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<JournalTitle>Journal of Medical and Surgical Research</JournalTitle>
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<Volume-Issue>Vol. XII, n 3</Volume-Issue>
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<IssueTopic>Multidisciplinary</IssueTopic>
<IssueLanguage>English</IssueLanguage>
<Season>March 2026</Season>
<SpecialIssue>N</SpecialIssue>
<SupplementaryIssue>N</SupplementaryIssue>
<IssueOA>Y</IssueOA>
<PubDate>
<Year>-0001</Year>
<Month>11</Month>
<Day>30</Day>
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<ArticleType>JMSR Pediatrics</ArticleType>
<ArticleTitle>Barriers and facilitators to the implementation of neonatal death audits in Morocco: a qualitative study using the consolidated framework for implementation research framework</ArticleTitle>
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<ArticleLanguage>English</ArticleLanguage>
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<FirstPage>1523</FirstPage>
<LastPage>1535</LastPage>
<AuthorList>
<Author>
<FirstName>Maoukil</FirstName>
<LastName>Hind</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>N</CorrespondingAuthor>
<ORCID/>
<FirstName>Barkat</FirstName>
<LastName>Amina</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>Y</CorrespondingAuthor>
<ORCID/>
<FirstName>Bouzid</FirstName>
<LastName>Azzedine</LastName>
<AuthorLanguage>English</AuthorLanguage>
<Affiliation/>
<CorrespondingAuthor>Y</CorrespondingAuthor>
<ORCID/>
<FirstName>Elomrani</FirstName>
<LastName>Sanae</LastName>
<AuthorLanguage>English</AuthorLanguage>
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<Abstract>Introduction: Aligned with the Sustainable Development Goals (SDG 3.2), Morocco has been working since 2018 to integrate the audit of neonatal deaths and stillbirths in hospitals into the Maternal Death Surveillance, Neonatal Audit, and Response System (MDSNARS), to reduce neonatal mortality to 7 per 1000 live births by 2030. However, the lack of accurate data on neonatal mortality hinders the planning and implementation of targeted strategies. Objective: The aim of this study is to identify and explain the multilevel determinants influencing the implementation of neonatal death audits, using the Consolidated Framework for Implementation Research (CFIR) framework, in order to inform system strengthening strategies. Methods: A descriptive and exploratory qualitative study was conducted in the Marrakech-Safi region. A total of twenty semi-structured interviews were conducted with stakeholders involved in MDSNARS at the national, regional, and local levels. The data were transcribed, translated into French, and analyzed using thematic content analysis. Results: Findings indicate that the implementation of neonatal audits remains partial. The main barriers identified include a shortage of qualified staff, a non-operational neonatal unit, and a negative perception of audits, often associated with a punitive approach. On the other hand, the scientific legitimacy of the audit, the quality of continuing education, and close support from the central level appear to be important motivators for teams in the field. Conclusion: Neonatal audit is a key lever for improving neonatal care. To optimize its effectiveness, it is imperative to strengthen motivating factors and remove barriers identified among healthcare providers and within hospitals.</Abstract>
<AbstractLanguage>English</AbstractLanguage>
<Keywords>Barriers and facilitators, CFIR, Clinical audit, Death surveillance system, Morocco, Neonatal mortality</Keywords>
<URLs>
<Abstract>https://www.journal-jmsr.net/ubijournal-v1copy/journals/abstract.php?article_id=16208&title=Barriers and facilitators to the implementation of neonatal death audits in Morocco: a qualitative study using the consolidated framework for implementation research framework</Abstract>
