Objective To describe maternal mortality and stillbirth rates among women admitted via a maternity waiting area (MWA) and women admitted directly to the same hospital (non-MWA) over a 22-year period.Design Retrospective cohort study.Setting Hospital in rural Ethiopia, which provided comprehensive emergency obstetric care and has an established MWA.Population All women admitted for delivery between 1987 and 2008.Methods Data on maternal deaths, stillbirths, caesarean section and uterine rupture were abstracted from routine hospital records. Sociodemographic characteristics, antenatal care and other data were collected for 2008 only. Rates and 95% confidence intervals were calculated for maternal mortality and stillbirth.Main outcome measures Maternal mortality and stillbirth.Results There were 24 148 deliveries over the study period, 6805 admitted via MWA and 17 343 admitted directly. Maternal mortality was 89.9 per 100 000 live births (95% CI, 41.1-195.2) for MWA women and 1333.1 per 100 000 live births (95% CI, 1156.2-1536.7) for non-MWA women; stillbirth rates were 17.6 per 1000 births (95% CI, 14.8-21.0) and 191.2 per 1000 births (95% CI, 185.4-197.1), respectively; 38.5% of MWA women were delivered by caesarean section compared with 20.3% of non-MWA women, and none had uterine rupture, compared with 5.8% in the non-MWA group. For the 1714 women admitted in 2008, relatively small differences in sociodemographic characteristics, distance and antenatal care uptake were found between groups.Conclusions Maternal mortality and stillbirth rates were substantially lower in women admitted via MWA. It is likely that at least part of this difference is accounted for by the timely and appropriate obstetric management of women using this facility.

Attat MWH users had less favourable sociodemographic characteristics but better birth outcomes than Attat non-users and Butajira women.

Objective To describe facilitators for maternity waiting home (MWH) utilisation from the perspectives of MWH users and health staff. Methods Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed‐methods design. This included seven in‐depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2‐week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation. Results The MWH at Attat Hospital has become a well‐established intervention for high‐risk pregnant women (1987–2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142–832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (EmONC) seemed to have contributed to realising community support for the MWH. The qualitative data also revealed that awareness of pregnancy‐related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby. Conclusions Facilitators for MWH utilisation according to users and staff were perceived high‐quality EmONC, integrated health services, awareness of pregnancy‐related complications and the husband's support in overcoming barriers. If providing high‐quality EmONC and integrating health services are prioritised, MWHs have the potential to become an accepted intervention in (rural) communities. Only then can MWHs improve access to EmONC.

In Ethiopia cervical carcinoma is the most frequent cancer in women. HPV infection is a prerequisite for this disease. However, to date there have been no data on human papilloma virus (HPV) prevalence in Ethiopia. Outpatients attending Attat hospital in rural Ethiopia were examined for the presence of HPV DNA using the Digene HPV test. 15.9% of patients were found to be HPV positive. The proportion of HPV high risk types was 13.2% [age-standardised rates: HPV: 14.4% (95% CI: 8.5-20.2); HPV high risk: 11.6% (95% CI: 6.3-16.9)]. Compared to other countries HPV prevalence is high, especially of high risk types. Until vaccination programmes take effect, screening programmes should not be based on HPV testing alone as this will lead to significant overtreatment of healthy women.