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Facilitators for maternity waiting home utilisation at Attat Hospital: a mixed‐methods study based on 45 years of experience
Author(s) -
Vermeiden Tienke,
Schiffer Rita,
Langhorst Jorine,
Klappe Neel,
Asera Wolde,
Getnet Gashaw,
Stekelenburg Jelle,
Akker Thomas
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13158
Subject(s) - medicine , focus group , descriptive statistics , health facility , data collection , nursing , government (linguistics) , public health , family medicine , population , environmental health , health services , business , linguistics , statistics , philosophy , mathematics , marketing
Abstract Objective To describe facilitators for maternity waiting home ( MWH ) utilisation from the perspectives of MWH users and health staff. Methods Data collection took place over several time frames between March 2014 and January 2018 at Attat Hospital in Ethiopia, using a mixed‐methods design. This included seven in‐depth interviews with staff and users, three focus group discussions with 28 users and attendants, a structured questionnaire among 244 users, a 2‐week observation period and review of annual facility reports. The MWH was built in 1973; consistent records were kept from 1987. Data analysis was done through content analysis, descriptive statistics and data triangulation. Results The MWH at Attat Hospital has become a well‐established intervention for high‐risk pregnant women (1987–2017: from 142 users of 777 total attended births [18.3%] to 571 of 3693 [15.5%]; range 142–832 users). From 2008, utilisation stabilised at on average 662 women annually. Between 2014 and 2017, total attended births doubled following government promotion of facility births; MWH utilisation stayed approximately the same. Perceived high quality of care at the health facility was expressed by users to be an important reason for MWH utilisation (114 of 128 MWH users who had previous experience with maternity services at Attat Hospital rated overall services as good). A strong community public health programme and continuous provision of comprehensive emergency obstetric and neonatal care (Em ONC ) seemed to have contributed to realising community support for the MWH . The qualitative data also revealed that awareness of pregnancy‐related complications and supportive husbands (203 of 244 supported the MWH stay financially) were key facilitators. Barriers to utilisation existed (no cooking utensils at the MWH [198/244]; attendant being away from work [190/244]), but users considered these necessary to overcome for the perceived benefit: a healthy mother and baby. Conclusions Facilitators for MWH utilisation according to users and staff were perceived high‐quality Em ONC , integrated health services, awareness of pregnancy‐related complications and the husband's support in overcoming barriers. If providing high‐quality Em ONC and integrating health services are prioritised, MWH s have the potential to become an accepted intervention in (rural) communities. Only then can MWH s improve access to Em ONC .