Scoping review: strategies of providing care for children with chronic health conditions in low- and middle-income countries.

Abstract

To identify and review strategies of providing care for children living with chronic health conditions in low- and middle-income countries. We searched MEDLINE and Cochrane EPOC databases for papers evaluating strategies of providing care for children with chronic health conditions in low- or middle-income countries. Data were systematically extracted using a standardised data charting form, and analysed according to Arksey and O'Malley's 'descriptive analytical method' for scoping reviews. Our search identified 71 papers addressing eight chronic conditions; two chronic communicable diseases (HIV and TB) accounted for the majority of papers (n=37, 52%). Nine (13%) papers reported the use of a package of care provision strategies (mostly related to HIV and/or TB in sub-Saharan Africa). Most papers addressed a narrow aspect of clinical care provision, such as patient education (n=23) or task-shifting (n=15). Few papers addressed the strategies for providing care at the community (n=10, 15%) or policy (n=6, 9%) level. Low-income countries were under-represented (n=24, 34%), almost exclusively involving HIV interventions in sub-Saharan Africa (n=21). Strategies and summary findings are described and components of future models of care proposed. Strategies that have been effective in reducing child mortality globally are unlikely to adequately address the needs of children with chronic health conditions in low- and middle-income settings. Current evidence mostly relates to disease-specific, narrow strategies, and more research is required to develop and evaluate the integrated models of care, which may be effective in improving the outcomes for these children.