Table 3.

Barriers to MPDSR implementation in Ethiopia 2024

Main Theme	Sub-theme	studies
Leadership and Governance level factors	Politicization of maternal and perinatal deaths	Tura AK et al. [12] and Melberg et al., 2019 [11]
	Role confusion	Abebe et al. [10]
	Lack of adequate legal framework	Melberg et al. [15] and Tura AK et al. [12]
Health system level factors	Lack of conducive learning environment	Tura AK et al. [12] and Cetin et al. [16]
	Lack of financial resource	Tesfaye T. et al. [13], Abebe et al. [10], and Ayele et al. [14]
	High staff turnover	Tesfaye T. et al. [13] and Abebe et al. [10]
	Poor handover system	Abebe et al. [10]
	Competing priorities	Abebe et al. [10]
	Ignoring death on arrival	Tura AK et al. [12]
	Lack of appropriate feedback to lower health facilities	Tura AK et al. [12]
	Failure to implement recommendations or changes	Tariku MK et al. [31]
Health worker level factors	Fear of blame and litigation	Abebe et al. [10], Ayele et al. [14], Cetin et al. [16], Melberg et al., 2019 [11], Melberg et al. [15], and Tura AK. et al. [12],
	Knowledge and skills gap	Tariku MK et al. [31]
	Defensive attitude and practice	Ayele et al. [14], Melberg et al., 2019 [11], and Tura AK et al. [12]
	Lack of the safety of health workers	Cetin et al. [16], Ayele et al. [14], Tura AK et al. [12], and Melberg et al., 2020 [15]
	Workload	Cetin et al. [16] and Melberg et al., 2019 [11]
	Poor attendance	Tura AK et al. [12]