Table 1.

Summary of included studies

Reference	Country context	Type of crisis	Self-care intervention	Method	Study population	Aim	Relevant findings
(Abbas, Mirzazada et al. 2020) [24]	6 districts in Badakhshan Province, Afghanistan	Conflict	Misoprostol for treatment of PPH	Double-blind, randomized placebo-controlled trial	2337 women, of whom 1884 delivered at home & 453 delivered at a health facility	To assess the effectiveness, safety, & acceptability of misoprostol use to treat PPH after its use prophylactically	Among the 1884 women who delivered at home, 98.7% reported self-use of misoprostol for PPH prevention. 4.4%, 82/1884 were diagnosed with PPH & administered treatment.
(Adejuyigbe, Bee et al. 2015) [25]	2 LGAs in Borno State in North East Nigeria	Conflict	Essential newborn care (thermal care	Qualitative newborn care narratives, observations of bathing & in-depth interviews	10 Bura & 10 Kanuri recent mothers, grandmothers, fathers, health workers & birth attendants.	To explore thermal care practices.	Near universal early bathing of babies, link between delayed bathing & body odour later in life. Skin to skin care was not practised.
(Ammerdorffer, Laws et al. 2021) [26]	Lebanon	Conflict	Self-administration of injectable contraception, OTC oral contraceptive pills, self-management of medical abortion process in the first trimester.	Document review	Lebanon National Drug Index, Lebanon National Drugs Database, Ministry of Public Health website	To review the regulation status of self-administration of injectable contraception, OTC oral contraception & self-management of medical abortion	No official procedure to change Prescription only medicine (POM) to over-the-counter (OTC). Ulipristal acetate is only available OTC not provided by Ministry of Health but is available at pharmacies to purchase.
(Berry-Bibee, St Jean et al. 2018) [27]	Cap Haitien, Haiti	Natural disaster	Self-management of medical abortion process in the first trimester.	Mixed methods: 8 focus groups with women & interviews with women’s health providers, survey to pregnant or recently pregnant women	62 women, 13 health providers, 255 pregnant or recently pregnant women < 20 weeks gestation presenting to the hospital.	To document access to illegal abortion, unscheduled hospital visits related to unsafe abortion methods & perceived barriers to abortion-related care.	78 of 150 women who stated that their pregnancy was unintended reported attempting an induced abortion using misoprostol either alone or as a part of the medication/herb regimen for their self-managed abortion (85.1%, n = 63).
(Bertrand, Bidashimwa et al. 2018) [28]	Kinshasa, Democratic Republic of the Congo	Conflict	DMPA-SC self-injection.	Prospective cohort: Women who selected DMPA-SC interviewed upon acceptance (baseline) & then 3, 6 & 12 months later.	850 women selected DMPA-SC at a community outreach event beside a health centre.	To assess the acceptability & feasibility of DMPA-SC self-injection.	640 (75.3%) opted for self-injection over being injected by the nursing students for reasons of convenience & personal agency. 47.5% were anxious at baseline (for fear of needles or injecting incorrectly). Over 80% reported feeling very ready after training, confident that they knew how to self-inject & confident that they would remember the next injection date. At 3 months, 97% described it as easy. Half (54%) experienced side effects, mainly menstrual irregularities, the main reason for discontinuation. At 6-month follow-up, self-injectors cited effectiveness & ease of use, one quarter reported side effects.
(Burke 2018) [29] Conference abstract	Northern Haiti	Natural disaster	Misoprostol for prevention of PPH.	Participants received group & individual counselling on birth preparedness, PPH prevention, & importance of facility birth. At enrolment, participants received 3200 mcg tablets of misoprostol & instructions for self-administration after birth. A postpartum questionnaire was administered 2 weeks after birth.	338 women 32 weeks gestation.	To explore the feasibility of advanced distribution of misoprostol to pregnant women to self-administer at the time of delivery to prevent PPH.	72% of participants delivered in a health facility & 80% of all participants took misoprostol. Among women who delivered at home, 87% took misoprostol & all took the medication correctly after delivery.
(Conserve, Michel et al. 2020) [30]	Haiti	Natural disaster	Self-testing HIV (HIVST)	16 key informant interviews & 9 focus groups.	44 healthcare workers, 31 Option B+ clients, &13 men, representatives of the Ministry of Health & a NGO involved in HIV partner services.	To assess the perspectives of women living with HIV (WLWH), their male partners, & healthcare professionals on the perceived advantages & disadvantages of HIVST, & recommendations for implementing HIVST.	HIVST advantages included an increase in the number of people who would learn their HIV status & start treatment. Perceived disadvantages were lack of support to ensure self-testers initiate treatment, uncertainty about male partner’s reaction, risk of violence towards women delivering HIVST kits after receiving an HIVST kit from a woman, & the inability of women to counsel a man in case his self-test result is positive. Need to coupling HIVST distribution with public information, education & communication through media & social marketing, relying on community health workers to mediate use of HIVST & ensure linkage to care.
