Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Reproductive Health
Published in: Reproductive Health 1/2017

Open Access 01-12-2017 | Research

The influence of quality maternity waiting homes on utilization of facilities for delivery in rural Zambia

Authors: Elizabeth G. Henry, Katherine Semrau, Davidson H. Hamer, Taryn Vian, Mary Nambao, Kaluba Mataka, Nancy A. Scott

Published in: Reproductive Health | Issue 1/2017

Login to get access

Abstract

Background

Residential accommodation for expectant mothers adjacent to health facilities, known as maternity waiting homes (MWH), is an intervention designed to improve access to skilled deliveries in low-income countries like Zambia where the maternal mortality ratio is estimated at 398 deaths per 100,000 live births. Our study aimed to assess the relationship between MWH quality and the likelihood of facility delivery in Kalomo and Choma Districts in Southern Province, Zambia.

Methods

We systematically assessed and inventoried the functional capacity of all existing MWH using a quantitative facility survey and photographs of the structures. We calculated a composite score and used multivariate regression to quantify MWH quality and its association with the likelihood of facility delivery using household survey data collected on delivery location in Kalomo and Choma Districts from 2011–2013.

Results

MWH were generally in poor condition and composite scores varied widely, with a median score of 28.0 and ranging from 12 to 66 out of a possible 75 points. Of the 17,200 total deliveries captured from 2011–2013 in 40 study catchment area facilities, a higher proportion occurred in facilities where there was either a MWH or the health facility provided space for pregnant waiting mothers compared to those with no accommodations (60.7% versus 55.9%, p <0.001). After controlling for confounders including implementation of Saving Mothers Giving Life, a large-scale maternal health systems strengthening program, among women whose catchment area facilities had an MWH, those women with MWHs in their catchment area that were rated medium or high quality had a 95% increase in the odds of facility delivery than those whose catchment area MWHs were of poor quality (OR: 1.95, 95% CI 1.76, 2.16).

Conclusions

Improving both the availability and the quality of MWH represents a potentially useful strategy to increasing facility delivery in rural Zambia.

