Maternity Waiting Homes Research Articles

Husband's intention to support during pregnancy for the use of maternity waiting home in Jimma Zone, Southwest, Ethiopia: a community-based cross-sectional study.

Husbands are the primary decision-makers about the place of childbirth. Lack of husbands' support for maternal health care is associated with low maternal waiting home utilization and less is known about the husbands' intention to support their wife's use of maternal waiting homes (MWHs) and underlying beliefs in Ethiopia. This community-based cross-sectional survey aimed to study husbands' intention to support during pregnancy through the use of maternity waiting homes in Jimma Zone, Southwest Ethiopia. A cross-sectional study was conducted among 396 randomly selected husbands whose wives were pregnant. Interviewer-administered, a structured questionnaire developed based on the Theory of Planned Behavior (TPB) was used to collect the data. Multivariable logistic regression analyses were used to examine the association between behavioral intention and constructs of the theory of planned behavior. Of the 396 husbands who took part in the study, 42.7% intend to support their partner's use of a maternity waiting home. Intention to support a wife to use a maternity waiting home was associated with subjective norm [AOR = 1.303, 95% CI (1.054, 1.611)] and perceived behavioral control [AOR = 1.446, 95% CI (1.234, 1.695)]. Among the control beliefs, "having childcare"; "having a person who stays with a wife at a maternity waiting home"; and "availability of quality service provided to a wife in the maternity waiting home" significantly separated intenders and non-intenders. The findings suggest that husbands who perceived more social pressure and felt in control of barriers were more likely to intend to support their partner in using a maternity waiting home. Intervention should focus on underlying normative and control beliefs to improve the husband's intention.

A phenomenological qualitative study of male-partners perspectives of maternity waiting homes in rural Ethiopia

BackgroundThe implementation of maternity waiting home (MWH) has been used as a strategy to improve maternal health outcomes in low-resource settings such as Ethiopia. However, MWH utilization is low in Ethiopia, and women's access to MWH depends largely on male partners' decisions. This study explored male-partners perspectives of MWHs including their experiences of paternal support in rural Ethiopia. Study designAn exploratory qualitative study with a phenomenological methodological orientation was performed. MethodsThis study was conducted in Ana-Lemo and Gibe districts of Hadiya Zone, in rural Southern Ethiopia. The study participants were male partners. A purposive sampling technique was used to recruit 47 participants. Data were collected from May 10–25, 2023. Four focus group discussions, 15 in-depth interviews, and observations were conducted. The interviews were audio-recorded, transcribed and the thematic content analysis was performed using ATLAS.ti 7.1.4 software. ResultsThis study showed that male-partners participated in spousal communication and provided practical support such as sharing household chores and financial support; however, they did not accompany their spouses to health facilities. Long distances, lack of transportation, poor referral services, and perceived poor quality of care were barriers to maternal health services. Furthermore, male-partners demonstrated poor awareness and unfavorable attitudes of MWHs. ConclusionsMale-partners participated in spousal communication, shared household chores and provided financial support to their spouses; however, they did not accompany them to health facilities. They had poor awareness and unfavorable attitudes of MWHs. Creating awareness among male partners may improve their attitude towards MWHs and other maternal health services in rural Ethiopia.

Perspectives of pregnant women on the utilisation of a maternity waiting home near Onandjokwe Lutheran Hospital in Oshikoto Region, Namibia.

Despite the efforts of Namibia's Ministry of Health and Social Services to build maternity waiting homes (MWHs), few pregnant women make use of them. Long distances among the general population in Namibia limit the utilisation of MWHs. Little research has investigated what factors are limiting the use of these facilities despite the urgent need for them. The aim of this study thus was to explore and describe the perspectives of pregnant women on the utilisation of the MWHs near Onandjokwe Lutheran Hospital in Oshikoto Region. A qualitative, exploratory, descriptive and contextual design was employed. The accessible population in this study comprised 18 participants who were selected for the study using a purposive sampling technique. Participants reported numerous barriers to visiting MWHs in Namibia, including an inadequate number of rooms, theft, food scarcity and the effects of poverty on the living conditions of the MWH users. Enablers visiting MWHs included the safe delivery of babies by skilled staff, reduced transport costs, access to timely management of labour complications and affordable accommodation. The study revealed that a number of barriers must be overcome before the desired number of women take advantage of MWHs. Multiple factors act as constraints to their use, including inadequate number of rooms, theft, food scarcity and the long distance between patients' homes and MWH services.Contribution:The study's findings can be used to develop targeted interventions and strategies that can be used by MWH providers to address the identified barriers.

