiting Homes and health facilities without functional maternity waiting homes in Liberia. 2) To examine birth outcomes and care utilization amongst health facilities with and without functional maternity waiting homes in Liberia. DESIGN Secondary analysis design using data from a facility capacity checklist and Liberia's Health Management Information System. SETTING 71 health facilities associated with functional maternity waiting homes and 14 health facilities without functional maternity waiting homes across 14 counties of Liberia. PARTICIPANTS No human participants were used in this study. METHODS Independent t-test, Pearson chi-square test, and logistic regression were performed to assess quality, birth outcomes, and service utilization between health facilities with and without functional maternity waiting homes. FINDINGS The overall health facility quality was not significantly different between health facilities associated with functional maternity waiting homes and those without. However, health facilities with functional maternity waiting homes had better infection control with the presence of soap and sharps boxes. Health facilities with functional maternity waiting homes were also more likely to have parenteral oxytocic drugs and were better able to perform assisted vaginal deliveries. The presence of functional maternity waiting homes were not significantly associated with health facility quality, birth outcomes, or care utilization. CONCLUSION AND IMPLICATIONS Health facilities with functional MWHs were better prepared to prevent infection and manage complicated deliveries. This study further highlights specific areas for quality improvement amongst these health facilities, including labor complications management.
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Affiliation(s)
- Rachel Horton
- Undergraduate Student, University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48104, United States.
| | - Haeun Lee
- Graduate Student, University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48104, United States.
| | - Joseph E Perosky
- Resident Physician, Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, 400 North Ingalls, Ann Arbor, MI 48104, United States.
| | | | - Jody R Lori
- Professor & Associate Dean for Global Affairs, University of Michigan, School of Nursing, 400 North Ingalls, Ann Arbor, MI 48104, United States.
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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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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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Agness Mseteka: Maternity Waiting Home Caretaker and Protector of Pregnant Women in Rural Zambia. Ann Glob Health 2021; 87:54. [PMID: 34221907 PMCID: PMC8231459 DOI: 10.5334/aogh.3253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To share her story, we interviewed Agness Mseteka about her experience as a maternity waiting home (MWH) caretaker at the district hospital in rural Lundazi, Zambia. Maternity waiting homes, also known as mother’s shelters, are structures built near healthcare facilities to minimize the critical barrier of distance to accessing maternal health services. Agness’ story highlights the central role caretakers play in contributing to the successful implementation and sustainability of MWH interventions. Agness is well positioned to be an agent of positive change by bringing health education to pregnant women. An important lesson learned from Agness’ story is the need for future research to explore the sustainability of MWHs and long-term effectiveness of income generating activities by the community after the completion of externally funded implementing programs.
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Implementation of shelter and Mid-Level Provider (MLP) to decrease Mother Mortality Rate (MMR) in Indonesia. ENFERMERIA CLINICA 2021. [PMID: 33040887 DOI: 10.1016/j.enfcli.2020.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This is research to find constraints faced in the utilization of shelter at East Sulawesi. METHOD The qualitative study will be designed. The methods of data collecting use were FGD and in-depth interview. RESULT The study found that the shelter is a residential house with facilities of beds and household appliances. Rental fees for housing and meals were provided free of charge. All fees are covered by government insurance. A pregnant woman did not have any activities and without any companion from health personnel when living in a shelter. Besides, pregnant women felt more comfortable living near their families. CONCLUSION There are some limitations to the utilization of shelters, such as human resources, cost, psychological condition, education, and facilities.
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Kurji J, Hackett K, Wild K, Lassi Z. The effect of maternity waiting homes on perinatal mortality is inconclusive: a critical appraisal of existing evidence from Sub-Saharan Africa. BMC Res Notes 2021; 14:86. [PMID: 33750459 PMCID: PMC7942174 DOI: 10.1186/s13104-021-05501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/25/2021] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Kristy Hackett
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Kayli Wild
- Judith Lumley Centre and Institute for Human Security & Social Change, La Trobe University, Plenty Road, Bundoora, Melbourne, 3086, Australia
| | - Zohra Lassi
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Helen Mayo North, 30 Frome Street, Adelaide, Australia.
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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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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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