Trial registration

The Zambia Chlorhexidine Application Trial is registered at Clinical Trials.gov (identifier: NCT01241318)
Literature
1.
World Health Organization (WHO). Trends in Maternal Mortality: 1990 to 2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. 2014
2.
Safe Motherhood Programme, World Health Organization (WHO). Mother-Baby Package: Implementing safe motherhood in countries. Geneva; 1994.
3.
World Health Organization (WHO). Making pregnancy safer: the critical role of the skilled attendant a joint statement by WHO, ICM and FIGO. 2004.
4.
Central Statistical Office (CSO) Zambia, [Ministry of Health (MOH) [Zambia], ICF International. Zambia Demographic and Health Survey 2013–14. Rockville, Maryland, USA; 2014.
5.
6.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38:1091–110.CrossRefPubMed
7.
Sialubanje C, Massar K, Hamer DH, Ruiter RAC. Personal and environmental predictors of the intention to use maternal healthcare services in Kalomo, Zambia. Health Educ. Res. 2014
8.
Lohela TJ, Campbell OMR, Gabrysch S. Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia. PLoS One. 2012;7.
9.
Kyei NNA, Campbell OMR, Gabrysch S. The influence of distance and level of service provision on antenatal care use in rural Zambia. PLoS One. 2012;7:e46475.CrossRefPubMedPubMedCentral
10.
Sialubanje C, Massar K, Hamer DH, Ruiter RAC. Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study. BMC Pregnancy and Childbirth. 2015;15:216.CrossRefPubMedPubMedCentral
11.
Chama-chiliba CM, Koch SF. An assessment of the effect of user fee policy reform on facility-based deliveries in rural Zambia. BMC Res. Notes. BioMed Central; 2014;29.
12.
Gabrysch S, Cousens S, Cox J, Campbell OMRO. The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med. 2011;8:e1000394.CrossRefPubMedPubMedCentral
13.
World Health Organization. WHO recommendations on health promotion interventions for maternal and newborn health. 2015. p. 94.
14.
WHO. Maternity Waiting Homes: A review of experiences. Geneva WHO. 1996;96:1–44.
15.
Gaym A, Pearson L, Soe KWW. Maternity waiting homes in Ethiopia--three decades experience. Ethiop Med J. 2012;50:209–19.PubMed
16.
van Lonkhuijzen L, Stekelenburg J, van Roosmalen J. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries. Cochrane Database Syst Rev. 2012;10:CD006759.PubMedPubMedCentral
17.
Van Den Heuvel OA, de Mey WG, Buddingh H, Bots ML. Use of maternal care in a rural area of Zimbabwe: a population-based study. Acta Obstet Gynecol Scand. 1999;78:838–46.CrossRefPubMed
18.
Sialubanje C, Massar K, G van der Pijl MS, Maria Kirch E, Hamer DH, C Ruiter RA. Improving access to skilled facility-based delivery services: Women’s beliefs on facilitators and barriers to the utilisation of maternity waiting homes in rural Zambia. Reprod. Health. 2015
19.
Scott N, Biemba G, Hamer DH, Vian T, Semrau K, Simon JL, et al. Improving equitable access to safe deliveries in Zambia: Findings from a formative evaluation. Boston, MA; 2014.
20.
Semrau KEA, Herlihy JM, Grogan C, Musokotwane K, Yeboah-Antwi K, Mbewe R, et al. Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia: a cluster randomised controlled trial. Lancet Glob. Heal. 2016
21.
Central Statistical Office (CSO) Zambia, Road N. 2010 census of population and housing. 2012.
22.
Republic of Zambia Minist. List of health facilities in Zambia. 2011. p. 1–115.
23.
Saving Mothers Giving Life. Saving mothers, giving life making pregnancy & childbirth safer in Uganda and Zambia: annual report 2013. 2014. p. 1–2.
24.
Kruk ME, Rabkin M, Grépin KA, Austin-Evelyn K, Greeson D, Masvawure TB, et al. “Big push” to reduce maternal mortality in Uganda and Zambia enhanced health systems but lacked a sustainability plan. Health Aff. 2014;33:1058–66.CrossRef
25.
Kruk ME, Vail D, Austin-Evelyn K, Atuyambe L, Greeson D, Grepin KA, et al. Evaluation of a maternal health program in Uganda and Zambia finds mixed results on quality of care and satisfaction. Health Aff. 2016;35:510–9.CrossRef
26.
Henry EG, Thea DM, Hamer DH, DeJong W, Musokotwane K, Chibwe KC, et al. The impact of a multi-level maternal health program on facility delivery and capacity for emergency obstetric care in Zambia. Under Rev. 2017;
27.
Hamer DH, Mazimba A, Musokotwane K, Banda B, Mpamba C, Mwangelwa B, et al. Engagement of the community, traditional leaders, and public health system in the design and implementation of a large community-based cluster randomized trial of umbilical cord care in Zambia. :1–29.
28.
World Health Organization (WHO), UNFPA, UNICEF, AMDD. Monitoring emergency obstetric care. In: A handbook. 2009.
29.
SAS Institute. SAS, version 9.3 of the SAS system for windows. In: Cary, NC: SAS Institute Inc. Product or service names are registered trademarks or trademarks of SAS institute Inc., Cary, NC, USA. 2011.
30.
Stekelenburg J, Kyanamina S, Mukelabai M, Wolffers I, van Roosmalen J. Waiting too long: low use of maternal health services in Kalabo, Zambia. Trop Med Int Health. 2004;9:390–8.CrossRefPubMed
31.
Lori JR, Wadsworth AC, Munro ML, Rominski S. Promoting access: the use of maternity waiting homes to achieve safe motherhood. Midwifery. 2013;29:1095–102.CrossRefPubMedPubMedCentral
32.
Moyer CA, Dako-Gyeke P, Adanu RM. Facility-based delivery and maternal and early neonatal mortality in sub-Saharan Africa: a regional review of the literature. Afr J Reprod Health. 2013;17:30–43.PubMed
33.
Larson E, Hermosilla S, Kimweri A, Mbaruku GM, Kruk ME. Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study. BMC Health Serv Res. 2014;14:483.CrossRefPubMedPubMedCentral
34.
Sialubanje C, Massar K, Kirch EM, van der Pijl MSG, Hamer DH, Ruiter RAC. Husbands’ experiences and perceptions regarding the use of maternity waiting homes in rural Zambia. Int J Gynecol Obstet Int Fed Gynecol Obstet. 2016;133:108–11.CrossRef
35.
Kelly J, Kohls E, Poovan P, Schiffer R, Redito A, Winter H, et al. The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia. BJOG. 2010;117:1377–83.CrossRefPubMed
36.
Sialubanje C, Massar K, Hamer DH, Ruiter RAC. Understanding the psychosocial and environmental factors and barriers affecting utilization of maternal healthcare services in Kalomo, Zambia: a qualitative study. Health Educ Res. 2014;29:521–32.CrossRefPubMed
Metadata
Title
The influence of quality maternity waiting homes on utilization of facilities for delivery in rural Zambia
Authors
Elizabeth G. Henry
Katherine Semrau
Davidson H. Hamer
Taryn Vian
Mary Nambao
Kaluba Mataka
Nancy A. Scott
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2017
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-017-0328-z

Other articles of this Issue 1/2017

Reproductive Health 1/2017 Go to the issue

Research

Repeat cesarean section in subsequent gestation of women from a birth cohort in Brazil

Research

Increasing utilisation of skilled facility-based maternal healthcare services in rural Zambia: the role of safe motherhood action groups

Review

Defining disrespect and abuse of newborns: a review of the evidence and an expanded typology of respectful maternity care

Research

Persisting demand and supply gap for maternal and newborn care in eastern Uganda: a mixed-method cross-sectional study

Research

Is a woman’s first pregnancy outcome related to her years of schooling? An assessment of women’s adolescent pregnancy outcomes and subsequent educational attainment in Ghana

Research

Effects of parents training on parents’ knowledge and attitudes about adolescent sexuality in Accra Metropolis, Ghana