Factors associated with maternity waiting home use among women in Jimma Zone, Ethiopia: a multilevel cross-sectional analysis

Abstract

ObjectiveTo identify individual-, household- and community-level factors associated with maternity waiting home (MWH) use in Ethiopia.DesignCross-sectional analysis of baseline household survey data from an ongoing cluster-randomised controlled trial using multilevel analyses.SettingTwenty-four rural primary care facility catchment areas in Jimma Zone, Ethiopia.Participants3784 women who had a pregnancy outcome (live birth, stillbirth, spontaneous/induced abortion) 12 months prior to September 2016.Outcome measureThe 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.ResultsOverall, 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.ConclusionsUtilisation 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.

<p>A Culturally Sensitive and Supportive Maternity Care Service Increases the Uptake of Maternity Waiting Homes in Ethiopia</p>

“…Our study identified low utilization of MWHs was linked with socio-economic, demographic, cultural, and facilityrelated constraints. Only 42.5% of women in our study utilized MWHs, which is higher than previous studies done in Ethiopia, 24,25 and Zambia (27.3%). 26 The availability of MWHs in all health centers in the study area, the recent health policy of the government of Ethiopia targeting to decrease the maternal and child mortality, the presence of health extension workers (HEWs) who can reach out to the grass-root level community and linking their service to the next level health institutions in Ethiopia are possible explanations accounting for the use of MWHs being higher than those reported in the previous studies mentioned above.…”

Promoting equity in maternal, newborn and child health – how does gender factor in? Perceptions of public servants in the Ethiopian health sector

“…This research is part of the Safe Motherhood Project, a mixed-methods intervention trial testing the rollout and scale up of interventions to reduce preventable maternal and newborn morbidity and mortality [41][42][43]. The Safe Motherhood Project has rolled out two interventions (an information, education and communication intervention, and maternity waiting area (MWA) upgrades) and conducted multiple rounds of data collection (prior to the design of the interventions, at baseline and at end line) [44].…”

Maternity waiting homes as component of birth preparedness and complication readiness for rural women in hard-to-reach areas in Ethiopia

“…The calculated sample size using the above assumptions was 663. In addition, the sample size for the barriers to MWH use (women's occupation, household index, and travel time to obstetric care facility) [29] was computed yet the result yielded a smaller sample size than the level of utilization. An additional 10% from the estimated sample size was considered to compensate for potential non-responses and multiplying the design effect by two, and the nal sample size for the study was 814.…”