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Yarinbab TE, Gesesew HA, Belachew T. Effectiveness of couple-based health education on utilization of maternity waiting homes among pregnant women in rural Ethiopia: A study protocol for cluster-randomized trial. Heliyon 2024; 10:e31791. [PMID: 38845960 PMCID: PMC11153171 DOI: 10.1016/j.heliyon.2024.e31791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background Maternity waiting homes are used to enhance women's access to health facilities in low-resource settings; however, its use remains low in Ethiopia. It is important to investigate strategies that can enhance the usage of maternity waiting homes in Ethiopia. Methods The purpose of his study is to assess how well couple-focused health education works to increase maternal knowledge, attitudes, and use of maternity waiting homes in rural Ethiopia. A cluster-randomized trial with two parallel groups will be the study's design. Three hundred twenty samples will be drawn from 16 clusters (160 in each group). Clusters will be assigned to intervention or control groups using a restricted randomization with a 1:1 allocation ratio. Women who are in their 14-16 weeks of gestation, or in the early stages of their second trimester, along with their male partners, will participate in the study. Health education, home visits, and the distribution of leaflets will be the intervention packages. Discussion The trial results will provide conclusive evidence on whether couple-based health education can improve women's access to maternity waiting homes in rural Ethiopia.
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Affiliation(s)
- Teklemariam Ergat Yarinbab
- Institute of Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
| | - Hailay Abrha Gesesew
- Research Center for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Tefera Belachew
- Institute of Health, Department of Nutrition & Dietetics, Jimma University, Jimma, Ethiopia
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Yarinbab TE, Gesesew HA, Belachew T. A phenomenological qualitative study of male-partners perspectives of maternity waiting homes in rural Ethiopia. PUBLIC HEALTH IN PRACTICE 2024; 7:100513. [PMID: 38846109 PMCID: PMC11153227 DOI: 10.1016/j.puhip.2024.100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/27/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Background The implementation of maternity waiting home (MWH) has been used as a strategy to improve maternal health outcomes in low-resource settings such as Ethiopia. However, MWH utilization is low in Ethiopia, and women's access to MWH depends largely on male partners' decisions. This study explored male-partners perspectives of MWHs including their experiences of paternal support in rural Ethiopia. Study design An exploratory qualitative study with a phenomenological methodological orientation was performed. Methods This study was conducted in Ana-Lemo and Gibe districts of Hadiya Zone, in rural Southern Ethiopia. The study participants were male partners. A purposive sampling technique was used to recruit 47 participants. Data were collected from May 10-25, 2023. Four focus group discussions, 15 in-depth interviews, and observations were conducted. The interviews were audio-recorded, transcribed and the thematic content analysis was performed using ATLAS.ti 7.1.4 software. Results This study showed that male-partners participated in spousal communication and provided practical support such as sharing household chores and financial support; however, they did not accompany their spouses to health facilities. Long distances, lack of transportation, poor referral services, and perceived poor quality of care were barriers to maternal health services. Furthermore, male-partners demonstrated poor awareness and unfavorable attitudes of MWHs. Conclusions Male-partners participated in spousal communication, shared household chores and provided financial support to their spouses; however, they did not accompany them to health facilities. They had poor awareness and unfavorable attitudes of MWHs. Creating awareness among male partners may improve their attitude towards MWHs and other maternal health services in rural Ethiopia.
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Affiliation(s)
- Teklemariam Ergat Yarinbab
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
- Department of Public Health, College of Health Sciences, Mizan Tepi University, Mizan Teferi, P.O.Box 260, Ethiopia
| | - Hailay Abrha Gesesew
- Research Center for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, 88Wakefield Street, SA, 5000, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, P.O.Box 231, Ethiopia
| | - Tefera Belachew
- Department of Nutrition & Dietetics, Institute of Health, Jimma University, Jimma, P.O.Box 378, Ethiopia
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Mukonka V, Sialubanje C, McAuliffe FM, Babaniyi O, Malumo S, Phiri J, Fitzpatrick P. Effect of a mother-baby delivery pack on institutional deliveries: A community intervention trial to address maternal mortality in rural Zambia. PLoS One 2024; 19:e0296001. [PMID: 38466648 PMCID: PMC10927137 DOI: 10.1371/journal.pone.0296001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/16/2023] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVES To test the effect of providing additional health education during antenatal care (ANC) and a mother-baby delivery pack on institutional deliveries in Monze, Zambia. SETTING 16 primary health facilities conducting deliveries in the district. PARTICIPANT A total of 5000 pregnant women at any gestation and age attending antenatal care (ANC) services in selected health facilities were eligible for enrolment into the study. Out of these, 4,500 (90%) were enrolled into and completed the study. A total of 3,882 (77.6%) were included in the analysis; 12.4% were not included in the analysis due to incomplete data. INTERVENTION A three-year study (2012 to 2014) analysing baseline delivery data for 2012 and 2013 followed by a community intervention trial was conducted from January to December 2014. Health facilities on the western side were assigned to the intervention arm; those on the eastern side were in the control. In addition to the health education provided during routine ANC visits, participants in the intervention arm received health education and a mother-baby delivery pack when they arrived at the health facility for delivery. Participants in the control arm continued with routine ANC services. OUTCOME MEASURES The primary measure was the number of institutional deliveries in both arms over the one-year period. Secondary measures were utilisation of ANC, post-natal care (PNC) and under-five clinic services. Descriptive statistics (frequencies, proportions, means and standard deviation) were computed to summarise participant characteristics. Chi-square and Independent T-tests were used to make comparisons between the two arms. One way analysis of variance (ANOVA) was used to test the effect of the intervention after one year (p-value<0.05). Analysis was conducted using R-studio statistical software version 4.2.1. The p-value<0.05 was considered significant. RESULTS Analysis showed a 15.9% increase in the number of institutional deliveries and a significant difference in the mean number of deliveries between intervention and control arms after one year (F(1,46) = 18.85, p<0.001). Post hoc analysis showed a significant difference in the mean number of deliveries between the intervention and control arms for 2014 (p<0.001). Compared to the control arm, participants in the intervention arm returned earlier for PNC clinic visit, brought their children back and started the under-five clinic visits earlier. CONCLUSION These findings provide evidence for the effectiveness of the mother-baby delivery pack and additional health education sessions on increasing institutional deliveries, PNC and under-five children's clinic utilisation in rural Zambia. TRIAL REGISTRATION ISRCTN Registry (ISRCTN15439813 DOI 10.1186/ISRCTN15439813); Pan African Clinical Trial Registry (PACTR202212611709509).
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Affiliation(s)
- Victor Mukonka
- School of Medicine, Copperbelt University, Ndola, Zambia
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Cephas Sialubanje
- School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | | | - Sarai Malumo
- World Health Organization, Country Office, Lusaka, Zambia
| | - Joseph Phiri
- National Malaria Elimination Centre, Ministry of Health, Lusaka, Zambia
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
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Tayebwa E, Gatimu SM, Kalisa R, Kim YM, van Dillen J, Stekelenburg J. Provider and client perspectives on the use of maternity waiting homes in rural Rwanda. Glob Health Action 2023; 16:2210881. [PMID: 37190999 DOI: 10.1080/16549716.2023.2210881] [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: 05/17/2023] Open
Abstract
BACKGROUND The World Health Organization recommends the implementation of maternity waiting homes (MWH) to reduce delays in access to obstetric care, particularly for high-risk pregnancies and mothers living far from health facilities, and as a result, several countries have rolled out MWHs. However, Rwanda has not implemented this recommendation on a large scale. There is only one MWH in the country, hence a gap in knowledge regarding the potential utilisation and benefits of MWHs. OBJECTIVE To explore providers' and clients' perspectives on facilitators and barriers to the use of MWH in rural Rwanda. METHODS We conducted a qualitative study to explore health providers' and clients' perspectives on facilitators and barriers to the use of MWH in Rwanda, between December 2020 and January 2021. We used key informant interviews and focus group discussions to collect data. Data were analysed using NVivo qualitative analysis software version 11. RESULTS Facilitators included perceptions that the MWH offered either a peaceful and home-like environment, good-quality services, or timely obstetric services, and was associated with good maternal and neonatal outcomes. Barriers included limited awareness of the MWH among pregnant women, fear of health providers to operate the MWH at full capacity, women's lack of autonomy, uncertainty over funding for the MWH, and perceived high user fees. CONCLUSION The Ruli MWH offers a peaceful environment for pregnant women while providing quality and timely obstetric care, resulting in positive maternal and neonatal outcomes for women. However, its existence and benefits are not widely known, and its use is limited due to inadequate resources. There is a need for increased awareness of the MWH among healthcare providers and the community, and lessons from this MWH could inform the scale up of MWHs in Rwanda.
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Affiliation(s)
- Edwin Tayebwa
- Department of Health Sciences, Global Health, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Richard Kalisa
- School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Young-Mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, MD, USA
| | - Jeroen van Dillen
- Amalia Children's Hospital, Radboudumc Nijmegen, Nijmegen, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Binyaruka P, Foss A, Alibrahim A, Mziray N, Cassidy R, Borghi J. Supply-side factors influencing demand for facility-based delivery in Tanzania: a multilevel analysis. HEALTH ECONOMICS REVIEW 2023; 13:52. [PMID: 37930445 PMCID: PMC10629065 DOI: 10.1186/s13561-023-00468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Improving access to facility-based delivery care has the potential to reduce maternal and newborn deaths across settings. Yet, the access to a health facility for childbirth remains low especially in low-income settings. To inform evidence-based interventions, more evidence is needed especially accounting for demand- and supply-side factors influencing access to facility-based delivery care. We aimed to fill this knowledge gap using data from Tanzania. METHODS We used data from a cross-sectional survey (conducted in January 2012) of 150 health facilities, 1494 patients and 2846 households with women who had given births in the last 12 months before the survey across 11 districts in three regions in Tanzania. The main outcome was the place of delivery (giving birth in a health facility or otherwise), while explanatory variables were measured at the individual woman and facility level. Given the hierarchical structure of the data and variance in demand across facilities, we used a multilevel mixed-effect logistic regression to explore the determinants of facility-based delivery care. RESULTS Eighty-six percent of 2846 women gave birth in a health facility. Demand for facility-based delivery care was influenced more by demand-side factors (76%) than supply-side factors (24%). On demand-side factors, facility births were more common among women who were educated, Muslim, wealthier, with their first childbirth, and those who had at least four antenatal care visits. On supply-side factors, facility births were more common in facilities offering outreach services, longer consultation times and higher interpersonal quality. In contrast, facilities with longer average waiting times, longer travel times and higher chances of charging delivery fees had few facility births. CONCLUSIONS Policy responses should aim for strategies to improve demand like health education to raise awareness towards care seeking among less educated groups and those with higher parity, reduce financial barriers to access (including time costs to reach and access care), and policy interventions to enhance interpersonal quality in service provision.
