BMJ Qual Saf 21:423-431 doi:10.1136/bmjqs-2011-000445
  • Systematic review

What gets published: the characteristics of quality improvement research articles from low- and middle-income countries

  1. Kedar S Mate1,3
  1. 1Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  2. 2Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
  3. 3Department of Medicine, Weill Cornell Medical Center, New York, New York, USA
  1. Correspondence to Zoe K Sifrim, Low and Middle Income Countries, Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138, USA; zsifrim{at}
  1. Contributors All authors contributed to the overall conceptualisation and study design of the systematic review. ZKS designed and executed the search, analysed the data, and drafted the initial manuscript. KSM designed the search and analysis strategy and edited and revised the manuscript. PMB edited and revised the manuscript. All authors have agreed on the final version of the manuscript.

  • Accepted 20 February 2012
  • Published Online First 23 March 2012


Objectives Reports of quality improvement (QI) research from low- and middle-income countries (LMICs) remain sparse in the scientific literature. The authors reviewed the published literature to describe the characteristics of such reports.

Methods The authors conducted a systematic search for QI research articles from LMICs catalogued in the PubMed databases prior to December 2011, complemented by recommendations from experts in the field. Articles were categorised based on bibliometric and research characteristics. Twenty papers were randomly selected for narrative analysis regarding strategies used to present the methods and results of interventions.

Results Seventy-six articles met the inclusion criteria. Publication rate accelerated over time, particularly among observational studies. Most studies did not use a concurrent control group; pre-/post-study designs were most common overall. Four papers were published in top-tier journals, 17 in journals at the top of their specialty and 20 in quality-specific journals. Among the papers selected for narrative analysis, four distinct components were observed in most: a description of the problem state, a description of the improvement processes and tools, a separate description of the interventions tested and a description of the evaluation methods.

Discussion The small number of articles identified by this review suggests that publication of QI research from LMICs remains challenging. However, recent increases in publication rates, especially among observational studies, may attest to greater interest in the topic among scientific audiences. Though the authors are not able to compare this sample with unpublished papers, the four components observed by them in the narrative analysis seem to strengthen QI research reports.


  • Funding No external funding was obtained for the execution of this project. The salaries of the authors were provided by the Institute for Healthcare Improvement.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement All data has been published in the manuscript or the web appendix.

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