Effect of couple-based health education on male-partners knowledge and attitude towards maternity waiting homes in rural Ethiopia: a cluster-randomized trial

This cluster-randomized controlled trial examined the effect of couple-based health education on male partners’ knowledge and attitude towards maternity waiting homes (MWH) in rural Ethiopia. Sixteen clusters and 320 couples were randomly assigned to intervention group (receiving group health education, home visits and print health messages alongside usual care) or control group (receiving usual care). The Chi-square test was used to estimate statistical differences, and the difference-in-differences model was used to estimate the effect of the intervention. The generalized linear regression model was used to determine the odds of outcomes between the groups. Statistical significance was set at p < 0.05, with a 95% CI. There were no significant differences in baseline characteristics between the control and intervention groups. The net effect of the intervention on improving knowledge about MWHs, and attitude towards MWHs were 35.6% and 36.2%, respectively. The participants in the intervention group were 5.5 times more likely to have good knowledge about MWH (AOR 5.55, 95% CI 3.37–9.14) and 5.6 times more likely to have a favorable attitude towards MWH (AOR 5.61, 95% CI 3.45–9.10) compared to their counterparts. Health education provided to couples significantly improved male partners’ knowledge and attitude towards MWHs in rural Ethiopia.Trial registration: ClinicalTrials.gov Identifier: NCT05015023.

Determinants of maternity waiting home utilization among women who gave birth in public health facilities in the Gedeo Zone, southern Ethiopia: an unmatched case-control study.

Maternal mortality remains unacceptably high in Ethiopia, although most of its causes are preventable. One way of tackling this problem is by establishing a maternal waiting home (MWH) close to a health facility. Although the benefits of an MWH have been well-documented, the determinants of its use have not been well-studied. This study aims to identify the determinants of utilization of an MWH among women who gave birth in public health facilities in the Gedeo Zone, southern Ethiopia. A facility-based unmatched case-control study was conducted between January 2020 and February 2020) among 129 patients belonging to the case group and 257 belonging to the control group. The data were entered into the Epi-Data version 3.1 and exported to the SPSS version 20 statistical package for analysis. Descriptive statistics such as frequency, means, and standard deviations were computed. The association between variables was checked using logistic regression analysis, and odds ratios (ORs) with 95% confidence interval (CI) were used to determine the strength of this association. A p-value of < 0.05 was used as a cutoff point to measure statistical significance. A total of 378 respondents (126 cases and 252 controls) were included in the study, successfully achieving a response rate of 97.9%. The mean age of the participants was 27.4 (±5.6 SD) years, which was 28.4 (±5.5 SD) years for case group patients and 26.9 (±5.69 SD) years for control group patients. The educational status of women [adjusted odds ratio (AOR): 8.49, 95% CI: 2.91-24.7], travel time (AOR: 2.92, 95% CI:1.41-4.67), antenatal care visits (AOR: 3.54, 95% CI: 1.33-9.38), those having more than two children under the age of 5 years (AOR: 0.12, 95% CI: 0.06-0.26), those with a history of complications in previous childbirths (AOR: 4.52 95% CI: 2.41-8.47), previous place of delivery (AOR: 6.30, 95% CI: 2.71-14.78), and a lack of awareness (AOR: 5.8, 95% CI: 2.23-15.2) were all significantly associated with the utilization of an MWH. Educational status, antenatal care follow-up, number of children under 5 years old in the household, previous place of delivery, lack of awareness regarding maternal waiting home service, and travel time were all determinants of MWH use. This implies that interventions focusing on promoting antenatal care visits, institutional delivery, and raising awareness of the benefits of MWHs are important for improving their rate of utilization.

