@article {10776, title = {Facilitators and barriers to the effective implementation of the individual maternal near-miss case reviews in low/middle-income countries: a systematic review of qualitative studies.}, journal = {BMJ Open}, volume = {8}, year = {2018}, month = {2018 Jun 30}, pages = {e021281}, abstract = {

BACKGROUND: The maternal near-miss cases review (NMCR), a type of clinical audit, proved to be effective in improving quality of care and decreasing maternal mortality in low/middle-income countries (LMICs). However, challenges in its implementation have been described.

OBJECTIVES: Synthesising the evidence on facilitators and barriers to the effective implementation of NMCR in LMICs.

DESIGN: Systematic review of qualitative studies.

DATA SOURCES: MEDLINE, LILACS, Global Health Library, SCI-EXPANDED, SSCI, Cochrane library and Embase were searched in December 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Qualitative studies exploring facilitators and/or barriers of implementing NMCR in LMIC were included.

DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data, performed thematic analysis and assessed risk of bias.

RESULTS: Out of 25 361 papers retrieved, 9 studies from Benin, Brazil, Burkina Faso, Cote D{\textquoteright}Ivoire, Ghana, Malawi, Morocco, Tanzania, Uganda could be included in the review. The most frequently reported barriers to NMCR implementation were the following: absence of national guidelines and local protocols; insufficient training on how to perform the audit; lack of leadership, coordination, monitoring and supervision; lack of resources and work overload; fear of blame and punishment; poor knowledge of evidenced-based medicine; hierarchical differences among staff and poor understating of the benefits of the NMCR. Major facilitators to NMCR implementation included: good leadership and coordination; training of all key staff; a good cultural environment; clear staff{\textquoteright}s perception on the benefits of conducting audit; patient empowerment and the availability of external support.

CONCLUSIONS: In planning the NMCR implementation in LMICs, policy-makers should consider actions to prevent and mitigate common challenges to successful NMCR implementation. Future studies should aim at documenting facilitators and barriers to NMCR outside the African Region.

}, issn = {2044-6055}, doi = {10.1136/bmjopen-2017-021281}, author = {Lazzerini, Marzia and Ciuch, Margherita and Rusconi, Silvia and Covi, Benedetta} }