{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:48:43Z","timestamp":1787068123485,"version":"build-2736575974"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T00:00:00Z","timestamp":1601424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,11,20]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Globally, obstetric haemorrhage (OH) remains the leading cause of maternal mortality. Much of the associated mortality is ascribed to challenges surrounding deployment of innovations rather than lack of availability. In low- and middle-income countries (LMICs), where the burden is highest, there is a growing interest in implementation research as a means to bridge the \u2018know\u2013do\u2019 gap between proven interventions and their reliable implementation at scale. In this systematic review, we identified and synthesized qualitative and quantitative data across the implementation outcomes of OH prevention innovations in LMICs using a taxonomy developed by Proctor et al. We also identified service outcomes for the included innovations, as well as implementation strategies and implementation facilitators and barriers. Eligible studies were empirical, focused on the implementation of OH prevention programmes or policies and occurred in an LMIC. Eight databases were searched. Two authors independently assessed studies for selection and extracted data; the first author resolved discrepancies. Narrative synthesis was used to analyse and interpret the findings. Studies were predominantly focused in Africa and on primary prevention. Interventions included prophylactic use of uterotonics (n\u2009=\u20097), clinical provider skills training (n\u2009=\u20094) and provision of clinical guidelines (n\u2009=\u20091); some (n\u2009=\u20093) were also part of a multi-component quality improvement bundle. Various barriers were reported, including challenges among intervention beneficiaries, providers and within the health system; however, studies reported the development and testing of practical implementation solutions. These included training and monitoring of implementers, community and stakeholder engagement and guidance by external mentors. Some studies linked successful delivery to implementation outcomes, most commonly adoption and acceptability, but also feasibility, penetration and sustainability. Findings suggest that innovations to prevent OH can be acceptable, appropriate and feasible in LMIC settings; however, more research is needed to better evaluate these and other under-reported implementation outcomes.<\/jats:p>","DOI":"10.1093\/heapol\/czaa074","type":"journal-article","created":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T15:16:57Z","timestamp":1593443817000},"page":"1208-1227","source":"Crossref","is-referenced-by-count":7,"title":["Implementation outcomes of policy and programme innovations to prevent obstetric haemorrhage in low- and middle-income countries: a systematic review"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8051-0021","authenticated-orcid":false,"given":"Nessa","family":"Ryan","sequence":"first","affiliation":[{"name":"Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorice","family":"Vieira","sequence":"additional","affiliation":[{"name":"Department of Medical Library Services, NYU Grossman School of Medicine, 577 First Avenue, 2nd Floor, Room 202, New York, NY 10016, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena","family":"Goffman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 W 168th St, Rm PH16-74, New York, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan M","family":"Bloch","sequence":"additional","affiliation":[{"name":"Department of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe Street\/Carnegie 446 D1, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godwin O","family":"Akaba","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of Abuja\/University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda S","family":"D\u2019mello","sequence":"additional","affiliation":[{"name":"Maternal and Newborn Healthcare Department, Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), P.O. Box 23310, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chioma","family":"Egekeze","sequence":"additional","affiliation":[{"name":"Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anya","family":"Snyder","sequence":"additional","affiliation":[{"name":"Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Lyimo","sequence":"additional","affiliation":[{"name":"National Blood Transfusion Service, Max Mbwana St, Box: 65019 DSM, Dar es Salaam, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obiageli","family":"Nnodu","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Sickle Cell Disease Research and Training, Department of Haematology, University of Abuja, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Peprah","sequence":"additional","affiliation":[{"name":"Global Health Program, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA"},{"name":"Department of Social and Behavioral