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Low- and middle-income countries face many common barriers to implementation of maternal health evidence products.

Puchalski Ritchie LM, Khan S, Moore JE, Timmings C, van Lettow M, Vogel JP, Khan DN, Mbaruku G, Mrisho M, Mugerwa K, Uka S, Gülmezoglu AM, Straus SE

  • Journal Journal of clinical epidemiology

  • Published 27 Feb 2016

  • Volume 76

  • Pagination 229-37

  • DOI 10.1016/j.jclinepi.2016.02.017


To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings.

Secondary analysis of qualitative data.

Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis.

Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products.

By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs.