Quality and utilization patterns of maternity waiting homes at referral facilities in rural Zambia: A mixed-methods multiple case analysis of intervention and standard of care sites

Autoři: Rachael Bonawitz aff001;  Kathleen L. McGlasson aff001;  Jeanette L. Kaiser aff001;  Thandiwe Ngoma aff004;  Rachel M. Fong aff001;  Godfrey Biemba aff005;  Misheck Bwalya aff004;  Davidson H. Hamer aff001;  Nancy A. Scott aff001
Působiště autorů: Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America aff001;  Division of Hospital Medicine, Saint Christopher’s Hospital for Children, Philadelphia PA, United States of America aff002;  Department of Pediatrics, Drexel University College of Medicine, Philadelphia, PA, United States of America aff003;  Department of Research, Right to Care Zambia, Lusaka, Zambia aff004;  National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia aff005;  Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, United States of America aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225523



Maternity waiting homes, defined as residential lodging near a health facility, are recommended by the WHO. An improved MWH model, responsive to community standards for functionality and comfort, was implemented at two purposively selected health facilities in rural Zambia providing comprehensive emergency obstetric and neonatal care (CEmONC) services (intervention MWHs), and compared to three existing standard-of-care MWHs (comparison MWHs) at other CEmONC sites in the same districts.


We used a mixed-methods time-series design for this analysis. Quantitative data including MWH quality, MWH utilization, and demographics of women utilizing MWHs were collected from September 2016 through May 2018 to capture pre-post intervention trends. Qualitative data were obtained from two focus group discussions conducted with pregnant women at intervention MWHs in August 2017 and May 2018. The primary outcomes were quality scoring of the MWHs and maternal utilization of the MWHs.


MWH quality was similar at all sites during the pre-intervention time period, with a significant change in overall quality scores between intervention (mean score 83.8, SD 12) and comparison (mean score 43.1, SD 10.2) sites after the intervention (p <0.0001). Women utilizing intervention and comparison MWHs at all time points had very similar demographics. After implementation of the intervention, there were marked increases in MWH utilization at both intervention and comparison sites, with a greater percentage increase at one of two intervention sites.


An improved MWH model can result in measurably improved quality scores for MWHs, and can result in increased utilization of MWHs at rural CEmONC facilities. MWHs are part of the infrastructure that might be needed for health systems to provide high quality “right place” maternal care in rural settings.

Klíčová slova:

Cements – Hospitals – Labor and delivery – Neonatal care – Obstetrics and gynecology – Pregnancy – Urban areas – Shelters


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Článek vyšel v časopise


2019 Číslo 11