Nancy Scott | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: Residential accommodation for expectant mothers adjacent to health facilities, also known as maternity homes, is a strategy to improve access to skilled deliveries in low-income countries like Zambia where the maternal mortality ratio is 280-398 deaths per 100,000 live births. Our study aimed to describe the general conditions of maternity homes and to assess the relationship between maternity home quality and likelihood of facility delivery in Kalomo District in Southern Province, Zambia.

Methods: We systematically assessed and inventoried the functional capacity of all existing maternity homes in the domains of 1) infrastructure and amenities; 2) funding and maintenance; 3) management and operations; 4) utilization and services; and 5) communication and care coordination, using a quantitative facility survey and photographs of the structures. We calculated a composite score to rank maternity home quality and used multivariate regression to assess the likelihood of facility delivery based on this score using household survey data collected on delivery location in Kalomo District from 2011-2013.

Results: In Kalomo, 69% (25/36) of facilities had an affiliated maternity home. Despite operating on average for 9 years, they were generally in poor condition and varied widely across the 5 domains examined. Of 8,033 total deliveries recorded from 2011-2013 in catchment areas for 18 Kalomo facilities, a higher proportion occurred in facilities where maternity homes were ranked high compared to low (64.1% versus 55.2%, p<0.001). After controlling for confounders including implementation of Saving Mothers Giving Life, a large-scale maternal health systems strengthening program, women were still 54% more likely to deliver at facilities with a high quality maternity home (OR: 1.54, 95% CI 1.38,1.71).

Conclusions: Improving the quality of maternity homes represents a potentially useful strategy to increasing facility delivery in rural Zambia.   * With funding provided by Merck Sharp & Dohme Corp.