Delivering maternal and neonatal health interventions in conflict settings: a systematic review

Abstract

BackgroundWhile much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings.MethodsWe searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and maternal and neonatal health. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing a maternal or neonatal health intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention, and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated but no meta-analysis was undertaken.Results115 publications met our eligibility criteria. Intervention delivery was most frequently reported in the sub-Saharan Africa region, and most publications focused on displaced populations based in camps. Reported maternal interventions targeted antenatal, obstetric and postnatal care; neonatal interventions focused mostly on essential newborn care. Most interventions were delivered in hospitals and clinics, by doctors and nurses, and were mostly delivered through non-governmental organisations or the existing healthcare system. Delivery barriers included insecurity, lack of resources and lack of skilled health staff. Multi-stakeholder collaboration, the introduction of new technology or systems innovations, and staff training were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited.DiscussionThe relevant existing literature focuses mostly on maternal health especially around the antenatal period. There is still limited literature on postnatal care in conflict settings and even less on newborn care. In crisis settings, as much as in non-crisis settings, there is a need to focus on the first day of birth for both maternal and neonatal health. There is also a need to do more research on how best to involve community members in the delivery of maternal and neonatal health interventions.PROSPERO registration numberCRD42019125221.

Self-care interventions for sexual and reproductive health in humanitarian and fragile settings: a scoping review

“…To some extent, this reflects broader trends in research on SRH in humanitarian settings. Recent reviews of SRH service delivery in humanitarian settings note a lack of research on effective delivery strategies for SRH interventions in conflict-affected settings, especially in areas where health infrastructure has been damaged or services limited [ 49 , 50 ]. Authors examining evidence of effectiveness and utilization of SRH services also found few studies describing how interventions are coordinated or evaluating interventions as part of a coordinated package of SRH services [ 51 , 52 ].…”

“…However, the lack of discussion on commodity security and financing considerations was surprising. Other reviews and case studies have highlighted safety and security constraints, movement restrictions, forced displacement, supply chain disruptions, and shortages of skilled health professionals as barriers to SRH intervention delivery in conflict-affected settings [ 49 , 50 , 58 ]. None of the studies we reviewed mentioned barriers to self-care or implementation considerations that are specific to humanitarian contexts or ways in which strategies for introduction, promotion, monitoring, support or sustainability of self-care were tailored to account for health system disruptions or humanitarian access constraints.…”

Delivering nutrition interventions to women and children in conflict settings: a systematic review

“…This systematic review on nutritional interventions is a part of series of reviews in conflict settings which includes delivery of mental health, sexual and reproductive health and other interventions in conflict settings. [11][12][13][14][15][16][17][18] This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (online supplemental appendix 1), 19 and its protocol is registered with PROSPERO (the international prospective register of systematic reviews, www. crd.…”

Assessing respectful maternity care in a fragile, conflict-affected context: Observations from a 2016 national assessment in Afghanistan

“…Understanding socio-cultural and contextual factors underpinning acceptance of mistreatment in childbirth, related to conflict, insecurity, gender and power dynamics, is critical for improving the quality of maternity care in afghanistan and similar fragile and conflict affected settings.The number of women and children affected by armed conflict has grown steadily since 2000; during this period, at least 630 million women and children-10% of women and 16% of children worldwide-have either been displaced by conflict or living dangerously close to armed conflict events (Bendavid et al, 2021). With this shifting global landscape, there is growing attention to quality of health services in crisis-affected settings, with efforts to review evidence on health system quality (Jordan et al, 2021), understand context-specific challenges to delivery of quality care (Munyuzangabo et al, 2021), and develop operational guidance for improving quality of care (Syed et al, 2020) in areas affected by conflict and fragility.As authors of the Lancet Maternal Series in 2016 emphasize: Every woman, every newborn, everywhere has the right to appropriate, timely, evidence-based, respectful care (The Lancet, 2016). Mistreatment during childbirth has been highlighted as a significant obstacle in reducing maternal and newborn mortality around the globe -it contributes to negative user experiences and can be a significant deterrent to the uptake of facility-based childbirth (…”

“…The number of women and children affected by armed conflict has grown steadily since 2000; during this period, at least 630 million women and children-10% of women and 16% of children worldwide-have either been displaced by conflict or living dangerously close to armed conflict events (Bendavid et al, 2021). With this shifting global landscape, there is growing attention to quality of health services in crisis-affected settings, with efforts to review evidence on health system quality (Jordan et al, 2021), understand context-specific challenges to delivery of quality care (Munyuzangabo et al, 2021), and develop operational guidance for improving quality of care (Syed et al, 2020) in areas affected by conflict and fragility.…”