Barriers to access and utilization of healthcare by children with neurological impairments and disability in low-and middle-income countries: a systematic review

• Published in: Wellcome open research 2021, Vol.6, p.61
• Main Authors: Mwangi, Lucy W, Abuga, Jonathan A, Cottrell, Emma, Kariuki, Symon M, Kinyanjui, Samson M, Newton, Charles Rjc
• Format: Article
• Language: English
• Subjects: disability; eng; healthcare; neurological impairments; rehabilitation; resource-limited settings; Systematic Review
• ISSN: 2398-502X; 2398-502X
• DOI: 10.12688/wellcomeopenres.16593.2

Neurological impairments (NI) and disability are common among older children in low-and middle-income countries (LMICs). We conducted a systematic review to examine the barriers limiting access and utilization of biomedical and rehabilitative care by children and adolescents with NI in LMICs. 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 studies reporting 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. Our literature searches identified 3,258 reports of which 20 were included in the final analysis. Fifteen studies (75.0%) originated from diverse settings in sub-Saharan Africa (SSA). Factors limiting access and utilization of healthcare services in >50% of the studies were: financial constraints (N=17, 85.0%), geographical and physical inaccessibility (N=14, 70.0%), inadequate healthcare resources (N=14, 70.0%), prohibitive culture and beliefs (N=12, 60.0%), and inadequate education/awareness (N=11, 55.0%). Factors reported in