%0 Journal Article %J BMJ Open %D 2018 %T 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. %A Lazzerini, Marzia %A Ciuch, Margherita %A Rusconi, Silvia %A Covi, Benedetta %X

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'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'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.

%B BMJ Open %V 8 %P e021281 %8 2018 Jun 30 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/29961025?dopt=Abstract %R 10.1136/bmjopen-2017-021281