Abstract
BackgroundEthiopia has been expanding maternity waiting homes to bridge geographical gaps between health facilities and communities in order to improve access to skilled care. In 2015, the Ministry of Health revised its national guidelines to standardize the rapid expansion of waiting homes. Little has been done to document their distribution, service availability and readiness. This paper addresses these gaps as well as their association with perinatal mortality and obstetric complication rates.MethodsWe utilized data from the 2016 national Emergency Obstetric and Newborn Care assessment, a census of 3804 public and private health facilities. Data were collected between May and December 2016 through interviews with health care workers, record reviews, and observation of infrastructure. Descriptive statistics describe the distribution and characteristics of waiting homes and linear regression models examined the correlation between independent variables and institutional perinatal and peripartum outcomes.ResultsNationally, about half of facilities had a waiting home. More than two-thirds of facilities in Amhara and half of the facilities in SNNP and Oromia had a home while the region of Gambella had none. Highly urbanized regions had few homes.Conditions were better among homes at hospitals than at health centers. Finished floors, electricity, water, toilets, and beds with mattresses were available at three (or more) out of four hospital homes. Waiting homes in pastoralist regions were often at a disadvantage.Health facilities with waiting homes had similar or lower rates of perinatal death and direct obstetric complication rates than facilities without a home. The perinatal mortality was 47% lower in hospitals with a home than those without. Similarly, the direct obstetric complication rate was 49% lower at hospitals with a home compared to hospitals without.ConclusionsThe findings should inform regional maternal and newborn improvement strategies, indicating gaps in the distribution and conditions, especially in the pastoralist regions. The impact of waiting homes on maternal and perinatal outcomes appear promising and as homes continue to expand, so should efforts to regularly monitor, refine and document their impact.
Highlights
Ethiopia has been expanding maternity waiting homes to bridge geographical gaps between health facilities and communities in order to improve access to skilled care
The study results are presented in three sections: 1) distribution of Maternity Waiting Homes (MWH), 2) infrastructure and condition of MWHs, and 3) univariate and multivariate analyses of the relationship between the availability of MWHs, other facility characteristics and perinatal death rates (PDR) and direct obstetric complication rates (DOCR)
We examined the influence of a MWH on the PDR and DOCR while controlling for region, managing authority, Fig. 1 Percent distribution of facilities with maternity waiting homes according to summary index score, by facility characteristics location, emergency obstetric and newborn care (EmONC) status and readiness, availability of transport, density of skilled birth attendants (SBA) and annual volume of deliveries
Summary
Ethiopia has been expanding maternity waiting homes to bridge geographical gaps between health facilities and communities in order to improve access to skilled care. Three-quarters of maternal and newborn deaths are clustered around the time of labor and delivery, indicating that timely access to quality intrapartum services is a key factor to maternal and newborn survival [1,2,3,4]. This presents a challenge in many low and middle-income countries (LMICs), where access to evidencebased life-saving interventions is often low [5, 6]. The 2016 Ethiopian Demographic and Health Survey reports that while 62% of pregnant women made at least one skilled ANC visit, only 28% delivered their babies under the assistance of a skilled person, and even fewer (17%) received postnatal care within 48 h of the birth [11] despite institutional delivery levels showing a three-fold increase between 2011 and 2016 [11, 12]
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