Maternity waiting homes as part of a comprehensive approach to maternal and newborn care: a cross-sectional survey

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Abstract

Background

Increased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. Additionally, maternity waiting homes (MWHs) have been identified as a critical link in the continuum of care for maternal and newborn health yet there is scant data on the associations among MWH use and antenatal/postnatal attendance, family planning and immunization rates of newborns.

Methods

A cross-sectional household survey was conducted to collect data from women who delivered a child in the past 13 months from catchment areas associated with 40 healthcare facilities in seven rural Saving Mothers Giving Life districts in Zambia. Multi-stage random sampling procedures were employed with a final sample of n = 2381. Logistic regression models with adjusted odds ratios and 95% confidence intervals were used to analyze the data.

Results

The use of a MWH was associated with increased odds of attending four or more antenatal care visits (OR = 1.45, 95% CI = 1.26, 1.68), attending all postnatal care check-ups (OR = 2.00, 95% CI = 1.29, 3.12) and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH.

Conclusions

This is the first study to quantitatively examine the relationship between the use of MWHs and antenatal and postnatal uptake. Developing a comprehensive package of services for maternal and newborn care has the potential to improve acceptability, accessibility, and availability of healthcare services for maternal and newborn health. Maternity waiting homes have the potential to be used as part of a multi-pronged approach to improve maternal and newborn outcomes.

Trial registration

National Institutes of Health Trial Registration NCT02620436, Impact Evaluation of Maternity Homes Access in Zambia, Date of Registration - December 3, 2015.

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Most cited references 9

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Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis

Choolwe Jacobs, Mosa Moshabela, Sitali Maswenyeho … (2017)

Objective Optimal utilization of maternal health-care services is associated with reduction of mortality and morbidity for both mothers and their neonates. However, deficiencies and disparity in the use of key maternal health services within most developing countries still persist. We examined patterns and predictors associated with the utilization of specific indicators for maternal health services among mothers living in the poorest and remote district populations of Zambia. Methods A cross-sectional baseline household survey was conducted in May 2012. A total of 551 mothers with children between the ages 0 and 5 months were sampled from 29 catchment areas in four rural and remote districts of Zambia using the lot quality assurance sampling method. Using multilevel modeling, we accounted for individual- and community-level factors associated with utilization of maternal health-care services, with a focus on antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC). Results Utilization rates of focused ANC, SBA, and PNC within 48 h were 30, 37, and 28%, respectively. The mother’s ability to take an HIV test and receiving test results and uptake of intermittent preventive treatment for malaria were positive predictors of focused ANC. Receiving ANC at least once from skilled personnel was a significant predictor of SBA and PNC within 48 h after delivery. Women who live in centralized rural areas were more likely to use SBA than those living in remote rural areas. Conclusion Utilization of maternal health services by mothers living among the remote and poor marginalized populations of Zambia is much lower than the national averages. Finding that women that receive ANC once from a skilled attendant among the remote and poorest populations are more likely to have a SBA and PNC, suggests the importance of contact with a skilled health worker even if it is just once, in influencing use of services. Therefore, it appears that in order for women in these marginalized communities to benefit from SBA and PNC, it is important for them to have at least one ANC provided by a skilled personnel, rather than non-skilled health-care providers.

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Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings.

A Kearns, J M Caglia, P Ten Hoope-Bender … (2016)

Key lessons can be drawn from innovative approaches that have been implemented to ensure access to better antenatal care (ANC) and postnatal care (PNC). This paper examines the successes and challenges of ANC and PNC delivery models in several settings around the world; discusses the lessons to be learned from them; and makes recommendations for future programmes. Based on this review, we conclude that close monitoring of ANC and PNC quality and delivery models, health workforce support, appropriate use of electronic technologies, integrated care, a woman-friendly perspective, and adequate infrastructure are key elements of successful programmes that benefit the health and wellbeing of women, their newborns and families. However, a full evaluation of care delivery models is needed to establish their acceptability, accessibility, availability and quality.

