Quality and utilization patterns of maternity waiting homes at referral facilities in rural Zambia: A mixed-methods multiple case analysis of intervention and standard of care sites

Bonawitz, Rachael; McGlasson, Kathleen L; Kaiser, Jeanette L; Ngoma, Thandiwe; Fong, Rachel M; Biemba, Godfrey; Bwalya, Misheck; Hamer, Davidson H.; Scott, Nancy A.

doi:10.1371/journal.pone.0225523

Cited by 10 publications

(18 citation statements)

References 21 publications

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“…In terms of PNC, our findings are consistent with those of researchers in Zambia’s Southern and Eastern Provinces who used a time-series design to examine pre-post MWH intervention trends [ 30 ]. Researchers found the use of MWHs for PNC increased at one of two intervention sites even though both sites had dedicated space for PNC users [ 30 ]. Postnatal care is directly associated with place of birth and delivery by a skilled health provider [ 28 , 31 ].…”

Section: Discussionsupporting

confidence: 87%

How maternity waiting home use influences attendance of antenatal and postnatal care

et al. 2021

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As highlighted in the International Year of the Nurse and the Midwife, access to quality nursing and midwifery care is essential to promote maternal-newborn health and improve survival. One intervention aimed at improving maternal-newborn health and reducing underutilization of pregnancy services is the construction of maternity waiting homes (MWHs). The purpose of this study was to assess whether there was a significant change in antenatal care (ANC) and postnatal care (PNC) attendance, family planning use, and vaccination rates before and after implementation of the Core MWH Model in rural Zambia. A quasi-experimental controlled before-and-after design was used to evaluate the impact of the Core MWH Model by assessing associations between ANC and PNC attendance, family planning use, and vaccination rates for mothers who gave birth to a child in the past 13 months. Twenty health care facilities received the Core MWH Model and 20 were identified as comparison facilities. Before-and-after community surveys were carried out. Multivariable logistic regression were used to assess the association between Core MWH Model use and ANC and PNC attendance. The total sample includes 4711 mothers. Mothers who used the Core MWH Model had better ANC and PNC attendance, family planning use, and vaccination rates than mothers who did not use a MWH. All mothers appeared to fare better across these outcomes at endline. We found an association between Core MWH Model use and better ANC and PNC attendance, family planning use, and newborn vaccination outcomes. Maternity waiting homes may serve as a catalyst to improve use of facility services for vulnerable mothers.

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Section: Discussionsupporting

confidence: 87%

How maternity waiting home use influences attendance of antenatal and postnatal care

et al. 2021

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“…Levels of MWH utilization globally have been reported to be sub-optimal, partly due to the poor quality of services available at MWHs [ 17 ]. A recent Zambian study using upgraded MWHs reported increased utilization levels at one of the two improved sites [ 22 ]. Social support for pregnant women has also been found to impact MWH use [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia

et al. 2020

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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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“…All 66 records retrieved were observational. There was great variance in terms of study design, with cohort studies [ 9 10 11 12 13 14 15 16 17 18 ], cross-sectional studies [ 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 ], intervention studies [ 40 41 42 43 44 45 46 47 48 49 50 ], and unspecified studies included [ 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 ]. Of the 66 studies, only one mentioned any kind costing analysis of MWHs [ 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…All 66 records retrieved were observational. There was great variance in terms of study design, with cohort studies [9][10][11][12][13][14][15][16][17][18], cross-sectional studies , intervention studies [40][41][42][43][44][45][46][47][48][49][50], and unspecified studies included . Of the 66 studies, only one mentioned any kind costing analysis of MWHs [47].…”

Section: Resultsmentioning

confidence: 99%

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

Smith

Henrikson

Thapa

et al. 2022

Annals of Global Health

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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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Quality and utilization patterns of maternity waiting homes at referral facilities in rural Zambia: A mixed-methods multiple case analysis of intervention and standard of care sites

Cited by 10 publications

References 21 publications

How maternity waiting home use influences attendance of antenatal and postnatal care

How maternity waiting home use influences attendance of antenatal and postnatal care

Effectiveness of upgraded maternity waiting homes and local leader training on improving institutional births: a cluster-randomized controlled trial in Jimma, Ethiopia

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

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