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Barriers to Healthcare Access for Children With Congenital Heart Disease in Low- and Middle-Income Countries: A
Rodrigo Lopez-Barreda1,2, Silvia Amesty3, Milena Pavlova4
1Pontificia Universidad Católica de Chile, Chile.
Insights
Barriers to pediatric congenital heart disease (CHD) care in low- and middle-income countries (LMICs) are widespread, affecting environment, workforce, infrastructure, and policy. Integrated health system strengthening is crucial for improving CHD outcomes.
Area of Science:
- Global Health
- Pediatric Cardiology
- Health Systems Research
Background:
- Access to timely and appropriate care for children with congenital heart disease (CHD) is inequitable in low- and middle-income countries (LMICs).
- Significant barriers hinder healthcare access for pediatric CHD patients in these regions.
Purpose of the Study:
- To systematically review and synthesize recent evidence on barriers to healthcare access for pediatric CHD.
- To analyze system-level determinants using the SHEL human factors framework.
Main Methods:
- Updated systematic review following PRISMA guidelines.
- Searches conducted in major databases: PubMed/MEDLINE, Scopus, and Web of Science.
- Regional trends mapped using WHO classifications.
Main Results:
- Barriers identified across environmental factors, workforce limitations, infrastructure constraints, and policy/organizational deficiencies.
- Many obstacles originate at the primary care level, leading to delayed diagnosis and referral.
- Distribution of barriers varied by region, though all SHEL domains were affected.
Conclusions:
- Improving pediatric CHD outcomes in LMICs necessitates integrated health system strengthening.
- Addressing barriers across all levels of care is essential for equitable healthcare access.
Background:
Access to timely and appropriate care for children with congenital heart disease (CHD) remains highly inequitable in low- and middle-income countries (LMICs).
Objectives:
This systematic review synthesizes recent evidence on barriers to healthcare access for pediatric CHD and applies the SHEL human factors framework to analyze system-level determinants.
Design:
This updated systematic review extends a prior analysis, applying PRISMA guidelines. Search was conducted in PubMed/MEDLINE, Scopus, and Web of Science. Regional trends were mapped via WHO classifications.
Results:
Most studies reported barriers related to environmental factors, followed by workforce limitations, infrastructure constraints, and policy or organizational deficiencies. Many obstacles originated at the primary care level, contributing to delayed diagnosis and referral. Although all regions exhibited barriers across SHEL domains, their relative distribution varied by region.
Conclusion:
These findings highlight that improving CHD outcomes in LMICs requires integrated health system strengthening across levels of care.
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