PONE-D-20-31460

How maternity waiting home use influences attendance of antenatal and postnatal care

PLOS ONE

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Academic Editor

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Partly

Reviewer #2: Partly

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: The manuscript is properly written, and consider all scientific plausibility. General comment:the author need to mention about the structure, service/intervention provided to the mother who have used MWHs. what service the mother received through their stay in MWHs?. the study focused only individual factors, but not consider facility factors, and need to mention as a limitation, because for service outcome, facility factors are more relevant than individual factor. During the interpretation of the study result, MWHs users more likely higher in ANC, PNC and FP use, why? need explanation in the discussion part of the study. Avoiding pregnancy, there is a lot of intervention introduced to improve FP use, how this study sure MWHs contribute FP, perhaps, MWHs significantly contribute for immediate use of postpartum FP use. If the author consider this and other editorial issues, might be accepted for publication.

Reviewer #2: Thank you for the manuscript.

It describes a study in rural Zambia before and after a “Core MWH model” intervention. It reports on whether five maternal and newborn health system uptake indicators (≥4 ANC, any PNC, taking active measures to avoid pregnancy, child having received at least one vaccination, having received all vaccinations) are linked to MWH use, after controlling for sociodemographic characteristics and survey period. In adjusted analysis, the authors report that among mothers who had used a MWH before giving birth odds of the outcomes were increased.

The most important comment regards the conclusions of the study. The authors state that “mothers who went to a MWH had better ANC and PNC attendance, FP use … at endline” (line 244) and the title states that MWH use influences ANC and PNC. The outcomes and the exposure are linked, but the latter does is not necessarily responsible for the outcome. PNC, active measures to avoid pregnancy, and immunization are temporally after birth, so it appears plausible that exposure to midwives during a MWH stay may improve these outcomes. However, MWH use takes place before birth and ANC temporally precedes a MWH stay. Though ANC and MWH use were statistically linked, it is not clear how the conclusion that MWH influences ANC can be drawn from the results.

The second is about the intervention. The authors state that “Purpose of the study is the change in health system indicators before/after core MWH model (line 149 – 151)”. This model includes different components. Authors should refer to the “core MWH model” as the intervention, not just MWH use.

Additional comments

Throughout the manuscript, the authors should use give birth in place of “deliver”

Title – can the title be reworded to “are linked”? The authors could consider referring to the “core MWH model”

Abstract – this does not read easily at the moment. Methods in this section should be made clearer. Authors should include that before/after community surveys were carried out, as at present it is not mentioned.

Ln 84 – Authors state that “MWH may serve … especially those living furthest”. As distance from place of residence was not studied, this conclusion does not seem supported by the evidence in this study.

Introduction – can be more concise. Paragraph 3 is a bit difficult to follow. Further detail about the Zambian health system, where the MWH were located (in proximity to hospitals only or to other facilities too?) and which women received advise to stay in a MWH would enable readers to make comparisons to other contexts.

Line 124 – should read obstetric instead of pregnancy

Methods – authors sometimes refer to 2 outcomes (eg line 184) (ANC and PNC), in other parts of methods and results sections refer to five outcomes (Tables 1, 4 and 5). It should be clarified.

Results – this section is very clear.

Ln 217 – “…mothers who “visited” a MWH”. Do the authors refer to a MWH stay? The term visited makes it confusing to readers

Discussion

A discussion of how the authors interpret the finding of the link between ANC and MWH use should be included.

Women who are more concerned about their pregnancy, for example for a previous perinatal death, or for a multiple pregnancy, will access ANC early and use a MWH before birth. The two may be therefore be linked but one does not cause the other. More cautious language may be more suitable.

Do the authors refer to ANC in successive pregnancies? The information collected during the post-intervention survey (women who had given birth ≤13 months at the time of survey) does not seem to support this.

Also, community mobilization in the course of the intervention may have contributed to both ANC and MWH.

In addition, the link between MWH and facility birth is not discussed. Women who stay in a MWH will give birth in a facility – exposure to a skilled midwife will take place in both, and it is difficult in my view to separate the two effects.

In this respect, I believe the expression “they may serve as a catalyst” is great.

Wealth was not studied as a determinant. The authors should include this as a limitation, as there is some evidence that MWH are used preferentially by poorer women – see for example https://doi.org/10.1093/heapol/czx100

(I acknowledge that I was among authors of this publication)

Obstetric risk factors were not part of the control variables. In many contexts, women with higher obstetric risk are advised to access MWH before birth. This should be noted in greater detail among limitations.

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Reviewer #1: No

Reviewer #2: No

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How maternity waiting home use influences attendance of antenatal and postnatal care

PONE-D-20-31460R1

Dear Dr. Buser,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Vijayaprasad Gopichandran

Academic Editor

PLOS ONE

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