A hospital-based cohort study was carried out in a district hospital in Zimbabwe to evaluate the effect of a maternity waiting home on perinatal mortality. Information on antenatal risk factors, use of antenatal care, access to the hospital and stage of labour on arrival was collected for each woman delivering at the hospital during the period 1989-1991 (n = 6438). Women who stayed in the maternity waiting home had a lower risk of perinatal death compared to women who came directly from home to the hospital during labour. The crude relative risk of perinatal death for the women coming from home was 1.7 (95% confidence interval (CI) 1.1-2.6; P < 0.05). After adjusting for the effect of potential confounding variables, the relative risk decreased to 1.5 (95% CI 0.95-2.5, P = 0.07). However, when the analysis was restricted to women with antenatal risk factors there was a significant 50% reduction in the risk of perinatal death for the women who stayed at the maternity waiting home compared to women who came from home during labour (adjusted relative risk 1.9; 95% CI 1.1-3.4; P < 0.05). The use of maternity waiting homes has the potential to reduce perinatal mortality in rural areas with low geographic access to hospitals and merits further evaluation.
PIP: Obstructed labor, prematurity, and antepartum hemorrhage are some of the important causes of perinatal mortality in developing countries. The development and use of maternity waiting homes (MWH), lodgings close to hospitals, have been recommended by the World Health Organization as a strategy for reducing levels of maternal morbidity and mortality. Although MWHs are designed mainly to reduce levels of intra- and post-partum maternal complications of high-risk pregnancies, they also have the potential to reduce adverse perinatal outcomes for newborns. This paper reports findings from a study conducted under routine program conditions in Zimbabwe which compared intra-hospital perinatal deaths among women who stayed in a MWH and those who came directly from home during labor, adjusted for potential confounding factors which may affect the incidence of perinatal mortality. Information was collected on the antenatal risk factors, use of antenatal care, access to the hospital, and stage of labor on arrival for each of the 6438 women delivering at Chipinge Hospital during the period 1989-1991. Women who stayed in the MWH had a lower risk of perinatal death compared to women who came directly from home to the hospital during labor; the crude relative risk of perinatal death for the women coming home was 1.7. Once adjusted for the effect of potential confounding, relative risk fell to 1.5. Among women with antenatal risk factors, however, those who stayed at the MWH were 50% less likely to experience a perinatal death than women who came from home during labor. The authors therefore conclude that the use of MWHs has the potential to reduce perinatal mortality in rural areas with low geographic access to hospitals and merits further evaluation.