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.

Pregnant women's intentions to use maternity waiting homes and its associated factors in rural districts of Hadiya Zone, Southern Ethiopia.

As part of a strategy to reduce maternal and perinatal mortality, Ethiopia's government has made a significant effort to expand the number of Maternity Waiting Homes (MWHs). However, worldwide there is a substantial regional variation in pregnant women's intention to use MWHs. Therefore, the aim of this study is to assess pregnant women's intention to use maternity waiting home and its associated factors in the rural district of Hadiya Zone, Southern Ethiopia. This was a cross-sectional study carried out on 385 pregnant women from March 1-28, 2020. A systematic random sampling technique was used to recruit the study participants. SPSS software (version 24.0) was used to enter and analyze the data. Bivariate and multivariate logistic regression analyses were used to determine an association between each independent and dependent variables. Odds ratio with their 95% confidence intervals was computed to ascertain the existence and strength of an association, and statistical significance was affirmed at a p-value of < 0.05. The prevalence of pregnant women's intension to use MWHs was observed to be 55.6%. A poor wealth status (AOR = 2.52; 95% CI:1.05-6.05), having a previous history of institutional delivery (AOR = 4.78; 95% CI:1.16-9.64), attending four or more antenatal care visits (AOR = 3.34; 95%CI:1.35-8.29), having obstetric complications during previous pregnancy (AOR = 3.76; 95% CI:1.45-9.77), and having favourable attitude towards MWHs (AOR = 13.51; 95% CI: 5.85-9.54) had a significant association with an intention to use MWHs. According to the findings of this study, more than half of pregnant women have been intended to use MWHs. Therefore, boosting the uptake of the antenatal care visit, raising awareness about the risk and consequences of obstetric complications, and strengthening behavioral modification strategies is very crucial to increase pregnant women's intention to use MWHs.

Provider and client perspectives on the use of maternity waiting homes in rural Rwanda

ABSTRACT Background The World Health Organization recommends the implementation of maternity waiting homes (MWH) to reduce delays in access to obstetric care, particularly for high-risk pregnancies and mothers living far from health facilities, and as a result, several countries have rolled out MWHs. However, Rwanda has not implemented this recommendation on a large scale. There is only one MWH in the country, hence a gap in knowledge regarding the potential utilisation and benefits of MWHs. Objective To explore providers’ and clients’ perspectives on facilitators and barriers to the use of MWH in rural Rwanda. Methods We conducted a qualitative study to explore health providers’ and clients’ perspectives on facilitators and barriers to the use of MWH in Rwanda, between December 2020 and January 2021. We used key informant interviews and focus group discussions to collect data. Data were analysed using NVivo qualitative analysis software version 11. Results Facilitators included perceptions that the MWH offered either a peaceful and home-like environment, good-quality services, or timely obstetric services, and was associated with good maternal and neonatal outcomes. Barriers included limited awareness of the MWH among pregnant women, fear of health providers to operate the MWH at full capacity, women’s lack of autonomy, uncertainty over funding for the MWH, and perceived high user fees. Conclusion The Ruli MWH offers a peaceful environment for pregnant women while providing quality and timely obstetric care, resulting in positive maternal and neonatal outcomes for women. However, its existence and benefits are not widely known, and its use is limited due to inadequate resources. There is a need for increased awareness of the MWH among healthcare providers and the community, and lessons from this MWH could inform the scale up of MWHs in Rwanda.

