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

PLoS ONE, Volume 17, No. 7 July, Year 2022

Interpretação

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.

AI Digest

Study Justification:

– Maternal mortality and adverse pregnancy outcomes are significant challenges in developing countries.
– Long distances and lack of transportation are major barriers for pregnant women to access skilled birth attendants in Ethiopia.
– Maternity waiting homes (MWHs) can help address these barriers and improve maternal health outcomes.
– However, there is a lack of evidence regarding the utilization of MWHs in the study area.

Study Highlights:

– The study aimed to assess the utilization of MWH services and associated factors among mothers who gave birth in the last year in Dabat district, northwest Ethiopia.
– 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 through face-to-face interviews using a structured questionnaire.
– The study found that MWH utilization by pregnant women was 16.2%.
– Factors associated with MWH utilization included the mother’s age, level of education, length of stay in MWH, knowledge of pregnancy danger signs, joint decision-making on the mother’s health, and availability of support for household activities.
– The study highlights the need to improve women’s educational status, provide health education on pregnancy danger signs, empower women in decision-making, and shorten the length of stay in MWHs to enhance utilization.

Recommendations for Lay Reader and Policy Maker:

– Expand strategies to improve women’s educational status.
– Provide health education on pregnancy danger signs to increase awareness.
– Empower women in decision-making regarding their health.
– Shorten the length of stay in MWHs to improve utilization.

Key Role Players:

– Ministry of Health: Responsible for policy development and implementation.
– Health Extension Workers: Involved in identifying eligible women and assisting with data collection.
– Health Centers: Provide MWH services and support implementation of recommendations.
– Community Health Workers: Engage in health education and awareness campaigns.
– Non-Governmental Organizations: Support implementation of interventions and provide resources.

Cost Items for Planning Recommendations:

– Educational programs: Budget for training and educational materials.
– Health promotion campaigns: Allocate funds for awareness-raising activities.
– Infrastructure improvement: Invest in facilities to accommodate shorter stays in MWHs.
– Staff training: Provide training for healthcare providers on MWH services.
– Monitoring and evaluation: Allocate resources for monitoring and evaluating the implementation of recommendations.

Força da prova

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the study design, sample size determination, data collection methods, and statistical analysis. However, it lacks information on the representativeness of the sample and potential limitations of the study. To improve the evidence, the authors could include information on the representativeness of the sample, such as the demographic characteristics of the study population compared to the general population. Additionally, they could discuss potential limitations of the study, such as selection bias or measurement error, and how these limitations may affect the generalizability of the findings.

Resumo

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.

Materiais

Inovações

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement health education programs to improve women’s knowledge of pregnancy danger signs and the importance of utilizing maternal waiting homes. This can be done through community outreach programs, antenatal care visits, and media campaigns.

2. Improve transportation access: Address the main geographic barrier of long distances and lack of transportation by providing reliable and affordable transportation options for pregnant women to reach health facilities. This can include establishing transportation services specifically for pregnant women or improving existing transportation infrastructure.

3. Empower women’s decision-making power: Promote joint decision-making between women and their partners regarding maternal health. This can be achieved through community engagement activities that emphasize the importance of involving women in decisions about their own health.

4. Shorten the length of stay at maternity waiting homes: Explore strategies to reduce the duration of stay at maternity waiting homes without compromising the safety and quality of care. This can include streamlining administrative processes, improving efficiency in service delivery, and ensuring adequate staffing and resources at the waiting homes.

5. Enhance women’s educational status: Implement initiatives to improve women’s educational opportunities and literacy rates. This can include providing scholarships, vocational training, and adult education programs to empower women and increase their access to information and resources.

By implementing these recommendations, it is expected that access to maternal health services, including the utilization of maternity waiting homes, will be improved, leading to a reduction in maternal mortality and adverse pregnancy outcomes in the study area.

AI Innovations Description

The study titled “Utilization of maternal waiting home and associated factors among women who gave birth in the last one year, Dabat district, Northwest Ethiopia” aimed to assess the utilization of maternity waiting home services and identify factors associated with its utilization among mothers in Dabat district, northwest Ethiopia.