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Maternity waiting homes and traditional midwives in rural Liberia.

Walter Gwenegale, Jennifer Moore, Carol J Boyd … (2013)

Maternity waiting homes (MWHs) can reduce maternal morbidity and mortality by increasing access to skilled birth attendants (SBAs). The present analysis was conducted to determine whether MWHs increase the use of SBAs at rural primary health clinics in Liberia; to determine whether traditional midwives (TMs) are able to work with SBAs as a team and to describe the perceptions of TMs as they engage with SBAs; and to determine whether MWHs decrease maternal and child morbidity and mortality.

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Author and article information

Contributors

Jody R. Lori:

ORCID: http://orcid.org/0000-0003-0564-5783

(734) 763-0097 , jrlori@umich.edu

Joseph Perosky: josepero@umich.edu

Michelle L. Munro-Kramer: mlmunro@umich.edu

Phil Veliz: ptveliz@umich.edu

Gertrude Musonda: gmusonda@africare.org

Jameson Kaunda: jkaunda@africare.org

Carol J. Boyd: caroboyd@umich.edu

Rachael Bonawitz: Rebonaiwi@bu.edu

Godfrey Biemba: gbiemba@gmail.com

Thandiwe Ngoma: Thandiwe.Ngoma@equiphealth.org

Nancy Scott: nscott@bu.edu

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 4 July 2019

Publication date PMC-release: 4 July 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 228

Affiliations

[1 ]ISNI 0000000086837370, GRID grid.214458.e, Office of Global Affairs, PAHO/WHO Collaborating Center, School of Nursing, 400 N. Ingalls, , University of Michigan, ; Ann Arbor, MI 48109 USA

[2 ]ISNI 0000000086837370, GRID grid.214458.e, School of Nursing, , University of Michigan, ; 400 N. Ingalls, Ann Arbor, MI 48109 USA

[3 ]Africare-Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Box, 33921 Lusaka, Zambia

[4 ]ISNI 0000000086837370, GRID grid.214458.e, Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, , University of Michigan, ; Ann Arbor, MI 48109 USA

[5 ]ISNI 0000000086837370, GRID grid.214458.e, Institute for Research on Women and Gender, , University of Michigan, ; Ann Arbor, MI 48109 USA

[6 ]ISNI 0000 0004 1936 7558, GRID grid.189504.1, School of Public Health, , Boston University, ; Boston, MA 02118 USA

[7 ]Boston University, School of Public Health, Director/CEO, National Health Research Authority (NHRA), Lusaka, Zambia

[8 ]Right to Care Zambia, Lusaka, Zambia

Author information

Jody R. Lori http://orcid.org/0000-0003-0564-5783

Article

Publisher ID: 2384

DOI: 10.1186/s12884-019-2384-6

PMC ID: 6610940

PubMed ID: 31272402

SO-VID: 42a6acd0-d80c-4adb-8fea-38bffa170e50

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 15 July 2018

Date accepted : 27 June 2019

Funding

Funded by: MSD for Mothers

Award ID: MRK 1846-06500.COL

Award Recipient : Jody R. Lori

Funded by: Bill & Melinda Gates Foundation

Award ID: OPP1130334

Award Recipient : Jody R. Lori

Funded by: The ELMA Foundation

Award ID: ELMA-15-F0017

Award Recipient : Jody R. Lori

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: antenatal care,maternity waiting homes,postnatal care,zambia

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: antenatal care, maternity waiting homes, postnatal care, zambia

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Maternity waiting homes as part of a comprehensive approach to maternal and newborn care: a cross-sectional survey

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Abstract

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Trial registration

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Advocacy for Maternal and Women’s Health

Most cited references 9

Predictors of Antenatal Care, Skilled Birth Attendance, and Postnatal Care Utilization among the Remote and Poorest Rural Communities of Zambia: A Multilevel Analysis

Antenatal and postnatal care: a review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings.

Maternity waiting homes and traditional midwives in rural Liberia.

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Cited by 12

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