Effectiveness of maternity waiting homes in increasing utilization of facility-based delivery: A systematic review

To reduce the second delay contributing to maternal mortality, maternity waiting homes have been recommended for implementation especially in remote areas to help improve access to facility-based skilled delivery. Evidence of its effectiveness, however, is limited. This systematic review, therefore, aims to assess the effectiveness of the Maternity waiting home strategy in increasing utilization of facility delivery. Search for relevant articles was conducted on PubMed, Scopus, Google Scholar, Ebscohost, and Science Direct from database inception to March 30, 2021. Two reviewers independently screened the articles and assessed the quality of the studies. The identified maternity waiting home interventions and their effectiveness in improving facility-based delivery uptake were narratively synthesized and reported following the preferred reporting items for systematic reviews and meta-analysis reporting guidelines. The search yielded 670 articles of which five studies fulfilled the inclusion criteria. The three of five studies revealed that there is a significant association between Maternity waiting home use and utilization of facility-based delivery. The quality of the Maternity waiting homes significantly improved facility-based delivery uptake. Maternity Waiting Homes appear to be promising in decreasing barriers to skilled delivery attendance however the quality of evidence is low. More interventional studies of robust design are needed to clearly demonstrate its effectiveness.

Distrust of Healthcare Services: Pregnant Women’s Lack of Willingness to Use Maternity Waiting Home Service in Wonogiri Regency

To reduce the maternal mortality rate, a health service program that ensures the good health of pregnant women is needed. Maternity Waiting Home (MWH) is a program to reduce maternal mortality. This program is implemented in various regions in Indonesia, and the one is in Wonogiri Regency. In its implementation, it is not uncommon to find obstacles that come from various parties. This study uses a qualitative descriptive method to explain the Maternity Waiting Home (MWH) service and its distrust. This study seeks to explain the trust of various stakeholders, especially pregnant women, in the Maternity Waiting Home (MWH) service in Wonogiri Regency. Focus Group Discussions (FGD) and interviews were conducted to collect data by generating samples from various stakeholders. In reality, the Maternity Waiting Home (MWH) service in Wonogiri Regency experiences obstacles, especially from the trust of its users. Many pregnant women are unwilling to use the Maternity Waiting Home (MWH) service for several reasons. There is distrust in the service because of many factors. This study concludes that Maternity Waiting Home (MWH) service stakeholders in Wonogiri Regency should address and fix this important problem by intensifying socialization about the urgent of Maternity Waiting Home (MWH) service.

Out-of-Pocket Expenditures for Delivery for Maternity Waiting Home Users and Non-users in Rural Zambia

Background: Utilizing maternity waiting homes (MWHs) is a strategy to improve access to skilled obstetric care in rural Zambia. However, out-of-pocket (OOP) expenses remain a barrier for many women. We assessed delivery-related expenditure for women who used MWHs and those who did not who delivered at a rural health facility. Methods: During the endline of an impact evaluation for an MWH intervention, household surveys (n = 826) were conducted with women who delivered a baby in the previous 13 months at a rural health facility and lived >10 km from a health facility in seven districts of rural Zambia. We captured the amount women reported spending on delivery. We compared OOP spending between women who used MWHs and those who did not. Amounts were converted from Zambian kwacha (ZMW) to US dollar (USD). Results: After controlling for confounders, there was no significant difference in delivery-related expenditure between women who used MWHs (US$40.01) and those who did not (US$36.66) (P=.06). Both groups reported baby clothes as the largest expenditure. MWH users reported spending slightly more on accommodation compared to those did not use MWHs, but this difference represents only a fraction of total costs associated with delivery. Conclusion: Findings suggest that for women coming from far away, utilizing MWHs while awaiting delivery is not costlier overall than for women who deliver at a health facility but do not utilize a MWH.

