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Increasing access to reproductive health services through maternity waiting homes for women living farthest from a health facility in rural Zambia: a quasi-experimental study
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  • Jody Lori,
  • Michelle Munro-Kramer,
  • Haiyin Liu,
  • Kathleen McGlasson,
  • Xingyu Zhang,
  • HaEun Lee,
  • Thandiwe Ngoma,
  • Jeanette Kaiser,
  • Misheck Bwalya,
  • Gertrude Musonda,
  • Isaac Sakala,
  • Joseph Perosky,
  • Rachel Fong,
  • Carol Boyd,
  • Parker Chastain,
  • Peter Rockers,
  • Davidson Hamer, MD,
  • Godfrey Biemba,
  • Taryn Vian,
  • Rachael Bonawitz,
  • Nancy Lockhart,
  • Nancy Scott
Jody Lori
University of Michigan
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Michelle Munro-Kramer
University of Michigan
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Haiyin Liu
University of Michigan
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Kathleen McGlasson
Boston University
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Xingyu Zhang
University of Michigan
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HaEun Lee
University of Michigan
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Thandiwe Ngoma
Right to Care
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Jeanette Kaiser
Boston University
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Misheck Bwalya
Right to Care
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Gertrude Musonda
Africare
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Isaac Sakala
Africare
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Joseph Perosky
University of Michigan
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Rachel Fong
Boston University
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Carol Boyd
University of Michigan
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Parker Chastain
Boston University
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Peter Rockers
Boston University
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Davidson Hamer, MD
Boston University School of Public Health
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Godfrey Biemba
National Health Research Authority
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Taryn Vian
Boston University
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Rachael Bonawitz
Boston University
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Nancy Lockhart
University of Michigan
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Nancy Scott
Boston University
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Abstract

Objective: To report on the effectiveness of a standardized core Maternity Waiting Home (MWH) model to increase facility deliveries and access to reproductive health services among women living farthest from a health facility (>10km) using facility-based data. Design: Quasi-experimental design. Setting: Seven rural districts in Zambia. Population: Women delivering at 40 health facilities between June 2016 to August 2018. Methods: 20 intervention sites and 20 comparison sites were used to test if MWHs increased access to reproductive health services for women living in rural Zambia. The difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our primary outcomes. Main Outcome Measures: Differences in the change from baseline to endline in the percentage of women who: 1) traveled greater than 10 km for delivery, (2) attended a postnatal visit at 6 days postpartum, and (3) were referred to a higher-level health facility between intervention and comparison group. Results: We detected a significant difference for the percentage of deliveries at intervention facilities with the core MWH model for all women living >10km away (p=0.03), adolescent women (<18 years) living >10km away (p=0.002), and primigravida women living >10km away (p=0.01). There were no significant differences for women attending a postnatal care visit at 6 days postpartum (p=0.07) or for women referred to the next level of care (p=0.29). Conclusion: The core MWH model was successful in reaching women with historically low rates of facility delivery, those living >10km from a healthcare facility, including adolescent women and primigravidas.

Peer review status:ACCEPTED

07 Oct 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
12 Oct 2020Submission Checks Completed
12 Oct 2020Assigned to Editor
12 Oct 2020Reviewer(s) Assigned
09 Nov 2020Review(s) Completed, Editorial Evaluation Pending
24 Dec 2020Editorial Decision: Revise Major
05 Feb 20211st Revision Received
09 Feb 2021Assigned to Editor
09 Feb 2021Submission Checks Completed
19 Feb 2021Reviewer(s) Assigned
21 Feb 2021Review(s) Completed, Editorial Evaluation Pending
26 Mar 2021Editorial Decision: Revise Major
28 Apr 20212nd Revision Received
29 Apr 2021Assigned to Editor
29 Apr 2021Submission Checks Completed
29 Apr 2021Review(s) Completed, Editorial Evaluation Pending
08 May 2021Editorial Decision: Accept