JMIR Publications

ABSTRACT

Background:

The majority of global maternal and newborn deaths occur in low- and middle-income countries (LMICs), often due to a lack of resources, adequate training of healthcare providers, and timely care. Low-cost digital health interventions (DHIs) could help improve Emergency Obstetric and Newborn Care (EmONC) services in resource-limited settings by incorporating innovative approaches to enhance the traditional model of care.

Objective:

Given the importance of developing, implementing, and evaluating context-specific digital interventions for such settings, we systematically explored the key characteristics and usefulness of DHIs implemented for improving EmONC services in low-resource settings, as well as barriers to implementation.

Methods:

We followed the existing guidelines for conducting the scoping review, including the methodological framework for scoping studies by Arksey and O'Malley, the updated Joanna Briggs Institute Methodology for Scoping Review, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched three databases: PubMed, Web of Science, and the Cochrane Library and identified articles published prior to November 2024 that described digital interventions aimed at enhancing EmONC in LMICs. Extracted data included the following: purposes, features and functionalities of DHIs, mode of delivery, outcomes, and barriers to implementation.

Results:

A total of 33 eligible articles from 18 countries were included in the review. These articles described 21 distinct DHIs, which were categorised according to the World Health Organisation Classification of Digital Interventions, Services, and Applications in Health (WHO CDISAH). These digital interventions were reported either as standalone interventions (n=19) or combined with other non-digital approaches (n=13). Most studies used mHealth-based interventions, primarily targeting healthcare providers (n=28) through mobile apps and text-based messaging, with a focus on EmONC education and training (n=19). The review’s findings suggest generally positive impacts of DHIs on healthcare providers' clinical practices, although maternal and perinatal health outcomes varied depending on the type of intervention. Although DHIs have the potential to improve services and access to EmONC in various healthcare settings, the advancement and implementation of these technologies in LMICs have progressed at a slow pace. The most common barrier identified was the lack of EmONC resources such as medication, healthcare workers, and ambulances, which challenged the implementation of these interventions.

Conclusions:

Our findings highlight the potential of DHIs to improve EmONC services in resource-scarce settings. Future research is needed in this area, which should prioritise rigorous evaluation of DHIs focusing on maternal and perinatal health outcomes, address context-specific challenges in health infrastructure, and evaluate the cost-effectiveness to support the development, effective use, and regulation of DHIs in LMICs.