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The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia

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Abstract:

Please cite this paper as: Kelly J, Kohls E, Poovan P, Schiffer R, Redito A, Winter H, MacArthur C. The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia. BJOG 2010;117:1377–1383. Objective 

To describe maternal mortality and stillbirth rates among women admitted via a maternity waiting area (MWA) and women admitted directly to the same hospital (non-MWA) over a 22-year period. Design 

Retrospective cohort study. Setting 

Hospital in rural Ethiopia, which provided comprehensive emergency obstetric care and has an established MWA. Population 

All women admitted for delivery between 1987 and 2008. Methods 

Data on maternal deaths, stillbirths, caesarean section and uterine rupture were abstracted from routine hospital records. Sociodemographic characteristics, antenatal care and other data were collected for 2008 only. Rates and 95% confidence intervals were calculated for maternal mortality and stillbirth. Main outcome measures 

Maternal mortality and stillbirth. Results 

There were 24 148 deliveries over the study period, 6805 admitted via MWA and 17 343 admitted directly. Maternal mortality was 89.9 per 100 000 live births (95% CI, 41.1–195.2) for MWA women and 1333.1 per 100 000 live births (95% CI, 1156.2–1536.7) for non-MWA women; stillbirth rates were 17.6 per 1000 births (95% CI, 14.8–21.0) and 191.2 per 1000 births (95% CI, 185.4–197.1), respectively; 38.5% of MWA women were delivered by caesarean section compared with 20.3% of non-MWA women, and none had uterine rupture, compared with 5.8% in the non-MWA group. For the 1714 women admitted in 2008, relatively small differences in sociodemographic characteristics, distance and antenatal care uptake were found between groups. Conclusions 

Maternal mortality and stillbirth rates were substantially lower in women admitted via MWA. It is likely that at least part of this difference is accounted for by the timely and appropriate obstetric management of women using this facility.

Keywords: maternal mortality; maternity waiting area; stillbirth

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1471-0528.2010.02669.x

Affiliations: 1: Attat Hospital, Welkitay, Ethiopia 2: Public Health, Epidemiology and Biostatistics, College of Medicine, University of Birmingham, Birmingham, UK

Publication date: October 1, 2010

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