1
|
Yarinbab TE, Gesesew HA, Harrison MS, Belachew T. Factors associated with knowledge and attitude towards maternity waiting homes among pregnant women: baseline results from a cluster-randomized trial in rural Ethiopia. Sci Rep 2023; 13:11854. [PMID: 37481627 PMCID: PMC10363115 DOI: 10.1038/s41598-023-39029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023] Open
Abstract
Ethiopia has implemented maternity waiting homes over the last several decades; however, its utilization is low. This study aimed to assess the factors associated with knowledge of and attitude towards maternity waiting homes among pregnant women in rural Ethiopia. The baseline survey was conducted from September 15 to October 30, 2022, in rural Southern Ethiopia. Survey data were collected from 320 women in their second trimester of pregnancy. The data analysis was performed using SPSS version 25. The mean age of the participants was 27.79 (SD ± 6.242) years. Nearly two-thirds (57.5%) of the participants had no formal education and more than three-fourths (72.5%) were housewives. Only approximately one-fourth (23.75%) of the participants used maternity waiting homes. Furthermore, 33.75% had good knowledge, 28.75% had favorable attitudes, and around one-fourth (26.25%) had good male partner involvement. Age group 30 to 39 years (AOR 4.78, 95% CI 1.12-20.36), household income (AOR 6.41, 95% CI 2.78-14.81), having pregnancy intention (AOR 2.63, 95% CI 1.21-5.73), and history of obstetric complications (AOR 6.72, 95% CI 2.81-16.07) were significantly associated with good knowledge about maternity waiting homes. Similarly, age group 30 to 39 years (AOR 4.23, 95% CI 1.14-15.65), household income (AOR 7.12, 95% CI 3.26-15.55), having pregnancy intention (AOR 2.57, 95% CI 1.21-5.47), and history of obstetric complications (AOR 5.59, 95% CI 2.30-13.59) were significantly associated with favorable attitudes towards maternity waiting homes. Providing health education and promoting male partner participation through educating couples may improve women's access to maternity waiting homes.
Collapse
Affiliation(s)
- Teklemariam Ergat Yarinbab
- Department of Population and Family Health, Institute of Health, Jimma University, Jimma, Ethiopia.
- Department of Epidemiology and Biostatistics, College of Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia.
| | - Hailay Abrha Gesesew
- Research Center for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, Australia
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Margo Shawn Harrison
- Department of Gynecology and Obstetrics, School of Medicine, University of Colorado, Denver, CO, USA
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
2
|
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. BMC Public Health 2022; 22:1724. [PMID: 36096779 PMCID: PMC9465910 DOI: 10.1186/s12889-022-14121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Abstract
Background Savings 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). Methods Secondary 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. Results Interaction 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. Conclusion Access 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 registration NCT02620436.
Collapse
|
3
|
Fong RM, Kaiser JL, Ngoma T, Vian T, Bwalya M, Sakanga VR, Lori JR, Kuhfeldt KJ, Musonda G, Munro-Kramer M, Rockers PC, Hamer DH, Ahmed Mdluli E, Biemba G, Scott NA. 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. BMJ Open 2022; 12:e058512. [PMID: 35879007 PMCID: PMC9328096 DOI: 10.1136/bmjopen-2021-058512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Women 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 delivery. We qualitatively assessed whether MWHs changed perceived barriers to facility delivery among remote-living women. DESIGN We administered in-depth interviews (IDIs) to a randomly selected subsample of women in intervention (n=78) and control (n=80) groups who participated in the primary quasi-experimental evaluation of an improved MWH model. The IDIs explored perceptions and preferences of delivery location. We conducted content analysis to understand perceived barriers and facilitators to facility delivery. SETTING AND PARTICIPANTS Participants lived in villages 10+ km from the health facility and had delivered a baby in the previous 12 months. INTERVENTION The improved MWH model was implemented at 20 rural health facilities. RESULTS Over 96% of participants in the intervention arm and 90% in the control arm delivered their last baby at a health facility. Key barriers to facility delivery were distance and transportation, and costs associated with delivery. Facilitators included no user fees, penalties for home delivery, desire for safe delivery and availability of MWHs. Most themes were similar between study arms. Both discussed the role MWHs have in improving access to facility-based delivery. Intervention arm participants expressed that the improved MWH model encourages use and helps overcome the distance barrier. Control arm participants either expressed a desire for an improved MWH model or did not consider it in their decision making. CONCLUSIONS Even in areas with high facility-based delivery rates in rural Zambia, barriers to access persist. MWHs may be useful to address the distance challenge, but no single intervention is likely to address all barriers experienced by rural, low-resourced populations. MWHs should be considered in a broader systems approach to improving access in remote areas. TRIAL REGISTRATION NUMBER NCT02620436.
