Utilization Of Maternity Waiting Homes Research Articles

Research implementation and evaluation of the maternity waiting home program for enhancing maternal health in remote area of Indonesia

BackgroundThe limited accessibility of healthcare facilities contributes to delays, resulting in an increased risk of maternal mortality. One crucial strategy for improving access to care is the implementation of standardized Maternity Waiting Homes (MWH). This study aims to identify strategies for enhancing the MWH program's effectiveness in remote areas. MethodsThis research is implementation research using a mixed-method approach. Focus group discussions and in-depth interviews were conducted among stakeholders and health workers to explore barriers and attitudes in implementing MWH. The quantitative data collection with a cross-sectional design was conducted to identify the use of MWH by pregnant women and families. A quasi-experimental method with a pre-test and post-test control group design was performed to implement a collaborative empowerment model of Community Health Workers (CHW) and midwives. ResultsThis study revealed that the utilization of the MWH program by the community was deficient. This was attributed to the lack of knowledge regarding MWH among pregnant women and families, the distances between residences and the MWH, high costs, and a shortage of MWH healthcare providers. After implementing a collaborative model, there were three times improvements in knowledge (Rs = 0.26, P-value = 0.032) and willingness to utilize MWH (P-value = 0.037) among pregnant women in the intervention group. ConclusionImplementing a collaborative empowerment model of CHW and midwives has enhanced knowledge acquisition and utilization of MWH among pregnant women. This approach ought to be utilized to improve MWH or health facility utilization, particularly in specific locations.

Utilization of Maternity Waiting Homes in the Islands: A Study Literature

The maternal mortality rate is still high in Indonesia, especially in the archipelago, and shows a low level of health. A Maternity Waiting Home (MWH) is a place or room near a health facility (hospital, health center, poskesdes) that can be used as a temporary residence for pregnant women and their companions (husband/cadre/shaman/family) for several days while waiting for delivery and a few days after giving birth. A literature review using the narrative literature review method was carried out by synthesizing and analyzing 3 scientific article search engines. Searching for manuscripts on the three search engines found 6 manuscripts that match the specified topic, namely the use of birth waiting homes for mothers in the islands. The results of the literature review showed that several factors influence the use of MWH, including distance to health facilities, travel time, socio-economic conditions of the community, completeness of MWH facilities, and community participation. Efforts to utilize this MWH are expected to increase access to health services, and the number of deliveries to incompetent health care facilities and can reduce cases of complications for pregnant women, maternity mothers, postpartum mothers, and newborns.

Benefits, barriers and enablers of maternity waiting homes utilization in Ethiopia: an integrative review of national implementation experience to date

BackgroundThough Ethiopia has expanded Maternity Waiting Homes (MWHs) to reduce maternal and perinatal mortality, the utilization rate is low. To maximize the use of MWH, policymakers must be aware of the barriers and benefits of using MWH. This review aimed to describe the evidence on the barriers and benefits to access and use of MWHs in Ethiopia.MethodsData were sourced from PubMed, Google Scholars and Dimensions. Thirty-one studies were identified as the best evidence for inclusion in this review. We adopted an integrative review process based on the five-stage process proposed by Whittemore and Knafl.ResultsThe key themes identified were the benefits, barriers and enablers of MWH utilization with 10 sub-themes. The themes about benefits of MWHs were lower incidence rate of perinatal death and complications, the low incidence rate of maternal complications and death, and good access to maternal health care. The themes associated with barriers to staying at MWH were distance, transportation, financial costs (higher out-of-pocket payments), the physical aspects of MWHs, cultural constraints and lack of awareness regarding MWHs, women’s perceptions of the quality of care at MWHs, and poor provider interaction to women staying at MWH. Enablers to pregnant women to stay at MWHs were availability of MWHs which are attached with obstetric services with quality and compassionate care.ConclusionThis study synthesized research evidence on MWH implementation, aiming to identify benefits, barriers, and enablers for MWH implementation in Ethiopia. Despite the limited and variable evidence, the implementation of the MWH strategy is an appropriate strategy to improve access to skilled birth attendance in rural Ethiopia.

