Context matters: a systematic review of neonatal care in humanitarian emergencies

Abstract

BackgroundOf the 15 countries with the highest neonatal mortality rates, 13 are characterised by conflict and political instability. Despite well-documented evidence of best practice interventions for neonatal survival, it remains less clear on how these practices are implemented in humanitarian emergency settings.ObjectiveTo conduct a systematic review of published and grey literature on the implementation strategies and challenges in addressing neonatal care in humanitarian emergencies.MethodsA systematic literature search was conducted in SCOPUS, MEDLINE, Web of Science, CINHAL and Global Health for studies published between 1 January 2003 and 30 June 2018. Additionally, websites of organisations actively working in humanitarian emergencies were searched. Interventions were reviewed against the existing essential newborn care framework according to the standards outlined in the Newborn Health in Humanitarian Settings Field Guide.ResultsTwenty-one studies were identified: eight reporting on conflict and refugee settings, nine followed natural disasters and four discussed multiple emergency settings. Few studies addressed all the components of essential newborn care outlined in the field guide regardless of the emergency type. The review of literature demonstrated challenges in addressing essential newborn care identified in all humanitarian settings including the lack of adequate equipment, financing, and trained staff. Implementation strategies identified included quality improvement training for staff, the development of evacuation procedures, integrating with local and government resources and generating spaces in health facilities specifically for newborn care.ConclusionsThe requirements and initiatives needed to deliver essential newborn care in humanitarian settings are highly variable and context dependent. Given the diversity of factors needing to be addressed by the field guide, more research should be directed towards the adaptability of the implementation strategies to differing emergency contexts.Trial registrationPROSPERO registration ID: CRD42018098824