Collapse
Affiliation(s)
- Rachel M Fong
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeanette L Kaiser
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Taryn Vian
- University of San Francisco - School of Nursing and Health Professions, San Francisco, California, USA
| | | | | | - Jody R Lori
- Office for Global Affairs & PAHO/WHO Collaborating Center, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Kayla J Kuhfeldt
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Michelle Munro-Kramer
- Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter C Rockers
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Godfrey Biemba
- Pediatric Centre of Excellence, National Health Research Authority, Lusaka, Zambia
| | - Nancy A Scott
- Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Scott NA, Kaiser JL, Ngoma T, McGlasson KL, Henry EG, Munro-Kramer ML, Biemba G, Bwalya M, Sakanga VR, Musonda G, Hamer DH, Boyd CJ, Bonawitz R, Vian T, Kruk ME, Fong RM, Chastain PS, Mataka K, Ahmed Mdluli E, Veliz P, Lori JR, Rockers PC. If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia. BMJ Glob Health 2021; 6:e006385. [PMID: 34876457 PMCID: PMC8655557 DOI: 10.1136/bmjgh-2021-006385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/23/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Maternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase health facility delivery among remote-living women in Zambia. METHODS We conducted a quasi-experimental study at 40 rural health centres (RHC) that offer basic emergency obstetric care and had no recent stockouts of oxytocin or magnesium sulfate, located within 2 hours of a referral hospital. Intervention clusters (n=20) received an improved MWH model. Control clusters (n=20) implemented standard of care. Clusters were assigned to study arm using a matched-pair randomisation procedure (n=20) or non-randomly with matching criteria (n=20). We interviewed repeated cross-sectional random samples of women in villages 10+ kilometres from their RHC. The primary outcome was facility delivery; secondary outcomes included postnatal care utilisation, counselling, services received and expenditures. Intention-to-treat analysis was conducted. Generalised estimating equations were used to estimate ORs. RESULTS We interviewed 2381 women at baseline (March 2016) and 2330 at endline (October 2018). The improved MWH model was associated with increased odds of facility delivery (OR 1.60 (95% CI: 1.13 to 2.27); p<0.001) and MWH utilisation (OR 2.44 (1.62 to 3.67); p<0.001). The intervention was also associated with increased odds of postnatal attendance (OR 1.55 (1.10 to 2.19); p<0.001); counselling for family planning (OR 1.48 (1.15 to 1.91); p=0.002), breast feeding (OR 1.51 (1.20 to 1.90); p<0.001), and kangaroo care (OR 1.44 (1.15, 1.79); p=0.001); and caesarean section (OR 1.71 (1.16 to 2.54); p=0.007). No differences were observed in household expenditures for delivery. CONCLUSION MWHs near well-equipped RHCs increased access to facility delivery, encouraged use of facilities with emergency care capacity, and improved exposure to counselling. MWHs can be useful in the effort to increase delivery at advanced facilities in areas where substantial numbers of women live remotely. TRIAL REGISTRATION NUMBER NCT02620436.
Collapse
Affiliation(s)
- Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Kathleen L McGlasson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Henry
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michelle L Munro-Kramer
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Godfrey Biemba
- National Health Research Authority Zambia, Lusaka, Zambia
| | - Misheck Bwalya
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | | | | | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taryn Vian
- University of San Francisco - School of Nursing and Health Professions, San Francisco, California, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Parker S Chastain
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | - Philip Veliz
- Applied Biostatistics Laboratory, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Jody R Lori
- Center for Global Affairs & PAHO/WHO Collaborating Center, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
5
|
Lee H, Maffioli EM, Veliz PT, Sakala I, Chiboola NM, Lori JR. Direct and opportunity costs related to utilizing maternity waiting homes in rural Zambia. Midwifery 2021; 105:103211. [PMID: 34894428 PMCID: PMC8811481 DOI: 10.1016/j.midw.2021.103211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/13/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Lack of financial resources is a critical barrier to utilising Maternity Waiting Homes (MWHs) in low-income countries (LICs). Food and user fees are most frequent expenditures for women utilising MWHs in rural Zambia. Being away from various household chores, the loss of income generating activities (IGAs), may also be a financial constraint in utilising MWHs.
Aim To assess the direct and opportunity costs involved in utilising maternity waiting homes. Method A cross-sectional admission survey administered to women who used ten maternity waiting homes across two rural districts in Zambia. A total of 3,796 women participated in the survey. Descriptive analysis was conducted on three domains of the data: demographic characteristics of women, direct costs, and opportunity costs. Findings Waiting to deliver (86.3%), safe birth (70.8%), and distance (56.0%) were the most frequent reasons women reported for using a maternity waiting home. In terms of direct costs, roughly 65% of the women brought seven days or fewer days' worth of food to the maternity waiting homes, with salt, mealie meals, and vegetables being the most frequently brought items. Only 5.8% of the women spent money on transport. More than half of the women reported paying user fees that ranged from 1 to 5 or more kwacha (US$0.10- 0.52). In terms of opportunity costs, 52% of the women participated in some form of income generating activities (IGAs) when at home. Approximately 35% of the women reported they lost earned income (1 to 50 or more kwacha) by staying at a maternity waiting home. Conclusion A large proportion of women paid for food and user fees to access a maternity waiting home, while a low number of women paid for transport. Even though it is difficult to assign monetary value to women's household chores, being away from these responsibilities and the potential loss of earned income appear to remain a cost to accessing maternity waiting homes. More research is needed to understand how to overcome these financial constraints and assist women in utilising a maternity waiting home.
Collapse
Affiliation(s)
- HaEun Lee
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States.
| | - Elisa M Maffioli
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, United States
| | - Philip T Veliz
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States
| | - Isaac Sakala
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Box 33921 Lusaka, Zambia
| | - Nchimunya M Chiboola
- Africare Zambia, Flat A, Plot 2407/10 MBX, Off Twin Palm Road, Ibex Hill, Box 33921 Lusaka, Zambia
| | - Jody R Lori
- School of Nursing, University of Michigan, 400 N Ingalls St. Ann Arbor, MI 48104, United States
| |
Collapse
|