Maternity waiting shelters and pregnancy outcome: experience from a rural area in Zimbabwe

Despite efforts to improve prenatal and perinatal health care in developing countries, child-birth remains hazardous for both mother and child. Several measures have been initiated to try to improve maternal and perinatal morbidity and mortality. One such measure is the establishment of maternity waiting shelters at hospitals where mothers can wait so that, when they go into labour or develop antenatal complications, they can transfer to the hospital wards for management and safe delivery. From May 1987 to April 1989, we evaluated pregnancy outcome among 280 women using such a shelter in a remote rural district in Zimbabwe. Perinatal mortality was higher (29.8 per 1000) among 773 non-waiting mothers than among the waiting mothers (25.0 per 1000), although this was not statistically significant (p > 0.05). However, there were significantly more low birthweight babies (11.4%) among the non-waiting mothers than among the waiting mothers (4.3%) (p < 0.01). Fetal deaths were more common than early neonatal deaths, suggesting that maternal factors accounted for most of the perinatal deaths. Poor pregnancy outcome was associated more with primigravidae and grand multigravidae than with those who had had one to four pregnancies. We conclude that maternity waiting shelters can contribute to preventing low birthweight and, to a lesser extent, improve perinatal outcome. There is a need to strengthen health care referral systems and to increase efforts to improve other determinants of perinatal and maternal morbidity and mortality.