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

ABSTRACT: 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.

SUBMITTER: Buser JM

PROVIDER: S-EPMC7822518 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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

Buser Julie M JM Munro-Kramer Michelle L ML Veliz Philip T PT Zhang Xingyu X Lockhart Nancy N Biemba Godfrey G Ngoma Thandiwe T Scott Nancy N Lori Jody R JR

PloS one 20210122 1

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 ...[more]

PMID: 33481942

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Project description:Although Ethiopia is scaling up Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, women's use of MWHs varies markedly between facilities. To maximize MWH utilization, it is essential that policymakers are aware of supportive and inhibitory factors. This study had the objective to describe factors and perceived barriers associated with potential utilization of an MWH among recently delivered and pregnant women in Southern Ethiopia.A community-based cross-sectional study was conducted between March and November 2014 among 428 recently delivered and pregnant women in the Eastern Gurage Zone, Southern Ethiopia, where an MWH was established for high-risk pregnant women to await onset of labour. The structured questionnaire contained questions regarding possible determinants and barriers. Logistic regression with 95% Confidence Intervals (CI) was used to examine association of selected variables with potential MWH use.While only thirty women (7.0%) had heard of MWHs prior to the study, 236 (55.1%), after being explained the concept, indicated that they intended to stay at such a structure in the future. The most important factors associated with intended MWH use in the bivariate analysis were a woman's education (secondary school or higher vs. no schooling: odds ratio [OR] 6.3 [95% CI 3.46 to 11.37]), her husband's education (secondary school or higher vs. no schooling: OR 5.4 [95% CI 3.21 to 9.06]) and envisioning relatively few barriers to MWH use (OR 0.32 [95% CI 0.25 to 0.39]). After adjusting for possible confounders, potential users had more frequently suffered complications in previous childbirths (adjusted odds ratio [aOR] 4.0 [95% CI 1.13 to 13.99]) and envisioned fewer barriers to MWH use (aOR 0.3 [95% CI 0.23 to 0.38]). Barriers to utilization included being away from the household (aOR 18.1 [95% CI 5.62 to 58.46]) and having children in the household cared for by the community during a woman's absence (aOR 9.3 [95% CI 2.67 to 32.65]).Most respondents had no knowledge about MWHs. Having had complications during past births and envisioning few barriers were factors found to be positively associated with intended MWH use. Unless community awareness of preventive maternity care increases and barriers for women to stay at MWHs are overcome, these facilities will continue to be underutilized, especially among marginalized women.

Project description:BackgroundA maternity waiting home is a temporary residence in which pregnant women from remote areas wait for their childbirth. It is an approach targeted to advance access to emergency obstetric care services especially, in hard-to-reach areas to escalate institutional delivery to reduce complications that occur during childbirth. Apart from the availability of this service, the intention of pregnant women to utilize the existing service is very important to achieve its goals. Thus, this study aimed to assess the intention to use maternity waiting homes and associated factors among pregnant women.MethodsCommunity-based cross-sectional study was conducted among 605 pregnant women using a multistage sampling technique from March 10 to April 10, 2019, by using a structured questionnaire through a face-to-face interview. The collected data was entered into Epi-Data version 3.1 and analyzed using the SPSS version 24 statistical package. Logistic regression analysis was used to test the association. All variables at p-value < 0.25 in bivariate analysis were entered into multivariate analysis. Lastly, a significant association was declared at a P-value of < 0.05 with 95% CI.ResultsIn this study, the intention to use maternity waiting homes was 295(48.8%, 95%CI: 47%-55%)). Occupation (government employee) (AOR:2.87,95%CI: 1.54-5.36), previous childbirth history (AOR:2.1,95%CI:1.22-3.57), past experience in maternity waiting home use AOR:4.35,95%CI:2.63-7.18), direct (AOR:1.57,95%CI:1.01-2.47) and indirect (AOR: 2.18, 1.38,3.44) subject norms and direct (AOR:3.00,95%CI:2.03-4.43), and indirect (AOR = 1.84,95%CI:1.25-2.71) perceived behavioral control of respondents were significantly associated variables with intention to use maternity waiting home.ConclusionThe magnitude of intention to use maternity waiting homes among pregnant women is low. Community disapproval, low self-efficacy, maternal employment, history of previous birth, and past experiences of MWHs utilization are predictors of intention to use MWHs, and intervention programs, such as health education, strengthening and integration of community in health system programs need to be provided.