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Affiliation(s)
- Peter Binyaruka
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania.
| | - Anna Foss
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Abdullah Alibrahim
- College of Engineering and Petroleum, Kuwait University, Kuwait City, Kuwait
| | - Nicholaus Mziray
- Department of Health System, Impact Evaluation and Policy, Ifakara Health Institute, PO Box 78373, Dar es Salaam, Tanzania
| | - Rachel Cassidy
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
- KPM Center for Public Management, University of Bern, Schanzeneckstrasse 1, Bern, 3012, Switzerland
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Yarinbab TE, Gesesew HA, Harrison MS, Belachew T. Effect of couple-based health education on male-partners knowledge and attitude towards maternity waiting homes in rural Ethiopia: a cluster-randomized trial. Sci Rep 2023; 13:18446. [PMID: 37891206 PMCID: PMC10611718 DOI: 10.1038/s41598-023-45681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/23/2023] [Indexed: 10/29/2023] Open
Abstract
This cluster-randomized controlled trial examined the effect of couple-based health education on male partners' knowledge and attitude towards maternity waiting homes (MWH) in rural Ethiopia. Sixteen clusters and 320 couples were randomly assigned to intervention group (receiving group health education, home visits and print health messages alongside usual care) or control group (receiving usual care). The Chi-square test was used to estimate statistical differences, and the difference-in-differences model was used to estimate the effect of the intervention. The generalized linear regression model was used to determine the odds of outcomes between the groups. Statistical significance was set at p < 0.05, with a 95% CI. There were no significant differences in baseline characteristics between the control and intervention groups. The net effect of the intervention on improving knowledge about MWHs, and attitude towards MWHs were 35.6% and 36.2%, respectively. The participants in the intervention group were 5.5 times more likely to have good knowledge about MWH (AOR 5.55, 95% CI 3.37-9.14) and 5.6 times more likely to have a favorable attitude towards MWH (AOR 5.61, 95% CI 3.45-9.10) compared to their counterparts. Health education provided to couples significantly improved male partners' knowledge and attitude towards MWHs in rural Ethiopia.Trial registration: ClinicalTrials.gov Identifier: NCT05015023.
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Affiliation(s)
- Teklemariam Ergat Yarinbab
- Institute of Health, Department of Population and Family Health, Jimma University, Jimma, Ethiopia.
- Department of Epidemiology and Biostatistics, College of Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia.
| | - Hailay Abrha Gesesew
- Research Center for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Margo Shawn Harrison
- Department of Gynecology and Obstetrics, School of Medicine, University of Colorado, Denver, CO, USA
| | - Tefera Belachew
- Department of Nutrition & Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
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Kalindi AM, Houle B, Smyth BM, Chisumpa VH. Gender inequities in women's access to maternal health care utilisation in Zambia: a qualitative analysis. BMC Pregnancy Childbirth 2023; 23:755. [PMID: 37884910 PMCID: PMC10601225 DOI: 10.1186/s12884-023-06078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The role of gender inequities in women's ability to access maternal health care has mainly been analysed from either women's or men's perspective only. In this article, we explore the role of gender inequities in maternal health care utilisation from both men's and women's perspectives. METHODS Thirty-six interviews were conducted with reproductive age women (n = 24), and men whose wives/partners gave birth within the last three years prior to our study in Zambia (n = 12). Our study sought to improve understanding of the normative environment in which women and men make decisions on maternal health care utilisation in Zambia. RESULTS We found that men and women had different expectations regarding their gender roles in maternal health care utilisation, which created inequities reinforced by societal norms and traditions. Men make most household decisions including those related to reproductive health and they often have the major say in access to maternal health services despite not having holistic maternal health information which creates challenges in maternal health care utilisation. CONCLUSION The study highlights the need for maternal health care utilisation decisions to be made by both men and women and that men should be fully involved in maternal health care from pregnancy until after child birth. Further, there is urgent need for concerted and sustained efforts to change traditional norms that reinforce these inequities and affect maternal health care utilisation if Zambia is to meet Sustainable Development Goal-3.1.
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Affiliation(s)
- Audrey M Kalindi
- School of Demography, The Australian National University, Acton, ACT, Australia.
| | - Brian Houle
- School of Demography, The Australian National University, Acton, ACT, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Bruce M Smyth
- Centre for Social Research and Methods, The Australian National University, Acton, ACT, Australia
| | - Vesper H Chisumpa
- Department of Population Studies, School of Humanities and Social Sciences, The University of Zambia, Lusaka, Zambia
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Tilahun D, Shaka MF, Belay MM. Determinants of maternity waiting home utilization among women who gave birth in public health facilities in the Gedeo Zone, southern Ethiopia: an unmatched case-control study. Front Glob Womens Health 2023; 4:1170843. [PMID: 37654684 PMCID: PMC10465344 DOI: 10.3389/fgwh.2023.1170843] [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: 02/24/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Background Maternal mortality remains unacceptably high in Ethiopia, although most of its causes are preventable. One way of tackling this problem is by establishing a maternal waiting home (MWH) close to a health facility. Although the benefits of an MWH have been well-documented, the determinants of its use have not been well-studied. This study aims to identify the determinants of utilization of an MWH among women who gave birth in public health facilities in the Gedeo Zone, southern Ethiopia. Methods A facility-based unmatched case-control study was conducted between January 2020 and February 2020) among 129 patients belonging to the case group and 257 belonging to the control group. The data were entered into the Epi-Data version 3.1 and exported to the SPSS version 20 statistical package for analysis. Descriptive statistics such as frequency, means, and standard deviations were computed. The association between variables was checked using logistic regression analysis, and odds ratios (ORs) with 95% confidence interval (CI) were used to determine the strength of this association. A p-value of < 0.05 was used as a cutoff point to measure statistical significance. Result A total of 378 respondents (126 cases and 252 controls) were included in the study, successfully achieving a response rate of 97.9%. The mean age of the participants was 27.4 (±5.6 SD) years, which was 28.4 (±5.5 SD) years for case group patients and 26.9 (±5.69 SD) years for control group patients. The educational status of women [adjusted odds ratio (AOR): 8.49, 95% CI: 2.91-24.7], travel time (AOR: 2.92, 95% CI:1.41-4.67), antenatal care visits (AOR: 3.54, 95% CI: 1.33-9.38), those having more than two children under the age of 5 years (AOR: 0.12, 95% CI: 0.06-0.26), those with a history of complications in previous childbirths (AOR: 4.52 95% CI: 2.41-8.47), previous place of delivery (AOR: 6.30, 95% CI: 2.71-14.78), and a lack of awareness (AOR: 5.8, 95% CI: 2.23-15.2) were all significantly associated with the utilization of an MWH. Conclusion Educational status, antenatal care follow-up, number of children under 5 years old in the household, previous place of delivery, lack of awareness regarding maternal waiting home service, and travel time were all determinants of MWH use. This implies that interventions focusing on promoting antenatal care visits, institutional delivery, and raising awareness of the benefits of MWHs are important for improving their rate of utilization.
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Affiliation(s)
| | | | - Moges Mareg Belay
- Department of Reproductive Health, Dilla University College of Health Sciences and Medicine, Dilla, Ethiopia
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Gebeyehu NA, Assefa Y, Abebe K. Intention to use maternal waiting home and its predictors among pregnant women in Ethiopia: systematic review and meta-analysis. Eur J Med Res 2023; 28:274. [PMID: 37550705 PMCID: PMC10405426 DOI: 10.1186/s40001-023-01248-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND A high maternal death rate is a result of maternal delays in seeking emergency obstetric care, particularly in countries with limited resources like Ethiopia. Utilizing maternity waiting homes is a strategy to overcome geographical barriers and improve maternal and neonatal health outcomes. Pregnant women must intend to use this service in addition to it being available. Therefore, the goal of this study was to assess pregnant women's intentions to use maternity waiting homes and associated characteristics. METHODS PubMed, Google Scholar, Scopus, Science Direct, and online institutional repository homes were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (v. 14). Publication bias was checked by forest plot, Begg's, and Egger's tests. To look for heterogeneity, I2 was computed, and an overall estimated analysis was carried out. Subgroup analysis was done by study region, sample size, and publication. The pooled odds ratio for associated factors was also computed. RESULTS Out of 258 articles assessed, 8 studies with 4111 study participants met the criteria and were included in this study. The pooled prevalence of intention to use maternity waiting home was 52.25% (95% CI 45.88-58.66), I2 = 93.8%). Amhara region had a higher intention to use maternal waiting for home prevalence (63.5%), per subgroup analysis. In studies with sample sizes higher than 5000, the usage of maternity waiting homes was less prevalent (45.2%). Between published research (52.9%) and unpublished studies (51.3%), there was no appreciable difference in the intention to use a maternity waiting home. Experience of maternity waiting home (AOR = 3.337; 95% CI 2.038-5.463), direct subjective norm (AOR = 2.763; 95% CI 1.395-5.471), and direct perceived behavioral control (AOR = 23.147; 95% CI 2.341-4.231). CONCLUSION In Ethiopia, the intention to use maternity waiting was low. There was an intentional variation in to use of maternity waiting homes across regions of Ethiopia. Improving behavioral perception through intervention programs such as antenatal education should have been strengthened.
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Affiliation(s)
- Natnael Atnafu Gebeyehu
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia.
| | - Yibeltal Assefa
- Department of Public Health, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
| | - Kelemu Abebe
- Department of Midwifery, College of Medicine and Health Science, Wolaita Sodo University, Sodo, Ethiopia
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van Braam EJ, McRae DN, Portela AG, Stekelenburg J, Penn-Kekana L. Stakeholders' perspectives on the acceptability and feasibility of maternity waiting homes: a qualitative synthesis. Reprod Health 2023; 20:101. [PMID: 37407983 PMCID: PMC10324180 DOI: 10.1186/s12978-023-01615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of stakeholders' perspectives (women, families, communities and health workers) on the acceptability and feasibility of MWHs. METHODS A qualitative evidence synthesis was conducted. Studies that were published between January 1990 and July 2020, containing qualitative data on the perspectives of the stakeholder groups were included. A combination of inductive and deductive coding and thematic synthesis was used to capture the main perspectives in a thematic framework. RESULTS Out of 4,532 papers that were found in the initial search, a total of 38 studies were included for the thematic analysis. Six themes emerged: (1) individual factors, such as perceived benefits, awareness and knowledge of the MWH; (2) interpersonal factors and domestic responsibilities, such as household and childcare responsibilities, decision-making processes and social support; (3) MWH characteristics, such as basic services and food provision, state of MWH infrastructure; (4) financial and geographical accessibility, such as transport availability, costs for MWH attendance and loss of income opportunity; (5) perceived quality of care in the MWH and the adjacent health facility, including regular check-ups by health workers and respectful care; and (6) Organization and advocacy, for example funding, community engagement, governmental involvement. The decision-making process of women and their families for using an MWH involves balancing out the gains and losses, associated with all six themes. CONCLUSION This systematic synthesis of qualitative literature provides in-depth insights of interrelating factors that influence acceptability and feasibility of MWHs according to different stakeholders. The findings highlight the potential of MWHs as important links in the maternal and neonatal health (MNH) care delivery system. The complexity and scope of these determinants of utilization underlines the need for MWH implementation strategy to be guided by context. Better documentation of MWH implementation, is needed to understand which type of MWH is most effective in which setting, and to ensure that those who most need the MWH will use it and receive quality services. These results can be of interest for stakeholders, implementers of health interventions, and governmental parties that are responsible for MNH policy development to implement acceptable and feasible MWHs that provide the greatest benefits for its users. Trial registration Systematic review registration number: PROSPERO 2020, CRD42020192219.