(de Vries, Hamad et al. 2021) [31]	Gaza	Conflict	Essential new-born care	Mixed methods: qualitative informant interviews, in-depth interviews &/or focus group discussions secondary analysis of Ministry of Health annual reports, central statistics & MICSs.	Women targeted by the programme, non-targeted women, husbands, & home visitors.	To evaluate a postnatal home visiting program.	Women in the program demonstrated improved breastfeeding practices & increased uptake of breastfeeding, reduced harmful traditional norms & practices, improved relationships between women & providers & women’s self-esteem.
(Draiko, McKague et al. 2021) [32]	Jubek County, South Sudan	Conflict	Essential new-born care	Pre/post quasi-experimental study.	3143 pregnant women from 6 rural communities: 1825 women in the treatment group & 1318 women in the control group.	To assess the effectiveness of applying chlorhexidine gel to the umbilical cord stump on cord sepsis & neonatal mortality rates.	The neonatal cord infection rate among the treatment group was 17.0%, compared to 38.9% in the control group (P < 0.05). Neonatal mortality was least in the intervention (1.3%) & highest in the control (13.3%) group.
(Gill and Tam 2021) [33] Conference abstract	Venezuela	Complex	Self-management of medical abortion process in the first trimester	Mixed-methods implementation research study co-design Qualitative interviews & survey.	Women, grassroots community-based organizations, healthcare providers, SRH advocates & program experts.	Understand how Venezuelan women access SRH information & services; preferences for design of a digital tool to safely facilitate self-managed abortions & contraception access.	30% of surveyed Venezuelan women had an abortion, half used unsafe methods. 83% own a smartphone, 77% have internet access. Women were supportive of a digital tool.
(Haver, Ansari et al. 2016) [34]	20 districts, across 5 provinces (Faryab, Jawzjan, Kabul, Badakhshan, & Bamyan) Afghanistan	Conflict	Misoprostol for prevention of PPH	Cross-sectional pre & post household survey.	Pre-intervention households- (n = 408) & post intervention households (n = 408).	To determine the effectiveness of advance distribution of misoprostol for self-administration.	Uterotonic use among women in the sample increased from 50.3% preintervention to 74.3% postintervention. Significant difference in uterotonic use at home births was observed among women who lived farthest from a health facility (> 90 min self-reported travel time) compared to women who lived closer (88.5% vs 38.9%; P < 0001). All women who accepted misoprostol & gave birth at home used the drug. No maternal deaths were identified among those women who used misoprostol.
(Komakech, Lubogo et al. 2020) [35]	Refugee camps Adjumani district, west Nile, Uganda	Conflict	Essential new-born care	Cross-sectional semi-structured questionnaire.	561 mothers of infants aged 0–6 months.	To assess essential newborn care practices & its determinants.	57% of the mothers breastfed their newborns within one hour. 50.1% of mothers cleaned the umbilical cord of their newborns. 17% of the newborns received optimal thermal care immediately after birth. Mothers aged 20–24 years (OR 0.38, CI 0.17–0.96) & those involved in subsistence farming (OR 0.67, CI 0.38–1.45) were less likely to practice good newborn care compared to those in other occupations.
(Lathrop, Burke et al. 2018) [36] Conference abstract	Northeast Department of Haiti	Natural disaster	Misoprostol for prevention of PPH	12 semi-structured focus groups.	Health providers, community health workers (CHWs), traditional birth attendants (TBAs) & community leaders.	To explore community acceptability of advanced distribution of misoprostol to pregnant women.	The TBAs & CHWs felt their participation in the misoprostol strengthened pregnant women’s trust in their work. The majority felt that women had positive experiences with the drug. Several providers said the misoprostol program strengthened the collaboration between health centres, CHWs, TBAs & community leaders. They felt this was based on understanding that the program was life-saving & brought positive health outcomes to their communities. Sustainability of the intervention was important to several community leaders. All participants felt the intervention was acceptable to their communities.
