International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Glob Health. 2024 Jul 12;14:04133. doi: 10.7189/jogh.14.04133.
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 focussed 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.
背景:每年受人道主义危机影响的全球人口数量持续刷新纪录,导致紧张和支离破碎的卫生系统在 60 多个国家依赖人道主义援助。然而,人们对危机环境下孕产妇和围产期死亡监测与应对(MPDSR)的实施情况知之甚少。本范围综述旨在综合人道主义环境中 MPDSR 及相关死亡审查干预措施实施情况的证据。
方法:我们以英文和法文搜索了 2016 年至 2022 年发表的同行评议和灰色文献,报道了人道主义环境中的 MPDSR 和相关死亡审查干预措施。我们筛选并审查了 1405 条记录,从中确定了 25 篇同行评议文章和 11 份报告。然后,我们使用内容和主题分析来了解这些干预措施的采用、适宜性、保真度、渗透度和可持续性。
结果:在 36 篇记录中,33 项独特的计划在 27 个国家的人道主义环境中报告了 37 项干预措施,占 2023 年联合国人道主义呼吁的国家的 69%。大多数确定的计划侧重于孕产妇死亡干预措施;处于试点或早期中期实施阶段(1-5 年);并与卫生系统的整合有限。虽然我们确定了大量关于 MPDSR 和相关死亡审查干预措施的文件,但在这些干预措施的采用、保真度、渗透度和可持续性方面仍然存在大量证据空白。在人道主义环境中,实施受到严重资源限制、多变的领导层、普遍的指责文化以及社区内的不信任的影响。
结论:新兴的 MPDSR 实施动态显示了人道主义行为者、社区和卫生系统之间的复杂相互作用,值得深入调查。未来在人道主义环境中评估确定的 MPDSR 方案的混合方法研究将极大地增强证据基础。投资于比较卫生系统研究,以了解如何最好地将 MPDSR 和相关死亡审查干预措施适用于人道主义环境,是下一步的关键。
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