by Nazeem Muhajarine

When a university takes on an international development project, it brings numerous assets that allow it to work in partnership with local communities and systems. The ability to generate new knowledge through research that often seeks to be grounded in the experience of its partners and are relevant to them is a key asset. The Mozambique-Canada Maternal Health Project has adopted this approach. Three research projects—maternal experiences study, maternity waiting homes study, and maternal near-miss study—have already created new insights that are valued by local partners and communities, as well as researchers. And there is more to come.

This report provides an update on each of these three research projects. In the coming months, as we wrap up our seventh year of the project, we expect to share the final results, and discuss how they inform decisions at health systems and impact local communities, especially women and girls.

Project 1 | The Maternal Experiences Study has reached an exciting juncture where all data have been gathered, transcribed, and translated from Xitswa or Chope (local languages) into Portuguese and then to English. The data compiled into individual data files—sets of stories—reflect ongoing conversations shared by research participants. We are now ready to conduct longitudinal analyses of these rich and varied experiences that the women have so bravely, and graciously, shared.

Terezinha da Silva (standing) leads a training session for the Maternal Experience Study

Three rounds of in-person interviews were done with women, including young girls, in 10 of the 20 rural communities in which the project works. First, with 50 women, creating a baseline understanding of women’s experiences in rural settings during pregnancy and childbirth and the contexts of their lives more broadly. This was followed by two rounds of in-depth interviews with a subset of 20 women. Our research assistant in Inhambane, Assucena Maite, has proven incredibly thoughtful and skilled in her ability to engage a diversity of women in markedly difficulty conversations—for example, touching on ill-treatment in the health system; violence at home; grieving for children lost; sex and sexuality and power; early and forced marriage; youth and sex education—while drawing out their articulations of hope for the future. Drawing from these research data, Denise Kouri has led the analyses of rounds one and two, in collaboration with the study PI Sylvia Abonyi and the rest of the research team. An immediate contribution of these research findings was the development of teaching tools that the project has been using with community members and health workers. Findings from the first and second rounds of interviews have been shared with Mozambique health partners, practitioners and managers, who have been visibly moved by the women’s stories and inspired to make changes in maternal care. At this penultimate stage of analysis and reflection, we are looking forward to bringing each story full circle to deepen their combined research impact on policy, health care, and community settings alike.

Nadege Uwamahoro instructing data collectors before they conducted pilot interviews, Maternity Waiting Homes study

Project 2 | The Maternity Waiting Homes Study is a multi-component study that aims to add new knowledge about how and why MWHs contribute effectively to healthy births, in what situations or contexts, and for whom. The project initiated a comprehensive realist evaluation of five maternity waiting homes constructed as part of the project’s strategy to reduce maternal mortality in Inhambane. Realist evaluations transcend traditional evaluations by seeking to develop a theory about why interventions work or do not work, rather than merely assessing whether an intervention works. The primary goal is to enhance understanding of the adoption and non-adoption of MWHs among women, families, communities, and health-system stakeholders. This involves examining the circumstances, motivations, and conditions under which MWHs are utilized. The research builds on and will facilitate the refinement of theories we had developed through a realistic review of MWH literature from low-and middle-income countries, published in BMJ Global Health.

Through a comparative design, the research will contrast the project’s newly established MWHs in Vilankulos, Homoine, and Chipole with the pre-existing MWHs in Quissico, Inharrime, and Mapinhane. This design aims to illuminate the role of a MWH’s physical environment and other contextual differences, including differences in approaches to service delivery at the participating facilities. This research project is coordinated and led by Nadege Uwamohoro, who has successfully recruited local data collectors and assembled a working group comprising representatives from the provincial health directorate, participating health facilities, and community support workers from relevant districts. The data collectors and working group members have undergone thorough orientation and training, enabling them to field-test research tools and to gather baseline data.

Project 3 | For every maternal death (itself a tragic event), some estimates have that 4 to 5 mothers avert death. In Inhambane, we do not know how many mothers have near-miss events. The Maternal Near-miss Studies in Inhambane are designed to fill this gap—and more. Using abstracted data from the MNM 1.0 study in two hospitals, Maud Muosieyiri, conducting her master’s research, determined that the additional clinical criteria identified more MNMs than using the original WHO clinical criteria. Specifically, clinical markers like Hypertension, Anemia, and Dystocia improved the ability of the clinical indicators to identify MNMs. Furthermore, distance from home to the hospital, type of hospital, and age of the mother significantly influenced the identification of MNMs.

Fernanda Andre interviews a mother for the Maternal Near-miss Study – Inharrime – Zavala, September 22, 2022.

The MNM 2.0 study, which was scaled up to include two additional regional hospitals in Inhambane province, collected data from 638 pregnant women admitted to the maternity wards. Collecting data for her PhD thesis research, Fernanda Andre followed up the quantitative component, the hospital abstracted data, with qualitative interviews with 43 women who were classified as having experienced a near-miss. These women resided in rural Inhambane, more than 8km from the hospital, without proper roads or transportation means. These data are currently being analyzed, and the goal is to have findings by the end of autumn 2023.

Compiled and submitted by Nazeem Muhajarine, Principal Investigator, MCMH Project

Contributors: Jessie Forsyth, Denise Kouri (Maternal Experience Study), Nadege Uwamohoro (Maternity Waiting Homes Study), Maud Muosieyiri, Fernanda Andre (Maternal Near-miss Studies).