Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
BMJ Open. 2022 Jul 25;12(7):e058512. doi: 10.1136/bmjopen-2021-058512.
Women in sub-Saharan Africa face well-documented barriers to facility-based deliveries. An improved maternity waiting homes (MWH) model was implemented in rural Zambia to bring pregnant women closer to facilities for delivery. We qualitatively assessed whether MWHs changed perceived barriers to facility delivery among remote-living women.
We administered in-depth interviews (IDIs) to a randomly selected subsample of women in intervention (n=78) and control (n=80) groups who participated in the primary quasi-experimental evaluation of an improved MWH model. The IDIs explored perceptions and preferences of delivery location. We conducted content analysis to understand perceived barriers and facilitators to facility delivery.
Participants lived in villages 10+ km from the health facility and had delivered a baby in the previous 12 months.
The improved MWH model was implemented at 20 rural health facilities.
Over 96% of participants in the intervention arm and 90% in the control arm delivered their last baby at a health facility. Key barriers to facility delivery were distance and transportation, and costs associated with delivery. Facilitators included no user fees, penalties for home delivery, desire for safe delivery and availability of MWHs. Most themes were similar between study arms. Both discussed the role MWHs have in improving access to facility-based delivery. Intervention arm participants expressed that the improved MWH model encourages use and helps overcome the distance barrier. Control arm participants either expressed a desire for an improved MWH model or did not consider it in their decision making.
Even in areas with high facility-based delivery rates in rural Zambia, barriers to access persist. MWHs may be useful to address the distance challenge, but no single intervention is likely to address all barriers experienced by rural, low-resourced populations. MWHs should be considered in a broader systems approach to improving access in remote areas.
NCT02620436.
撒哈拉以南非洲的女性在获得医疗机构分娩方面面临着众所周知的障碍。赞比亚农村地区实施了改良的产妇等候之家（MWH）模式，旨在让孕妇更接近分娩设施。我们通过定性评估来研究 MWH 是否改变了居住在偏远地区的女性对医疗机构分娩的看法。
我们对参与改良 MWH 模型的初步准实验评估的干预组（n=78）和对照组（n=80）中随机选择的一小部分女性进行了深入访谈（IDIs）。这些 IDIs 探讨了对分娩地点的看法和偏好。我们进行了内容分析，以了解获得医疗机构分娩的障碍和促进因素。
参与者居住在距离卫生机构 10 公里以上的村庄，并且在过去 12 个月内分娩过婴儿。
改良的 MWH 模型在 20 个农村卫生机构实施。
干预组的 96%以上参与者和对照组的 90%参与者在卫生机构分娩了最后一个婴儿。获得医疗机构分娩的主要障碍是距离和交通，以及与分娩相关的费用。促进因素包括无用户费用、对家庭分娩的罚款、对安全分娩的渴望以及 MWH 的可用性。研究组的大多数主题都相似。两组都讨论了 MWH 在改善获得医疗机构分娩方面的作用。干预组的参与者表示，改良的 MWH 模式鼓励使用并有助于克服距离障碍。对照组的参与者要么表示希望改进 MWH 模式，要么在决策中没有考虑这一点。
即使在赞比亚农村地区，医疗机构分娩率较高的地区，获得医疗机构分娩的障碍仍然存在。MWH 可能有助于解决距离挑战，但没有任何单一的干预措施能够解决农村、资源匮乏地区人口所面临的所有障碍。MWH 应在改善偏远地区获得服务的更广泛系统方法中加以考虑。
NCT02620436。
