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Journal Article

Jul 12, 2024

Conflict | Data/Statistics

Implementation of maternal and perinatal death surveillance and response and related death review interventions in humanitarian settings: A scoping review

While much can be learned from prior literature reviews, including studies on implementation factors influencing MPDSR [28–32], learnings from varying humanitarian contexts could lend insights on how to optimally implement MPDSR in disrupted environments, weakened health systems, and complex governance and stakeholder landscapes. Thus, we undertook a scoping review of peer-reviewed and grey literature to synthesise evidence and glean lessons on the implementation of MPDSR and related death review interventions in humanitarian settings.

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Authors

Meighan Mary

Hannah Tappis

Elaine Scudder

Andreea A Creanga

Authors

Meighan Mary, Hannah Tappis, Elaine Scudder, Andreea A Creanga

Related Topics
ConflictData/StatisticsFragile SettingsHumanitarianMaternalMonitoring & Evaluation (M&E)MortalityPolicy
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Background

The global population impacted by humanitarian crises continues to break records each year, leaving strained and fractured health systems reliant upon humanitarian assistance in more than 60 countries. Yet little is known about implementation of maternal and perinatal death surveillance and response (MPDSR) within crisis-affected contexts. This scoping review aimed to synthesise evidence on the implementation of MPDSR and related death review interventions in humanitarian settings.

Methods

We searched for peer-reviewed and grey literature in English and French published in 2016–22 that reported on MPDSR and related death review interventions within humanitarian settings. We screened and reviewed 1405 records, among which we identified 25 peer-reviewed articles and 11 reports. We then used content and thematic analysis to understand the adoption, appropriateness, fidelity, penetration, and sustainability of these interventions.

Results

Across the 36 records, 33 unique programmes reported on 37 interventions within humanitarian contexts in 27 countries, representing 69% of the countries with a 2023 United Nations humanitarian appeal. Most identified programmes focused on maternal death interventions; were in the pilot or early-mid implementation phases (1–5 years); and had limited integration within health systems. While we identified substantive documentation of MPDSR and related death review interventions, extensive gaps in evidence remain pertaining to the adoption, fidelity, penetration, and sustainability of these interventions. Across humanitarian contexts, implementation was influenced by severe resource limitations, variable leadership, pervasive blame culture, and mistrust within communities.

Conclusions

Emergent MPDSR implementation dynamics show a complex interplay between humanitarian actors, communities, and health systems, worthy of in-depth investigation. Future mixed methods research evaluating the gamut of identified MPDSR programmes in humanitarian contexts will greatly bolster the evidence base. Investment in comparative health systems research to understand how best to adapt MPDSR and related death review interventions to humanitarian contexts is a crucial next step.

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