Maternity waiting homes and traditional midwives in rural Liberia

ObjectiveMaternity waiting homes (MWHs) can reduce maternal morbidity and mortality by increasing access to skilled birth attendants (SBAs). The present analysis was conducted to determine whether MWHs increase the use of SBAs at rural primary health clinics in Liberia; to determine whether traditional midwives (TMs) are able to work with SBAs as a team and to describe the perceptions of TMs as they engage with SBAs; and to determine whether MWHs decrease maternal and child morbidity and mortality.MethodsThe present analysis was conducted halfway through a large cohort study in which 5 Liberian communities received the intervention (establishment of an MWH) and 5 Liberian communities did not (control group). Focus groups were conducted to examine the views of TMs on their integration into health teams.ResultsCommunities with MWHs experienced a significant increase in team births from baseline to post‐intervention (10.8% versus 95.2%, P < 0.001), with greater TM engagement. Lower rates of maternal and perinatal death were reported from communities with MWHs.ConclusionThe reduction in morbidity and mortality indicates that the establishment of MWHs is an effective strategy to increase the use of SBAs, improve the collaboration between SBAs and TMs, and improve maternal and neonatal health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135181/1/ijgo114.pd

A case series study on the effect of Ebola on facility-based deliveries in rural Liberia

Abstract Background As communities’ fears of Ebola virus disease (EVD) in West Africa exacerbate and their trust in healthcare providers diminishes, EVD has the potential to reverse the recent progress made in promoting facility-based delivery. Using retrospective data from a study focused on maternal and newborn health, this analysis examined the influence of EVD on the use of facility-based maternity care in Bong Country, Liberia, which shares a boarder with Sierra Leone - near the epicenter of the outbreak. Methods Using a case series design, retrospective data from logbooks were collected at 12 study sites in one county. These data were then analyzed to determine women’s use of facility-based maternity care between January 2012 and October 2014. The primary outcome was the number of facility-based deliveries over time. The first suspected case of EVD in Bong County was reported on June 30, 2014. Heat maps were generated and the number of deliveries was normalized to the average number of deliveries during the full 12 months before the EVD outbreak (March 2013 – February 2014). Results Prior to the EVD outbreak, facility-based deliveries steadily increased in Bong County reaching an all-time high of over 500 per month at study sites in the first half of 2014 – indicating Liberia was making inroads in normalizing institutional maternal healthcare. However, as reports of EVD escalated, facility-based deliveries decreased to a low of 113 in August 2014. Conclusion Ebola virus disease has negatively impacted the use of facility-based maternity services, placing childbearing women at increased risk for morbidity and death.http://deepblue.lib.umich.edu/bitstream/2027.42/114384/1/12884_2015_Article_694.pd

It takes a village: a comparative study of maternity waiting homes in rural Liberia

Background: Although evidence is insufficient to determine the effectiveness of maternity waiting homes on improvement of maternal and newborn health, several countries have identified success in institutionalisation of maternity waiting homes as a way to reduce maternal and neonatal deaths by increasing access to skilled birth attendants. We examined maternity waiting homes as an intervention to decrease maternal and neonatal morbidity and mortality in Liberia, west Africa. Methods: With a matched cohort design in remote, rural Liberia, five primary health-care facilities with new maternity waiting homes (exposed intervention group) were matched to five facilities without maternity waiting homes (unexposed comparison group). All 10 clinics have 24-h staffing and are overseen by Africare-Liberia. We collected data for team births (skilled birth attendants and traditional midwives working together during delivery) from December, 2010, to August, 2012 and data for maternal deaths from March, 2011, to September, 2012. We used a logistic regression model with generalised estimating equations to evaluate differences from baseline (Dec 1, 2010– Feb 28, 2011) to postintervention (June 1, 2012–Aug 31, 2012). Findings: The proportion of team births significantly increased in communities with maternity waiting homes from 18 (10·80%) of 166 (95% CI 0·03–0·32) to 248 (95·20%) of 248 (0·73–0·99, p<0·001), whereas in communities without maternity waiting homes the team births increased from 40 (20·50%) of 195 (0·04–0·63) to 178 (69·80%) of 255 (0·20–0·96, p=0·065). Team births increased more rapidly in MWH communities (Wald's c2=3·75, df=1, p=0·053). Maternal deaths significantly differed between communities with maternity waiting homes (n=3) and communities without maternity waiting homes (n=12; Wald's c2=4·22, df=1, p=0·040). Interpretation: Our findings add to the evidence of the potential benefit and effectiveness of maternity waiting homes. Funding: US Agency for International Development & Fogarty International, National Institutes of Health