Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study.

Abstract

ObjectiveTo report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility.DesignQuasi‐experimental design with partial randomisation at the cluster level.SettingSeven rural districts in Zambia.PopulationWomen delivering at 40 health facilities between June 2016 and August 2018.MethodsTwenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference‐in‐differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes.Main outcome measuresDifferences in the change from baseline to study period in the percentage of women living >10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher‐level health facility between intervention and comparison group.ResultsWe detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10 km away (DID 4.2%, 95% CI 0.6–7.6, P = 0.03), adolescent women (<18 years) living >10 km away (DID 18.1%, 95% CI 6.3–29.8, P = 0.002) and primigravida women living >10 km away (DID 9.3%, 95% CI 2.4–16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7–28, P < 0.001).ConclusionThe core MWH model was successful in increasing rates of facility delivery for women living >10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit.Tweetable abstractA core MWH model increased facility delivery for women living >10 km from a health facility including adolescents and primigravidas in Zambia.