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 professionals, 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 and analysed barriers to implementing DHIs for improving EmONC services in low-resource settings.

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, advantages, and barriers to implementation.

Results:

total of 31 eligible articles from 16 countries were included in the review. These articles described 19 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=12). The majority of DHIs primarily targeted healthcare providers as their main users (n=28), with a focus on EmONC education and training (n=19). While DHIs have the potential to improve services and access to EmONC in various healthcare settings, progress in their development and implementation in LMICs has been slow. 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. The most common barrier 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 access to and quality of EmONC in low-resource settings. Despite this, we identified a need to conduct further rigorous research in this area, particularly focusing on maternal and perinatal health outcomes. Future research should prioritise addressing challenges in health infrastructure, digital literacy, and cultural barriers, as well as evaluating the cost-effectiveness of DHIs compared to traditional services.