JMIR Publications

ABSTRACT

Background:

Obstetric complications remain a major cause of maternal morbidity and mortality globally, particularly in low- and middle-income countries (LMICs). Many obstetric emergencies originate or are first recognized at home, where family caregivers, community members, and community health workers play a critical role in identifying danger signs, initiating responses, and facilitating timely referral to health facilities. Despite this, maternal health systems remain largely facility-centred, and evidence on interventions supporting household-level recognition, decision-making, response, and referral processes remains fragmented.

Objective:

This scoping review aims to map existing interventions and approaches that support the early recognition, response, decision-making, and referral of obstetric complications at the pre-facility level.

Methods:

This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The review will follow the methodological framework proposed by Arksey and O’Malley and refined by Levac et al. and will be reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Electronic databases, including PubMed, Scopus, MEDLINE, CINAHL, African Journals Online, and Google Scholar, will be searched. Grey literature sources, including World Health Organization reports, government documents, theses, and dissertations, will also be reviewed. Two reviewers will independently screen titles, abstracts, and full texts. Data will be extracted using a standardized charting form and synthesized descriptively and thematically.

Results:

Preliminary searches and screening identified studies from several Sub-Saharan African countries, including Ghana, Uganda, Zimbabwe, Ethiopia, and South Africa. Relevant interventions included mobile health applications, mobile-phone messaging systems, obstetric referral support mechanisms, and community-based maternal health initiatives. The preliminary screening confirmed the feasibility of the review and informed minor refinements to the screening and data extraction procedures. Full screening, data extraction, and synthesis are expected to be completed by August 2026.

Conclusions:

This review will provide a comprehensive overview of interventions supporting household-level recognition, response, and referral for obstetric complications and identify evidence gaps to inform future maternal health interventions and digital innovations.