Published in PLOS One on 2026-09-01, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Serah Wanjiru Wachira, Ruth Wagathu, Beth Waweru, Rose Maina, Abednego Ongeso, Constance Sibongile Shumba, Benard Daniel Mutwiri, Diana Mbattude, Cliff Asher Aliga, Lucy Kisaka, Peter Gatiti, Maurine Rofhiwa Musie, Sabita Tuladhar
Source: PLOS One • DOI 10.1371/journal.pone.0355174
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
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.
This scoping review aimed to identify strategies reported in the literature to improve outcomes of obstetric emergencies in SSA.
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.
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.
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.
Introduction
Obstetric emergencies remain a leading cause of preventable maternal morbidity and mortality globally, with a disproportionate burden borne by countries in sub-Saharan Africa (SSA). SSA accounts for around 70% of global maternal deaths, despite progress in reducing maternal mortality since 2000 [1,2]. This high maternal mortality is driven by delays in the recognition of complications, timely referral, and receipt of appropriate care, factors widely conceptualised within the ‘three delays’ framework and consistently demonstrated in facility-based referral studies [3]. Maternal mortality in SSA is caused by obstetric emergencies, with obstetric haemorrhage, hypertensive disorders of pregnancy, maternal sepsis, obstructed labour, and complications of unsafe abortion accounting for a substantial proportion of maternal deaths [4]. These obstetric emergencies require timely and coordinated responses that extend beyond isolated clinical interventions to include skilled health workers, reliable commodities and blood supply, functional referral pathways, and responsive health system organisation [5–7]. Consequently, strategies to improve outcomes of obstetric emergencies should be understood as multidimensional, encompassing life-saving clinical interventions, workforce capacity-building, effective referral and transport mechanisms, and broader health-system and socio-structural determinants that shape access to timely, quality care.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Serah Wanjiru Wachira, Ruth Wagathu, Beth Waweru, Rose Maina, Abednego Ongeso, Constance Sibongile Shumba, Benard Daniel Mutwiri, Diana Mbattude, Cliff Asher Aliga, Lucy Kisaka, Peter Gatiti, Maurine Rofhiwa Musie, Sabita Tuladhar. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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