It takes a village: a comparative study of maternity waiting homes in rural Liberia

Abstract

Background: Although evidence is insufficient to determine the effectiveness of maternity waiting homes on improvement of maternal and newborn health, several countries have identified success in institutionalisation of maternity waiting homes as a way to reduce maternal and neonatal deaths by increasing access to skilled birth attendants. We examined maternity waiting homes as an intervention to decrease maternal and neonatal morbidity and mortality in Liberia, west Africa. Methods: With a matched cohort design in remote, rural Liberia, five primary health-care facilities with new maternity waiting homes (exposed intervention group) were matched to five facilities without maternity waiting homes (unexposed comparison group). All 10 clinics have 24-h staffing and are overseen by Africare-Liberia. We collected data for team births (skilled birth attendants and traditional midwives working together during delivery) from December, 2010, to August, 2012 and data for maternal deaths from March, 2011, to September, 2012. We used a logistic regression model with generalised estimating equations to evaluate differences from baseline (Dec 1, 2010– Feb 28, 2011) to postintervention (June 1, 2012–Aug 31, 2012). Findings: The proportion of team births significantly increased in communities with maternity waiting homes from 18 (10·80%) of 166 (95% CI 0·03–0·32) to 248 (95·20%) of 248 (0·73–0·99, p<0·001), whereas in communities without maternity waiting homes the team births increased from 40 (20·50%) of 195 (0·04–0·63) to 178 (69·80%) of 255 (0·20–0·96, p=0·065). Team births increased more rapidly in MWH communities (Wald's c2=3·75, df=1, p=0·053). Maternal deaths significantly differed between communities with maternity waiting homes (n=3) and communities without maternity waiting homes (n=12; Wald's c2=4·22, df=1, p=0·040). Interpretation: Our findings add to the evidence of the potential benefit and effectiveness of maternity waiting homes. Funding: US Agency for International Development & Fogarty International, National Institutes of Health.