Abstract
BackgroundIncreased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. Additionally, maternity waiting homes (MWHs) have been identified as a critical link in the continuum of care for maternal and newborn health yet there is scant data on the associations among MWH use and antenatal/postnatal attendance, family planning and immunization rates of newborns.MethodsA cross-sectional household survey was conducted to collect data from women who delivered a child in the past 13 months from catchment areas associated with 40 healthcare facilities in seven rural Saving Mothers Giving Life districts in Zambia. Multi-stage random sampling procedures were employed with a final sample of n = 2381. Logistic regression models with adjusted odds ratios and 95% confidence intervals were used to analyze the data.ResultsThe use of a MWH was associated with increased odds of attending four or more antenatal care visits (OR = 1.45, 95% CI = 1.26, 1.68), attending all postnatal care check-ups (OR = 2.00, 95% CI = 1.29, 3.12) and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH.ConclusionsThis is the first study to quantitatively examine the relationship between the use of MWHs and antenatal and postnatal uptake. Developing a comprehensive package of services for maternal and newborn care has the potential to improve acceptability, accessibility, and availability of healthcare services for maternal and newborn health. Maternity waiting homes have the potential to be used as part of a multi-pronged approach to improve maternal and newborn outcomes.Trial registrationNational Institutes of Health Trial Registration NCT02620436, Impact Evaluation of Maternity Homes Access in Zambia, Date of Registration - December 3, 2015.
Highlights
Increased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes
The results indicate the use of a Maternity waiting home (MWH) was associated with increased odds of attending four or more antenatal care (ANC) visits (OR = 1.45, 95% Confidence interval (CI) = 1.26, 1.68), attending all postnatal care (PNC) check-ups (OR = 2.00, 95% confidence intervals (95% CI) = 1.29, 3.12), and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH
At the end of this study, there were no national policies regarding standardization of MWHs in Zambia, wide variation could exist at each MWH. This is the first study to quantitatively examine the relationship between the use of MWHs and ANC and PNC utilization
Summary
Increased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. It is well recognized that underutilization of life-saving health services has been associated with poor maternal and newborn outcomes [1]: multiple factors influence the use of maternal health services for women living in poor, remote communities. According to the most recent Demographic and Health Survey only 55.5% of women attended four or more ANC visits [7], the number of visits deemed the most beneficial by the World Health Organization (WHO) until recently [5]
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