Limits...
A systematic review of strategies to increase access to health services among children in low and middle income countries

View Article: PubMed Central - PubMed

ABSTRACT

Background: Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented.

Methods: We conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results.

Results: Fifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies.

Conclusions: This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution.

Systematic review registration: PROSPERO CRD420160334200

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-017-2180-9) contains supplementary material, which is available to authorized users.

No MeSH data available.


Flow chart of search results
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC5382494&req=5

Fig1: Flow chart of search results

Mentions: A total of 11,031 records were initially identified by the electronic searches, of which 1037 were duplicates and removed. A further 9,882 records were excluded during the initial screening yielding 164 potentially eligible studies for which full text reports were sought. Following the full text review, 114 studies were excluded and the full text could not be located for 2 articles [27, 28]. An additional 13 studies were identified through screening reference lists of the included publications, yielding a total of 63 publications for inclusion in the review. Five of these were duplicate publications on the same study and these were grouped together leaving a total of 57 included studies. FigureĀ 1 shows the PRISMA flow chart.Fig. 1


A systematic review of strategies to increase access to health services among children in low and middle income countries
Flow chart of search results
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382494&req=5

Fig1: Flow chart of search results
Mentions: A total of 11,031 records were initially identified by the electronic searches, of which 1037 were duplicates and removed. A further 9,882 records were excluded during the initial screening yielding 164 potentially eligible studies for which full text reports were sought. Following the full text review, 114 studies were excluded and the full text could not be located for 2 articles [27, 28]. An additional 13 studies were identified through screening reference lists of the included publications, yielding a total of 63 publications for inclusion in the review. Five of these were duplicate publications on the same study and these were grouped together leaving a total of 57 included studies. FigureĀ 1 shows the PRISMA flow chart.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries (LMIC) exist. Failure to access healthcare is an important contributor to child mortality in these settings. Barriers to access have been widely studied, however effective interventions to overcome barriers and increase access to services for children are less well documented.

Methods: We conducted a systematic review of effectiveness of interventions aimed at increasing access to health services for children aged 5 years and below in LMIC. Four databases (EMBASE, Global Health, MEDLINE, and PSYCINFO) were searched in January 2016. Studies were included if they evaluated interventions that aimed to increase: health care utilisation; immunisation uptake; and compliance with medication or referral. Randomised controlled trials and non-randomised controlled study designs were included in the review. A narrative approach was used to synthesise results.

Results: Fifty seven studies were included in the review. Approximately half of studies (49%) were conducted in sub-Saharan Africa. Most studies were randomised controlled trials (n = 44; 77%) with the remaining studies employing non-randomised designs. Very few studies were judged as high quality. Studies evaluated a diverse range of interventions and various outcomes. Supply side interventions included: delivery of services at or closer to home and service level improvements (eg. integration of services). Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes. A consistent pattern was not noted for the remaining studies.

Conclusions: This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC. It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home. However, given the methodological limitations found in existing studies, the results of this review must be interpreted with caution.

Systematic review registration: PROSPERO CRD420160334200

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-017-2180-9) contains supplementary material, which is available to authorized users.

No MeSH data available.