Maternity waiting homes as component of birth preparedness and complication readiness for rural women in hard-to-reach areas in Ethiopia

BackgroundIn rural areas of Ethiopia, 57% of births occur at home without the assistance of skilled birth attendants, geographical inaccessibility being one of the main factors that hinder skilled birth attendance. Establishment of maternity waiting homes (MWH) is part of a strategy to improve access to skilled care by bringing pregnant women physically close to health facilities. This study assessed barriers to MWHs in Arba Minch Zuria District, Southern Ethiopia.MethodsA community-based cross-sectional study was undertaken from February 01 to 28, 2019. Study participants were selected by computer-generated random numbers from a list of women who gave birth from 2017 to 2018 in Arba Minch Health and Demographic Surveillance System site. Data were collected using a pre-tested and interviewer-administered questionnaire. Stata software version-15 was used for data management and analysis, and variables with p-values ≤ 0.2 in bivariate analysis were considered for multivariable logistic regression analysis. Level of statistical significance was declared at a p-value < 0.05. Qualitative data were analyzed manually based on thematic areas.ResultsMWH utilization was found to be 8.4%. Wealth index (lowest wealth quintile aOR 7.3; 95% CI 1.2, 42), decisions made jointly with male partners (husbands) for obstetric emergencies (aOR 3.6; 95% CI 1.0, 12), birth preparedness plan practice (aOR 6.5; 95% CI 2.3, 18.2), complications in previous childbirth (aOR 3; 95% 1.0, 9), history of previous institutional childbirth (aOR 12; 95% CI 3.8, 40), residence in areas within two hours walking distance to the nearest health facility (aOR 3.3; 95% CI: 1.4, 7.7), and ease of access to transport in obstetric emergencies (aOR 8.8; 95% CI: 3.9, 19) were factors that showed significant associations with MWH utilization.ConclusionsA low proportion of women has ever used MWHs in the study area. To increase MWH utilization, promoting birth preparedness practices, incorporating MWH as part of a personalized birth plan, improving access to health institutions for women living far away and upgrading existing MWHs are highly recommended.

Essential services provided and costs of facility-based maternity waiting homes in Ethiopia.

Introductionthe objective was to describe establishment cost, essential services provided and operating costs of maternity waiting homes (MWH) in Ethiopia.Methodsa cross-sectional study was carried out from December 2017 to June 2018 in eight health facilities with maternity waiting homes (MWH) in the Gurage Zone of Ethiopia. MWH users exit interviews and observational checklists were used to collect data on essential services provided. Cost-related data were retrieved from relevant records in the health facilities.Resultsmost clinical services and basic amenities were available and provided for MWH users. The average capital costs of a MWH were $2,245 US with fixed costs of $1,476 US per year. The personnel cost for a MWH was $1,439 US per year. The average annual running cost of a MWH was $1,303 US per year. The average estimated MWH utilization and delivery costs was $16.9 US per woman.Conclusionmost MWHs provided essential clinical services and basic amenities. The majority of the cost of a MWH was attributed to building construction costs. If building cost is annualized, the unit cost of a MWH service is in an acceptable range which encourage government considering expansion of the service in rural area.

A Culturally Sensitive and Supportive Maternity Care Service Increases the Uptake of Maternity Waiting Homes in Ethiopia.

BackgroundMaternal delays in utilization of emergency obstetric care are impacting on a high maternal mortality, especially in the poor resource countries including Ethiopia. Different strategies are designed and employed to reduce those maternal delays, and one of such strategies employed to overcome the geographic barriers and improve maternal and neonatal health outcomes is utilization of maternity waiting homes (MWHs). Studies related to the utilization of MWHs and associated factors are limited in Ethiopia and there were none in the study area.ObjectiveThe aim of this study was to assess the utilization of maternity waiting homes and associated factors.Methods and MaterialsA community-based cross-sectional study design was conducted, using multistage sampling technique. Logistic regression analysis with 95% CI for odds ratio (OR) was used to identify significant factors.ResultsA total of 379 women participated in this study, making a response rate of 85%. Of the total participants, 42.5% (95% CI=38–48) of women utilized MWHs. After controlling for potential confounders, women’s decision-making capacity (AOR=12.74; 95% CI=6.18–26.26), women having someone who can care for their children and/or husband at home (AOR=2.71; 95% CI=1.44–5.09), MWHs offering food service (AOR=4.03; 95% CI=2.07– 7.85), offering and/or allowing women to practice their own cultural ceremony (allowing to cook their own food type, porridge, coffee, etc) (AOR=9.55; 95% CI=4.45–20.47), and women’s attitude towards MWHs (AOR=0.09; 95% CI=0.03–0.23) were factors significantly associated with the utilization of MWHs.ConclusionCompared to its contribution in reducing maternal and perinatal mortality, the utilization of MWHs was low in this study area. The integration of culturally sensitive and supportive maternity services, along with community participatory approach, would increase utilization of MWHs and consequently contribute in achieving the SDGs related to maternal and neonatal health.

Association of maternity waiting home utilization with women's perceived geographic barriers and delivery complications in Ethiopia.

