Table 2_Towards a universal implementation of labor companionship: a synthesis of the policy and facility environment of eight low-and-middle income countries.docx

BackgroundLabor companionship, the presence of a woman's person of choice during childbirth, has benefits to both woman and baby and is recommended by the World Health Organization since 2012. However, implementation remains sub-optimal, especially in low-and-middle-income countries (LMICs). This study aimed to understand the maturity of labor companionship implementation in eight low-and-middle income countries with focus on the policy and facility environment.
MethodsThis was a multi-country study nested in two hospital-based implementation research studies: Action Leveraging Evidence to Reduce perinatal mortality and morbidity in Sub-Saharan Africa (ALERT) study and the QUALIty DECision-making by women and providers for appropriate use of caesarean section (QUALI-DEC) study. We included 48 hospitals from eight countries: Argentina, Burkina Faso, Thailand and Viet Nam (QUALI-DEC) and four from each of Benin, Malawi, Tanzania and Uganda (ALERT). We used data from (i) a document review, including national policy documents and (ii) health facility readiness assessment, including physical layouts of maternity wards, all collected between December 2019 and April 2021. Our analysis included two steps, (1) a structured data abstraction with coding to pre-defined categories to analyse the national polices and available resources on a facility level which informed the (2) categorization of implementation maturity in three implementation phases modelled by the framework by Bergh et al. and the logic model developed by Bohren et al.
ResultsThree of the eight countries lacked any national-level companionship policies, four had some mentioning and only one had detailed guidance on roles of labor companions and implementation guidelines. The physical outlines of maternity wards varied greatly, and lack of space was one of the main implementation barriers to all countries except Argentina. We classified Benin, Thailand and Viet Nam in the pre-implementation phase because of missing guidelines and limited implementation; Burkina Faso, Malawi, Uganda and Tanzania in the early implementation phase; and Argentina in the institutionalization phase where policies and facility resources were conducive.
ConclusionSuccessful implementation was supported by concrete and contextualized implementation guidance. To move to high implementation levels, supporting policies, guidelines and structural changes in the maternity wards are needed.

背景
分娩陪伴（Labor companionship，即产妇在分娩过程中由其自主选择的人员在场陪同）对母婴均有益处，世界卫生组织（World Health Organization, WHO）自2012年起便推荐该实践。但目前其实施效果仍未达最优，在中低收入国家（low-and-middle-income countries, LMICs）中这一问题尤为突出。本研究旨在探究8个中低收入国家的分娩陪伴实施成熟度，重点关注政策与设施环境。

方法
本研究为一项多国研究，嵌套于两项基于医院的实施研究：即“非洲撒哈拉以南地区利用证据降低围产期死亡率与发病率行动（Action Leveraging Evidence to Reduce perinatal mortality and morbidity in Sub-Saharan Africa, ALERT）”研究，以及“女性与医护人员基于质量决策以合理使用剖宫产术（QUALIty DECision-making by women and providers for appropriate use of caesarean section, QUALI-DEC）”研究。本研究纳入8个国家的48家医院：阿根廷、布基纳法索、泰国、越南的医院纳入QUALI-DEC研究，贝宁、马拉维、坦桑尼亚、乌干达4国各提供4家医院，纳入ALERT研究。我们采用的数据来源于两部分：(i) 文献综述，涵盖国家层面的政策文件；(ii) 医疗机构就绪性评估，包括产科病房的物理布局，所有数据均收集于2019年12月至2021年4月期间。本次分析分为两个步骤：(1) 结构化数据提取，通过对预定义类别进行编码，分析国家政策及医疗机构层面的可用资源，以此为基础(2) 参考Bergh等人提出的框架与Bohren等人开发的逻辑模型，将实施成熟度划分为三个实施阶段。

结果
8个国家中，3个国家未出台任何国家级分娩陪伴政策，4个国家的政策中仅提及分娩陪伴，仅1个国家制定了关于分娩陪伴角色及实施指南的详细指导文件。产科病房的物理布局差异极大，除阿根廷外，其余国家均将空间不足列为主要实施障碍之一。我们将贝宁、泰国、越南划分为预实施阶段，原因是其缺乏相关指南且实施范围有限；布基纳法索、马拉维、乌干达、坦桑尼亚划分为初步实施阶段；阿根廷则处于制度化实施阶段，其政策与医疗机构资源均对分娩陪伴的实施较为有利。

结论
成功的分娩陪伴实施离不开具体且贴合当地情境的实施指南支持。若要达到较高的实施水平，还需配套相关政策、指南以及产科病房的结构改造。