Sciences, New York University School of Global Public Health, 14 East 4th St, RM300A, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,30]]},"reference":[{"key":"2021011515443787800_czaa074-B1","doi-asserted-by":"crossref","first-page":"1345497","DOI":"10.1080\/16549716.2017.1345497","article-title":"A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons","volume":"10","author":"Ajeani","year":"2017","journal-title":"Global Health Action"},{"key":"2021011515443787800_czaa074-B2","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1891\/2156-5287.7.2.87","article-title":"Midwives utilization of life saving skills for prevention and management of hemorrhage in primary health centers in Anambra State, Nigeria","volume":"7","author":"Anastacia Nkwonta","year":"2017","journal-title":"International Journal of Childbirth"},{"key":"2021011515443787800_czaa074-B3","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1111\/j.1471-0528.2008.01866.x","article-title":"Maternal mortality in sub-Saharan Africa: the contribution of ineffective blood transfusion services","volume":"115","author":"Bates","year":"2008","journal-title":"BJOG"},{"key":"2021011515443787800_czaa074-B4","first-page":"CD007412","article-title":"Active versus expectant management for women in the third stage of labor","volume":"2","author":"Begley","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2021011515443787800_czaa074-B5","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/1471-0528.12818","article-title":"Improving postpartum care for mothers and newborns in Niger and Mali: a case study of an integrated maternal and newborn improvement programme","volume":"121","author":"Boucar","year":"2014","journal-title":"BJOG: An International Journal of Obstetrics & Gynaecology"},{"key":"2021011515443787800_czaa074-B6","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ijgo.2015.06.047","article-title":"A mixed-methods study of barriers and facilitators to the implementation of postpartum hemorrhage guidelines in Uganda","volume":"132","author":"Braddick","year":"2016","journal-title":"International Journal of Gynecology & Obstetrics"},{"key":"2021011515443787800_czaa074-B7","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1080\/17441692.2016.1172102","article-title":"A case study of community-based distribution and use of misoprostol and chlorhexidine in Sokoto State, Nigeria","volume":"12","author":"Cannon","year":"2017","journal-title":"Global Public Health"},{"key":"2021011515443787800_czaa074-B8","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/AOG.0000000000003108","article-title":"Implementation of the alliance for innovation on maternal health program to reduce maternal mortality in Malawi","volume":"133","author":"Chang","year":"2019","journal-title":"Obstetrics and Gynecology"},{"key":"2021011515443787800_czaa074-B9","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/1748-5908-8-22","article-title":"Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures","volume":"8","author":"Chaudoir","year":"2013","journal-title":"Implementation Science"},{"key":"2021011515443787800_czaa074-B10","volume-title":"CASP Cohort Study Checklist","year":"2020"},{"key":"2021011515443787800_czaa074-B11","volume-title":"CASP Qualitative Checklist","year":"2020"},{"key":"2021011515443787800_czaa074-B12","volume-title":"CASP Randomised Control Trial Checklist","year":"2020"},{"key":"2021011515443787800_czaa074-B13","doi-asserted-by":"crossref","first-page":"e0207909","DOI":"10.1371\/journal.pone.0207909","article-title":"Peer-assisted learning after onsite, low-dose, high-frequency training and practice on simulators to prevent and treat postpartum hemorrhage and neonatal asphyxia: a pragmatic trial in 12 districts in Uganda","volume":"13","author":"Evans","year":"2018","journal-title":"PLoS One"},{"key":"2021011515443787800_czaa074-B14","first-page":"442","article-title":"Postpartum hemorrhage: prevention and treatment","volume":"7","author":"Evensen","year":"2017","journal-title":"American Family Physician"},{"key":"2021011515443787800_czaa074-B15","year":"2012"},{"key":"2021011515443787800_czaa074-B16","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta23090","article-title":"Uterotonic drugs to prevent postpartum haemorrhage: a network meta-analysis","volume":"23","author":"Gallos","year":"2019","journal-title":"Health Technology Assessment"},{"key":"2021011515443787800_czaa074-B17","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.ijgo.2014.04.019","article-title":"A multifaceted intervention to increase prophylactic oxytocin use during the third stage of labor and to reduce routine episiotomies in Nicaragua","volume":"127","author":"Garcia-Elorrio","year":"2014","journal-title":"International Journal of Gynecology & Obstetrics"},{"key":"2021011515443787800_czaa074-B18","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.ejogrb.2019.07.018","article-title":"Non-clinical interventions to prevent postpartum haemorrhage and improve its management: a systematic