The aim of this study is to identify the influence of perceived geographic barriers to the utilization of maternity waiting homes (MWHs) and to explore factors associated with current delivery complications among MWH users and nonusers. An observational cross-sectional study was conducted between December 2017 and June 2018 in eight health facilities with MWH in the Gurage zone of Ethiopia. The associated factors were identified by using the combination of a directed acyclic graph (DAG) concept and multiple logistic regression for data analysis. A total of 716 women were included in the study, of whom 358 were MWH users. MWH users had lower odds of having delivery complications. Lower odds of delivery complications were found among women who gave birth in non-cesarean section (CS) facilities. Women with pregnancy complications and did not used MWH were more likely to develop delivery complications. Women with delivery complications had higher odds of undergoing cesarean delivery and neonatal death. Geographic barriers influenced the utilization of MWH. The women who used MWH had lower delivery complications. This study strengthens the evidence of MWH utilization as a useful strategy to overcome geographic barriers and lower delivery complications.

Utilization of maternity waiting homes: before, during, and after the Ebola virus disease outbreak in Bong County, Liberia.

BackgroundMaternity waiting homes (MWHs) are used to increase the number of women delivering at health care facilities. The first MWHs in Liberia were opened in 2012, prior to the Ebola virus disease (EVD) outbreak.MethodsLongitudinal data were collected from registries on MWH use, antenatal care, postnatal care and facility deliveries from 2012 to 2016 to assess MWH utilization.ResultsAll indicators examined declined during the EVD outbreak, but within 6 months of the cessation of the outbreak they returned to pre-EVD levels.ConclusionsFindings suggest MWH utilization remained stable after international funding ceased and EV affected the region.

Maternity Waiting Home Use by HIV-positive Pregnant Women in Zambia: Opportunity for Improved Prevention of Maternal to Child Transmission of HIV.

Background:Maternity waiting homes (MWHs), defined as residential lodging near health facilities, are an intervention to improve access to maternal care recommended by the World Health Organization. Little is known about utilization of MWHs by HIV-positive women. This paper describes: 1) maternal awareness and utilization of MWHs in rural Zambia among HIV-positive women, and 2) health outcomes for HIV-positive women and their infants with regards to utilization of MWHs.Methods:Data were collected from recently delivered women (delivered after 35 weeks in the previous 12 months) living >9.5 km from 40 health facilities in rural Zambia. For our analysis, primary outcomes were compared between self-identified HIV-positive and HIV-negative women in the sample. Primary outcomes include: 1) awareness of MWHs and 2) utilization of MWHs. We summarized simple descriptive statistics, stratified by maternal self-reported HIV status. We conducted bivariate analyses using chi-square tests, t-tests and Wilcoxon rank sum test.Results:Among 2,381 women, 50 (2.4%) self-identified as HIV-positive. HIV-positive women were older and had more pregnancies and children than HIV-negative women (p<0.001). There was no difference in awareness of MWHs, but HIV-positive women were more likely to use a MWH than HIV-negative women. There was no difference in receipt of infant antiretroviral prophylaxis between women who did or did not stay at a MWH.Conclusion and Global Health Implications:Though HIV prevalence in this sample was lower than expected, MWHs may represent a useful strategy to improve prevention of mother to child transmission of HIV in high prevalence, low-resource settings.

English

Improving maternal and child health is foundation for every nations, communities and families. Millennium Development Goals had applied various strategies to overcome the gaps resulted in maternal and child health morbidity and mortality from global to local levels. Among the strategies is maternity waiting home, an important tool-had been addressed those in need of access and hard/difficult to reach for skilled delivery. Consequently, the aim of this review is to narrate the existing strategies, summarized outcome and impact of maternity waiting homes in Ethiopia as well as make recommendations. Four databases were searched to access literatures; they are: Science Direct, Google Scholar, Open Access Journals Search Engine and PubMed. Published literatures and other library sources were explored to get unpublished works in the topic. Boolean connectors were used to connect the key words. Exclusion and inclusion criteria were established. From all databases, five literatures were identified, screened, and included; all were facility based studies. Three were cross sectional, one prospective and the other retrospective cohort in their design of study. Two cohorts studies claimed that there is difference between the outcome of perinatal and mothers following maternity waiting homes utilization. Cohort studies revealed that mothers who utilized maternity waiting homes are less likely to have negative health consequences; themselves and their perinatal. Findings from existing literatures show that there have been significant differences in maternal and perinatal mortality among maternity waiting homes utilizers and non-utilizers, with its own limitations; although no community or facility based studies were conducted. Consequently, it is vital to conduct community based randomized trial to examine the observable effect of maternity waiting homes in improvement of perinatal and maternal health.&nbsp; &nbsp; Key words: Effects, Ethiopia, factors, problems, maternal waiting homes.

Factors associated with intended use of a maternity waiting home in Southern Ethiopia: a community-based cross-sectional study

BackgroundAlthough 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.MethodsA 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.ResultsWhile 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]).ConclusionsMost 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.