Rwanda has made remarkable progress in reducing maternal deaths although there was stagnation in maternal mortality rate between 2015 and 2020. Preventable causes such as postpartum hemorrhage, obstructed labor, sepsis, and hypertensive disorders still prevail. Distance remains a major factor influencing access to care, especially for pregnant women in rural areas. As such, utilization of maternity waiting homes (MWH) in rural areas could help bridge the access gap. Implementation of Maternal and Perinatal Death Surveillance and Response (MPDSR) helps to identify gaps in care. This thesis of Edwin Tayebwa aimed to improve the understanding of interventions that Rwanda could undertake to improve maternity care in rural areas.
We utilized the World Health Organization framework for the quality of maternal and newborn health care to organize our studies. We found that maternal death audits were conducted regularly though implementation of MPDSR was at varying stages. On exploration of birth outcomes among mothers that stayed in a MWH and those that did not, we found that MWH users had better outcomes compared to non-users. Severe maternal outcomes were more frequent among MWH non-users than users and the management of complications was optimal. Management of coincidental conditions and unanticipated complications was suboptimal. We found that the MWH offered a peaceful and home-like environment, good-quality services, timely maternity care, and was associated with good outcomes, although barriers were also reported. Based on these findings and following a discussion founded on relevant literature, we formulated recommendations to improve the quality of maternity care in rural Rwanda.
