{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T18:14:38Z","timestamp":1788286478038,"version":"build-2803163510"},"reference-count":101,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This scoping review aimed to identify strategies reported in the literature to improve outcomes of obstetric emergencies in SSA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355174","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:32:51Z","timestamp":1788283971000},"page":"e0355174","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Strategies to improve outcomes of obstetric emergencies in sub-Saharan Africa: A scoping review"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8684-5773","authenticated-orcid":true,"given":"Serah Wanjiru","family":"Wachira","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Wagathu","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2416-5670","authenticated-orcid":true,"given":"Beth","family":"Waweru","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4548-8252","authenticated-orcid":true,"given":"Rose","family":"Maina","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abednego","family":"Ongeso","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7787-9998","authenticated-orcid":true,"given":"Constance Sibongile","family":"Shumba","sequence":"additional","affiliation":[{"name":"Institute for Health and Humanity, Medical College of Wisconsin","place":["Milwaukee, Wisconsin, United States of America"],"department":["Division of Epidemiology and Social Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benard Daniel","family":"Mutwiri","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Nairobi, Kenya"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Mbattude","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Kampala, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cliff Asher","family":"Aliga","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Kisaka","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery, East Africa, The Aga Khan University","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Gatiti","sequence":"additional","affiliation":[{"name":"Library, The Aga Khan University","place":["Nairobi, Kenya"],"department":["Faculty of Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"pone.0355174.ref001","author":"WHO","year":"2025"},{"key":"pone.0355174.ref002","volume-title":"Trends in maternal mortality estimates 2000 to 2023: Estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division. 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