Evaluasi pelaksanaan program rumah tunggu kelahiran (RTK) dengan logic model di Kabupaten Jayapura Provinsi Papua

Background: One of the government's efforts to increase the coverage of deliveries in health facilities is by establishing a maternity waiting home (MWH)Objective: This study aims to evaluate the implementation of the MWHs Program in the Depapre district and Unurum Guay, Jayapura district, Papua. The component of study including the input component, process, output and external factor Method: Type of this research is qualitative research, evaluate the program using the Logic model conducted in MWHs Jayapura district. The research subjects included 9 program managers, and 28 people in community.. Data collection performed with interviews, observation, questionnaires and document analysisResults: The results indicate that the input component includes the availability of funding, policies, facilities infrastructure, and inadequate transportation which has impact for MWHs service process. Process of implementation of MWHs in form of disseminating information, cooperation, recording, reporting and supervision has not optimal. The output component form of MWHs utilization already well even though in the following year there was a decrease Conclusion: The implementation of the MWHs program is not optimal. The input component is still inadequate, the process component has not run optimally and the output component has not achieved the expected results. Strategy is needed for program implementation runs a well

A cost description of the setup costs of community-owned maternity waiting homes in rural Zambia.

Maternity waiting homes (MWHs) are one strategy to improve access to skilled obstetric care in low resource settings such as Zambia. The Maternity Homes Access in Zambia project built 10 MWHs at rural health centers in Zambia for women awaiting delivery and postnatal care (PNC) visits. The objective of this paper is to summarize the costs associated with setup of 10 MWHs, including infrastructure, furnishing, stakeholder engagement, and activities to build the capacity of local communities to govern MWHs. We do not present operational costs after setup was complete. We used a retrospective, top-down program costing approach. We reviewed study documentation to compile planned and actual costs by site. All costs were annuitized using a 3% discount rate and organized by cost categories: (1) Capital: infrastructure and furnishing, and (2) Installation: capacity building activities and stakeholder engagement. We assumed lifespans of 30 years for infrastructure; 5 years for furnishings; and 3 years for installation activities. Annuitized costs were used to estimate cost per night stayed and per visit for delivery and PNC-related stays. We also modeled theoretical utilization and cost scenarios. The average setup cost of one MWH was $85,284 (capital: 76%; installation: 24%). Annuitized setup cost per MWH was USD$12,516 per year. At an observed occupancy rate of 39%, setup cost per visit to the MWH was USD$70, while setup cost per night stayed was USD$6. The cost of stakeholder engagement activities was underbudgeted by half at the beginning of this project.This analysis serves as a planning resource for governments and implementers that are considering MWHs as a component of their overall maternal and child health strategy. Planning considerations should include the annuitized cost, value of capacity building and stakeholder engagement, and that cost per bed night and visit are dependent upon utilization.

A Maternity Waiting Home Is an Alternative Approach for the Accessibility of Pregnant Women in an Obstetrically Underserved Area of Korea.

We analyzed whether a maternity waiting home (MWH) for pregnant women in an obstetrically underserved area of Gangwon-do in Korea, which has been in operation since August 2018, has improved the accessibility of a maternity hospital and pregnancy outcomes. We compared and analyzed the accessibility of maternity hospitals for 170 pregnant women who applied for the MWH from August 2018 to May 2022. Among the 170 participants, 64 were MWH users and 106 non-users. The effect on pregnancy outcomes between MWH users and non-users was analyzed in the 160 people who achieved a pregnancy outcome. Although the average distance and travel time from the pregnant women's residence in the obstetrically underserved area to a maternity hospital were 56.4 ± 1.6 km and 63.4 ± 1.4 minutes, respectively, the average distance between the MWH and the MWH users' maternity hospital was 2.7 ± 0.2 km, and the travel time was 10.7 ± 0.6 minutes. The distance was 55.6 km closer on average and the travel time 54.1 minutes shorter. MWH users gave birth at a significantly later gestation age (38.9 ± 0.2 vs. 38.3 ± 0.15 weeks, P = 0.024) and to infants with heavier birth weights (3,300 ± 60 vs. 3,100 ± 50 gm, P = 0.024) compared with non-users. The rate of Cesarean section was significantly higher in the MWH users (47.5% vs. 44.6%, P = 0.047). The MWH users tended to be associated with a lower rate of neonatal intensive care unit admission (5.1% vs. 11.0%, P = 0.204), lower birth weight (< 2.5 kg) (1.7% vs. 8.0%, P = 0.155), and lower fetal death rate in the uterus (0% vs. 1.0%, P = 1.0) compared with non-users, but the differences were not significant. The MWH helped pregnant women in obstetrically underserved areas by improving accessibility to a maternity hospital and lengthening gestation. As a result, neonatal birth weight was heavier for MWH users than non-users. MWHs in Korea can provide an alternative way to improve accessibility to maternity healthcare for pregnant women in obstetrically underserved areas, where it is difficult to establish maternity hospitals, and thereby will improve their pregnancy outcomes.

