Postpartum physical intimate partner violence among women in rural Zambia

ObjectiveTo examine the demographic characteristics and mental health of women in rural Zambia who experienced physical intimate partner violence (IPV) postpartum.MethodsThe present secondary analysis was conducted using baseline data from an impact evaluation of a maternity waiting home intervention in rural Zambia. A quantitative household survey was conducted over 6 weeks, from midâ April to late May, 2016, at 40 rural health facility catchment areas among 2381 postpartum women (13 months after delivery; age â ¥15 years).ResultsA total of 192 (8.1%) women reported experiencing any type of physical IPV in the preceding 2 weeks; 126 had experienced severe physical IPV (had been kicked, dragged, beat, and/or choked by a husband or partner). High levels of depression were recorded for 174 (7.3%) women in the preceding 2 weeks. Being a female head of household was associated with an increased likelihood of experiencing severe physical IPV (aOR 2.64, 95% CI 1.70â 4.10). Women with high depression scores were also at an increased risk of experiencing any physical IPV (aOR 17.1, 95% CI 8.44â 34.9) and severe physical IPV (aOR 15.4, 95% CI 5.17â 45.9).ConclusionFuture work should consider the implications of government and educational policies that could impact the screening and treatment of pregnant women affected by all forms of physical IPV and depression in rural Zambia.Postpartum physical intimate partner violence among women in rural Zambia was associated with being a female head of household and high levels of depression.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146407/1/ijgo12654.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146407/2/ijgo12654_am.pd

Maternity waiting homes as part of a comprehensive approach to maternal and newborn care: a cross-sectional survey

Abstract Background Increased encounters with the healthcare system at multiple levels have the potential to improve maternal and newborn outcomes. The literature is replete with evidence on the impact of antenatal care and postnatal care to improve outcomes. Additionally, maternity waiting homes (MWHs) have been identified as a critical link in the continuum of care for maternal and newborn health yet there is scant data on the associations among MWH use and antenatal/postnatal attendance, family planning and immunization rates of newborns. Methods A cross-sectional household survey was conducted to collect data from women who delivered a child in the past 13 months from catchment areas associated with 40 healthcare facilities in seven rural Saving Mothers Giving Life districts in Zambia. Multi-stage random sampling procedures were employed with a final sample of n = 2381. Logistic regression models with adjusted odds ratios and 95% confidence intervals were used to analyze the data. Results The use of a MWH was associated with increased odds of attending four or more antenatal care visits (OR = 1.45, 95% CI = 1.26, 1.68), attending all postnatal care check-ups (OR = 2.00, 95% CI = 1.29, 3.12) and taking measures to avoid pregnancy (OR = 1.31, 95% CI = 1.10, 1.55) when compared to participants who did not use a MWH. Conclusions This is the first study to quantitatively examine the relationship between the use of MWHs and antenatal and postnatal uptake. Developing a comprehensive package of services for maternal and newborn care has the potential to improve acceptability, accessibility, and availability of healthcare services for maternal and newborn health. Maternity waiting homes have the potential to be used as part of a multi-pronged approach to improve maternal and newborn outcomes. Trial registration National Institutes of Health Trial Registration NCT02620436, Impact Evaluation of Maternity Homes Access in Zambia, Date of Registration - December 3, 2015.https://deepblue.lib.umich.edu/bitstream/2027.42/152216/1/12884_2019_Article_2384.pd

Dataset for "If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia"

MSD for Mothers, Bill & Melinda Gates Foundation, The ELMA Foundatio

Increasing Facility Delivery Through Maternity Waiting Homes for Women Living Farthest From a Health Facility in Rural Zambia: A Quasi-experimental Study

Objective To report on the effectiveness of a standardized core Maternity Waiting Home (MWH) model to increase facility deliveries among women living \u3e10 km from a health facility. Design Quasi-experimental design with partial randomization at the cluster level. Setting Seven rural districts in Zambia. Population Women delivering at 40 health facilities between June 2016 and August 2018. Methods Twenty intervention and 20 comparison sites were used to test whether MWHs increased facility delivery for women living in rural Zambia. Difference-in-differences (DID) methodology was used to examine the effectiveness of the core MWH model on our identified outcomes. Main outcome measures Differences in the change from baseline to study period in the percentage of women living \u3e10 km from a health facility who: (1) delivered at the health facility, (2) attended a postnatal care (PNC) visit and (3) were referred to a higher-level health facility between intervention and comparison group. Results We detected a significant difference in the percentage of deliveries at intervention facilities with the core MWH model for all women living \u3e10 km away (DID 4.2%, 95% CI 0.6–7.6, P = 0.03), adolescent women (\u3c18 years) living \u3e10 km away (DID 18.1%, 95% CI 6.3–29.8, P = 0.002) and primigravida women living \u3e10 km away (DID 9.3%, 95% CI 2.4–16.4, P = 0.01) and for women attending the first PNC visit (DID 17.8%, 95% CI 7.7–28, P \u3c 0.001). Conclusion The core MWH model was successful in increasing rates of facility delivery for women living \u3e10 km from a healthcare facility, including adolescent women and primigravidas and attendance at the first PNC visit

If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia

Introduction: Maternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase health facility delivery among remote-living women in Zambia. Methods: We conducted a quasi-experimental study at 40 rural health centres (RHC) that offer basic emergency obstetric care and had no recent stockouts of oxytocin or magnesium sulfate, located within 2 hours of a referral hospital. Intervention clusters (n=20) received an improved MWH model. Control clusters (n=20) implemented standard of care. Clusters were assigned to study arm using a matched-pair randomisation procedure (n=20) or non-randomly with matching criteria (n=20). We interviewed repeated cross-sectional random samples of women in villages 10+ kilometres from their RHC. The primary outcome was facility delivery; secondary outcomes included postnatal care utilisation, counselling, services received and expenditures. Intention-to-treat analysis was conducted. Generalised estimating equations were used to estimate ORs. Results: We interviewed 2381 women at baseline (March 2016) and 2330 at endline (October 2018). The improved MWH model was associated with increased odds of facility delivery (OR 1.60 (95% CI: 1.13 to 2.27); p\u3c0.001) and MWH utilisation (OR 2.44 (1.62 to 3.67); p\u3c0.001). The intervention was also associated with increased odds of postnatal attendance (OR 1.55 (1.10 to 2.19); p\u3c0.001); counselling for family planning (OR 1.48 (1.15 to 1.91); p=0.002), breast feeding (OR 1.51 (1.20 to 1.90); p\u3c0.001), and kangaroo care (OR 1.44 (1.15, 1.79); p=0.001); and caesarean section (OR 1.71 (1.16 to 2.54); p=0.007). No differences were observed in household expenditures for delivery. Conclusion: MWHs near well-equipped RHCs increased access to facility delivery, encouraged use of facilities with emergency care capacity, and improved exposure to counselling. MWHs can be useful in the effort to increase delivery at advanced facilities in areas where substantial numbers of women live remotely