review","volume":"240","author":"Gaucher","year":"2019","journal-title":"European Journal of Obstetrics & Gynecology and Reproductive Biology"},{"key":"2021011515443787800_czaa074-B19","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1055\/s-0038-1676976","article-title":"The New York state safe motherhood initiative: early impact of obstetric hemorrhage bundle implementation","volume":"36","author":"Goffman","year":"2019","journal-title":"American Journal of Perinatology"},{"key":"2021011515443787800_czaa074-B20","volume-title":"Crossing the Quality Chasm: A New Health System for the 21st Century","year":"2001"},{"key":"2021011515443787800_czaa074-B21","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12916-018-1237-x","article-title":"Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review","volume":"17","author":"Kemp","year":"2019","journal-title":"BMC Medicine"},{"key":"2021011515443787800_czaa074-B22","doi-asserted-by":"crossref","first-page":"e63846","DOI":"10.1371\/journal.pone.0063846","article-title":"Why are women dying when they reach hospital on time? A systematic review of the \u2018third delay\u2019","volume":"8","author":"Knight","year":"2013","journal-title":"PLoS One"},{"key":"2021011515443787800_czaa074-B23","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.0 (Updated July 2019)","author":"Lefebvre","year":"2019"},{"key":"2021011515443787800_czaa074-B24","author":"Likis Fe","year":"2015"},{"key":"2021011515443787800_czaa074-B25","doi-asserted-by":"crossref","first-page":"e37","DOI":"10.2196\/mhealth.3942","article-title":"Usability and feasibility of PIERS on the move: an mHealth app for pre-eclampsia triage","volume":"3","author":"Lim","year":"2015","journal-title":"JMIR Mhealth and Uhealth"},{"key":"2021011515443787800_czaa074-B26","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1111\/j.1538-7836.2011.04398.x","article-title":"Obstetric hemorrhage","volume":"9","author":"Mclintock","year":"2011","journal-title":"Journal of Thrombosis and Haemostasis"},{"key":"2021011515443787800_czaa074-B27","doi-asserted-by":"crossref","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Medicine"},{"key":"2021011515443787800_czaa074-B28","first-page":"300","article-title":"Bedside availability of prepared oxytocin and rapid administration after delivery to prevent postpartum hemorrhage: an observational study in Karnataka, India","volume":"3","author":"Moucheraud","year":"2015","journal-title":"Global Health: Science and Practice"},{"key":"2021011515443787800_czaa074-B29","doi-asserted-by":"crossref","first-page":"e0170739","DOI":"10.1371\/journal.pone.0170739","article-title":"Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto State, Nigeria: early results and lessons learned","volume":"12","author":"Orobaton","year":"2017","journal-title":"PLos One"},{"key":"2021011515443787800_czaa074-B30","doi-asserted-by":"crossref","first-page":"S46","DOI":"10.1016\/j.ijgo.2015.03.007","article-title":"Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care","volume":"130","author":"Otolorin","year":"2015","journal-title":"International Journal of Gynecology & Obstetrics"},{"key":"2021011515443787800_czaa074-B31","doi-asserted-by":"crossref","first-page":"e1001589","DOI":"10.1371\/journal.pmed.1001589","article-title":"A risk prediction model for the assessment and triage of women with hypertensive disorders of pregnancy in low-resourced settings: the miniPIERS (Pre-eclampsia Integrated Estimate of RiSk) multi-country prospective cohort study","volume":"11","author":"Payne","year":"2014","journal-title":"PLoS Medicine"},{"key":"2021011515443787800_czaa074-B32","doi-asserted-by":"crossref","first-page":"762","DOI":"10.15585\/mmwr.mm6835a3","article-title":"Racial\/ethnic disparities in pregnancy-related deaths\u2014United States, 2007\u20132016","volume":"68","author":"Petersen","year":"2019","journal-title":"MMWR. Morbidity and Mortality Weekly Report"},{"key":"2021011515443787800_czaa074-B33","doi-asserted-by":"crossref","first-page":"i6795","DOI":"10.1136\/bmj.i6795","article-title":"Standards for Reporting Implementation Studies (StaRI) statement","volume":"356","author":"Pinnock","year":"2017","journal-title":"BMJ (Clinical Research ed.)"},{"key":"2021011515443787800_czaa074-B34","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2147\/IJWH.S51661","article-title":"Prevention of postpartum hemorrhage in low-resource settings: current perspectives","volume":"5","author":"Prata","year":"2013","journal-title":"International Journal of Women's Health"},{"key":"2021011515443787800_czaa074-B35","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Administration and Policy in Mental Health and Mental Health Services Research"},{"key":"2021011515443787800_czaa074-B36","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s10488-008-0197-4","article-title":"Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges","volume":"36","author":"Proctor","year":"2009","journal-title":"Administration and Policy in Mental Health"},{"key":"2021011515443787800_czaa074-B37","first-page":"CD001808","article-title":"Prophylactic