Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
BMJ Glob Health. 2021 Feb;5(Suppl 1). doi: 10.1136/bmjgh-2020-003750.
While much progress was made throughout the Millennium Development Goals era in reducing maternal and neonatal mortality, both remain unacceptably high, especially in areas affected by humanitarian crises. While valuable guidance on interventions to improve maternal and neonatal health in both non-crisis and crisis settings exists, guidance on how best to deliver these interventions in crisis settings, and especially in conflict settings, is still limited. This systematic review aimed to synthesise the available literature on the delivery on maternal and neonatal health interventions in conflict settings.
We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and maternal and neonatal health. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing a maternal or neonatal health intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention, and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated but no meta-analysis was undertaken.
115 publications met our eligibility criteria. Intervention delivery was most frequently reported in the sub-Saharan Africa region, and most publications focused on displaced populations based in camps. Reported maternal interventions targeted antenatal, obstetric and postnatal care; neonatal interventions focused mostly on essential newborn care. Most interventions were delivered in hospitals and clinics, by doctors and nurses, and were mostly delivered through non-governmental organisations or the existing healthcare system. Delivery barriers included insecurity, lack of resources and lack of skilled health staff. Multi-stakeholder collaboration, the introduction of new technology or systems innovations, and staff training were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited.
The relevant existing literature focuses mostly on maternal health especially around the antenatal period. There is still limited literature on postnatal care in conflict settings and even less on newborn care. In crisis settings, as much as in non-crisis settings, there is a need to focus on the first day of birth for both maternal and neonatal health. There is also a need to do more research on how best to involve community members in the delivery of maternal and neonatal health interventions.
CRD42019125221.
虽然在千年发展目标时代，母婴死亡率的降低取得了很大进展，但这两个指标仍然高得令人无法接受，尤其是在受人道主义危机影响的地区。虽然在非危机和危机环境中改善母婴健康的干预措施方面有宝贵的指导，但在危机环境中，特别是在冲突环境中，如何最好地提供这些干预措施的指导仍然有限。本系统评价旨在综合现有文献，了解冲突环境中母婴健康干预措施的实施情况。
我们使用与冲突、妇女和儿童以及母婴健康相关的术语，在 MEDLINE、Embase、CINAHL 和 PsycINFO 数据库中进行了检索。我们还在 10 个人道主义组织的网站上搜索了相关的灰色文献。纳入了报告在中低收入国家受冲突影响人群，并描述了在冲突结束时或结束后 5 年内提供的母婴健康干预措施的出版物。提取了有关人口、干预措施和提供特征的信息，并进行了叙述性综合。对干预措施覆盖率和效果的定量数据进行了制表，但没有进行荟萃分析。
符合入选标准的出版物有 115 篇。干预措施的提供情况报告最频繁的是撒哈拉以南非洲地区，大多数出版物都侧重于难民营中的流离失所者。报告的产妇干预措施针对产前、产科和产后护理；新生儿干预措施主要集中在基本新生儿护理上。大多数干预措施是在医院和诊所，由医生和护士提供，主要通过非政府组织或现有医疗保健系统提供。提供方面的障碍包括不安全、资源匮乏和缺乏熟练卫生人员。多利益攸关方合作、引入新技术或系统创新以及人员培训是提供方面的促进因素。干预措施覆盖率或效果数据的报告有限。
现有相关文献主要集中在孕产妇健康方面，尤其是在产前期间。在冲突环境下，关于产后护理的文献仍然很少，关于新生儿护理的文献则更少。在危机环境中，与非危机环境一样，需要重点关注母婴健康的第一天。还需要做更多的研究，了解如何最好地让社区成员参与提供母婴健康干预措施。
PROSPERO 注册号：CRD42019125221。