Intention to use maternity waiting home and associated factors among pregnant women in Gamo Gofa zone, Southern Ethiopia, 2019

Background A maternity waiting home is a temporary residence in which pregnant women from remote areas wait for their childbirth. It is an approach targeted to advance access to emergency obstetric care services especially, in hard-to-reach areas to escalate institutional delivery to reduce complications that occur during childbirth. Apart from the availability of this service, the intention of pregnant women to utilize the existing service is very important to achieve its goals. Thus, this study aimed to assess the intention to use maternity waiting homes and associated factors among pregnant women. Methods Community-based cross-sectional study was conducted among 605 pregnant women using a multistage sampling technique from March 10 to April 10, 2019, by using a structured questionnaire through a face-to-face interview. The collected data was entered into Epi-Data version 3.1 and analyzed using the SPSS version 24 statistical package. Logistic regression analysis was used to test the association. All variables at p-value < 0.25 in bivariate analysis were entered into multivariate analysis. Lastly, a significant association was declared at a P-value of < 0.05 with 95% CI. Results In this study, the intention to use maternity waiting homes was 295(48.8%, 95%CI: 47%-55%)). Occupation (government employee) (AOR:2.87,95%CI: 1.54–5.36), previous childbirth history (AOR:2.1,95%CI:1.22–3.57), past experience in maternity waiting home use AOR:4.35,95%CI:2.63–7.18), direct (AOR:1.57,95%CI:1.01–2.47) and indirect (AOR: 2.18, 1.38,3.44) subject norms and direct (AOR:3.00,95%CI:2.03–4.43), and indirect (AOR = 1.84,95%CI:1.25–2.71) perceived behavioral control of respondents were significantly associated variables with intention to use maternity waiting home. Conclusion The magnitude of intention to use maternity waiting homes among pregnant women is low. Community disapproval, low self-efficacy, maternal employment, history of previous birth, and past experiences of MWHs utilization are predictors of intention to use MWHs, and intervention programs, such as health education, strengthening and integration of community in health system programs need to be provided.

The Association Between Maternity Waiting Home Use and Maternal–Newborn Knowledge: Latent Class Analysis

Background and PurposeAn exploratory latent class analysis (LCA) was performed assessing the association between maternity waiting home (MWH) use and maternal–newborn care knowledge.MethodsA two-group comparison design using a face-to-face interview (n = 250) was conducted to understand if MWH use was associated with greater maternal knowledge of newborn care.ResultsHigh levels of maternal knowledge of newborn care were associated with MWH use. Mothers with low levels of knowledge were less likely to use an MWH prior to delivery and more likely to have fewer pregnancies, attend less than four antenatal care (ANC) visits, and receive no education about newborn health problems during ANC.ConclusionsNurses need to target younger, primigravida mothers attending fewer ANC visits with educational opportunities while advocating for expansion of health education at MWHs to potentiate long-term benefits for improved maternal–newborn health and delivery outcomes.

Understanding the implementation (including women’s use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol

IntroductionMaternity waiting homes in low-income and middle-income countries provide accommodation near health facilities for pregnant women close to the time of birth to promote facility-based birth and birth with a skilled professional and to enable timely access to emergency obstetric services when needed. To date, no studies have provided a systematic, comprehensive synthesis explaining facilitators and barriers to successful maternity waiting home implementation and whether and how implementation strategies and recommendations vary by context. This synthesis will systematically consolidate the evidence, answering the question, ‘How, why, for whom, and in what context are maternity waiting homes successfully implemented in low-income and middle-income countries?’.Methods and analysisMethods include standard steps for realist synthesis: determining the scope of the review, searching for evidence, appraising and extracting data, synthesising and analysing the data and developing recommendations for dissemination. Steps are iterative, repeating until theoretical saturation is achieved. Searching will be conducted in 13 electronic databases with results managed in Eppi-Reviewer V.4. There will be no language, study-type or document-type restrictions. Items documented prior to 1990 will be excluded. To ensure our initial and revised programme theories accurately reflect the experiences and knowledge of key stakeholders, most notably the beneficiaries, interviews will be conducted with maternity waiting home users/nonusers, healthcare staff, policymakers and programme designers. All data will be analysed using context–mechanism–outcome configurations, refined and synthesised to produce a final programme theory.Ethics and disseminationEthics approval for the project will be obtained from the Mozambican National Bioethical Commission, Jimma University College of Health Sciences Institutional Review Board and the University of Saskatchewan Bioethical Research Ethics Board. To ensure results of the evaluation are available for uptake by a wide range of stakeholders, dissemination will include peer-reviewed journal publication, a plain-language brief, and conference presentations to stakeholders’ practice audiences.PROSPERO registration numberCRD42020173595.

