title: A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries.
abstract: BACKGROUND
  Healthcare measures to prevent maternal deaths are well known. However, effective implementation of this knowledge to change practice remains a challenge.
  
  
  OBJECTIVE
  To assess whether strategies to promote the use of guidelines can improve obstetric practices in low- and middle-income countries (LMICs).
  
  
  METHODS
  Electronic databases were searched up to February 7, 2014, using relevant terms for implementation strategies (e.g. "audit," "education," "reminder"), and maternal mortality.
  
  
  METHODS
  Randomized and non-randomized studies of implementation strategies targeting healthcare professionals within the formal health services in LMICs were included.
  
  
  METHODS
  Cochrane methodological guidance was followed. Because of heterogeneity in the interventions, a narrative synthesis was completed.
  
  
  RESULTS
  Nine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor-patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies.
  
  
  CONCLUSIONS
  Implementation strategies targeting health professionals could lead to improvement in obstetric care in LMICs. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context.
  CRD42014010310.
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Mari
authors.initials: M
authors.lastname: Imamura
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Lovney
authors.initials: L
authors.lastname: Kanguru
authors.affiliation: Public Health Research Consultant, London, UK.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Penfold
authors.affiliation: Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Tim
authors.initials: T
authors.lastname: Stokes
authors.affiliation: Information Specialist Consultant, Munich, Germany.
authors.forename: Janette
authors.initials: J
authors.lastname: Camosso-Stefinovic
authors.affiliation: The National Institute for Health and Care Excellence, Manchester, UK.
authors.forename: Beth
authors.initials: B
authors.lastname: Shaw
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Hussein
mesh_terms: D003142:Communication; D003695:Delivery of Health Care / Q000592:standards*; D003906:Developing Countries; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality / Q000639:trends*; D065228:Non-Randomized Controlled Trials as Topic; D011203:Poverty; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic
keywords: Delivery of health care; Evidence-based medicine; Implementation research; Low-income countries; Maternal health services; Maternal mortality; Pregnancy; Systematic review