Project description:BackgroundAntenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling.MethodsThis study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software.ResultsClients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts.ConclusionsFindings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.

Project description:BackgroundThe implementation of Maternity Waiting Homes (MWHs) is a strategy to bring vulnerable women close to a health facility towards the end of their pregnancies. To date, while MWHs are a popular strategy, there is limited evidence on the role that MWHs play in reaching women most in need. This paper contributes to this topic by examining whether two program-supported MWHs in Malawi are reaching women in need and if there are changes in women reached over time.MethodsTwo rounds of exit interviews (2015 and 2017) were conducted with women within 3 months of delivery and included both MWH users and non-MWH users. These exit interviews included questions on sociodemographic factors, obstetric risk factors and use of health services. Bivariate statistics were used to compare MWH users and non-MWH users at baseline and endline and over time. Multivariable logistic regression was used to determine what factors were associated with MWH use, and Poisson regression was used to study factors associated with HIV knowledge. Descriptive data from discharge surveys were used to examine satisfaction with the MWH structure and environment over time.ResultsPrimiparous women were more likely to use a MWH compared to women of parity 2 (p < 0.05). Women who were told they were at risk of a complication were more likely to use a MWH compared to those who were not told they were at risk (p < 0.05). There were also significant findings for wealth and time to a facility, with poorer women and those who lived further from a facility being more likely to use a MWH. Attendance at a community event was associated with greater knowledge of HIV (p < 0.05).ConclusionsMWHs have a role to play in efforts to improve maternal health and reduce maternal mortality. Education provided within the MWHs and through community outreach can improve knowledge of important health topics. Malawi and other low and middle income countries must ensure that health facilities affiliated with the MWHs offer high quality services.

Project description:BACKGROUND:Maternity Waiting Homes (MWHs) have been advocated to improve the utilization of skilled birth attendants. Nevertheless, delivery attended by skilled personnel is low in Ethiopia and may indicate that the utilization of MWH is also low. The aim of this study is to explore the factors influencing women's access to the MWHs in rural Southwest Ethiopia. METHODS:Qualitative data were collected through focus group discussions with MWHs users and in-depth interviews with MWHs non-users, health extension workers and the clinicians. Four focus group discussions and 18 in-depth interviews were conducted between May 1 and June 1, 2017. Furthermore, observations were made to assess the availability of basic facilities at selected MWHs. Data were thematically analyzed using NVivo version 7. The concept of access defined by Thiede et al was applied to guide the analysis. RESULTS:Women had interest on MWHs and are aware of the existence of MWHs in their immediate vicinity. Health information disseminations and referral linkages by frontline health workers enabled women to timely access the MWHs. However, Women didn't understand the aims and benefits of MWHs. At the facility level, there were attempts to improve the acceptability of MWHs by allowing women to choose their delivery positions. But, participants claimed lack of privacy and presence of disrespectful care. Physical barriers (long distance, unavailability of transport options & unfavorable roads) were considered as potential problems for women residing in remote areas. MWH users mentioned absences of sufficient basic facilities, poor quality and varieties of food. Because of insufficient facilities, the cost of living was high for most users. The communities try to overcome the indirect costs through contributions in-kind and in-cash. CONCLUSIONS:The factors influencing women's access to the MWHs were structural and individual and resonate with Thiede et al. dimensions of access. A better understanding of which factors are most influential in preventing women's access to the MWHs in rural Southwest Ethiopia is needed to appropriately target interventions.

Dataset Information

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

Publications

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

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