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Affiliation(s)
| | - Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anayda G Portela
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
- Department Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Loveday Penn-Kekana
- Department of Maternal Health and Health Systems, London School of Hygiene and Tropical Medicine, London, UK
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Sserwanja Q, Gatasi G, Musaba MW. Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019-2020 Rwanda demographic health survey. BMC Pregnancy Childbirth 2022; 22:781. [PMID: 36261801 PMCID: PMC9583497 DOI: 10.1186/s12884-022-05109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda. METHODS We analyzed weighted secondary data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression. RESULTS Of the 6,302 women, 2,131 (33.8%) (95% CI: 32.8-35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11-1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01-1.52), southern region (AOR): 1.26, 95% CI: 1.04-1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30-1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15-1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07-1.46), those who were married (AOR): 1.35, 95% CI: 1.11-1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05-2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07-1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18-1.95). CONCLUSION We have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.
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Affiliation(s)
| | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Ministry of Education, Southeast University, 210009, Nanjing, Jiangsu Province, China
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.,Department of Obstetrics and Gynaecology, Busitema University, Tororo, Uganda
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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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Bala ET, Roets L. Challenges in postnatal care provision in Ethiopia. Front Public Health 2022; 10:922933. [PMID: 35991036 PMCID: PMC9387302 DOI: 10.3389/fpubh.2022.922933] [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] [Received: 04/18/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMost maternal deaths occur during the first 48 h after delivery; thus, a critical time for monitoring possible complications arising from the delivery. Quality postnatal care can contribute to a decrease in maternal mortality and morbidity rates. Despite the importance of postnatal care, it is generally a neglected aspect of maternal and child health services in most developing countries, including Ethiopia.ObjectivesThe objective of the study was to describe the challenges experienced by postnatal care providers and coordinators in providing postnatal care in the Ethiopian context.MethodsA quantitative cross-sectional descriptive study was conducted and data were gathered from 422 postnatal care providers and coordinators during November 2018. A simple random sampling technique was used to select the respondents and the data were gathered through a self-administered questionnaire. The data were cleaned, coded and entered into the Statistical Package for Social Sciences (SPSS) version 21 for analysis. Open-ended questions for qualitative enhancement were open-coded and thematically analyzed.ResultsThe findings revealed a lack of physical resources; infrastructure problems; cultural concerns; inadequate capacity building; inaccessibility of health services; unavailability of guidelines; a lack of communication with healthcare users and poor monitoring and evaluation as challenges.ConclusionTo improve postnatal care in Ethiopia and, ultimately, mother and child health, the challenges experienced by postnatal care providers and coordinators have to be dealt with. A strategic action plan with the active involvement of all stakeholders must be developed and implemented to deal with the challenges and improve postnatal care.
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Fontanet CP, Kaiser JL, Fong RM, Ngoma T, Lori JR, Biemba G, Munro-Kramer M, Sakala I, McGlasson KL, Vian T, Hamer DH, Rockers PC, Scott NA. Out-of-Pocket Expenditures for Delivery for Maternity Waiting Home Users and Non-users in Rural Zambia. Int J Health Policy Manag 2022; 11:1542-1549. [PMID: 34273929 PMCID: PMC9808339 DOI: 10.34172/ijhpm.2021.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 05/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Utilizing maternity waiting homes (MWHs) is a strategy to improve access to skilled obstetric care in rural Zambia. However, out-of-pocket (OOP) expenses remain a barrier for many women. We assessed delivery-related expenditure for women who used MWHs and those who did not who delivered at a rural health facility. METHODS During the endline of an impact evaluation for an MWH intervention, household surveys (n = 826) were conducted with women who delivered a baby in the previous 13 months at a rural health facility and lived >10 km from a health facility in seven districts of rural Zambia. We captured the amount women reported spending on delivery. We compared OOP spending between women who used MWHs and those who did not. Amounts were converted from Zambian kwacha (ZMW) to US dollar (USD). RESULTS After controlling for confounders, there was no significant difference in delivery-related expenditure between women who used MWHs (US$40.01) and those who did not (US$36.66) (P=.06). Both groups reported baby clothes as the largest expenditure. MWH users reported spending slightly more on accommodation compared to those did not use MWHs, but this difference represents only a fraction of total costs associated with delivery. CONCLUSION Findings suggest that for women coming from far away, utilizing MWHs while awaiting delivery is not costlier overall than for women who deliver at a health facility but do not utilize a MWH.
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Affiliation(s)
- Constance P. Fontanet
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L. Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Rachel M. Fong
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Jody R. Lori
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Michelle Munro-Kramer
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | | | - Kathleen Lucile McGlasson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Taryn Vian
- Department of Global Health, School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Peter C. Rockers
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Nancy A. Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Fong RM, Kaiser JL, Ngoma T, Vian T, Bwalya M, Sakanga VR, Lori JR, Kuhfeldt KJ, Musonda G, Munro-Kramer M, Rockers PC, Hamer DH, Ahmed Mdluli E, Biemba G, Scott NA. Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women's perceptions after implementation of an improved maternity waiting homes intervention. BMJ Open 2022; 12:e058512. [PMID: 35879007 PMCID: PMC9328096 DOI: 10.1136/bmjopen-2021-058512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Women in sub-Saharan Africa face well-documented barriers to facility-based deliveries. An improved maternity waiting homes (MWH) model was implemented in rural Zambia to bring pregnant women closer to facilities for delivery. We qualitatively assessed whether MWHs changed perceived barriers to facility delivery among remote-living women. DESIGN We administered in-depth interviews (IDIs) to a randomly selected subsample of women in intervention (n=78) and control (n=80) groups who participated in the primary quasi-experimental evaluation of an improved MWH model. The IDIs explored perceptions and preferences of delivery location. We conducted content analysis to understand perceived barriers and facilitators to facility delivery. SETTING AND PARTICIPANTS Participants lived in villages 10+ km from the health facility and had delivered a baby in the previous 12 months. INTERVENTION The improved MWH model was implemented at 20 rural health facilities. RESULTS Over 96% of participants in the intervention arm and 90% in the control arm delivered their last baby at a health facility. Key barriers to facility delivery were distance and transportation, and costs associated with delivery. Facilitators included no user fees, penalties for home delivery, desire for safe delivery and availability of MWHs. Most themes were similar between study arms. Both discussed the role MWHs have in improving access to facility-based delivery. Intervention arm participants expressed that the improved MWH model encourages use and helps overcome the distance barrier. Control arm participants either expressed a desire for an improved MWH model or did not consider it in their decision making. CONCLUSIONS Even in areas with high facility-based delivery rates in rural Zambia, barriers to access persist. MWHs may be useful to address the distance challenge, but no single intervention is likely to address all barriers experienced by rural, low-resourced populations. MWHs should be considered in a broader systems approach to improving access in remote areas. TRIAL REGISTRATION NUMBER NCT02620436.
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Affiliation(s)
- Rachel M Fong
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeanette L Kaiser
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Taryn Vian
- University of San Francisco - School of Nursing and Health Professions, San Francisco, California, USA
| | | | | | - Jody R Lori
- Office for Global Affairs & PAHO/WHO Collaborating Center, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kayla J Kuhfeldt
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Michelle Munro-Kramer
- Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter C Rockers
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Godfrey Biemba
- Pediatric Centre of Excellence, National Health Research Authority, Lusaka, Zambia
| | - Nancy A Scott
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Shiferaw MM, Tiguh AE, Kebede AA, Taye BT. Utilization of maternal waiting home and associated factors among women who gave birth in the last one year, Dabat district, Northwest Ethiopia. PLoS One 2022; 17:e0271113. [PMID: 35802568 PMCID: PMC9269408 DOI: 10.1371/journal.pone.0271113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
| | - Agumas Eskezia Tiguh
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Azmeraw Ambachew Kebede
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health science, University of Gondar, Gondar, Ethiopia
| | - Birhan Tsegaw Taye
- Department of Midwifery, College of Health science, Debre Birhan University, Debre Birhan, Ethiopia
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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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Continuum of care for maternal health in Uganda: A national cross-sectional study. PLoS One 2022; 17:e0264190. [PMID: 35202413 PMCID: PMC8870527 DOI: 10.1371/journal.pone.0264190] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/04/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction A continuum of maternal care approach can reduce gaps and missed opportunities experienced by women and newborns. We determined the level of coverage and factors associated with the continuum of maternal care in Uganda. Methods We used weighted data from the Uganda Demographic and Health Survey (UDHS) 2016. We included 10,152 women aged 15 to 49 years, who had had a live birth within five years preceding the survey. Stratified two-stage cluster sampling design was used to select participants. Continuum of maternal care was considered when a woman had at least four antenatal care (ANC) visits, had delivered in a health facility and they had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression analysis to determine factors associated with completion of the continuum of maternal care using SPSS version 25. Results The level of coverage of complete continuum of maternal care was 10.7% (1,091) (95% CI: 10.0–11.2). About 59.9% (6,080) (95% CI: 59.0–60.8) had four or more antenatal visits while 76.6% (7,780) (95% CI: 75.8–77.5) delivered in a health facility and 22.5% (2,280) (95% CI: 21.5–23.2) attended at least one postnatal care visit within six weeks. The following factors were associated with continuum of maternal care; initiating ANC in the first trimester (AOR 1.49, 95% CI: 1.23–1.79), having secondary level of education (AOR 1.60, 95% CI: 1.15–2.22) and tertiary level of education (AOR 2.08 95% CI: 1.38–3.13) compared to no formal education, being resident in Central Uganda (AOR 1.44, 95% CI:1.11–1.89), Northern Uganda (AOR 1.35, 95% CI: 1.06–1.71) and Western Uganda (AOR 0.61, 95% CI: 0.45–0.82) compared to Eastern Uganda, and exposure to newspapers and magazines. Conclusion The level of coverage of the complete continuum of maternal care was low and varied across regions. It was associated with easily modifiable factors such as early initiation of ANC, exposure to mass media and level of education. Interventions to improve utilisation of the continuum of maternal care should leverage mass media to promote services, especially among the least educated and the residents of Western Uganda.