(Logie, Abela  et al. 2021) [37]	Eastern Mediterranean Region	Conflict	All SRH self-care	Online cross-sectional Global Values & Preferences Survey (open questions only to be extracted survey results cannot be disaggregated)	Participants from crisis setting included Afghanistan (2), Lebanon (4), Somalia (1), Sudan (3), Syria (1), Yemen (1).	To access, knowledge, perceived challenges, & recommendations for the future.	Benefits acknowledged, need for linked care via hot lines, apps, home visits & transport to facility, provider training on interventions & dealing with self-effects & complications, issues with stigma in pharmacies noted in Syria.
(Maatouk, El Nakib et al. 2021) [38]	Lebanon	Conflict	HIV self-testing	Audit of National AIDS Program data	Men who have sex with men who received a HIVST kit.	To describe the effectiveness of implementing HIVST.	NGOs distributed 1103/1380 (79.9%) HIVST kits to their beneficiaries. The NGOs collected feedback on 111/1103 kit results, of which two were HIV-positive. From Jan-May 2020, 625/780 HIVST kits (80.1%) were distributed. This period was divided into pre-COVID-19 & during COVID-19. The follow-up with the beneficiaries during COVID-19 was much improved because of the absence of on-site activities, shifting more efforts towards HIVST (449/625).
(O’Laughlin, He et al. 2018) [39]	Nakivale refugee settlement, southwestern Uganda	Conflict	HIV self-testing	Household survey	566 adults living in 319 homes were visited.	To determine the feasibility & acceptability of home-based HIV testing.	90% of eligible adults noted to be living in those households at 3 visits, confirming this approach is feasible. 75% of eligible adults encountered participated in HIV testing & received their results, reflecting the acceptability of home-based testing.
(Sanghvi, Ansari et al. 2010) [40]	Rural Afghanistan	Conflict	Misoprostol for prevention of PPH	Nonrandomized experimental control design	3187 women, 2039 in the intervention group & 1148 in the control group.	To test the safety, acceptability, feasibility, & effectiveness of community-based education & distribution of misoprostol for prevention of PPH.	Of the 1421 women in the intervention group who took misoprostol, 100% correctly took it after birth, including 20 women with twin pregnancies. Adverse effect rates were lower in the intervention group than in the comparison group. Among women in the intervention group, 92% said they would use misoprostol in their next pregnancy. In the intervention area where community-based distribution of misoprostol was introduced, near-universal uterotonic coverage (92%) was achieved compared with 25% coverage in the control areas.
(Sibanda, d’Elbee et al. 2019) [41]	rural Zimbabwe	Complex crisis	HIV self-testing	Community cluster randomised control trial.	40 village groups.	To compare a community-led versus an established paid distribution (PD) community-based HIVST model.	From Oct 2018 to August 2019, 27,812 & 36,699 HIVST kits were distributed in community-led & PD communities, respectively. 11,150 participants & 5683 were surveyed in community-led arm. New HIV diagnosis was reported by 211 (3.7%) community-led versus 197 (3.6%) PD arm participants, adjusted OR (aOR) 1.1 (95% CI 0.72 to 1.56); 318 (25.9%) community-led arm participants linked to post-test services versus 361 (23.9%) in PD arm, aOR 1.1 (95% CI 0.75 to 1.49. Cost per HIVST kit distributed was US$6.29 & US$10.25 for PD & community-led HIVST, both lower than 2016/2017 costs for newly implemented PD (US$14.52).
(Smith, Dimiti et al. 2014) [42]	Mundri East County in Western Equatoria State, South Sudan	Conflict	Misoprostol for prevention of PPH	Descriptive observational study involving audit of facility registers, surveys of providers & women postpartum.	Women at approximately 32 weeks, 135 female home health promoters, Prenatal-care provider	To evaluate the program performance in terms of uterotonic coverage for facility & home births at the population level, & serious adverse effects of misoprostol use, effectiveness of counselling & program acceptability.	533 home births & 394 facility-based births were reported. Misoprostol was distributed in advance to 787 (84.9%) pregnant women, of whom 652 (82.8%) received the drug during home visits. Among the women who delivered at home, 527 (98.9%) reported taking misoprostol. A uterotonic for PPH prevention was provided at 342 (86.8%) facility-based deliveries. Total uterotonic coverage was 93.7%. No adverse events were reported.
(Tol, Leku et al. 2020) [43]	rural refugee settlements in northern Uganda	Conflict	Positive coping methods	cluster randomised trial.	694 female South Sudanese refugees	To assess the effectiveness of a facilitator-guided, group-based, self-help intervention.	Larger improvements for Self-Help Plus on psychological distress 3 months post intervention (β −1・20, 95% CI −2・33 to −0・08; p = 0・04; d − 0・26). Larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range − 0・30 to − 0・36). Refugees with different trauma exposure, length of time in settlements, & initial psychological distress benefited similarly.