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.

The role of Savings and Internal Lending Communities (SILCs) in improving community-level household wealth, financial preparedness for birth, and utilization of reproductive health services in rural Zambia: a secondary analysis

BackgroundSavings and Internal Lending Communities (SILCs) are a type of informal microfinance mechanism widely adapted in Zambia. The benefits of SILCs paired with other interventions have been studied in many countries. However, limited studies have examined SILCs in the context of maternal health. This study examined the association between having access to SILCs and: 1) household wealth, 2) financial preparedness for birth, and 3) utilization of various reproductive health services (RHSs).MethodsSecondary analysis was conducted on baseline and endline household survey data collected as part of a Maternity Waiting Home (MWH) intervention trial in 20 rural communities across seven districts of Zambia. Data from 4711 women who gave birth in the previous year (baseline: 2381 endline: 2330) were analyzed. The data were stratified into three community groups (CGs): CG1) communities with neither MWH nor SILC, CG2) communities with only MWH, and CG3) communities with both MWH and SILC. To capture the community level changes with the exposure to SILCs, different women were randomly selected from each of the communities for baseline and endline data, rather than same women being surveyed two times. Interaction effect of CG and timepoint on the outcome variables – household wealth, saving for birth, antenatal care visits, postnatal care visits, MWH utilization, health facility based delivery, and skilled provider assisted delivery – were examined.ResultsInteraction effect of CGs and timepoint were significantly associated only with MWH utilization, health facility delivery, and skilled provider delivery. Compared to women from CG3, women from CG1 had lower odds of utilizing MWHs and delivering at health facility at endline. Additionally, women from CG1 and women from CG2 had lower odds of delivering with a skilled provider compared to women from CG3.ConclusionAccess to SILCs was associated with increased MWH use and health facility delivery when MWHs were available. Furthermore, access to SILCs was associated with increased skilled provider delivery regardless of the availability of MWH. Future studies should explore the roles of SILCs in improving the continuity of reproductive health services.Trial registrationNCT02620436.

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.

Intention to Use Maternal Waiting Homes and Related Factors among Pregnant Women in Metu Woreda, Western Ethiopia.

Maternity Waiting Homes are houses built in the healthcare settings that lodge pregnant women in their term state of pregnancy to prevent labor and delivery-related complication. This study aimed to estimate the extent of pregnant women's intention to use Maternal Waiting Homes and identify its associated factors in Metu Woreda, Western Ethiopia. A community-based cross-sectional study was conducted from March 1-30, 2018. We used a systematic sampling method to select the study participants and Binary logistic regression analysis was used to identify factors associated with the intention of the women to use Maternal Waiting Homes. A total of (97%) of respondents' questionnaires were found complete and analyzed for this study. Almost half (48.8%) of the pregnant women who participated in the study were planned to use Maternal Waiting Homes in their prospective delivery. Based on multivariate logistic regression analysis; being illiterate and/or less educated in their educational status, having a history of using Maternal Waiting homes, and receiving a number of times antenatal care services were found statistically significantly associated with intention of the women to use Maternal Waiting Homes. It is trivial that more than half of the pregnant women who participated in the study were unintended to use Maternal Waiting Homes. Educational status, a number of times attending antenatal care services and experience of using Maternal Waiting Homes were found statistically significantly associated with women's intention to use Maternal Waiting Homes.