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The long-term effects of free care on birth outcomes: Evidence from a national policy reform in Zambia. SSM Popul Health 2022; 17:101051. [PMID: 35252533 PMCID: PMC8889414 DOI: 10.1016/j.ssmph.2022.101051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/04/2022] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
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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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Ngotie TK, Kaura DKM, Mash B. Awareness of cultural practices by skilled birth attendants during pregnancy and birth in Kenya: An interpretive phenomenological study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2022. [DOI: 10.1016/j.ijans.2022.100394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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23
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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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Sserwanja Q, Musaba MW, Mutisya LM, Olal E, Mukunya D. Continuum of maternity care in Zambia: a national representative survey. BMC Pregnancy Childbirth 2021; 21:604. [PMID: 34482830 PMCID: PMC8420052 DOI: 10.1186/s12884-021-04080-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background Globally, over half of maternal deaths are related to pregnancy-related complications. Provision of a continuum of care during pregnancy, childbirth and the postnatal period results in reduced maternal and neonatal morbidity and mortality. Hence this study determined the prevalence of the continuum of care and its determinants among women in Zambia. Methods We used weighted data from the Zambian Demographic and Health Survey (ZDHS) of 2018 for 7325 women aged 15 to 49 years. Multistage stratified sampling was used to select study participants. Complete continuum of care was considered when a woman had; at least four antenatal care (ANC) contacts, utilized a health facility for childbirth and had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression to explore continuum of care in Zambia. All our analyses were done using SPSS version 25. Results Of the 7,325 women, 38.0% (2787/7325) (95% confidence interval (CI): 36.9-39.1) had complete continuum of maternal healthcare. Women who had attained tertiary level of education (adjusted odds ratio (AOR): 1.93, 95% CI: 1.09-3.42) and whose partners had also attained tertiary level of education (AOR: 2.58, 95% CI: 1.54-4.32) were more likely to utilize the whole continuum of care compared to those who had no education. Women who initiated ANC after the first trimester (AOR: 0.46, 95% CI: 0.39-0.53) were less likely to utilize the whole continuum of care compared to those who initiated in the first semester. Women with exposure to radio (AOR: 1.58, 95% CI: 1.27-1.96) were more likely to utilize the whole continuum of care compared to those who were not exposed to radio. Women residing in the Western province were less likely to utilize the entire continuum of care compared to those in the other nine provinces. Conclusion Level of education of the women and of their partners, early timing of ANC initiation, residing in other provinces other than the Western province, and exposure to information through radio were positively associated with utilization of the entire continuum of care. Improving literacy levels and promoting maternity services through radio may improve the level of utilization of maternity services. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04080-1.
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Affiliation(s)
- Quraish Sserwanja
- Programs Department, GOAL, Arkaweet Block 65 House No. 227, Khartoum, Sudan.
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Linet M Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | | | - David Mukunya
- Department of Community and Public Health, Busitema University, Mbale, Uganda.,Sanyu Africa Research Institute, Mbale, Uganda
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Habte A, Dessu S, Lukas K. Determinants of Premature Rupture of Membranes Among Pregnant Women Admitted to Public Hospitals in Southern Ethiopia, 2020: A Hospital-Based Case-Control Study. Int J Womens Health 2021; 13:613-626. [PMID: 34188555 PMCID: PMC8235927 DOI: 10.2147/ijwh.s314780] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A gush of amniotic fluid any time before the onset of labor is known as premature rupture of the membranes (PROM). Its consequences vary from maternal and neonatal mortality and morbidity to country-wide economic loss. At the national level in general, and in the study area in particular, little is known about PROM and its determinants. Hence, this study aimed at identifying determinants of PROM among pregnant women admitted to public hospitals in Southern Ethiopia, 2020. METHODS AND MATERIALS A hospital-based unmatched case-control study was conducted on 279 pregnant women (93 cases and 186 controls) admitted to public hospitals from October 1 to 30, 2020. Pregnant women admitted to maternity wards of selected hospitals with a painless gush of fluid spilling out from the vaginal canal were considered as cases. Interviewer-administered questionnaires and data abstraction tools were used to collect data. The data were coded and entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. The determinants of PROM were identified by applying a multivariable logistic regression analysis at a p-value <0.05. RESULTS Term PROM accounted for the majority, 55 (59.2%) of cases. Previous history of abortion (AOR: 4.14, 95% CI: 2.21-9.07), lack of ANC (AOR: 3.51; 95% CI: 1.33-8.27), previous history of PROM (AOR: 4.91; 95% CI: 2.23-9.82), caesarean delivery (AOR: 3.02, 95% CI: 1.24-6,40), using of a maternal waiting room (MWR) (AOR: 0.33, 95% CI: 0.15-0.74), and mid-upper arm Circumference (MAUC) <23cm (AOR: 3.69, 95% CI: 1.58-8.64) were identified as significant determinants of PROM. CONCLUSION Health-care providers should work on providing adequate ANC by tracing mothers who have not received it and advising pregnant women to use MWR in the final weeks of their pregnancy. Furthermore, maternal and child health care units must place a strong focus on screening and managing the nutritional status of pregnant women. Furthermore, women with a history of abortion, caesarean section, and PROM need due attention from health care providers to mitigate the occurrence of PROM.
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Affiliation(s)
- Aklilu Habte
- Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Southern Ethiopia
| | - Samuel Dessu
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Southern Ethiopia
| | - Kaleegziabher Lukas
- Department of Epidemiology, School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
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26
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Intention to use maternity waiting home and associated factors among pregnant women in Gamo Gofa zone, Southern Ethiopia, 2019. PLoS One 2021; 16:e0251196. [PMID: 33983992 PMCID: PMC8118329 DOI: 10.1371/journal.pone.0251196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/21/2021] [Indexed: 11/28/2022] Open
Abstract
Background A maternity waiting home is a temporary residence in which pregnant women from remote areas wait for their childbirth. It is an approach targeted to advance access to emergency obstetric care services especially, in hard-to-reach areas to escalate institutional delivery to reduce complications that occur during childbirth. Apart from the availability of this service, the intention of pregnant women to utilize the existing service is very important to achieve its goals. Thus, this study aimed to assess the intention to use maternity waiting homes and associated factors among pregnant women. Methods Community-based cross-sectional study was conducted among 605 pregnant women using a multistage sampling technique from March 10 to April 10, 2019, by using a structured questionnaire through a face-to-face interview. The collected data was entered into Epi-Data version 3.1 and analyzed using the SPSS version 24 statistical package. Logistic regression analysis was used to test the association. All variables at p-value < 0.25 in bivariate analysis were entered into multivariate analysis. Lastly, a significant association was declared at a P-value of < 0.05 with 95% CI. Results In this study, the intention to use maternity waiting homes was 295(48.8%, 95%CI: 47%-55%)). Occupation (government employee) (AOR:2.87,95%CI: 1.54–5.36), previous childbirth history (AOR:2.1,95%CI:1.22–3.57), past experience in maternity waiting home use AOR:4.35,95%CI:2.63–7.18), direct (AOR:1.57,95%CI:1.01–2.47) and indirect (AOR: 2.18, 1.38,3.44) subject norms and direct (AOR:3.00,95%CI:2.03–4.43), and indirect (AOR = 1.84,95%CI:1.25–2.71) perceived behavioral control of respondents were significantly associated variables with intention to use maternity waiting home. Conclusion The magnitude of intention to use maternity waiting homes among pregnant women is low. Community disapproval, low self-efficacy, maternal employment, history of previous birth, and past experiences of MWHs utilization are predictors of intention to use MWHs, and intervention programs, such as health education, strengthening and integration of community in health system programs need to be provided.
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27
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Ofosu B, Ofori D, Ntumy M, Asah-Opoku K, Boafor T. Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach. BMC Health Serv Res 2021; 21:402. [PMID: 33926425 PMCID: PMC8082760 DOI: 10.1186/s12913-021-06402-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions in an urban district, using Ablekuma in Accra, Ghana as a case study. METHODS The study is an analytical cross-sectional study. Nine [1] targeted interviews were carried out for a three-week period in June and July 2019 after informed written consent with two [2] Obstetrics & Gynaecology consultants, two [2] Residents, one family physician, and four [3] Midwives managing emergency obstetric referral across different levels of facilities. Purposeful sampling technique was used to collect data that included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system. RESULTS Out of the 34 main activities in the referral process within the facilities, the study identified that 24 (70%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), Healthcare providers (HCP) knowledge and compliance to referral policy and guideline, and financing for referral. These findings have implication on delay in accessing care. HCP suggested that strengthening communication and coordination, reviewing referral policy, training of all stakeholders and provision of essential resources would be beneficial. CONCLUSION Our findings clearly establish that the emergency obstetric referral system between a typical teaching hospital in an urban district of Accra-Ghana and peripheral referral facilities, is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions, strengthening collaborations, communication and transport along the referral pathway. These suggestions are likely to ensure that women receive timely and quality care.
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Affiliation(s)
- Bernice Ofosu
- Department of Obstetrics & Gynaecology, KorleBu Teaching Hospital, Box 4236, Korle-Bu, Accra, Ghana
| | - Dan Ofori
- University of Ghana Business School, Legon, Ghana
| | - Michael Ntumy
- Department of Obstetrics & Gynaecology, KorleBu Teaching Hospital, Box 4236, Korle-Bu, Accra, Ghana
- University of Ghana Medical School, KorleBu, Accra, Ghana
| | - Kwaku Asah-Opoku
- Department of Obstetrics & Gynaecology, KorleBu Teaching Hospital, Box 4236, Korle-Bu, Accra, Ghana
- University of Ghana Medical School, KorleBu, Accra, Ghana
| | - Theodore Boafor
- Department of Obstetrics & Gynaecology, KorleBu Teaching Hospital, Box 4236, Korle-Bu, Accra, Ghana.
- University of Ghana Medical School, KorleBu, Accra, Ghana.
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Lee H, Maffioli EM, Veliz PT, Munro-Kramer ML, Phiri TK, Sakala I, Kaunda J, Chiboola NM, Lori JR. Role of Savings and Internal Lending Communities (SILCs) in improving household wealth and financial preparedness for birth in rural Zambia. Health Policy Plan 2021; 36:1269-1278. [PMID: 33909075 PMCID: PMC8428586 DOI: 10.1093/heapol/czab049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/23/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022] Open
Abstract
Savings and Internal Lending Communities (SILCs) are a type of informal microfinance mechanism adapted in many low- and middle-income countries (LMICs) to improve financial resources for poor and rural communities. Although SILCs are often paired with other health and non-health-related interventions, few studies have examined SILCs in the context of maternal health. This study examined the association between SILC participation, household wealth and financial preparedness for birth. The study also examined the association between sex and financial preparedness for birth. A secondary analysis was conducted on individual survey data collected from SILC participants in two rural districts of Zambia between October 2017 and February 2018. A convenience sample of 600 participants (Lundazi: n = 297; Mansa: n = 303) was analysed. Descriptive analyses were run to examine SILC participation and household wealth. Multiple binary logistic regression models were fit to assess the unadjusted and adjusted relationship between (1) SILC participation and household wealth, (2) SILC participation and financial preparedness for birth and (3) sex and financial preparedness for birth. The results show that SILC participation led to an average increase of 7.32 items of the 13 household wealth items. SILC participants who had their most recent childbirth after joining SILCs were more likely to be financially prepared for birth [adjusted odds ratio (AOR): 2.99; 95% confidence interval (95% CI): 1.70-5.26; P < 0.001] than participants who had their most recent childbirth before joining SILCs. Females were more likely to be financially prepared for birth than males if they had their most recent birth before joining an SILC (AOR: 1.79; 95% CI: 1.16-2.66; P < 0.01). SILC participation is shown to increase household wealth and financial preparedness for birth for both men and women. SILCs are a promising intervention that can help poor and rural populations by increasing financial resources and financially preparing parents for birth.
