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

Souhrn

Introduction

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.

Methods

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.

Results

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.

Conclusions

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


Zdroje

1. Alkema L, Chou D, Hogan D, Zhang S, Moller A, Gemmill A et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. The Lancet. 2016;387(10017):462–474.

2. World Health Organization. Making Pregnancy Safer: The Critical Role of the Skilled Attendant: A joint statement by WHO, ICM and FIGO. Geneva, Switzerland; 2004.

3. World Health Organization. Monitoring Emergency Obstetric Care: A Handbook. Geneva, Switzerland; 2009.

4. Moyer C, Mustafa A. Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review. Reproductive Health. 2013;10(1). doi: 10.1186/1742-4755-10-40 23962135

5. Sialubanje C, Massar K, Hamer D, Ruiter R. Personal and environmental factors associated with the utilisation of maternity waiting homes in rural Zambia. BMC Pregnancy and Childbirth. 2017;17(1). doi: 10.1186/s12884-017-1317-5 28472945

6. Lohela T, Campbell O, Gabrysch S. Distance to Care, Facility Delivery and Early Neonatal Mortality in Malawi and Zambia. PLoS ONE. 2012;7(12):e52110. doi: 10.1371/journal.pone.0052110 23300599

7. Sialubanje C, Massar K, Hamer DH, Ruiter RA. Reasons for home delivery and use of traditional birth attendants in rural Zambia: a qualitative study. BMC Pregnancy Childbirth. 2015;15. doi: 10.1186/s12884-015-0652-7 26361976

8. Scott NA, Henry EG, Kaiser JL, Mataka K, Rockers PC, Fong RM, et al. Factors affecting home delivery among women living in remote areas of rural Zambia: a cross-sectional, mixed-methods analysis. Int J Womens Health. 2018;10:589–601. doi: 10.2147/IJWH.S169067 30349403

9. Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, & Gülmezoglu AM.Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;11(1). doi: 10.1186/1742-4755-11-71 25238684

10. Gabrysch S, Campbell OMR. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy and Childbirth. 2009;9(1). doi: 10.1186/1471-2393-9-34 19671156

11. Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Systematic Reviews, 2017;6(1). doi: 10.1186/s13643-017-0503-x 28587676

12. World Health Organization. Recommendations on health promotion interventions for maternal and newborn health. Geneva, Switzerland; 2015.

13. Lori RJ, Wadsworth AC, Munro ML, Rominski S. Promoting access: the use of maternity waiting homes to achieve safe motherhood. Midwifery. 2013;29(10):1095–1102. doi: 10.1016/j.midw.2013.07.020 24012018

14. van Lonkhuijzen L, Stekelenburg J, van Roosmalen J. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries. Cochrane Database Syst Rev. 2012;10:CD006759. doi: 10.1002/14651858.CD006759.pub3 23076927

15. Henry EG, Semrau K, Hamer DH, Vian T, Nambao M, Mataka K, et al. The influence of quality maternity waiting homes on utilization of facilities for delivery in rural Zambia. Reprod Health. 2017;14(1). doi: 10.1186/s12978-017-0328-z 28558800

16. Central Statistical Office Zambia (CSO) [Zambia], Ministry of Health (MOH) [Zambia], and ICF International. Zambia Demographic and Health Survey 2013-14. Rockville, Maryland, USA: 2014.

17. Scott NA, Kaiser JL, Vian T, Bonawitz R, Fong RM, Ngoma T, et al. Impact of maternity waiting homes on facility delivery among remote households in Zambia: protocol for a quasi-experimental, mixed-methods study. BMJ Open. 2018;(8):e022224. doi: 10.1136/bmjopen-2018-022224 30099401

18. Chibuye PS, Bazant ES, Wallon M, Rao N, Fruhauf T. Experiences with and expectations of maternity waiting homes in Luapula Province, Zambia: a mixed-methods, cross-sectional study with women, community groups and stakeholders. BMC Pregnancy Childbirth. 2018;18(1). doi: 10.1186/s12884-017-1649-1 29370773

19. Lori JR, Munro-Kramer ML, Mdluli EA, Musonda GK, Boyd CJ. Developing a community driven sustainable model of maternity waiting homes for rural Zambia. Midwifery. 2016; 14:89–95. doi: 10.1016/j.midw.2016.08.005 27571773

20. Scott NA, Vian T, Kaiser JL, Ngoma T, Mataka K, Henry EG, et al. Listening to the community: Using formative research to strengthen maternity waiting homes in Zambia. PLoS One. 2018; 13(3):e0194535. doi: 10.1371/journal.pone.0194535 29543884

21. Vaismoradi M, Turunen H, Bondas T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs Health Sci. 2013 Sep; 15:398–405. doi: 10.1111/nhs.12048 23480423

22. Vermeiden T, Schiffer R, Langhorst J, Klappe N, Asera W, Getnet G, et al. Facilitators for maternity waiting home utilization at Attat Hospital: a mixed-methods study based on 45 years of experience. Trop Med Int Health. 2018;12(12):1332–1341. doi: 10.1111/tmi.13158 30286267

23. Republic of Zambia Ministry of Health. Zambia National Maternal and Neonatal Services Referral Guidelines. 2018.

24. Dadi TL, Bekele BB, Kasaye HK, Nigussie T. Role of maternity waiting homes in the reduction of maternal death and stillbirth in developing countries and its contribution for maternal death reduction in Ethiopia: a systematic review and meta-analysis. BMC Health Serv Res. 2018;18(1):748. doi: 10.1186/s12913-018-3559-y 30285757

25. Braat F, Vermeiden T, Getnet G, Schiffer R, van den Akker T, Stekelenburg J. Comparison of pregnancy outcomes between maternity waiting home users and non-users at hospitals with and without a maternity waiting home: a retrospective cohort study. Int Health. 2018;10(1):47–53. doi: 10.1093/inthealth/ihx056 29342256

26. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder-DeWan A, et al. High-quality health systems in the Sustainable Development Goals era: time for a revolution. Lancet GH. 2018;6(110):e1196–252. doi: 10.1016/S2214-109X(18)30386-3


Článek vyšel v časopise

PLOS One


2019 Číslo 11