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

Jaameeta Kurji, Kristy Hackett, Kayli Wild, Zohra Lassi

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article number86
JournalBMC Research Notes
Volume14
Issue number1
DOIs
Publication statusPublished or Issued - Dec 2021
Externally publishedYes

Keywords

  • Heterogeneity
  • Maternity waiting homes
  • Meta-analysis
  • Observational studies
  • Perinatal mortality
  • Random-effects models
  • Stillbirths
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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