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<References>
<ReferencesarticleTitle>References</ReferencesarticleTitle>
<ReferencesfirstPage>16</ReferencesfirstPage>
<ReferenceslastPage>19</ReferenceslastPage>
<References>Ouattara CA, Tinto R, Traore IT, Traore S, Tamboura H, Bamouni J, Meda ZC, and; Savadogo LGB. (2025). Facteurs pronostiques de la mortalitand;eacute; nand;eacute;onatale au CHU Sourand;ocirc; Sanou de Bobo-Dioulasso, Burkina Faso: une and;eacute;tude transversale. Pan African Medical Journal, 47(1). Retrieved from https://www.ajol.info/index.php/pamj/article/view/288394
Hough A, Shakur-Still H, Roberts I, Koukounari A, Lawn JE, Collaborators the WT. Stillbirths and neonatal deaths among 18 942 women with postpartum hemorrhage: Analysis of perinatal outcomes in the WOMAN trial. International Journal of Gynecology and; Obstetrics [Internet]. 2021;153(1):146and;#8209;53. Disponible sur: https://onlinelibrary.wiley.com/doi/abs/10.1002/ijgo.13413
Lawn JE, Bhutta ZA, Ezeaka C, Saugstad O. Ending Preventable Neonatal Deaths: Multicountry Evidence to Inform Accelerated Progress to the Sustainable Development Goal by 2030. Neonatology. 16 mai 2023;120(4):491and;#8209;9. Disponible sur: https://doi.org/10.1159/000530496
Mulugeta Dile Worke, Afework Tadele Mekonnen et Simachew Kassa. Incidence and determinants of neonatal mortality in the first three days of delivery in northwestern Ethiopia: a prospective cohort study | BMC Pregnancy and Childbirth [Internet]. Disponible sur: https://link.springer.com/article/10.1186/s12884-021-04122-8
Elomrani S, Bezad R, Brouwere VD, Campbell OMR, Lange IL, Oswald WE, et al. Approaching the SDG targets with sustained political commitment: drivers of the notable decline in maternal and neonatal mortality in Morocco. BMJ Glob Health [Internet]. 2024; Disponible sur: https://gh.bmj.com/content/9/Suppl_2/e011278
Abouchadi. A, Belghiti Alaoui A, Meski F.Z, De Brouwere V. Implementing a maternal mortality surveillance system in Morocco and;ndash; challenges and opportunities - 2013 - Tropical Medicine and; International Health - Wiley Online Library [Internet]. Disponible sur: https://onlinelibrary.wiley.com/doi/10.1111/tmi.12053
Willcox ML, Okello IA, Maidwell-Smith A, Tura AK, van den Akker T, Knight M. Maternal and perinatal death surveillance and response: a systematic review of qualitative studies. Bull World Health Organ [Internet]. 1 janv 2023;101(1):62-75G. Disponible sur: https://pmc.ncbi.nlm.nih.gov/articles/PMC9795385/
EL Hiyani M, Benlenda O, Alaoui AM, Abouqal R, Thimou Izgua A. An interrupted time series analysis to assess the impact of implementing the clinical audit process for stillbirths and neonatal deaths in Morocco. Clinical Epidemiology and Global Health [Internet]. 1 janv 2025;31:101898. Disponible sur: https://www.sciencedirect.com/science/article/pii/S2213398424003956
Chafik K, Aslaou F, Barich F, Laamiri FZ, El Ouardighi I, Barkat A. The Prevalence of Neonatal Near Misses in Rabat, Morocco. Cureus [Internet]. 1 fand;eacute;vr 2023; Disponible sur: https://www.cureus.com/articles/133449-the-prevalence-of-neonatal-near-misses-in-rabat-morocco
Gondwe MJ, Mhango JM, Desmond N, Aminu M, Allen S. Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review. BMJ Open Qual [Internet]. 15 mars 2021;10(1). Disponible sur: https://bmjopenquality.bmj.com/content/10/1/e001266
Kerber KJ, Mathai M, Lewis G, Flenady V, Erwich JJH, Segun T, et al. Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby. BMC Pregnancy Childbirth [Internet]. 11 sept 2015;15(2):S9. Disponible sur: https://doi.org/10.1186/1471-2393-15-S2-S9
Helps and;Auml;, Leitao S, Gutman A, Greene R, Oand;rsquo;Donoghue K. National perinatal mortality audits and resultant initiatives in four countries. European Journal of Obstetrics and; Gynecology and Reproductive Biology [Internet]. 1 dand;eacute;c 2021;267:111and;#8209;9. Disponible sur: https://www.sciencedirect.com/science/article/pii/S0301211521005017
Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Sci. 29 oct 2022;17(1):75. Disponible sur: https://doi.org/10.1186/s13012-022-01245-0
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Sci [Internet]. 7 aoand;ucirc;t 2009;4(1):50. Disponible sur: https://doi.org/10.1186/1748-5908-4-50
Ministand;egrave;re de la santand;eacute; et de la protection sociale. Santand;eacute; en chiffres.. Disponible sur: https://www.sante.gov.ma/Documents/2021/12/Sante%20en%20chiffres%202019%20.pdf
Nilsen P. Making Sense of Implementation Theories, Models, and Frameworks. In: Albers B, Shlonsky A, Mildon R, and;eacute;diteurs. Implementation Science 30 [Internet]. Cham: Springer International Publishing; 2020. p. 53and;#8209;79. Disponible sur: https://doi.org/10.1007/978-3-030-03874-8_3
Willmington C, Belardi P, Murante AM, Vainieri M. The contribution of benchmarking to quality improvement in healthcare. A systematic literature review. BMC Health Serv Res [Internet]. 2 fand;eacute;vr 2022;22(1):139. Disponible sur: https://doi.org/10.1186/s12913-022-07467-8
Kinney MV, Walugembe DR, Wanduru P, Waiswa P, George A. Maternal and perinatal death surveillance and response in low- and middle-income countries: a scoping review of implementation factors. Health Policy Plan. 1 juill 2021;36(6):955and;#8209;73. Disponible sur: https://doi.org/10.1093/heapol/czab011
J Jepkosgei, J Nzinga, MB Adam, M English. Exploring healthcare workersand;rsquo; perceptions on the use of morbidity and mortality audits as an avenue for learning and care improvement in Kenyan hospitalsand;rsquo; newborn units/BMC Health Services Research [Internet]. 2022. Disponible sur: https://link.springer.com/article/10.1186/s12913-022-07572-8
McAlearney AS, Terris D, Hardacre J, Spurgeon P, Brown C, Baumgart A, Nystrand;ouml;m ME. Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change. Qual Manag Health Care. 2014 Oct-Dec;23(4):254-67. doi: 10.1097/QMH.0000000000000044.
Orgill M, Gilson L, Chitha W, Michel J, Erasmus E, Marchal B, et al. A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa. Int J Equity Health [Internet]. 29 mars 2019;18(1):53. Disponible sur: https://doi.org/10.1186/s12939-019-0952-z
Brantuo MNA, Cristofalo E, Meheand;scaron; MM, Ameh J, Brako NO, Boahene F, et al. Evidence-based training and mentorship combined with enhanced outcomes surveillance to address the leading causes of neonatal mortality at the district hospital level in Ghana. Tropical Medicine and; International Health [Internet]. 2014;19(4):417and;#8209;26. Disponible sur: https://onlinelibrary.wiley.com/doi/abs/10.1111/tmi.12270
Abraham TH, Stewart GL, Solimeo SL. The importance of soft skills development in a hard data world: learning from interviews with healthcare leaders. BMC Med Educ [Internet]. 6 mars 2021;21(1):147. Disponible sur: https://doi.org/10.1186/s12909-021-02567-1
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaardand;#8208;Jensen J, French SD, et al. Audit and feedback: effects on professional practice and healthcare outcomes - Ivers, N-2012/Cochrane Library. Disponible sur: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000259.pub3/full
Sun L, Booth A, Sworn K. Adaptability, Scalability and Sustainability (ASaS) of complex health interventions: a systematic review of theories, models and frameworks. Implementation Sci [Internet]. 17 juill 2024;19(1):52. Disponible sur: https://doi.org/10.1186/s13012-024-01375-7
Norcross JC, Krebs PM, Prochaska JO. Stages of change. Journal of Clinical Psychology [Internet]. 2011;67(2):143and;#8209;54. Disponible sur: https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.20758</References>
</References>
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