oxytocin for the third stage of labour to prevent postpartum haemorrhage","volume":"29","author":"Salati","year":"2019","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"2021011515443787800_czaa074-B38","doi-asserted-by":"crossref","first-page":"e323","DOI":"10.1016\/S2214-109X(14)70227-X","article-title":"Global causes of maternal death: a WHO systematic analysis","volume":"2","author":"Say","year":"2014","journal-title":"The Lancet Global Health"},{"key":"2021011515443787800_czaa074-B39","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/1471-0528.12636","article-title":"Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health","volume":"121","author":"Sheldon","year":"2014","journal-title":"BJOG"},{"key":"2021011515443787800_czaa074-B40","volume-title":"Scaling Up Health Service Delivery: From Pilot Innovations to Policies Program","author":"Simmons","year":"2007"},{"key":"2021011515443787800_czaa074-B41","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1093\/heapol\/czv012","article-title":"Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation","volume":"31","author":"Smith","year":"2016","journal-title":"Health Policy and Planning"},{"key":"2021011515443787800_czaa074-B42","doi-asserted-by":"crossref","first-page":"S83","DOI":"10.1111\/jmwh.12154","article-title":"Interpretation of national policy regarding community-based use of misoprostol for postpartum hemorrhage prevention in Ethiopia: a tale of two regions","volume":"59","author":"Spangler","year":"2014","journal-title":"Journal of Midwifery & Women's Health"},{"key":"2021011515443787800_czaa074-B43","doi-asserted-by":"crossref","first-page":"207","DOI":"10.2471\/BLT.08.052597","article-title":"Use of active management of the third stage of labour in seven developing countries","volume":"87","author":"Stanton","year":"2009","journal-title":"Bulletin of the World Health Organization"},{"key":"2021011515443787800_czaa074-B44","volume-title":"Priority Medicines for Europe and the World \u201cA Public Health Approach to Innovation\u201d","author":"Tanna","year":"2013"},{"key":"2021011515443787800_czaa074-B45","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1186\/s12884-019-2539-5","article-title":"Effect of community-based distribution of misoprostol on facility delivery: a scoping review","volume":"19","author":"Tiruneh","year":"2019","journal-title":"BMC Pregnancy and Childbirth"},{"key":"2021011515443787800_czaa074-B46","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13033-020-00372-9","article-title":"Implementation outcomes of cognitive behavioural therapy delivered by non-specialists for common mental disorders and substance-use disorders in low- and middle-income countries: a systematic review","volume":"14","author":"Verhey","year":"2020","journal-title":"International Journal of Mental Health Systems"},{"key":"2021011515443787800_czaa074-B47","doi-asserted-by":"crossref","first-page":"1701","DOI":"10.1016\/S1701-2163(16)35405-6","article-title":"Preeclampsia in low and middle income countries-health services lessons learned from the PRE-EMPT (PRE-Eclampsia-Eclampsia Monitoring, Prevention and Treatment) project","volume":"34","author":"von Dadelszen","year":"2012","journal-title":"Journal of Obstetrics and Gynaecology Canada"},{"key":"2021011515443787800_czaa074-B48","first-page":"76","article-title":"Self-administered misoprostol to prevent bleeding after homebirths in Uganda: a placebo-controlled randomised trial","volume":"120","author":"Weeks","year":"2013","journal-title":"BJOG"},{"key":"2021011515443787800_czaa074-B49","volume-title":"World Health Report 2000\u2014Health Systems: Improving Performance","year":"2000"},{"key":"2021011515443787800_czaa074-B50","volume-title":"Standards for Improving Quality of Maternal and Newborn Care in Health Facilities","year":"2016"},{"key":"2021011515443787800_czaa074-B51","volume-title":"WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage","year":"2018"},{"key":"2021011515443787800_czaa074-B52","volume-title":"WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience","year":"2018"}],"container-title":["Health Policy and Planning"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/heapol\/article-pdf\/35\/9\/1208\/35885412\/czaa074.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/heapol\/article-pdf\/35\/9\/1208\/35885412\/czaa074.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T15:46:01Z","timestamp":1610725561000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/heapol\/article\/35\/9\/1208\/5913103"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,30]]},"references-count":52,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9,30]]},"published-print":{"date-parts":[[2020,11,20]]}},"URL":"https:\/\/doi.org\/10.1093\/heapol\/czaa074","relation":{},"ISSN":["0268-1080","1460-2237"],"issn-type":[{"value":"0268-1080","type":"print"},{"value":"1460-2237","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,11]]},"published":{"date-parts":[[2020,9,30]]}}}