Sustainable palm weevil farming as nutrition supplementation at maternity waiting homes in Liberia

BackgroundFood insecurity is a global health challenge exacerbated by COVID-19. In Liberia, two-thirds of pregnant women are anemic, one-third of children are stunted, and 70% of households experienced food insecurity due to COVID-19. Edible insects are a nutritious, environmentally responsible, and cost-effective dietary supplement used throughout sub-Saharan Africa. Rearing palm weevil insects at maternity waiting homes (MWHs)—residential dwellings near hospitals where pregnant women await childbirth and receive postpartum services—could serve as a nutritious supplement for expectant mothers in Liberia and provide an income generating activity for MWHs.MethodsFollowing a one-day training, sixteen participants established palm weevil rearing sites at four MWHs in Liberia. Pre- and post-knowledge scores were assessed immediately prior to and following training. Pre-and post-knowledge scores were analyzed using paired t-test. Participants tracked two palm weevil rearing cycles (four months), using harvest amounts, turnover, barriers to implementation, and income generated as metrics. The number of women attending MWHs was recorded throughout the study period (July-December 2020).ResultsSixteen participants from four MWHs completed the training and two rearing cycles (four months) successfully. All participants showed statistically significant increases in knowledge scores following the one-day workshop with a pre-test score of 2.31 and post-test score of 7.75 out of 10 (p < 0.001). Over the 6-month study, 217 women stayed in four MWHs. Larval production from the various rearing centers ranged from 120 to 721 larvae, with all four sites producing enough palm weevil to sustain MWH residents who desired to consume the insects. One site successfully commercialized its harvest to sell approximately 50% for a total of 2,000 LD (13 USD) in income. Three of the four sites continued edible insect production beyond the four-month study period.ConclusionsAn edible insect project using palm weevil larva is one promising intervention as a nutrition supplement for expectant mothers at pre-established MWHs in rural Liberia. Edible insect rearing also has potential as an income generating activity for MWHs. Future studies should focus on addressing common barriers of remote implementation and metric tracking during the COVID-19 pandemic and reinforcing infrastructure to protect larvae rearing supplies.

Barriers and facilitators to facility-based delivery in rural Zambia: a qualitative study of women’s perceptions after implementation of an improved maternity waiting homes intervention

ObjectivesWomen in sub-Saharan Africa face well-documented barriers to facility-based deliveries. An improved maternity waiting homes (MWH) model was implemented in rural Zambia to bring pregnant women closer to facilities for...

Intention to Use and Predictors of Use of Maternity Waiting Home among Pregnant Women in Hargeisa City Health Centers, Somaliland.

BackgroundMaternity waiting homes (MWHs) can help women receive the necessary obstetric care and referral if needed. However, there is a lack of evidence on whether women have the desire to stay away from their homes and the sociocultural predictors of their decision in Somaliland.ObjectiveThe purpose of this study was to measure predictors of the intention of women to stay in MWHs using the theory of planned behavior in Hargeisa city, Somaliland.MethodsA facility-based cross-sectional study was conducted from in April 2021 in Hargeisa health facilities among 422 randomly selected participants using an interviewer-administered and structured questionnaire. Data were transferred to Epi Data 4.6 and exported to SPSS 20 for further analysis. Descriptive, bivariate, and multivariate binary logistic regression analyses were used. ORs with 95% CIs were used to assess associations, and statistical significance was set at P<0.05.ResultsA total of 245 (58%, 95% CI 53.1%–62.8%) pregnant women intended to use an MWH. Multivariate analysis revealed that education (AOR 5.40, 95% CI 3.01–9.69), experience of using an MWH (AOR 3.80, 95% CI 2.32–6.27), multigravidity (AOR 2.2, 95% CI 1.16–4.29), subjective norms (AOR 1.8, 95% CI 1.05–3.11), indirect attitudes toward use of MWHs (AOR 1.9, 95% CI 1.01–3.92), and indirect subjective norms (AOR 2.0, 95% CI 1.16–3.60) were significantly associated with intention to use an MWH.ConclusionUsing an MWH is not the preference of many women. Personal characteristics, such as education, multigravidity, and perceived social pressure are important predictors of intention to use MWHs. It is important to raise the awareness of women and the community about the benefits of using MWHs in the early management of obstetric complications.

