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<JournalTitle>Journal of Medical and Surgical Research</JournalTitle>
<PISSN>I</PISSN>
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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>2026</Year>
<Month>03</Month>
<Day>14</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.</ArticleTitle>
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<ArticleLanguage>English</ArticleLanguage>
<ArticleOA>Y</ArticleOA>
<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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<CorrespondingAuthor>Y</CorrespondingAuthor>
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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, Marrakech-Safi region, Morocco, Neonatal mortality</Keywords>
<URLs>
<Abstract>https://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.</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, Savadogo LGB. 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 Afr Med J. 2024;47(1):154. doi: 10.11604/pamj.2024.47.154.36138
Hough A, Shakur-Still H, Roberts I, Koukounari A, Lawn JE, WOMAN Trial Collaborators. Stillbirths and neonatal deaths among 18 942 women with postpartum hemorrhage: Analysis of perinatal outcomes in the WOMAN trial. Int J Gynecol Obstet. 2021;153(1):146and;ndash;53. doi: 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. 2023;120(4):491and;ndash;9. doi: 10.1159/000530496
Worke MD, Mekonnen AT, Limenh SK. Incidence and determinants of neonatal mortality in the first three days of delivery in northwestern Ethiopia: a prospective cohort study. BMC Pregnancy Childbirth. 2021;21(1):647. doi: 10.1186/s12884-021-04122-8
Elomrani S, Bezad R, De Brouwere V, Campbell OMR, Lange IL, Oswald WE, Assarag B. Approaching the SDG targets with sustained political commitment: drivers of the notable decline in maternal and neonatal mortality in Morocco. BMJ Glob Health. 2024;9(Suppl 2):e011278. doi: 10.1136/bmjgh-2022-011278
Abouchadi S, Belghiti Alaoui A, Meski FZ, De Brouwere V. Implementing a maternal mortality surveillance system in Morocco and;ndash; challenges and opportunities. Trop Med Int Health. 2013;18(3):357and;ndash;65. 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. 2023;101(1):62and;ndash;75. doi: 10.2471/BLT.22.288703
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. Clin Epidemiol Glob Health. 2025;31:101898. doi: 10.1016/j.cegh.2024.101898
Chafik K, Aslaou F, Barich F, Laamiri FZ, El Ouardighi I, Barkat A. The Prevalence of Neonatal Near Misses in Rabat, Morocco. Cureus. 2023;15(2):e34486. doi: 10.7759/cureus.34486
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. 2021;10(1):e001266. doi: 10.1136/bmjoq-2020-001266
Kerber KJ, Mathai M, Lewis G, Flenady V, Erwich JJH, Segun T, Aliganyira P, Abdelmegeid A, Allanson E, Roos N, Rhoda N, Lawn JE, Pattinson R. Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby. BMC Pregnancy Childbirth. 2015;15(S2):S9. doi: 10.1186/1471-2393-15-S2-S9
Helps A, Leitao S, Gutman A, Greene R, Oand;rsquo;Donoghue K. National perinatal mortality audits and resultant initiatives in four countries. Eur J Obstet Gynecol Reprod Biol. 2021;267:111and;ndash;9. doi: 10.1016/j.ejogrb.2021.10.012
Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75. doi: 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. Implement Sci. 2009;4(1):50. doi: 10.1186/1748-5908-4-50
Ministand;egrave;re de la santand;eacute; et de la protection sociale. Santand;eacute; en chiffres 2019. Rabat, Maroc: Ministand;egrave;re de la santand;eacute; et de la protection sociale; 2021. 121 p. https://www.sante.gov.ma/Documents/2023/03/Sante%20en%20chiffre%202019%20VF%20(1).pdf
Nilsen P. Making Sense of Implementation Theories, Models, and Frameworks. In: Albers B, Shlonsky A, Mildon R, editors. Implementation Science 3.0. Cham: Springer International Publishing; 2020. p. 53and;ndash;79. doi: 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. 2022;22(1):139. doi: 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. 2021;36(6):955and;ndash;73. doi: 10.1093/heapol/czab011
Jepkosgei J, Nzinga J, Adam MB, English M. 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 Serv Res. 2022;22(1):172. doi: 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. 2013;22(2):86and;ndash;99. doi: 10.1097/QMH.0b013e31828bc37d
Orgill M, Gilson L, Chitha W, Michel J, Erasmus E, Marchal B, Harris B. 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. 2019;18(1):53. doi: 10.1186/s12939-019-0952-z
Brantuo MNA, Cristofalo E, Meheand;scaron; MM, Ameh J, Brako NO, Boahene F, Adjei SB, Opoku E, Banda H, Wang YT, Forgor AA, Punguire D, Brightson K, Sottie C, Owusu-Agyei S, Williams JE, Sulemana A, Oduro AR, Gyampong M, Sarpong D, 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. Trop Med Int Health. 2014;19(4):417and;ndash;26. doi: 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. 2021;21(1):147. doi: 10.1186/s12909-021-02567-1
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;2012(7):CD000259. doi: 10.1002/14651858.CD000259.pub3
Sun L, Booth A, Sworn K. Adaptability, Scalability and Sustainability (ASaS) of complex health interventions: a systematic review of theories, models and frameworks. Implement Sci. 2024;19(1):52. doi: 10.1186/s13012-024-01375-7
Norcross JC, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011;67(2):143and;ndash;54. doi: 10.1002/jclp.20758</References>
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