• Mari Imamura, Lovney Kanguru, Suzanne Penfold, Tim Stokes, Janette Camosso-Stefinovic, Beth Shaw, and Julia Hussein.
• Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
• Int J Gynaecol Obstet. 2017 Jan 1; 136 (1): 19-28.

BackgroundHealthcare measures to prevent maternal deaths are well known. However, effective implementation of this knowledge to change practice remains a challenge.ObjectivesTo assess whether strategies to promote the use of guidelines can improve obstetric practices in low- and middle-income countries (LMICs).Search StrategyElectronic databases were searched up to February 7, 2014, using relevant terms for implementation strategies (e.g. "audit," "education," "reminder"), and maternal mortality.Selection CriteriaRandomized and non-randomized studies of implementation strategies targeting healthcare professionals within the formal health services in LMICs were included.Data Collection And AnalysisCochrane methodological guidance was followed. Because of heterogeneity in the interventions, a narrative synthesis was completed.Main ResultsNine 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.ConclusionsImplementation 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.ProsperoCRD42014010310.© 2016 International Federation of Gynecology and Obstetrics.

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