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Affiliation(s)
- HaEun Lee
- Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
| | - Elisa M Maffioli
- Health Management and Policy, University of Michigan, School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Philip T Veliz
- Applied Biostatistics Laboratory, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
| | - Michelle L Munro-Kramer
- Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
| | - Tenford K Phiri
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Isaac Sakala
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Jameson Kaunda
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Nchimunya M Chiboola
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Lusaka 33921, Zambia
| | - Jody R Lori
- Associate Dean of Global Affairs, Health Behavior and Biological Sciences, University of Michigan, School of Nursing, 400 North Ingalls Street, Ann Arbor, MI 48109-5482, USA
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Beck D, Veliz PT, Munro-Kramer M, Ngoma T, Scott N, Kaiser JL, Musonda G, Lori JR. Home Birth in Rural Zambia: The Role of Intimate Partner Violence and Autonomous Decision-Making. J Midwifery Womens Health 2021; 66:256-264. [PMID: 33710761 DOI: 10.1111/jmwh.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 09/26/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Skilled care is indicated as a measure to prevent the deaths of pregnant women across sub-Saharan Africa. Despite this, many women continue to give birth at home. There has been little attention as to how the experience of intimate partner violence (IPV) or autonomous decision-making about place of birth influences home births in rural Zambia. This study explores how markers of sociocultural gender inequities (prevalence of IPV and autonomous decision-making) correlate with home birth in rural Zambia. METHODS This secondary analysis uses quantitative data from a baseline household survey with women who had given birth within the past 13 months in rural Zambia. Control variables shown to be significant in the literature were included in the model, and binary logistic regression was used to assess the influence of IPV and autonomous decision-making on home birth. RESULTS This sample included 2381 women from rural Zambia, of whom 384 reported a home birth within the past 13 months. Women who were autonomously making the decision about where to give birth were more likely to have a home birth (adjusted odds ratio [AOR], 1.729; SE, 0.210; 95% CI, 1.362-2.194; P < .001). Self-report of experiencing physical IPV in the past 2 weeks was not significant in predicting home birth (AOR, 0.783; SE, 0.181; 95% CI, 0.496-1.234; P = .293). Women who self-identified as Tumbuka or other, were able to afford school fees, had completed secondary education or higher, were married, and had 4 or more antenatal care visits were significantly less likely to report a home birth. DISCUSSION This quantitative analysis did not corroborate findings from other research that implicates IPV as a predictor of home birth. Additionally, autonomous decision-making was not associated with a decrease in home births. Future work should incorporate qualitative or mixed methods strategies to comprehensively explore household- and facility-level interventions to promote facility birth.
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Affiliation(s)
- Dana Beck
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Philip T Veliz
- Department of Populations, Systems, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Michelle Munro-Kramer
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan.,Office of Global Affairs, University of Michigan School of Nursing, Ann Arbor, Michigan
| | | | - Nancy Scott
- Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts
| | | | - Gertrude Musonda
- Office of Global Affairs, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Jody R Lori
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan.,Office of Global Affairs, University of Michigan School of Nursing, Ann Arbor, Michigan
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McRae DN, Portela A, Waldron T, Bergen N, Muhajarine N. Understanding the implementation (including women's use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol. BMJ Open 2021; 11:e039531. [PMID: 33658257 PMCID: PMC7931758 DOI: 10.1136/bmjopen-2020-039531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Maternity waiting homes in low-income and middle-income countries provide accommodation near health facilities for pregnant women close to the time of birth to promote facility-based birth and birth with a skilled professional and to enable timely access to emergency obstetric services when needed. To date, no studies have provided a systematic, comprehensive synthesis explaining facilitators and barriers to successful maternity waiting home implementation and whether and how implementation strategies and recommendations vary by context. This synthesis will systematically consolidate the evidence, answering the question, 'How, why, for whom, and in what context are maternity waiting homes successfully implemented in low-income and middle-income countries?'. METHODS AND ANALYSIS Methods include standard steps for realist synthesis: determining the scope of the review, searching for evidence, appraising and extracting data, synthesising and analysing the data and developing recommendations for dissemination. Steps are iterative, repeating until theoretical saturation is achieved. Searching will be conducted in 13 electronic databases with results managed in Eppi-Reviewer V.4. There will be no language, study-type or document-type restrictions. Items documented prior to 1990 will be excluded. To ensure our initial and revised programme theories accurately reflect the experiences and knowledge of key stakeholders, most notably the beneficiaries, interviews will be conducted with maternity waiting home users/nonusers, healthcare staff, policymakers and programme designers. All data will be analysed using context-mechanism-outcome configurations, refined and synthesised to produce a final programme theory. ETHICS AND DISSEMINATION Ethics approval for the project will be obtained from the Mozambican National Bioethical Commission, Jimma University College of Health Sciences Institutional Review Board and the University of Saskatchewan Bioethical Research Ethics Board. To ensure results of the evaluation are available for uptake by a wide range of stakeholders, dissemination will include peer-reviewed journal publication, a plain-language brief, and conference presentations to stakeholders' practice audiences. PROSPERO REGISTRATION NUMBER CRD42020173595.
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Affiliation(s)
- Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Tamara Waldron
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Nicole Bergen
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
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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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Udenigwe O, Okonofua FE, Ntoimo LFC, Imongan W, Igboin B, Yaya S. Perspectives of policymakers and health providers on barriers and facilitators to skilled pregnancy care: findings from a qualitative study in rural Nigeria. BMC Pregnancy Childbirth 2021; 21:20. [PMID: 33407238 PMCID: PMC7789224 DOI: 10.1186/s12884-020-03493-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background The uptake of skilled pregnancy care in rural areas of Nigeria remains a challenge amid the various strategies aimed at improving access to skilled care. The low use of skilled health care during pregnancy, childbirth and postpartum indicates that Nigerian women are paying a heavy price as seen in the country’s very high maternal mortality rates. The perceptions of key stakeholders on the use of skilled care will provide a broad understanding of factors that need to be addressed to increase women’s access to skilled pregnancy care. The objective of this study was therefore, to explore the perspectives of policymakers and health workers, two major stakeholders in the health system, on facilitators and barriers to women’s use of skilled pregnancy care in rural Edo State, Nigeria. Methods This paper draws on qualitative data collected in Edo State through key informant interviews with 13 key stakeholders (policy makers and healthcare providers) from a range of institutions. Data was analyzed using an iterative process of inductive and deductive approaches. Results Stakeholders identified barriers to pregnant women’s use of skilled pregnancy care and they include; financial constraints, women’s lack of decision-making power, ignorance, poor understanding of health, competitive services offered by traditional birth attendants, previous negative experience with skilled healthcare, shortage of health workforce, and poor financing and governance of the health system. Study participants suggested health insurance schemes, community support for skilled pregnancy care, favourable financial and governance policies, as necessary to facilitate women’s use of skilled pregnancy care. Conclusions This study adds to the literature, a rich description of views from policymakers and health providers on the deterrents and enablers to skilled pregnancy care. The views and recommendations of policymakers and health workers have highlighted the importance of multi-level factors in initiatives to improve pregnant women’s health behaviour. Therefore, initiatives seeking to improve pregnant women’s use of skilled pregnancy care should ensure that important factors at each distinct level of the social and physical environment are identified and addressed.
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Affiliation(s)
- Ogochukwu Udenigwe
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Friday E Okonofua
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria.,Centre for Excellence in Reproductive Health Innovation, Benin City, Nigeria
| | | | - Wilson Imongan
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria
| | - Brian Igboin
- Women's Health and Action Research Centre, KM 11 Lagos-Benin Expressway, Igue-Iyeha, Benin City, Edo State, Nigeria
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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He Z, Zhang C, Wang S, Bishwajit G, Yang X. Socioeconomic Determinants of Maternal HealthCare Utilisation in Zambia: 1997-2014. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211067480. [PMID: 34911372 PMCID: PMC8689614 DOI: 10.1177/00469580211067480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study aims at exploring the trends and socioeconomic inequalities in the use of maternal healthcare utilization between 1997 and 2014. Data were analyzed using descriptive and multivariate regression methods. Women in the higher wealth quintiles (Q4 and Q5) generally had higher prevalence of using health facility delivery and postnatal care services compared with those in the lower wealth quintiles (Q1 and Q2), whereas the prevalence of timely and adequate antenatal care visit was comparatively higher among those in the lower wealth quintiles. Findings indicated important sociodemographic inequalities in using maternal healthcare services, addressing which may help promote the utilization of these services.
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Affiliation(s)
- Zhifei He
- School of Politics and Public Administration, Southwest University of Political Science and Law, Chongqing, China
| | - Caihua Zhang
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Shiming Wang
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Ghose Bishwajit
- School of International Law, Southwest University of Political Science and Law, Chongqing, China
| | - Xinglong Yang
- School of International Law, Southwest University of Political Science and Law, Chongqing, China
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Birhan TY, Seretew WS. Trends and determinants of an acceptable antenatal care coverage in Ethiopia, evidence from 2005-2016 Ethiopian demographic and health survey; Multivariate decomposition analysis. ACTA ACUST UNITED AC 2020; 78:129. [PMID: 33292565 PMCID: PMC7716472 DOI: 10.1186/s13690-020-00510-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022]
Abstract
Background an acceptable antenatal care (ANC4+) is defined as attending at least four antenatal care visit, received at least one dose of tetanus toxoid (TT) injections and consumed 100 iron-folic acids (IFA) tablets/syrup during the last pregnancy. Since maternal health care service utilization continues to be an essential indicator for monitoring the improvements of maternal and child health outcomes. This study aimed to analyze the trends and determinants that contributed to the change in an acceptable antenatal care visit over the last 10 years in Ethiopia. Methods Nationally representative repeated cross-sectional survey was conducted using 2005, 2011, and 2016 Ethiopian Demographic and Health Survey datasets. The data were weighted and analyzed by STATA 14.1 software. Multivariate decomposition regression analysis was used to identify factors that contribute for the change in an acceptable antenatal care visit. A p-value < 0.05 was taken to declare statistically significant predictors to acceptable antenatal care visit. Results among the reproductive age women the rate of an acceptable antenatal care visits was increased from 16% in 2005 to 35% in 2016 in Ethiopia. In the multivariate decomposition analysis, about 29% of the increase in acceptable antenatal care visit was due to a difference in composition of women (endowments) across the surveys. Residence, religion, husband educational attainment, and wealth status was the main source of compositional change factors for the improvements of an acceptable antenatal care visit. Almost two-thirds of an overall change in acceptable antenatal care visit was due to the difference in coefficients/ change in behavior of the population. Religion, educational attainment (both women and husband), and residence are significantly contributed to the change in full antenatal care visit in Ethiopia over the last decades. Conclusion Besides the relevance of receiving an acceptable antenatal care visit for pregnant women and their babies, an acceptable antenatal care visit was slightly increased over time in Ethiopia. Women’s characteristics and behavior change were significantly associated with the change in acceptable antenatal care visits. Public interventions needed to improve acceptable antenatal care coverage, women’s education, and further advancing of health care facilities in rural communities should be done to maintain the further improvements acceptable antenatal care visits.
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Affiliation(s)
- Tilahun Yemanu Birhan
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Wullo Sisay Seretew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Selbana DW, Derese M, Sewmehone Endalew E, Gashaw BT. A Culturally Sensitive and Supportive Maternity Care Service Increases the Uptake of Maternity Waiting Homes in Ethiopia. Int J Womens Health 2020; 12:813-821. [PMID: 33116931 PMCID: PMC7553138 DOI: 10.2147/ijwh.s268245] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background Maternal delays in utilization of emergency obstetric care are impacting on a high maternal mortality, especially in the poor resource countries including Ethiopia. Different strategies are designed and employed to reduce those maternal delays, and one of such strategies employed to overcome the geographic barriers and improve maternal and neonatal health outcomes is utilization of maternity waiting homes (MWHs). Studies related to the utilization of MWHs and associated factors are limited in Ethiopia and there were none in the study area. Objective The aim of this study was to assess the utilization of maternity waiting homes and associated factors. Methods and Materials A community-based cross-sectional study design was conducted, using multistage sampling technique. Logistic regression analysis with 95% CI for odds ratio (OR) was used to identify significant factors. Results A total of 379 women participated in this study, making a response rate of 85%. Of the total participants, 42.5% (95% CI=38–48) of women utilized MWHs. After controlling for potential confounders, women’s decision-making capacity (AOR=12.74; 95% CI=6.18–26.26), women having someone who can care for their children and/or husband at home (AOR=2.71; 95% CI=1.44–5.09), MWHs offering food service (AOR=4.03; 95% CI=2.07– 7.85), offering and/or allowing women to practice their own cultural ceremony (allowing to cook their own food type, porridge, coffee, etc) (AOR=9.55; 95% CI=4.45–20.47), and women’s attitude towards MWHs (AOR=0.09; 95% CI=0.03–0.23) were factors significantly associated with the utilization of MWHs. Conclusion Compared to its contribution in reducing maternal and perinatal mortality, the utilization of MWHs was low in this study area. The integration of culturally sensitive and supportive maternity services, along with community participatory approach, would increase utilization of MWHs and consequently contribute in achieving the SDGs related to maternal and neonatal health.
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Affiliation(s)
| | - Msganaw Derese
- College of Health Sciences, Mizan-Tepi University, Mizan-Tepi, Ethiopia
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Nigussie T, Yaekob R, Geremew M, Asefa A. Predictors of Intention to Use Maternity Waiting Home Among Pregnant Women in Bench Maji Zone, Southwest Ethiopia Using the Theory of Planned Behavior. Int J Womens Health 2020; 12:901-910. [PMID: 33149701 PMCID: PMC7602906 DOI: 10.2147/ijwh.s267730] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ending preventable maternal mortality remains an unfinished agenda and one of the world's most critical challenges. Skilled care at birth is one of the crucial strategies that help to prevent deaths that occur during delivery. Maternity waiting homes have been endorsed to facilitate access to skilled care during intra-partum and post-partum periods for women living in rural areas. However, the majority of pregnant mothers in Ethiopia do not use this service; hence, this study aimed to assess the predictors of intention to use maternity waiting home. METHODS A community-based cross-sectional study was conducted from March 15 to June 20, 2018 in Bench Maji Zone, Southwest Ethiopia. A multistage sampling technique was used. The data were collected by trained data collectors using a structured pre-tested questionnaire. Data were entered into the epi data manager version 4.0.2.101 and exported to SPSS version 21 for analysis. The correlation among constructs of the theory of planned behavior was estimated. A hierarchical linear regression was used to identify predictors of intention to use maternity waiting home, and α value of less than 5% was used as a level of significance. RESULTS A total of 829 women were interviewed. The mean age of respondents was 27.1 (±5.2) years. Thirty-nine percent of the respondents used maternity waiting home previously. The attitude (β =0.12, p<0.001), subjective norm (β =0.47, p<0.001), perceived behavioral control (β =0.42, p<0.001), and ANC use during current pregnancy (β =0.07, p=0.030) were predictors of intension to use maternity waiting homes. R square was calculated to be 81%. CONCLUSION The intention to use maternity waiting homes was significantly associated with antenatal care use, attitude, subjective norm, and perceived behavioral control. Thus, multidimensional interventions are important to increase the intension to use MWH.
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Affiliation(s)
- Tadesse Nigussie
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Rahel Yaekob
- Department of Midwifery, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Mesfin Geremew
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Adane Asefa
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Kurji J, Gebretsadik LA, Wordofa MA, Morankar S, Bedru KH, Bulcha G, Bergen N, Kiros G, Asefa Y, Asfaw S, Mamo A, Endale E, Thavorn K, Labonte R, Taljaard M, Kulkarni MA. Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia. BMC Public Health 2020; 20:1593. [PMID: 33092565 PMCID: PMC7583173 DOI: 10.1186/s12889-020-09692-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Maternity waiting homes (MWHs), residential spaces for pregnant women close to obstetric care facilities, are being used to tackle physical barriers to access. However, their effectiveness has not been rigorously assessed. The objective of this cluster randomized trial was to evaluate the effectiveness of functional MWHs combined with community mobilization by trained local leaders in improving institutional births in Jimma Zone, Ethiopia. Methods A pragmatic, parallel arm cluster-randomized trial was conducted in three districts. Twenty-four primary health care units (PHCUs) were randomly assigned to either (i) upgraded MWHs combined with local leader training on safe motherhood strategies, (ii) local leader training only, or (iii) usual care. Data were collected using repeat cross-sectional surveys at baseline and 21 months after intervention to assess the effect of intervention on the primary outcome, defined as institutional births, at the individual level. Women who had a pregnancy outcome (livebirth, stillbirth or abortion) 12 months prior to being surveyed were eligible for interview. Random effects logistic regression was used to evaluate the effect of the interventions. Results Data from 24 PHCUs and 7593 women were analysed using intention-to-treat. The proportion of institutional births was comparable at baseline between the three arms. At endline, institutional births were slightly higher in the MWH + training (54% [n = 671/1239]) and training only arms (65% [n = 821/1263]) compared to usual care (51% [n = 646/1271]). MWH use at baseline was 6.7% (n = 256/3784) and 5.8% at endline (n = 219/3809). Both intervention groups exhibited a non-statistically significant higher odds of institutional births compared to usual care (MWH+ & leader training odds ratio [OR] = 1.09, 97.5% confidence interval [CI] 0.67 to 1.75; leader training OR = 1.37, 97.5% CI 0.85 to 2.22). Conclusions Both the combined MWH+ & leader training and the leader training alone intervention led to a small but non-significant increase in institutional births when compared to usual care. Implementation challenges and short intervention duration may have hindered intervention effectiveness. Nevertheless, the observed increases suggest the interventions have potential to improve women’s use of maternal healthcare services. Optimal distances at which MWHs are most beneficial to women need to be investigated. Trial registration The trial was retrospectively registered on the Clinical Trials website (https://clinicaltrials.gov) on 3rd October 2017. The trial identifier is NCT03299491.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada.
| | - Lakew Abebe Gebretsadik
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | - Sudhakar Morankar
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | | | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Getachew Kiros
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Yisalemush Asefa
- Department of Health Economics, Management & Policy, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Shifera Asfaw
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Erko Endale
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute General Campus, University of Ottawa, Ottawa, Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute Civic Campus, University of Ottawa, Ottawa, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, K1G 5Z3, Canada
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Fontanet CP, Fong RM, Kaiser JL, Bwalya M, Ngoma T, Vian T, Biemba G, Scott NA. A Qualitative Exploration of Community Ownership of a Maternity Waiting Home Model in Rural Zambia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:344-357. [PMID: 33008852 PMCID: PMC7541113 DOI: 10.9745/ghsp-d-20-00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
Community-based maternal child health programs should foster a sense of community ownership to promote sustainability. In rural Zambia, health interventions should be accessible to target communities and clear roles should be established among stakeholders for effective governance. Context: Ownership is an important construct of sustainability for community-based health programming, though it is often not clearly defined or measured. We implemented and evaluated a community-driven maternity waiting home (MWH) model in rural Zambia. We engaged stakeholders at all levels and provided intensive mentorship to an MWH governance committee comprised of community-selected members. We then examined how different stakeholders perceive community ownership of the MWH. Methods: We conducted 42 focus group discussions with community stakeholders (pregnant women, fathers, elders, and community health volunteers) and 161 in-depth interviews with MWH stakeholders (health facility staff, district health officials, and MWH governance committee and management unit members) at multiple time-points over 24 months. We conducted a content analysis and triangulated findings to understand community ownership of the MWH and observe changes in perceptions of ownership over time. Results: Community members’ perceptions of ownership were related to their ability to use the MWH and a responsibility toward its success. Community and MWH stakeholders described increasingly more specific responsibilities over time. Governance committee and management unit members perceived their ability to represent the community as a crucial component of their role. Multiple respondent types saw collaboration between the governance committee and the health facility staff as key to allowing the MWH to meet its goal of serving the community. Conclusion: The perceptions of community ownership evolved as the intervention became more established. Use of the MWH, and clear understanding of roles and responsibilities in management of the MWH, seemed to foster feelings of community ownership. To improve the sustainability of community-based maternal and child health programs, interventions should be accessible to target communities and clear roles should be established among stakeholders.
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Affiliation(s)
- Constance P Fontanet
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Misheck Bwalya
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Geleto A, Chojenta C, Taddele T, Loxton D. Perceptions of midwives on the quality of emergency obstetric care at hospitals in Ethiopia: A qualitative explanatory study. Midwifery 2020; 90:102814. [PMID: 32763670 DOI: 10.1016/j.midw.2020.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In Ethiopia, maternal mortality remains an important public health concern. High maternal mortality is attributed in part to the poor quality of obstetric care. This study was designed to investigate perceptions of midwives about the quality of emergency obstetric care provided at hospitals in the Harari region of Ethiopia. METHODS An explanatory qualitative study was conducted from December 2018 to February 2019 at public and private hospitals in the Harari region, Ethiopia. The data were obtained through in-depth interviews with 12 midwives working in maternity units. The interviewers took notes and audio-recorded the respondents' descriptions. Braun and Clarke's thematic analysis method was employed to analyse the data using Nvivo 12 qualitative data analysis software. RESULTS Poorly designed infrastructure, including a scarcity of beds, rooms and ambulances challenged the provision of quality obstetric services. Midwives working at hospitals were inadequate in number and training opportunities were scarce. Language barriers affected effective communication between patients and caregivers. Frequent disruptions to medical supplies resulted in the provision of suboptimal obstetric care as it created an inability to provide appropriate medications. A lack of treatment protocols, poor supportive supervision, and poor staff motivation impaired the provision of quality obstetric care at hospitals, although disparities were observed among hospitals in this regard. CONCLUSIONS Several interdependent factors limited the quality of emergency obstetric care at hospitals in the region. Quality improvement initiatives and equitable resource distribution for hospitals need to be enhanced while the existing health infrastructure, resources and service delivery management need to be strengthened.
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Affiliation(s)
- Ayele Geleto
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Catherine Chojenta
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
| | - Tefera Taddele
- Health System and Reproductive Health Directorate, the Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Newcastle, Australia.
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Maternity waiting homes in times of crisis: Can current models meet women's needs? Women Birth 2020; 34:306-308. [PMID: 32680790 DOI: 10.1016/j.wombi.2020.07.001] [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: 05/22/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Maternity waiting homes (MWHs) located close to birthing facilities are a conditional recommendation by the World Health Organisation, based on very low-quality evidence that they contribute to improvements in maternal or perinatal health outcomes. In addition, several studies suggest that more vulnerable women are less likely to use them. Yet significant investments continue to be made in building and running MWHs within conflict-affected and under-resourced health systems. AIMS We critically examine the literature to shed light on the challenges and opportunities provided by MWHs during health emergencies and in conflict situations. FINDINGS AND DISCUSSION MWHs are difficult to utilise during crises because they require women to be away from home, are often designed as dormitories, can lack security and be over-crowded. Some MWHs have been adapted during situations of political conflict to incorporate birthing and broader reproductive health care, thereby improving the availability of care away from over-burdened health facilities. How MWHs are adapted during times of crisis may provide insights into what systems of care are more appropriate in meeting women's needs more broadly. CONCLUSION The current global pandemic is an important time to reflect on whether MWHs are meeting the needs of a diverse range of women, in times of stability and during emergencies, and engage in genuine dialogue with women about the kinds of maternity care they want. We need to co-create those systems now so that they are more resilient during the inevitable crises we will face in the future.
