Summary of Evidence
This systematic review was conducted using three search engines. We found zero report of studies on the use of drones or UAVs in direct relation to maternal health outcomes, and three reports that were related to indirect maternal health purposes. These include two reports on delivery of blood products (Amukele et al., 2017) and one on the delivery of haematology specimens (Amukele et al., 2015).
The latest, reported in 2019 was a study in the Republic of Rwanda, a small country in Central East Africa (Evan et al., 2019) as compared to two previous studies that were conducted in Baltimore, USA. This was probably due to the fact that Rwanda has a high necessity for rapid blood supply to their remote rural areas. Furthermore, most studies were still in the simulation or experimental stages, with a large window for future research needs in real life situations in obstetric emergencies (Carillo-Larco et al., 2018).
There was also concern with regards to the climate issue in which drones can be used in reality. No study has been carried in tropical climates such as Malaysia where heavy rains and monsoon seasons are experienced on a regular basis. Despite the technological development in the area of liquid ingress protection such as waterproofing and water resistance, drones are generally unable to fly in heavy rain and weather hazards due to potential loss of communication, diminished aerodynamic performance and reduced operator effectiveness (Ranquist et al., 2017).
On the other hand, we also found that reviews on MedGRT and MedART are increasing in numbers for the past 10 years from 2009 to 2019. This positive trend signifies an increase in awareness among health providers in improving the efficiency of healthcare delivery and survival rates among patients (Taylor et al., 2018). However, unlike this systematic review, most of the previous studies were done separately either focusing on efficiency of MedGRT or MedART without comparing one to the other.
Comparing Non-Medical Drones Application
Following this systematic review, we noted an obvious deficiency in research on drone application in healthcare as compared to non-medical use cases. Back in the early introduction of drones, this advent technology was expensive and not popular. Usage was limited and the perception was negative. They were primarily used in active combat and military target killing. This perception affected our societal values and belief, and consequently our behavior towards the drone (Rao et al., 2016).
Nowadays, drones are used widely in more than fifty different applications; for example goods and food delivery services, agriculture, security systems, recording and aerial photography, archeological surveys, and meteorology analysis (Aydin, 2019).
For a medical drone, this changing paradigm from a life damaging to a life saving perception certainly required a lot more than simply an innovation; widespread public awareness was in order. A quantitative survey of public acceptance of drones using a Knowledge Attitude Practice (KAP) model and statistical analysis revealed that drones were not well accepted at present except for safety purposes and scientific research (Aydin, 2019). This low general public acceptance is conclusively due to its early reputation as weapons and privacy interrupters. Hence, it is important for future researchers to improve not only the application but also spreading awareness and mitigating risk in order to win public acceptance.
Stumbling Blocks in Maternal Healthcare-Specific Drone Application
The three arms of healthcare drone application are transport and delivery, search and rescue, and remote medical care. Until this systematic review was completed, there are eight additional journal publications in relation to drone applications in healthcare in general, four in cardiac arrest emergencies, three in search and rescue missions, and one in remote telemedicine.
Nevertheless, maternal healthcare specific drone application remains a scarcity. This may be attributable to a few obstacles. For instance, blood products such as red blood cells and platelets are labile and need to be handled in a specific environment. Unlike goods and meals, red blood cells need to be stored and maintained at temperatures between 2-4°C, and platelets at 22-24°C with constant agitation (Bardyn et al., 2017). This primarily translates into a massive challenge for drones adaptation in maternal healthcare. Thermologger, special storage, ice packs, and the flight distance of drones are challenges to contend with, in addition to maintaining optimum specific temperature in blood product transport, to ensure successful use of drones in obstetric emergencies in different geographical region. A drop in temperature may affect the biochemical components of blood products and leads to ineffective transport.
Other than environmental factors, the capability of drones to deliver blood products depend on payload limitation and drone battery life. This adds to the challenges for researchers to be able to deliver safely an adequate amount of blood components. In any obstetric emergency, at least 2-4 units of red blood cells are needed to save a patient’s life. Future drone use in such life scenarios requires the ability to carry a payload of at least 1.5-2.5 kilograms.
A sound, standard operating procedure in carrying out the task is also of paramount importance. Training drills will help prevent product wastage and accidents in transit. Success in overcoming these challenges may as well expand the potential use of drone beyond maternal healthcare-specific usage, including other modalities of medical intervention such as imaging and robotic arms.
Limitations
Several limitations were encountered during this systematic review. First, the instruments for extracting the information from the identified relevant sources are not validated. We extracted as much information as possible from the reports and summarised the finding, as in table 1.
Secondly, we did not search using the specialised search engines for engineering based and information technologies based databases. Consequently, this may have resulted in limited information and articles retrieved regarding technological aspects of drone utilization in obstetric emergencies. However, we believe that healthcare usage of drones is almost exclusively published in biomedical subscription databases. Thirdly, we did not record the reason for exclusion while screening through the titles and abstracts. However, we overcame the possible bias with our very specific inclusion criteria. We specified the use of drones for maternal health related purposes only, either a direct relationship such as Maternal Mortality Ratio, or indirect such as blood and haematology laboratory specimens.
Regardless, we believe this systematic review is the first to be conducted pertaining to the use of drones in maternal healthcare. Additionally, three search engines were used to ensure our review to be comprehensive and deductive.