A Systematic Review of Informal Healthcare Provision and Maternal Medicine in Urban Comoros

In urban Comoros, the informal healthcare sector is a significant but poorly understood component of the maternal health landscape. Operating outside formal regulatory frameworks, it is a primary source of medicine and care for many pregnant and postpartum women, with implications for health outcomes and system governance. This systematic review synthesises existing evidence on the role, characteristics, and impacts of informal healthcare provision for maternal medicine in urban Comoros. It aims to map the types of providers and medicines involved, understand utilisation patterns, and identify reported health and socio-economic outcomes. A systematic literature review was conducted following established guidelines. Multiple academic databases and grey literature sources were searched. Predefined inclusion and exclusion criteria were applied to identify relevant qualitative, quantitative, and mixed-methods studies. Eligible studies were critically appraised, with data extracted and synthesised thematically. The review identified a notable scarcity of peer-reviewed empirical research on this specific topic. The limited evidence suggests a predominant reliance on informal drug vendors for obtaining medicines, including antibiotics and uterotonics, often without prescription. A key theme was the perception of these vendors as more accessible and affordable than formal facilities, despite concerns about drug quality and appropriate use. Informal healthcare provision is a critical yet under-researched pillar of maternal healthcare in urban Comoros. The current evidence base is insufficient to fully characterise its operations or quantify its public health impact, representing a significant knowledge gap. Urgent primary research is needed to investigate the scale, practices, and clinical outcomes associated with informal maternal care. Policymakers should consider integrative strategies that address the drivers of informal sector use while strengthening medicine regulation and improving the affordability of formal maternal health services. Informal sector, maternal health, medicine, drug vendors, urban health, Comoros, systematic review. This review consolidates the fragmented evidence on informal maternal healthcare in urban Comoros, clearly delineates the current knowledge gap, and provides a foundation for future research and policy development.