Planning for Maternity Waiting Home Bed Capacity: Lessons from Rural Zambia.

Background:Maternity waiting homes (MWH) allow pregnant women to stay in a residential facility close to a health center while awaiting delivery. This approach can improve health outcomes for women and children. Health planners need to consider many factors in deciding the number of beds needed for an MWH.Objective:The objective of the study is to review experience in Zambia in planning and implementing MWHs, and consider lessons learned in determining optimal capacity.Methods:We conducted a study of 10 newly built MWH in Zambia over 12 months. For this case study analysis, data on beds, service volume, and catchment area population were examined, including women staying at the homes, bed occupancy, and average length of stay. We analyzed bed occupancy by location and health facility catchment area size, and categorized occupancy by month from very low to very high.Findings:Most study sites were rural, with 3 of the 10 study sites rural-remote. Four sites served small catchment areas (<9 000), 3 had medium (9 000–11 000), and 3 had large (>11 000) size populations. Annual occupancy was variable among the sites, ranging from 13% (a medium rural site) to 151% (a large rural-remote site). Occupancy higher than 100% was accommodated by repurposing the MWH postnatal beds and using extra mattresses. Most sites had between 26–69% annual occupancy, but monthly occupancy was highly variable for reasons that seem unrelated to catchment area size, rural or rural-remote location.Conclusion:Planning for MWH capacity is difficult due to high variability. Our analysis suggests planners should try to gather actual recent monthly birth data and estimate capacity using the highest expected utilization months, anticipating that facility-based deliveries may increase with introduction of a MWH. Further research is needed to document and share data on MWH operations, including utilization statistics like number of beds, mattresses, occupancy rates and average length of stay.

EVALUASI KEBIJAKAN RUMAH TUNGGU KELAHIRAN (RTK) DI KABUPATEN KONAWE PROVINSI SULAWESI TENGGARA TAHUN 2016

Background: The high maternal mortality rate (MMR) in Indonesia&#x0D; prompted the government to issue a Jampersal fund policy. One of&#x0D; the objectives of Jampersal fund is to provide budget for operational&#x0D; activities of Maternity Waiting Home (MWH) Program, a government&#x0D; strategy to facilitate access of pregnant mother to get health service&#x0D; to overcome pregnant, childbirth and childbirth problems as an effort&#x0D; to decrease maternal MMR in Indonesia.&#x0D; Objective: To describe the implementation of MWH policy as an&#x0D; effort to facilitate pregnant women, childbirth, and postpartum to get&#x0D; access to health service in Konawe Regency of Southeast Sulawesi Province.&#x0D; Methods: The study was descriptive using qualitative design with&#x0D; case study approach focusing on developing in-depth description&#x0D; and analysis of cases also studying MWH program.&#x0D; Results: MWH Program in Konawe Regency has been running for&#x0D; one year but there was still one Puskesmas that has not run the&#x0D; MWH program because the location of Puskesmas is far from the&#x0D; citizen’s residence. MWH is not only used by pregnant women who&#x0D; are far from the health facility and have a high risk but also used&#x0D; for all pregnant women who will give birth. MWH already meets the&#x0D; criteria set by the Ministry of Health. The operational cost of the&#x0D; waiting house guarantees all the costs of pregnant and family needs&#x0D; during their stay. The obstacles to MWH programs were disbursement of funds, rejection of pregnant women to the waiting house and difficult road access.&#x0D; Conclusion: MWH Program has been effective because it has&#x0D; been used by all pregnant women who have risk and who will give&#x0D; birth are placed in the waiting house of birth. The barriers that exist&#x0D; during the MWH program runs were disbursement of funds, the&#x0D; rejection of pregnant women into waiting homes and difficult road access.&#x0D;