Odunyemi Adelakun, Islam Md Tauhidul, Alam Khurshid
Murdoch Business School, Management & Marketing Department, Murdoch University, 90 South Street, Murdoch, Perth, Western Australia 6150, Australia.
Hospitals Management Board, Clinical Department, Alagbaka, Akure 340223, Ondo State, Nigeria.
Health Promot Int. 2024 Oct 1;39(5). doi: 10.1093/heapro/daae114.
The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.
撒哈拉以南非洲地区（SSA）非传染性疾病（NCDs）日益加重的经济负担阻碍了可持续发展目标的实现。然而，目前尚无这方面最新的证据综述。因此，我们的研究总结了文献中的现有证据，并找出了差距。我们系统检索了2015年至2023年期间的相关数据库（PubMed、Scopus、ProQuest），重点关注关于SSA地区非传染性疾病及其经济负担指标的实证研究，即灾难性卫生支出（CHE）、贫困、应对策略、挤出效应以及因经济原因未满足的需求（UNFRs）。我们研究了这些指标的分布、规模、方法途径以及分析深度。纳入的71项研究大多来自SSA地区低收入（n = 22）、中低收入（n = 47）和中高收入（n = 10）国家的单国研究（n = 64）、基于机构的研究（n = 52）。约50%的国家缺乏相关研究（n = 25），46%的研究来自西非。癌症、心血管疾病（CVD）和糖尿病是研究最多的非传染性疾病，癌症和CVD造成的经济负担最大。综述揭示了在深度、公平性分析和稳健性方面存在的方法学缺陷。中低收入国家的灾难性卫生支出较高（高达95.2%），而低收入和中高收入国家则较低。低收入和中低收入国家的因经济原因未满足的需求几乎达到100%。极端应对策略在低收入国家最为常见。目前尚无关于挤出效应和与大流行相关的因经济原因未满足的需求的研究。本研究强调了扩大研究的重要性，以完善对SSA地区非传染性疾病经济负担的方法学估计，从而得出公平性影响和政策建议。
