The effect of maternity waiting homes on perinatal mortality is inconclusive: a critical appraisal of existing evidence from Sub-Saharan Africa

Abstract

Objectives To assess the appropriateness of the statistical methodology used in a recent meta-analysis investigating the effect of maternity waiting homes (MWHs) on perinatal mortality in Sub-Saharan Africa. Results A recent meta-analysis published in BMC Research Notes used a fixed-effect model to generate an unadjusted summary estimate of the effectiveness of MWHs in reducing perinatal mortality in Africa using ten observational studies (pooled odds ratio 0.15, 95% confidence interval 0.14–0.17). The authors concluded that MWHs reduce perinatal mortality by over 80% and should be incorporated into routine maternal health care services. In the present article, we illustrate that due to the contextual and methodological heterogeneity present in existing studies, the authors’ conclusions about the effectiveness of MWHs in reducing perinatal mortality were likely overstated. Additionally, we argue that because of the selection bias and confounding inherent in observational studies, unadjusted pooled estimates provide little causal evidence for effectiveness. Additional studies with robust designs are required before an appropriately designed meta-analysis can be conducted; until then, the ability to draw causal inferences regarding the effectiveness of MWHs in reducing perinatal mortality is limited.

Intention to Use Maternal Waiting Homes and Related Factors among Pregnant Women in Metu Woreda, Western Ethiopia

“…Despite studies conducted revealing the use of Maternal Waiting Homes has a significant impact on reducing perinatal and maternal mortality ( 12 , 27 – 29 ), some studies conducted in Ethiopia revealed only 42.6% to 65.3% ( 28 – 30 ) pregnant women have intention to use Maternal Waiting Homes in their prospective delivery ( 31 ) while one study from the western part of Ethiopia revealed 38.7% of the study participants had experience in using Maternal Waiting Homes. Evidencing benefits of the use of Maternal Waiting Homes ( 12 , 27 – 29 ) to avert labor and delivery-related complications that may occur during labor and delivery and/or postpartum period is well established elsewhere ( 32 – 34 )…”