, 8 Ngumbo Road, Longacres, 10101, Lusaka, Zambia.
Jhpiego, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore, MD, 21231-3492, USA.
BMC Pregnancy Childbirth. 2018 Jan 25;18(1):42. doi: 10.1186/s12884-017-1649-1.
Luapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. To examine the experiences with maternity homes, formative research was undertaken in four districts of Luapula Province to assess women's and community's needs, use patterns, collaboration between maternity homes, facilities and communities, and promising practices and models in Central and Lusaka Provinces.
A cross-sectional, mixed-methods design was used. In Luapula Province, qualitative data were collected through 21 focus group discussions with 210 pregnant women, mothers, elderly women, and Safe Motherhood Action Groups (SMAGs) and 79 interviews with health workers, traditional leaders, couples and partner agency staff. Health facility assessment tools, service abstraction forms and registers from 17 facilities supplied quantitative data. Additional qualitative data were collected from 26 SMAGs and 10 health workers in Central and Lusaka Provinces to contextualise findings. Qualitative transcripts were analysed thematically using Atlas-ti. Quantitative data were analysed descriptively using Stata.
Women who used maternity homes recognized the advantages of facility-based births. However, women and community groups requested better infrastructure, services, food, security, privacy, and transportation. SMAGs led the construction of maternity homes and advocated the benefits to women and communities in collaboration with health workers, but management responsibilities of the homes remained unassigned to SMAGs or staff. Community norms often influenced women's decisions to use maternity homes. Successful maternity homes in Central Province also relied on SMAGs for financial support, but the sustainability of these models was not certain.
Women and communities in the selected facilities accept and value maternity homes. However, interventions are needed to address women's needs for better infrastructure, services, food, security, privacy and transportation. Strengthening relationships between the managers of the homes and their communities can serve as the foundation to meet the needs and expectations of pregnant women. Particular attention should be paid to ensuring that maternity homes meet quality standards and remain sustainable.
卢阿普拉省的孕产妇死亡率最高，其设施基础分娩率在赞比亚也是最低的。由于距离医疗机构较远，农村地区的妇女无法在设施中分娩。2013 年，政府将产妇之家纳入社区一级的卫生系统，以增加设施基础分娩数量并降低孕产妇死亡率。为了研究产妇之家的经验，在卢阿普拉省的四个地区开展了形成性研究，以评估妇女和社区的需求、使用模式、产妇之家与设施和社区之间的合作，以及中央省和卢萨卡省的良好做法和模式。
采用了横断面、混合方法设计。在卢阿普拉省，通过与 210 名孕妇、母亲、老年妇女和安全孕产行动小组以及 79 名卫生工作者、传统领袖、夫妇和合作伙伴机构工作人员进行 21 次焦点小组讨论和 79 次访谈收集定性数据。来自 17 个设施的卫生设施评估工具、服务摘要表和登记簿提供了定量数据。在中央省和卢萨卡省，还从 26 个安全孕产行动小组和 10 名卫生工作者那里收集了额外的定性数据，以对调查结果进行背景化。使用 Atlas-ti 对定性转录本进行主题分析。使用 Stata 对定量数据进行描述性分析。
使用产妇之家的妇女认识到了设施基础分娩的优势。然而，妇女和社区团体要求改善基础设施、服务、食品、安全、隐私和交通。安全孕产行动小组领导了产妇之家的建设，并与卫生工作者合作倡导这些服务对妇女和社区的好处，但产妇之家的管理责任仍未分配给安全孕产行动小组或工作人员。社区规范常常影响妇女使用产妇之家的决定。中央省成功的产妇之家也依赖安全孕产行动小组提供财政支持，但这些模式的可持续性尚不确定。
选定设施中的妇女和社区接受并重视产妇之家。然而，需要采取干预措施来满足妇女对改善基础设施、服务、食品、安全、隐私和交通的需求。加强产妇之家管理者与其社区之间的关系可以作为满足孕妇需求和期望的基础。特别需要注意确保产妇之家符合质量标准并保持可持续性。
