Digital Health Interventions in Emergency Obstetric and Newborn Care Services in Low- and Middle-Income Countries:...

The majority of global maternal and newborn deaths occur in low- and middle-income countries (LMICs), often due to a lack of resources, inadequate training of health care providers, and delayed or untimely care. Low-cost digital health interventions (DHIs) may help improve emergency obstetric and newborn care (EmONC) services in resource-limited settings by incorporating innovative approaches to enhance traditional models of care.

This study aimed to systematically explore the key characteristics and usefulness of DHIs implemented for improving EmONC services in low-resource settings, as well as to identify barriers to implementation, given the importance of developing, implementing, and evaluating context-specific digital interventions for such settings.

We followed the existing guidelines for conducting this scoping review, including the methodological framework for scoping studies, the updated Joanna Briggs Institute Methodology for Scoping Review, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We searched 3 databases-PubMed, Web of Science, and the Cochrane Library-and identified studies published before 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. We used the Mixed Methods Appraisal Tool for assessing study quality.

A total of 33 eligible studies from 18 countries were included in the review that described 21 distinct DHIs. Most qualitative (7/8) and mixed methods studies (4/5) were of high quality. However, most quantitative descriptive studies (15/20) had some form of sampling issues. The digital interventions were reported either as standalone interventions (n=19) or combined with other nondigital approaches (n=13). Most studies used mobile health-based interventions, primarily targeting health care 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 health care 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 health care 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, skilled workforce, and ambulances, which challenged the implementation of these interventions.

Our findings highlight the potential of DHIs to improve EmONC services in resource-scarce settings. Future research is needed in this area, which should prioritize the rigorous evaluation of DHIs, focusing on maternal and perinatal health outcomes, addressing context-specific challenges in health infrastructure, and evaluating the cost-effectiveness to support the development, effective use, and regulation of DHIs in LMICs. The proposed framework, based on our findings, can be used as a guide to develop and implement DHIs for EmONC support in low-resource settings.