Maternity waiting home Utilization and associated factors among women who gave birth in the Digelu and Tijo district of the Arsi Zone, Oromia, Ethiopia

BackgroundMaternity Waiting Homes (MWHs) is an intervention designed to reduce maternal and perinatal mortality. Ethiopia has introduced the intervention before three decades however; its utilization is very low. Therefore, this study is aimed to assess MWH utilization and associated factors among women who gave birth in the last 12 months in Digelu and Tijo district Arsi Zone Oromia Region, Ethiopia.MethodsCommunity-based cross-sectional study was conducted in April 2019 on 530 randomly selected women. Data were collected by face-to-face interview using structured questionnaire. Descriptive statistics and logistics regressions were used to analyze the results. Adjusted odds ratio and 95% confidence interval were respectively calculated to measure strength of association and its statistical significance.The confidence interval was used to declare statistical significance in the final model.ResultsOne hundred twenty-five (23.6%) of the respondents used maternity waiting home. Traveling time less than and equals to 60 minutes from a nearby health facility (AOR=0.16, 95% CI: 0.09, 0.27), women’s decision power (AOR=1.81, 95% CI: 1.10, 2.96), not utilizing antenatal care (AOR=0.6, 95% CI: 0.37, 0.97) and delivering more than three children (AOR=0.56, 95% CI: 0.34, 0.90) were independently associated with utilizing the maternity waiting home.ConclusionEven though the MWH was designed to reduce maternal and perinatal mortality, less than a quarter (23.6%) of women delivered in the last 12 months before the study in the Digelu and Tijo District had utilized the services. Increasing availability of the service, promoting antenatal care utilization, empowering women and evolving policy makers are recommended to enhance the current low utilization of the MWH.

Down-to-earth Approach as A Sociological Solution: Learning from Ineffectiveness of Maternity Waiting Home Implementation in Wonogiri, Indonesia

A maternity waiting home is a health facility that is considered helpful in preventing maternal deaths. The service aims to be a transit place for pregnant women to get primary health services. Due to geographic reasons, there is a waiting house for births—many cases of successful implementation of maternity waiting homes in various developing countries, especially in African countries. As a developing country, certain regions in Indonesia have implemented the service in imitation of the successful implementation of other countries. However, the implementation is not entirely effective. This study explores the root barriers in the implementation of the service from a sociological perspective. This study uses a qualitative research method with a case study approach. The data were collected through literature study, observation, in-depth interviews, and FGD. The results of this study were that various factors were found that caused the implementation of the maternity waiting home to be ineffective. Using a sociological analysis, the top-down policy of the maternity waiting for home is a significant factor in this ineffectiveness. This paper presents a concrete solution that uses an approach to emphasize the aspirations and needs of the community as a foundation in the implementation of this service.

Utilization of Maternity Waiting Home (MWH) to Improve Access to Health Services: Systematic Literature Review

Maternity waiting home (MWH) is a home built in the compound or near to health facilities that provides standard medical and emergency obstetric care services. MWH is considered to be a key strategy to "bridge the geographical gap" in obstetric care between rural areas with poor access to equipped facilities, and urban areas where the services are available. This study aimed to systematically review the utilization of MWH to improve access to health service. The method of finding articles in this study was in the period 2014 to 2018, free full text, human species, and scholarly journals which were then identified using an electronic database from Pubmed, Proquest and Onesearch. Three articles were carried out with thematic analysis to identify the main points. Factors associated with the utilization of MWH included (1) Distance; (2) Complication during pregnancy; and (3) Income. Barrier in the utilization of MWH were (1) Inadequate number of room and postpartum bed; (2) Lack of water and sanitation facilities; and (3) Unavailable electricity. Partnership between health workers in rural facilities, stronger role of stakeholders, and a broader health system, were expected to increase the utilization of MWH.