Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review
Journal – Wellcome Open Research
Article type – Journal research article – Clinical research
Publication date – Mar – 2021
Authors – Lucy W. Mwangi , Jonathan A. Abuga, Emma Cottrell, Symon M. Kariuki , Samson M. Kinyanjui, Charles RJC. Newton
Keywords – disability, healthcare, neurological impairments, rehabilitation, Resource-Limited Settings
Open access – Yes
Speciality – Neurosurgery, Paediatric surgery
World region Global
Language – English
Submitted to the One Surgery Index on March 28, 2021 at 7:39 am
Background: Neurological impairments (NI) and disability are common among survivors of childhood mortality in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical care by children and adolescents with NI in LMICs.
Methods: We searched PubMed, Latin America and Caribbean Health Sciences Literature, Global Index Medicus, and Google Scholar for studies published between 01/01/1990 and 14/11/2019 to identify relevant studies. We included all reports on barriers limiting access and utilization of preventive, curative, and rehabilitative care for children aged 0-19 years with NI in five domains: epilepsy, and cognitive, auditory, visual, and motor function impairment. Data from primary studies were synthesized using both qualitative and quantitative approaches, and we report a synthesized analysis of the barriers identified in the primary studies.
Results: Our literature searches identified 3,074 reports of which 16 were included in the final analysis. Fourteen studies (87.5%) originated from rural settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=15, 93.8%), geographical inaccessibility (N=11, 68.8%), inadequate healthcare resources (N=11, 68.8%), inadequate education/awareness (N=9, 56.3%), and prohibitive culture/beliefs (N=9, 56.3%). Factors reported in <50% of the studies related to the attitude of the patient, health worker, or society (N=7, 43.8%), poor doctor-patient communication (N=5, 31.3%), physical inaccessibility (N=3, 18.8%), and a lack of confidentiality for personal information (N=2, 12.5%). Very few reports were identified from outside Africa preventing a statistical analysis by continent and economic level.
Conclusions: Financial constraints, geographic inaccessibility, and inadequate healthcare resources were the most common barriers limiting access and utilization of healthcare services by children with NI in LMICs.
PROSPERO registration: CRD42020165296 (28/04/2020)
OSI Number – 20984