School of Public Health, Faculty of Health Sciences, Centre for Health Policy/MRC Health Policy Research Group, Private Bag X3, University of the Witwatersrand, Johannesburg, 2050, Gauteng, South Africa.
Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
BMC Pregnancy Childbirth. 2017 Aug 31;17(1):269. doi: 10.1186/s12884-017-1444-z.
Maternity waiting homes (MWHs) are accommodations located near a health facility where women can stay towards the end of pregnancy and/or after birth to enable timely access to essential childbirth care or care for complications. Although MWHs have been implemented for over four decades, different operational models exist. This secondary thematic +analysis explores factors related to their implementation.
A qualitative thematic analysis was conducted using 29 studies across 17 countries. The papers were identified through an existing Cochrane review and a mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and barriers and facilitators for implementation. The influence of contextual factors, the design of the MWHs, and the conditions under which they operated were examined.
Key problems of MWH implementation included challenges in MWH maintenance and utilization by pregnant women. Poor utilization was due to lack of knowledge and acceptance of the MWH among women and communities, long distances to reach the MWH, and culturally inappropriate care. Poor MWH structures were identified by almost all studies as a major barrier, and included poor toilets and kitchens, and a lack of space for family and companions. Facilitators included reduced or removal of costs associated with using a MWH, community involvement in the design and upkeep of the MWHs, activities to raise awareness and acceptance among family and community members, and integrating culturally-appropriate practices into the provision of maternal and newborn care at the MWHs and the health facilities to which they are linked.
MWHs should not be designed as an isolated intervention but using a health systems perspective, taking account of women and community perspectives, the quality of the MWH structure and the care provided at the health facility. Careful tailoring of the MWH to women's accommodation, social and dietary needs; low direct and indirect costs; and a functioning health system are key considerations when implementing MWH. Improved and harmonized documentation of implementation experiences would provide a better understanding of the factors that impact on successful implementation.
产妇等候之家（MWH）是指靠近医疗机构的住所，孕妇可以在那里待产和/或分娩后居住，以便及时获得基本的分娩护理或并发症护理。尽管 MWH 已经实施了四十多年，但存在不同的运作模式。本二次主题+分析探讨了与实施相关的因素。
使用来自 17 个国家的 29 项研究进行了定性主题分析。这些论文是通过现有的 Cochrane 综述和对孕产妇健康文献的映射确定的。支持研究证据使用框架（SURE）指导主题分析，以探讨各利益相关者的看法以及实施的障碍和促进因素。检查了背景因素的影响、MWH 的设计以及它们运作的条件。
MWH 实施的主要问题包括 MWH 的维护和孕妇利用方面的挑战。由于妇女和社区对 MWH 的了解和接受程度低、到达 MWH 的距离长以及护理方式不适合文化背景，导致利用率低。几乎所有研究都认为 MWH 结构不佳是一个主要障碍，包括厕所和厨房设施差，以及缺乏家庭和陪伴的空间。促进因素包括减少或免除使用 MWH 的相关费用、社区参与 MWH 的设计和维护、开展提高家庭和社区成员认识和接受度的活动，以及将文化适宜的做法纳入 MWH 提供的孕产妇和新生儿护理以及与之相关的卫生设施。
MWH 不应作为孤立的干预措施设计，而应从卫生系统的角度出发，考虑妇女和社区的观点、MWH 结构的质量以及与 MWH 相关联的卫生设施提供的护理。在实施 MWH 时，需要仔细调整其以适应妇女的住宿、社会和饮食需求；降低直接和间接成本；以及运作良好的卫生系统。改进和协调实施经验的记录将更好地了解影响成功实施的因素。
