Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review
5 affiliations
- 1School of Nursing and Midwifery, East Africa, The Aga Khan University, Nairobi, Kenya
- 2Division of Epidemiology and Social Sciences, Institute for Health and Humanity, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- 3School of Nursing and Midwifery, East Africa, The Aga Khan University, Kampala, Uganda
- 4School of Nursing and Midwifery, East Africa, The Aga Khan University, Dar es Salaam, Tanzania
- 5Faculty of Health Sciences, Library, The Aga Khan University, Nairobi, Kenya
Abstract
Background: Obstetric emergencies remain a leading cause of maternal morbidity and mortality in sub-Saharan Africa (SSA) despite increased access to facility-based deliveries and emergency obstetric care. Improving outcomes requires not only life-saving clinical interventions but also effective health system strategies. This review mapped published evidence on strategies used to improve outcomes of obstetric emergencies in SSA. Objective: This scoping review aimed to identify strategies reported in the literature to improve outcomes of obstetric emergencies in SSA. Methods: The review was reported in accordance with PRISMA-ScR. A comprehensive electronic search of PubMed, CINAHL, SCOPUS, and CORE identified studies published between January 2019 and December 2025. Eligible studies focused on strategies to improve outcomes for pregnant women experiencing obstetric emergencies in sub-Saharan Africa and were published in English. Data were extracted using a standardized data-extraction tool and descriptively mapped through thematic analysis to identify the range and characteristics of strategies reported across studies. Results: Of the 728 records identified, 64 studies met the inclusion criteria. The identified strategies were organised into four interrelated themes. Three themes described strategies to improve outcomes of obstetric emergencies: (1) life-saving clinical and health system interventions, including pharmacological therapies, monitoring and triage tools, and service-strengthening initiatives; (2) health workforce education, training, and mentorship, which improved provider competence and selected process outcomes but showed variable effects on maternal mortality; and (3) health system organisation, referral mechanisms, and policy implementation, including emergency obstetric care protocols, referral coordination, and service decentralisation. A fourth theme described contextual factors influencing the implementation and effectiveness of these strategies, including infrastructure limitations, resource constraints, workforce shortages, and delays in accessing care. Conclusion: Improving outcomes of obstetric emergencies in sub-Saharan Africa requires integrated, context-responsive strategies that combine evidence-based clinical interventions with strengthened health systems. This review demonstrates that effective obstetric emergency care depends not only on life-saving clinical management but also on coordinated referral systems, a competent and supported health workforce, functional health system organization, and enabling implementation contexts. Future research should evaluate the effectiveness, scalability, and sustainability of integrated strategies across diverse resource-constrained settings.
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BibTeX
@article{wachira2026strategies,
title = {{Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review}},
author = {Serah Wanjiru Wachira and Ruth Wagathu and Beth Waweru and Rose Maina and Abednego Ongeso and Constance Sibongile Shumba and Benard Daniel Mutwiri and Diana Mbattude and Cliff Asher Aliga and Lucy Kisaka and Peter Gatiti},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0355174},
url = {https://doi.org/10.1371/journal.pone.0355174},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review
AU - Serah Wanjiru Wachira
AU - Ruth Wagathu
AU - Beth Waweru
AU - Rose Maina
AU - Abednego Ongeso
AU - Constance Sibongile Shumba
AU - Benard Daniel Mutwiri
AU - Diana Mbattude
AU - Cliff Asher Aliga
AU - Lucy Kisaka
AU - Peter Gatiti
PY - 2026
DA - 2026/09/01
JO - PLOS One
DO - 10.1371/journal.pone.0355174
UR - https://doi.org/10.1371/journal.pone.0355174
AB - Background: Obstetric emergencies remain a leading cause of maternal morbidity and mortality in sub-Saharan Africa (SSA) despite increased access to facility-based deliveries and emergency obstetric care. Improving outcomes requires not only life-saving clinical interventions but also effective health system strategies. This review mapped published evidence on strategies used to improve outcomes of obstetric emergencies in SSA. Objective: This scoping review aimed to identify strategies reported in the literature to improve outcomes of obstetric emergencies in SSA. Methods: The review was reported in accordance with PRISMA-ScR. A comprehensive electronic search of PubMed, CINAHL, SCOPUS, and CORE identified studies published between January 2019 and December 2025. Eligible studies focused on strategies to improve outcomes for pregnant women experiencing obstetric emergencies in sub-Saharan Africa and were published in English. Data were extracted using a standardized data-extraction tool and descriptively mapped through thematic analysis to identify the range and characteristics of strategies reported across studies. Results: Of the 728 records identified, 64 studies met the inclusion criteria. The identified strategies were organised into four interrelated themes. Three themes described strategies to improve outcomes of obstetric emergencies: (1) life-saving clinical and health system interventions, including pharmacological therapies, monitoring and triage tools, and service-strengthening initiatives; (2) health workforce education, training, and mentorship, which improved provider competence and selected process outcomes but showed variable effects on maternal mortality; and (3) health system organisation, referral mechanisms, and policy implementation, including emergency obstetric care protocols, referral coordination, and service decentralisation. A fourth theme described contextual factors influencing the implementation and effectiveness of these strategies, including infrastructure limitations, resource constraints, workforce shortages, and delays in accessing care. Conclusion: Improving outcomes of obstetric emergencies in sub-Saharan Africa requires integrated, context-responsive strategies that combine evidence-based clinical interventions with strengthened health systems. This review demonstrates that effective obstetric emergency care depends not only on life-saving clinical management but also on coordinated referral systems, a competent and supported health workforce, functional health system organization, and enabling implementation contexts. Future research should evaluate the effectiveness, scalability, and sustainability of integrated strategies across diverse resource-constrained settings.
SN - 1932-6203
ER -