(Tonen-Wolyec, Batina-Agasa et al. 2019) [44]	Kisangani & Bunia Democratic Republic of the Congo	Conflict	HIV self-testing	Multicentre cross-sectional study	208 female sex workers (FSWs), 132 non FSWs.	To evaluate participants ability to read & interpret the results of a prototype HIVST.	2704 standardized tests (1248 positive, 1040 negative, 416 invalid) were interpreted; 2435 (90.1%) were correctly interpreted, 269 (9.9%) were misinterpreted. In FSWs & non-FSWs, test results were correctly interpreted in 87.4% (864/988) & 91.6% (1571/1716), respectively. Educational levels associated with the interpretation of positive, negative, & invalid HIV self-test results, but not “commercial sex work” & “language chosen for instructions for use.” Incorrect interpretation was significantly higher in participants with insufficient educational level than in those with sufficient education level for positive (13.1% vs 2.6%; adjusted OR: 4.5), negative (22.3% vs 2.6%; adjusted OR: 5.3), & invalid test results (23.8% v 6.4%; adjusted OR: 3.6).
(Tonen-Wolyec, Batina-Agasa et al. 2019) [45]	Kisangani, Democratic Republic of the Congo	Conflict	HIV self-testing	Cross-sectional, door-to-door survey.	628 adolescents	To evaluate the acceptability, feasibility, & accuracy of home-based, supervised HIVST.	Acceptability of HIVST was high (95.1%); 96.1% of participants correctly used the self-test, & 65.2% asked for verbal instructions. The majority of adolescents (93.5%) correctly interpreted their self-test results. Correct interpretation decreased significantly when adolescents had no formal education or attended primary school. The sensitivity of the Exacto Test HIV Self-test was estimated at 100%, while its specificity was 96.0%. The majority of participants (68.0%) affirmed that post-test counselling was essential, & that face-to-face counselling (78.9%) was preferred.
(Tonen-Wolyec, Kayembe Tshilumba et al. 2020) [46]	Kisangani, Democratic Republic of the Congo	Conflict	HIV self-testing	Randomized (1:1), non-blinded, non-inferiority trial using a blood-based & facility-based HIVST method.	530, adults 18 & 49 yrs., at high risk of acquiring HIV infection, did not know their HIV status, lived or worked in Kisangani for at least 6 months.	To compare the practicability & effectiveness of the two delivery approaches for HIVST, unassisted HIVST (UH) & directly assisted HIVST (DAH).	The rate of successfully performing the test was the same (93.2%) in the UH & DAH arms. The rate of correctly interpreting the results was 86.9% in the UH arm versus 93.2% in the DAH arm, for a difference of −6.3%. After the follow-up 72 h later, participants in the UH arm had a significantly lower chance of correctly interpreting the test results than those in the DAH arm (aRR: 0.60; P = 0.019). The positivity rate was 3.4% among the participants in the DAH arm & 1.7% among those in the UH arm, no significant differences were found between the two arms in the positivity rate, requests for assistance, & linkage to care. Willingness to buy an HIV self-test was higher in the UH arm than in the DAH arm (92.3% versus 74.1%; aRR: 4.20; P < 0.001).
(Tonen-Wolyec, Mbopi-Keou et al. 2019) [47]	Bunia, Democratic Republic of the Congo	Conflict	HIV self-testing	A representative cross-sectional study using a self-administered semi-structured questionnaire.	1012 university students	To describe the acceptability of HIVST in students.	Acceptability of unsupervised HIVST was higher in the group of young students as compared with older students & was markedly associated with prior knowledge on HIVST.
(Tonen-Wolyec, Mboumba Bouassa et al. 2020) [48]	Kisangani, Democratic Republic of the Congo	Conflict	HIV self-testing	Representative cross-sectional study using random sampling in clusters at three levels.	597 adolescents aged 15–19 years.	To determine the sociodemographic factors associated with adolescents preferring home-based HIVST over facility-based voluntary counselling and testing (VCT).	The majority of participants (323/597; 54.1% [95% CI: 50.0–58.0]) preferred home-based HIVST over facility-based VCT. In a multivariate analysis, male gender (adjusted OR: 1.5, 95% CI: 1.1–2.1), marriage or partnered civil status (adjusted OR: 1.8, 95% CI: 1.1–3.1), & previous knowledge about HIVST (adjusted OR: 4.2, 95% CI: 2.6–6.8) were associated with preference for homebased HIVST over facility-based VCT.