Comparison of quality, birth outcomes, and service utilization between health facilities with and without maternity waiting homes in Liberia.
Rachel Horton, Haeun Lee, Joseph E Perosky and 2 others
PMID 34959000WHAT IT FOUND
Health facilities with open maternity waiting homes did not show better overall quality, birth outcomes, or service use than those without.
They had more soap, sharps boxes, drugs for hemorrhage, and assisted vaginal delivery capability, but this did not translate into better outcomes.
Key findings
01Facilities with functional maternity waiting homes did not differ significantly from facilities without functional homes in overall composite quality, birth outcomes, or service utilization.
02Facilities with functional maternity waiting homes had higher infection-control scores (4.49 of 5 versus 4.07 of 5), with soap in 81% versus 50% and sharps boxes in all versus 93%.
03Facilities with functional maternity waiting homes were more likely to have parenteral oxytocic drugs for hemorrhage (90% versus 71%) and assisted vaginal delivery capability (25% versus 0%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only facilities linked to maternity waiting homes were sampled, so the findings may not apply to other health facilities in Liberia. The comparison groups were very unequal: 71 facilities had functional maternity waiting homes and 14 did not. There is no standardized tool for assessing basic emergency obstetric and newborn care quality, and this study used extracted checklist variables. The study did not measure all possible facility quality factors. The design compared existing facilities, so it cannot show that a maternity waiting home caused any outcome change.
Declared interests
This work was supported by the Bill and Melinda Gates Foundation. The paper states the funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation. The authors declared no competing interests.
The easy way to misread this
Do not conclude that maternity waiting homes improve maternal or newborn outcomes. The main comparisons of overall quality, birth outcomes, and service use did not show differences. The differences were in some infection-control supplies and individual emergency obstetric readiness items, and the study did not assign facilities to have or not have a maternity waiting home.