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Bulto GA, Demissie DB, Tasu TL, Demisse GA. Mother's satisfaction with the existing labor and delivery care services at public health facilities in West Shewa zone, Oromia region, Ethiopia. BMC Pregnancy Childbirth 2020; 20:303. [PMID: 32429878 PMCID: PMC7236095 DOI: 10.1186/s12884-020-02998-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mothers' satisfaction with care during childbirth is indicators of the quality care which affects skilled birth attendance. Negative client's experiences at health facilities cause them to delay or avoid seeking care, which highlights services providers should consider and act on the expectations and experiences of women and their families. Though there are few studies conducted in Ethiopia on maternal satisfaction with Labor and Delivery (LAD) services, there is no study conducted in the study area. Therefore the study aims to assess the mother's satisfaction with existing LAD services and associated factors at all levels of health care in the West Shewa zone. METHODS An institution-based cross-sectional study was conducted at public health facilities in West Shewa zone, Central Ethiopia. A systematic sampling technique was used to select 560 respondents by using their delivery registration number and data were collected through face to face interview. Mothers were considered satisfied if they responded satisfied/very satisfied with 75% or more of the questions assessing satisfaction. Binary and multivariable logistic regression analysis was used to identify associated factors. RESULTS The overall proportion of mothers who were satisfied with the current LAD care services were 60.8%. The main areas of dissatisfaction were; accessibility and cleanness of toilets/shower 72.6%, overall cleanness of the facility/including waiting-area 40.1% and presence of support a person during birth 38.0%. The presence of cultural practices (AOR = 2.5), discussion on the place of delivery with health worker during ANC (AOR = 1.75), providers asks for consent before procedure (AOR = 2.77), encouraging companion to remain with mother (AOR = 2.22), never leave mother alone or unattended (AOR = 2.56), giving periodic updates on status and progress of labor (AOR = 2.04) and explaining what is being done and to expect during LAD (AOR = 2.20) were factors identified to be significantly associated with satisfaction on LAD services. CONCLUSION The overall satisfaction of mothers with LAD services at public health facilities in the West-Shewa zone was relatively low. Presence of cultural practices, discussion on the place of delivery, asking for consent before the procedure, encouraging companion to remain with mothers and explaining what is being done were factors identified. Therefore, all stakeholders have to emphatically work on those identified factors to improve mothers' satisfaction with LAD services.
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Affiliation(s)
- Gizachew Abdissa Bulto
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Dereje Bayissa Demissie
- Department of Neonatal Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tefera Likasa Tasu
- Department of Nursing, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Getu Alemu Demisse
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Intentions to use maternity waiting homes and associated factors in Northwest Ethiopia. BMC Pregnancy Childbirth 2020; 20:281. [PMID: 32393188 PMCID: PMC7216713 DOI: 10.1186/s12884-020-02982-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/30/2020] [Indexed: 11/23/2022] Open
Abstract
Background Maternity Waiting Homes (MWHs) are residential facilities located within hospitals or health centers to accommodate women in their final weeks of pregnancy to bridge the geographical gap in obstetric care. Little is known, however, about women’s intentions to use MWHs. Thus, this study aimed to assess pregnant women’s intentions to use MWHs and associated factors in East Bellesa district, northwest Ethiopia. Methods A community-based cross-sectional study was conducted among 525 pregnant women in East Bellesa district from March to May 2018. Study participants were selected using systematic random sampling. Binary logistic regression was used for analysis. Adjusted Odds Ratio (aOR) with 95% Confidence Interval (CI), and p-value < 0.05 were used to identify factors associated with intentions to use MWHs. Results In the study area, 326/499 (65.3%) pregnant women had the intention to use MWHs. Pregnant women who had good knowledge about maternal healthcare and obstetric complications (aOR 6.40; 95% CI 3.6–11.5), positive subjective norms related to women’s perceptions of social pressure (aOR 5.14; 95% CI 2.9–9.2), positive perceived behavioral control of women on the extent to which women feel confident (aOR 4.74; 95% CI 2.7–8.4), rich wealth status (aOR 4.21; 95% CI 2.1–8.4), women who decided by themselves to use maternal services (aOR 2.74; 95% CI 1.2–6.2), attended antenatal care (aOR 2.24; 95% CI 1.2–4.1) and favorable attitudes towards women’s overall evaluation of MWHs (aOR 1.86; 95% CI 1.0–3.4) had higher odds of intentions to use MWHs. Conclusion Two thirds (65.3%) of pregnant women had intentions to use MWHs. Factors such as women’s knowledge, subjective norms related to women’s perceptions of social pressure, perceived behavioral control of women on the extent to which women feel confident to utilize, and wealth status, decision-making power, attending antenatal care and attitude towards women’s overall evaluation of MWHs were significantly associated with the intention to use MWHs. Therefore, improving women’s awareness by providing continuous health education during antenatal care visits, devising strategies to improve women’s wealth status, and strengthening decision-making power may enhance their intention to use MWHs.
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Henry EG, Ngoma T, Kaiser JL, Fong RM, Vian T, Hamer DH, Rockers PC, Biemba G, Scott NA. Evaluating implementation effectiveness and sustainability of a maternity waiting homes intervention to improve access to safe delivery in rural Zambia: a mixed-methods protocol. BMC Health Serv Res 2020; 20:191. [PMID: 32164728 PMCID: PMC7068884 DOI: 10.1186/s12913-020-4989-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 02/13/2020] [Indexed: 11/12/2022] Open
Abstract
Background In low-income countries such as Zambia, where maternal mortality rates are persistently high, maternity waiting homes (MWHs) represent one potential strategy to improve access to safe delivery, especially for women living in remote areas. The Maternity Homes Access in Zambia project (MAHMAZ) is evaluating the impact of a MWH model on women’s access to safe delivery in rural Zambia. There is a growing need to understand not only the effectiveness of interventions but also the effectiveness of their implementation in order to appropriately interpret outcomes. There is little evidence to guide effective implementation of MWH for both immediate uptake and to promote sustainability in this context. This protocol describes a study that aims to investigate the effectiveness of the implementation of MAHMAZ by not only documenting fidelity but also identifying factors that influence implementation success and affect longer-term sustainability. Methods This study will use mixed methods to evaluate the implementation effectiveness and sustainability of the MAHMAZ intervention. In our study, “implementation effectiveness” means to expand beyond measuring fidelity to the MWH model and includes assessing both the adoption and uptake of the model and identifying those factors that facilitate or inhibit uptake. Sustainability is defined as the routine implementation of an intervention after external support has ended. Quantitative methods include extracting data from existing records at the MWHs and health facilities to analyze patterns of utilization, and conducting a routine health facility assessment to determine facility-level factors that may influence MWH implementation and woman-level outcomes. We will also conduct an experience survey with MWH users and apply a checklist to assess fidelity to the MWH model. Qualitative methods include in-depth interviews and focus group discussions with MWH users, community members and other stakeholders. Qualitative data will be analyzed using an integrated framework drawing constructs from the Consolidated Framework for Implementation Research and the Conceptual Framework for Sustainability. Discussion The findings from this evaluation will be shared with policymakers formulating policy affecting the implementation of MWH and may be used as evidence for programmatic decisions by the government and supporting agencies in deciding to take this model to scale. Trial registration NCT02620436, Registered 3 December 2015, Prospectively registered (clinicaltrials.gov; for the overarching quasi-experimental impact study).
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Affiliation(s)
- Elizabeth G Henry
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA, 02118, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA, 02118, USA
| | - Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, 2130 Fulton Street, San Francisco, CA, 94117, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA, 02118, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA, 02118, USA
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown 3rd Floor, Boston, MA, 02118, USA.
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Naanyu V, Mujumdar V, Ahearn C, McConnell M, Cohen J. Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya. BMC Pregnancy Childbirth 2020; 20:30. [PMID: 31931745 PMCID: PMC6958584 DOI: 10.1186/s12884-019-2695-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 12/23/2019] [Indexed: 11/22/2022] Open
Abstract
Background In urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications. Methods This study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2–6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice. Results Findings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others’ perspectives on delivery location and lack of aides/escorts. Conclusions Results from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women’s preferences.
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Affiliation(s)
- V Naanyu
- Department of Health Policy and Management, School of Public Health, College of Health Science, Moi University, Eldoret, Kenya.
| | - V Mujumdar
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - C Ahearn
- Department of HIV, ID and Global Medicine, UCSF, San Francisco, California, USA
| | - M McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - J Cohen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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Kurji J, Kulkarni MA, Gebretsadik LA, Wordofa MA, Morankar S, Bedru KH, Bulcha G, Thavorn K, Labonte R, Taljaard M. Effectiveness of upgraded maternity waiting homes and local leader training in improving institutional births among women in the Jimma zone, Ethiopia: study protocol for a cluster-randomized controlled trial. Trials 2019; 20:671. [PMID: 31801584 PMCID: PMC6894194 DOI: 10.1186/s13063-019-3755-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022] Open
Abstract
Background Ethiopia is one of the ten countries in the world that together account for almost 60% of all maternal deaths. Recent reductions in maternal mortality have been seen, yet just 26% of women who gave birth in Ethiopia in 2016 reported doing so at a health facility. Maternity waiting homes (MWHs) have been introduced to overcome geographical and financial barriers to institutional births but there is no conclusive evidence as to their effectiveness. We aim to evaluate the effects of upgraded MWHs and local leader training in increasing institutional births in the Jimma zone of Ethiopia. Methods A parallel, three-arm, stratified, cluster-randomized controlled trial design is being employed to evaluate intervention effects on institutional births, which is the primary outcome. Trial arms are: (1) upgraded MWH + religious/community leader training; (2) leader training alone; and (3) standard care. Twenty-four primary health care unit catchment areas (clusters) have been randomized and 3840 women of reproductive age who had a pregnancy outcome (livebirth, stillbirth or abortion) are being randomly recruited for each survey round. Outcome assessments will be made using repeat cross-sectional surveys at baseline and 24 months postintervention. An intention to treat approach will be used and the primary outcome analysed using generalized linear mixed models with a random effect for cluster and time. A cost-effectiveness analysis will also be conducted from a societal perspective. Discussion This is one of the first trials to evaluate the effectiveness of upgraded MWHs and will provide much needed evidence to policy makers about aspects of functionality and the community engagement required as they scale-up this programme in Ethiopia. Trial registration ClinicalTrial.gov, NCT03299491. Retrospectively registered on 3 October 2017.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Lakew Abebe Gebretsadik
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | - Sudhakar Morankar
- Department of Health, Behaviour & Society, Jimma University, Jimma Town, Jimma Zone, Ethiopia
| | | | | | - Kednapa Thavorn
- Ontario Hospital Research Institute, The Ottawa Hospital - General Campus, Ottawa, ON, Canada
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Monica Taljaard
- Ontario Hospital Research Institute, Ottawa Hospital, Civic Campus, 1053 Carling Ave, Civic Box 693, Admin Services Building, ASB 2-004, Ottawa, ON, K1Y 4E9, Canada
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46
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Chiu C, Scott NA, Kaiser JL, Ngoma T, Lori JR, Boyd CJ, Rockers PC. Household saving during pregnancy and facility delivery in Zambia: a cross-sectional study. Health Policy Plan 2019; 34:102-109. [PMID: 30768183 PMCID: PMC6481286 DOI: 10.1093/heapol/czz005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2019] [Indexed: 11/25/2022] Open
Abstract
Financial barriers cause many women in low- and middle-income countries to deliver outside of a health facility, contributing to maternal and neonatal mortality. Savings accrued during pregnancy can increase access to safe delivery services. We investigated the relationship between household saving during pregnancy and facility delivery. A cross-section of 2381 women who delivered a child in the previous 12 months was sampled from 40 health facility catchment areas across eight districts in three provinces in Zambia in April and May of 2016. During a household survey, women reported on their perceptions of the adequacy of their household savings during their recent pregnancy. Households were categorized based on women’s responses as: did not save; saved but not enough; and saved enough. We estimated crude and adjusted associations between perceived adequacy of savings and facility delivery. We also explored associations between savings and expenditures on delivery. Overall, 51% of women surveyed reported that their household saved enough for delivery; 32% reported saving but not enough; and 17% did not save. Household wealth was positively associated with both categories of saving, while earlier attendance at antenatal care was positively associated with saving enough. Compared with women in households that did not save, those in households that saved but not enough (aOR 1.63; 95% CI: 1.17, 2.25) and saved enough (aOR 2.86; 95% CI: 2.05, 3.99) had significantly higher odds of facility delivery. Both categories of saving were significantly associated with higher overall expenditure on delivery, driven in large part by higher expenditures on baby clothes and transportation. Our findings suggest that interventions that encourage saving early in pregnancy may improve access to facility delivery services.