The study found that the utilization of maternity waiting homes by pregnant women in the study area was low, with only 16.2% of women utilizing these facilities. Several factors were found to be associated with the utilization of maternity waiting homes. These factors included the mother’s age (26-30 years), primary level of education, acceptance of the length of stay in maternity waiting homes, adequate knowledge of pregnancy danger signs, joint decision-making on the mother’s health, and availability of support for household activities.

Based on the findings of the study, the following recommendations can be made to improve access to maternal health:

1. Improve women’s educational status: Enhancing women’s educational opportunities can empower them to make informed decisions regarding their health and increase their awareness of the importance of utilizing maternity waiting homes.

2. Provide health education on pregnancy danger signs: Conducting health education programs that focus on educating pregnant women about the danger signs during pregnancy can help them recognize potential complications and seek timely medical care, including utilizing maternity waiting homes.

3. Empower women’s decision-making power: Promote gender equality and empower women to actively participate in decision-making processes regarding their health. This can be achieved through community awareness campaigns and interventions that promote women’s rights and autonomy.

4. Shorten the length of stay at maternity waiting homes: Reducing the duration of stay at maternity waiting homes can encourage more women to utilize these facilities. This can be achieved by improving the efficiency of healthcare services and ensuring that women receive timely and appropriate care during their stay.

By implementing these recommendations, it is expected that the utilization of maternity waiting homes will increase, leading to improved access to maternal health services and a reduction in maternal mortality and adverse pregnancy outcomes in the study area.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement health education programs to raise awareness about the importance of skilled birth attendance and the availability of maternity waiting homes. This can be done through community outreach programs, radio broadcasts, and informational campaigns.

2. Improve transportation infrastructure: Address the issue of long distances and lack of transportation by improving road networks and increasing the availability of public transportation options. This can include providing subsidies for transportation costs or establishing dedicated transportation services for pregnant women.

3. Strengthen antenatal care services: Enhance antenatal care services by ensuring that pregnant women have access to regular check-ups, information on birth preparedness, and knowledge about pregnancy danger signs. This can be achieved through training healthcare providers and improving the availability of antenatal care facilities.

4. Empower women’s decision-making: Promote women’s empowerment and involvement in decision-making regarding their own health. This can be done by providing education and support to women, as well as involving their partners and families in discussions about maternal health.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify the key indicators that will be used to measure the impact of the recommendations. These could include the percentage of pregnant women utilizing maternity waiting homes, the number of skilled birth attendants present during deliveries, and the reduction in maternal mortality rates.

2. Collect baseline data: Gather data on the current utilization of maternity waiting homes, transportation infrastructure, antenatal care services, and women’s decision-making power. This can be done through surveys, interviews, and data from healthcare facilities.

3. Develop a simulation model: Create a simulation model that incorporates the various factors influencing access to maternal health, such as distance to healthcare facilities, availability of transportation, and knowledge of pregnancy danger signs. This model should be based on the collected data and should consider the potential impact of the recommended interventions.

4. Run simulations: Use the simulation model to run different scenarios that reflect the implementation of the recommendations. This can involve adjusting variables such as the availability of transportation, the level of awareness and education, and the empowerment of women. Simulations can be run multiple times to assess the potential impact of different combinations of interventions.

5. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommendations on improving access to maternal health. This can involve comparing the baseline data with the simulated data to identify any significant changes or improvements.

6. Refine and validate the model: Refine the simulation model based on the analysis of the results and validate it using additional data or expert input. This will help ensure the accuracy and reliability of the model for future use.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of different interventions on improving access to maternal health. This can inform decision-making and help prioritize resources and efforts towards the most effective strategies.

Autores & Coautores

Statistics:

Citations: 1

Authors: 4

Identifiers:

DOI: 10.1371/journal.pone.0271113

Research Areas:

Community Interventions, Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female

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