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Randomized Controlled Trial
. 2021 Oct;128(11):1804-1812.
doi: 10.1111/1471-0528.16755. Epub 2021 Jun 8.

Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study

J R Lori  1 , M L Munro-Kramer  1 , H Liu  1 , K L McGlasson  2 , X Zhang  1 , H Lee  1 , T Ngoma  3 , J L Kaiser  2 , M Bwalya  3 , G Musonda  4 , I Sakala  4 , J E Perosky  1 , R M Fong  2 , C J Boyd  1 , P Chastain  2 , P C Rockers  2 , D H Hamer  2 , G Biemba  5 , T Vian  2 , R Bonawitz  2 , N Lockhart  1 , N A Scott  2
Affiliations
Randomized Controlled Trial

Increasing facility delivery through maternity waiting homes for women living far from a health facility in rural Zambia: a quasi-experimental study

J R Lori et al. BJOG. 2021 Oct.

Abstract

Objective: To report on the effectiveness of a standardised core Maternity Waiting Home (MWH) model to increase facility deliveries among women living >10 km from a health facility.

Design: Quasi-experimental design with partial randomisation at the cluster level.

Setting: Seven rural districts in Zambia.

Population: Women delivering at 40 health facilities between June 2016 and August 2018.

Methods: Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes.

Main outcome measures: Differences in the change from baseline to study period in the percentage of women living >10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group.

Results: We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living >10 km away (DID 4.2%, 95% CI 0.6-7.6, P = 0.03), adolescent women (<18 years) living >10 km away (DID 18.1%, 95% CI 6.3-29.8, P = 0.002) and primigravida women living >10 km away (DID 9.3%, 95% CI 2.4-16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7-28, P < 0.001).

Conclusion: The core MWH model was successful in increasing rates of facility delivery for women living >10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit.

Tweetable abstract: A core MWH model increased facility delivery for women living >10 km from a health facility including adolescents and primigravidas in Zambia.

Keywords: Facility delivery; Zambia; maternal health; maternity waiting homes; quasi-experimental with partial randomisation.

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