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Affiliation(s)
- Calvin Chiu
- Innovations for Poverty Action Zambia, Plot 26, Mwambula Street, Jesmondine, Lusaka, Zambia.,School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, USA
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA
| | - Thandiwe Ngoma
- Right to Care - Zambia, 11059 Off Brentwood Road, Longacres, Lusaka, Zambia
| | - Jody R Lori
- University of Michigan School of Nursing, Center for Global Affairs & PAHO/WHO Collaborating Center, 426 N Ingalls St, Ann Arbor, MI, USA
| | - Carol J Boyd
- Alcohol, Smoking and Health, University of Michigan School of Nursing, Center for the Study of Drugs, 426 N Ingalls St, Ann Arbor, MI, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA
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47
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Kurji J, Gebretsadik LA, Wordofa MA, Sudhakar M, Asefa Y, Kiros G, Mamo A, Bergen N, Asfaw S, Bedru KH, Bulcha G, Labonte R, Taljaard M, Kulkarni M. Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis. BMJ Open 2019; 9:e028210. [PMID: 31467047 PMCID: PMC6720516 DOI: 10.1136/bmjopen-2018-028210] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify individual-, household- and community-level factors associated with maternity waiting home (MWH) use in Ethiopia. DESIGN Cross-sectional analysis of baseline household survey data from an ongoing cluster-randomised controlled trial using multilevel analyses. SETTING Twenty-four rural primary care facility catchment areas in Jimma Zone, Ethiopia. PARTICIPANTS 3784 women who had a pregnancy outcome (live birth, stillbirth, spontaneous/induced abortion) 12 months prior to September 2016. OUTCOME MEASURE The primary outcome was self-reported MWH use for any pregnancy; hypothesised factors associated with MWH use included woman's education, woman's occupation, household wealth, involvement in health-related decision-making, companion support, travel time to health facility and community-levels of institutional births. RESULTS Overall, 7% of women reported past MWH use. Housewives (OR: 1.74, 95% CI 1.20 to 2.52), women with companions for facility visits (OR: 2.15, 95% CI 1.44 to 3.23), wealthier households (fourth vs first quintile OR: 3.20, 95% CI 1.93 to 5.33) and those with no health facility nearby or living >30 min from a health facility (OR: 2.37, 95% CI 1.80 to 3.13) had significantly higher odds of MWH use. Education, decision-making autonomy and community-level institutional births were not significantly associated with MWH use. CONCLUSIONS Utilisation inequities exist; women with less wealth and companion support experienced more difficulties in accessing MWHs. Short duration of stay and failure to consider MWH as part of birth preparedness planning suggests local referral and promotion practices need investigation to ensure that women who would benefit the most are linked to MWH services.
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Affiliation(s)
- Jaameeta Kurji
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | | | - Morankar Sudhakar
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Yisalemush Asefa
- Department of Health Economics, Management and Policy, Jimma University, Jimma, Ethiopia
| | - Getachew Kiros
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Abebe Mamo
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | - Nicole Bergen
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Shifera Asfaw
- Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
| | | | | | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | | | - Manisha Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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48
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Yasin C, Geleto A, Berhane Y. Referral linkage among public health facilities in Ethiopia: A qualitative explanatory study of facilitators and barriers for emergency obstetric referral in Addis Ababa city administration. Midwifery 2019; 79:102528. [PMID: 31442877 DOI: 10.1016/j.midw.2019.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/11/2019] [Accepted: 08/11/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In developing countries including Ethiopia, maternal mortality ratio remains unacceptably high. During pregnancy and childbirth, a woman may acquire one or more of obstetric complications including hemorrhage, sepsis, hypertension and obstructed labor. Early diagnosed and referral of women who experienced obstetric complications to a specialty center can save the life of women and babies. However, several factors might affect the referral procedures of these women. Therefore, this study was aimed at assessing the facilitators and barriers of obstetric referral in selected public health facilities of Addis Ababa city administration, Ethiopia. METHODS A qualitative study design was employed to obtain the narratives of 12 healthcare workers and three recently referred mothers. The study included a regional health bureau, a lead hospital and a health center. Thematic analysis was employed to present to present the findings of the study and open code software was used to code and generate the themes. RESULTS This study revealed several barriers and some facilitators of obstetric referral. Early identification of complications, exercising teamwork, availability of referral protocol, availability of ambulance and effective communication system were the major reported factors which enhanced obstetric referral. Several themes including poor perception of clients, poor supportive supervision, lack of staff motivation and shortage of beds and medical equipment, lack of competence among the staffs and shortage of ambulance at health center were emerged as barriers of obstetric referral. CONCLUSIONS This study revealed several barriers of obstetric referral in the Addis Ababa city administration although a number of facilitators of obstetric referral exist. All of the reported barriers are related to the existing health system that need a collective action of all the actors to eliminate the barriers while enhancing the facilitators of obstetric referral.
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Affiliation(s)
- Chaltu Yasin
- Oromia Regional Health Bureau, Addis Ababa, Ethiopia.
| | - Ayele Geleto
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Ethiopia.
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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49
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Kaiser JL, McGlasson KL, Rockers PC, Fong RM, Ngoma T, Hamer DH, Vian T, Biemba G, Lori JR, Scott NA. Out-of-pocket expenditure for home and facility-based delivery among rural women in Zambia: a mixed-methods, cross-sectional study. Int J Womens Health 2019; 11:411-430. [PMID: 31447591 PMCID: PMC6682766 DOI: 10.2147/ijwh.s214081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Out-of-pocket expenses associated with facility-based deliveries are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare differences between delivery locations (primary health center, hospital, or home). Methods We conducted household surveys and in-depth interviews among randomly selected remote Zambian women who delivered a baby within the last 13 months. Women reported expenditures for their most-recent delivery for delivery supplies, transportation, and baby clothes, among others. Expenditures were converted to US dollars for analysis. Results Of 2280 women sampled, 2223 (97.5%) reported spending money on their delivery. Nearly all respondents in the sample (95.9%) spent money on baby clothes/blanket, while over 80% purchased delivery supplies such as disinfectant or cord clamps, and a third spent on transportation. Women reported spending a mean of USD28.76 on their delivery, with baby clothes/blanket (USD21.46) being the main expenditure and delivery supplies (USD3.81) making up much of the remainder. Compared to women who delivered at home, women who delivered at a primary health center spent nearly USD4 (p<0.001) more for their delivery, while women who delivered at a level 1 or level 2 hospital spent over USD7.50 (p<0.001) more for delivery. Conclusion These expenses account for approximately one third of the monthly household income of the poorest Zambian households. While the abolition of user fees has reduced the direct costs of delivering at a health facility for the poorest members of society, remote Zambian women still face high out-of-pocket expenses in the form of delivery supplies that facilities should provide as well as unofficial policies/norms requiring women to bring new baby clothes/blanket to a facility-based delivery. Future programs that target these expenses may increase access to facility-based delivery.
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Affiliation(s)
- Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Kathleen L McGlasson
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Jody R Lori
- Department of Research, Office of Global Affairs and Pan American Health Organization/ World Health Organization Collaborating Center, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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50
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Yorlets RR, Iverson KR, Leslie HH, Gage AD, Roder-DeWan S, Nsona H, Shrime MG. Latent class analysis of the social determinants of health-seeking behaviour for delivery among pregnant women in Malawi. BMJ Glob Health 2019; 4:e000930. [PMID: 30997159 PMCID: PMC6441245 DOI: 10.1136/bmjgh-2018-000930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/14/2018] [Accepted: 12/13/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In the era of Sustainable Development Goals, reducing maternal and neonatal mortality is a priority. With one of the highest maternal mortality ratios in the world, Malawi has a significant opportunity for improvement. One effort to improve maternal outcomes involves increasing access to high-quality health facilities for delivery. This study aimed to determine the role that quality plays in women's choice of delivery facility. METHODS A revealed-preference latent class analysis was performed with data from 6625 facility births among women in Malawi from 2013 to 2014. Responses were weighted for national representativeness, and model structure and class number were selected using the Bayesian information criterion. RESULTS Two classes of preferences exist for pregnant women in Malawi. Most of the population 65.85% (95% CI 65.847% to 65.853%) prefer closer facilities that do not charge fees. The remaining third (34.15%, 95% CI 34.147% to 34.153%) prefers central hospitals, facilities with higher basic obstetric readiness scores and locations further from home. Women in this class are more likely to be older, literate, educated and wealthier than the majority of women. CONCLUSION For only one-third of pregnant Malawian women, structural quality of care, as measured by basic obstetric readiness score, factored into their choice of facility for delivery. Most women instead prioritise closer care and care without fees. Interventions designed to increase access to high-quality care in Malawi will need to take education, distance, fees and facility type into account, as structural quality alone is not predictive of facility type selection in this population.
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Affiliation(s)
- Rachel R Yorlets
- Department of Plastic & Oral Surgery, Harvard Medical School, Boston Children’s Hospital, Boston, Massachusetts, USA
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine R Iverson
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Hannah H Leslie
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Anna Davies Gage
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Sanam Roder-DeWan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Humphreys Nsona
- Integrated Management of Childhood Illnesses (IMCI), Ministry of Health, Lilongwe, Malawi
| | - Mark G Shrime
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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