Gunarathne Sajaan Praveena, Wickramasinghe Nuwan Darshana, Agampodi Thilini Chanchala, Prasanna Indika Ruwan, Agampodi Suneth Buddhika
Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
Department of Economics, Faculty of Social Sciences and Humanities, Rajarata University of Sri Lanka, Mihintale, Sri Lanka.
Int J Health Plann Manage. 2023 Jan;38(1):179-203. doi: 10.1002/hpm.3578. Epub 2022 Sep 21.
Owing to the lack of compiled global evidence on out-of-pocket expenditure (OOPE) for antenatal care (ANC), this systematic review and meta-analysis estimated the magnitude of OOPE for ANC in low and middle-income countries (LMICs).
An electronic search was conducted using 10 databases and a hand search of the eligible studies' reference lists. Studies on OOPE for ANC in LMICs, published in English without time restriction, were included. The comparability of OOPE values was improved using inflation and exchange rate adjustment to the year 2019. Random-effects meta-analysis was performed to generate pooled estimates.
Among the 9766 articles retrieved, 32 were selected. Only 13/137 (9.5%) countries reported evidence of OOPE during pregnancy in LMICs. The majority of the studies (n = 2779.4%) were from lower-middle-income settings. Ten (31.3%) studies from African region, 21 (65.6%) studies from South-East-Asian region, 1 (3.1%) study from region of Americas and none from the other regions were included. The average OOPE for ANC and single ANC visit ranged from United States Dollar (USD) 2.41 to USD 654.32 in LMICs, the lowest in Tanzania and the highest in India. The pooled OOPEs were USD 63.29 (95% confidence interval [CI] = 51.93-74.65) and USD 12.93 (95%CI = 4.54-21.31) for ANC and single ANC visit in LMICs, respectively.
The study revealed that the pooled estimates of OOPE for ANC throughout pregnancy and per visit were high in some countries, with a wide variability observed across countries. There was a lack of evidence on OOPE for ANC from many LMICs, and filling the evidence gap in LMICs is highlighted.
由于缺乏关于产前保健（ANC）自费支出（OOPE）的全球综合证据，本系统评价和荟萃分析估计了低收入和中等收入国家（LMICs）产前保健自费支出的规模。
使用10个数据库进行电子检索，并人工检索符合条件的研究的参考文献列表。纳入了在低收入和中等收入国家进行的、以英文发表且无时间限制的关于产前保健自费支出的研究。通过对2019年的通货膨胀和汇率调整，提高了自费支出值的可比性。进行随机效应荟萃分析以生成汇总估计值。
在检索到的9766篇文章中，选出了32篇。在低收入和中等收入国家中，只有13/137（9.5%）的国家报告了孕期自费支出的证据。大多数研究（n = 27，79.4%）来自中低收入地区。纳入了来自非洲地区的10项研究（31.3%）、东南亚地区的21项研究（65.6%）、美洲地区的1项研究（3.1%），其他地区没有研究。在低收入和中等收入国家，产前保健的平均自费支出和单次产前保健就诊的自费支出从2.41美元到654.32美元不等，坦桑尼亚最低，印度最高。在低收入和中等收入国家，产前保健和单次产前保健就诊的汇总自费支出分别为63.29美元（95%置信区间[CI]=51.93 - 74.65）和12.93美元（95%CI = 4.54 - 21.31）。
该研究表明，在一些国家，整个孕期和每次就诊的产前保健自费支出汇总估计值很高，各国之间存在很大差异。许多低收入和中等收入国家缺乏关于产前保健自费支出的证据，强调需要填补低收入和中等收入国家的证据空白。
