Abstract
BackgroundResidential 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.MethodsWe 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.ResultsMWH 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).ConclusionsImproving both the availability and the quality of MWH represents a potentially useful strategy to increasing facility delivery in rural Zambia.Trial registrationThe Zambia Chlorhexidine Application Trial is registered at Clinical Trials.gov (identifier: NCT01241318)
Highlights
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
Women who were married, had fewer years of education, more than one child, lived more than two hours away from a health facility, had less than the four recommended antenatal care (ANC) visits, and were not HIV positive were less likely to deliver in a facility
When we examined the relationship between MWH quality and facility delivery, again limiting our analysis only to those facilities with existing MWH structures and controlling for those covariates listed above, including facility capacity score, there was a 95% relative increase in the odds of facility delivery for high or medium-ranking MWHs compared to low-ranking shelters, adjusting for covariates (OR: 1.95, 95% CI: 1.76,2.16)
Summary
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. While the government has abolished user fees for maternal and child services to increase financial access to health care services in 2006, about 65% of the population lives in rural areas and still face physical barriers to access. A recent analysis of the effects of the abolished user-fee policy in Zambia suggests that this reform has not overcome key barriers to utilization of public sector facilities for delivery, and that both quality of care and difficulties related to distance may be a more important determinants [11]. Additional evidence confirms that the odds of facility delivery in rural Zambia decreases as distance to a facility increases [12]
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