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      Experiences with and expectations of maternity waiting homes in Luapula Province, Zambia: a mixed–methods, cross-sectional study with women, community groups and stakeholders

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          Abstract

          Background

          Luapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. To examine the experiences with maternity homes, formative research was undertaken in four districts of Luapula Province to assess women’s and community’s needs, use patterns, collaboration between maternity homes, facilities and communities, and promising practices and models in Central and Lusaka Provinces.

          Methods

          A cross-sectional, mixed-methods design was used. In Luapula Province, qualitative data were collected through 21 focus group discussions with 210 pregnant women, mothers, elderly women, and Safe Motherhood Action Groups (SMAGs) and 79 interviews with health workers, traditional leaders, couples and partner agency staff. Health facility assessment tools, service abstraction forms and registers from 17 facilities supplied quantitative data. Additional qualitative data were collected from 26 SMAGs and 10 health workers in Central and Lusaka Provinces to contextualise findings. Qualitative transcripts were analysed thematically using Atlas-ti. Quantitative data were analysed descriptively using Stata.

          Results

          Women who used maternity homes recognized the advantages of facility-based births. However, women and community groups requested better infrastructure, services, food, security, privacy, and transportation. SMAGs led the construction of maternity homes and advocated the benefits to women and communities in collaboration with health workers, but management responsibilities of the homes remained unassigned to SMAGs or staff. Community norms often influenced women’s decisions to use maternity homes. Successful maternity homes in Central Province also relied on SMAGs for financial support, but the sustainability of these models was not certain.

          Conclusions

          Women and communities in the selected facilities accept and value maternity homes. However, interventions are needed to address women’s needs for better infrastructure, services, food, security, privacy and transportation. Strengthening relationships between the managers of the homes and their communities can serve as the foundation to meet the needs and expectations of pregnant women. Particular attention should be paid to ensuring that maternity homes meet quality standards and remain sustainable.

          Electronic supplementary material

          The online version of this article (10.1186/s12884-017-1649-1) contains supplementary material, which is available to authorized users.

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          Most cited references23

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          The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia.

          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.
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            Maternity waiting homes in Ethiopia--three decades experience.

            Access to comprehensive emergency obstetric care is limited in Ethiopia. Maternity waiting homes are part of the strategies utilized to improve access to hard to reach rural populations. Despite long years of existence of this service in Ethiopia, the practice has not been adequately assessed so far.
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              Zambia demographic and health survey 2007

              (2009)
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                Author and article information

                Contributors
                peggychibuye@ymail.com
                Eva.Bazant@Jhpiego.org
                m.wallon@gmail.com
                namratha91@gmail.com
                tfruhau1@jhmi.edu
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central (London )
                1471-2393
                25 January 2018
                25 January 2018
                2018
                : 18
                : 42
                Affiliations
                [1 ]8 Ngumbo Road, Longacres, 10101 Lusaka, Zambia
                [2 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Jhpiego, an affiliate of Johns Hopkins University, ; 1615 Thames Street, Baltimore, MD 21231-3492 USA
                [3 ]Walko Global Development Partners, LLC, 805 Sycamore Place, Ann Arbor, MI 48104 USA
                [4 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Johns Hopkins Bloomberg School of Public Health, ; 615 N. Wolfe Street, Baltimore, MD 21205-2103 USA
                Article
                1649
                10.1186/s12884-017-1649-1
                5785796
                29370773
                9ecbe326-dc56-48d5-8ac8-6a06baf5df6a
                © The Author(s). 2018

                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
                : 24 May 2017
                : 28 December 2017
                Funding
                Funded by: Merck for Mothers
                Award ID: 13-AWD-032
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Obstetrics & Gynecology
                maternity waiting home,maternal health,infrastructure,safe motherhood action groups,luapula,zambia

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