Utilization of maternal waiting home and associated factors among women who gave birth in the last one year, Dabat district, Northwest Ethiopia

Background Maternal mortality and adverse pregnancy outcomes are still challenges in developing countries. In Ethiopia, long distances and lack of transportation are the main geographic barriers for pregnant women to utilize a skilled birth attendant. To alleviate this problem, maternity waiting homes are a gateway for women to deliver at the health facilities, thereby helping towards the reduction of the alarming maternal mortality trend and negative pregnancy outcomes. However, there is a paucity of evidence regarding the utilization of maternity waiting homes in the study area. Therefore, this study aimed to assess utilization of maternity waiting home services and associated factors among mothers who gave birth in the last year in Dabat district, northwest Ethiopia. Methods A community-based cross-sectional study was conducted from January 5 to February 30, 2019. A total of 402 eligible women were selected using a simple random sampling technique. Data were collected using a structured, pre-tested, and interviewer-administered questionnaire through face-to-face interviews. Data were entered into EPI info version 7.1.2 and exported to SPSS version 20 for analysis. Both bivariable and multivariable logistic regression models were fitted. Statistically significant associations between variables were determined based on the adjusted odds ratio (AOR) with its 95% confidence interval and pvalue of ≤ 0.05. Results Maternity waiting home utilization by pregnant women was found to be 16.2% (95% CI: 13, 20). The mothers’ age (26-30 years) (AOR = 0.24; 95% CI: 0.08,0.69), primary level of education (AOR = 9.05; 95% CI: 3.83, 21.43), accepted length of stay in maternity waiting homes (AOR = 3.15; 95% CI: 1.54, 6.43), adequate knowledge of pregnancy danger signs (AOR = 7.88; 95% CI: 3.72,16.69), jointly decision on the mother’s health (AOR = 2.76; 95% CI: 1.08,7.05), and getting people for household activities (AOR = 2.59, 95% CI: 1.21, 5.52) had significant association with maternity waiting home utilization. Conclusion In this study, maternity waiting home utilization was low. Thus, expanding a strategy to improve women’s educational status, health education communication regarding danger signs of pregnancy, empowering women’s decision-making power, and shortening the length of stay at maternity waiting homes may enhance maternity waiting home utilization. A community-based cross-sectional study was conducted from January 5 to February 30, 2019. The study was conducted in Dabat district, Amhara regional state, northwest Ethiopia, which is located about 245 km northwest of Bahir Dar (the capital city of Amhara regional state), and 70 km away from Gondar city. Dabat district has six administrative sub-divisions. Besides, there are a total of six health centers (one in each subdivision) in which only the four sub-divisions have maternity waiting homes. All women who gave birth in the last year before the study period in the selected clusters were the study population. Women who were seriously ill throughout the data collection period were excluded. The sample size for this study was determined by using a single proportion formula by considering the following assumptions; the prevalence of MWHs, 38.7%[18], 95% level of confidence, and a 5% margin of error. Therefore, (Zα/2)2p(1−p)d2=(1.96)2*0.387(1−0.387)(0.05)2=365. Where, n = required sample sizes, α = level of significance, z = standard normal distribution curve value for 95% confidence level = 1.96, p = proportion of maternity waiting home utilization, and d = margin of error. By considering a 10% non-response rate, the final minimum adequate sample size was 402. Dabat district has 6 administrative subdivisions, of these, only four of the subdivisions have MWH. A survey was conducted in the four subdivisions of the district with the assistance of health extension workers to identify women who were eligible for the study. Following the identification of the study population, a sampling frame was designed by compiling the list of all women in the four districts. Proportional allocation was done to each of the four subdivisions to draw the final sample size. Lastly, the study subjects were selected by using a simple random sampling technique (Fig 1). Utilization of MWHS (utilized/ not utilized) Socio-demographic characteristics; Age of the mother, religion, marital status, occupation, educational status, partner’s educational status, time taken to reach health facilities, transportation access to the health facilities, affordability of transport cost, way of transportation. Reproductive health and obstetrics related; Decision power of mother on own health, number of live birth, history of stillbirth, the birthplace of the last child, number of ANC visits of the last pregnancy, planned or unplanned pregnancy, place of ANC visit, information on birth preparedness plan, knowledge of danger sign during pregnancy, and awareness of expected date of delivery. Social and behavioral factors: possibility of getting people for household activities, getting people for a chilled caregiver, perceived the two-four weeks’ duration stay before labor at MWH is acceptable, the possibility of being away from the work. Those women who stayed in the MWH before delivery starting from 24 weeks of pregnancy duration and above in the last pregnancy [1]. A woman who list out three and more danger signs of pregnancy (Vaginal bleeding, gush of fluid per vagina, severe abdominal pain, high grade fever, fainting, decreased fetal movement, blurred vision, severe headache, edema or body swelling) was considered as knowledgeable [23–25]. Women’s perception of the length of two-four weeks is optimal. Data were collected using a pre-tested, semi-structured, and interviewer-administered questionnaire through face-to-face interviews. The study tool was prepared by reviewing related literature [18, 23, 26]. The questionnaire was first developed in English and then translated into the Amharic language, and then back to English to keep its consistency. Four diploma and one BSc midwives were employed for data collection and supervision, respectively. Before the actual date collection period, a pretest was done on 5% of the calculated sample size outside of the study area. Data collectors were trained on data collection techniques for one day. Supervision was followed regularly during the data collection period, and the collected data were checked daily for completeness and consistency. Data cleaning was performed to check for accuracy, completeness, consistencies, and missing values. After the data had been checked for completeness and accuracy, it was coded manually and then entered into Epi-Info version 7.1.2 and exported to SPSS version 20 for analysis. Descriptive data were presented by tables, graphs, charts, frequencies, and proportions. Binary logistic regression was used to identify statistically significant independent variables, and variables having a p-value of ≤0.25 in the bivariable logistic regression analysis were included in the multivariable logistic regression analysis to adjust for possible confounding factors. The adjusted odds ratio with a 95% confidence interval was used to determine the degree and direction of association between covariates and the outcome variable. The level of significance in the last model was declared at a p-value of ≤ 0.05. Ethical clearance was obtained from the school of midwifery Ethical Review Committee under the delegation of the Institutional Review Board (IRB) of the University of Gondar with reference number (SMIDW/19/498/2018). A formal letter of approval was taken from Dabat district administrative health office. The purpose of the study was explained to the study participants, and written informed consent was obtained from every study participant before data collection. For participants aged <18, written informed assent was taken from their parents.