Seneviwickrama Maheeka, Denagamagei Sashini Shehana, Jayakody Surangi, Gunasekera Sanjeeva, Liyanage Guwani
Centre for Cancer Research, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, 10250, Sri Lanka.
BMC Cancer. 2025 Jan 31;25(1):181. doi: 10.1186/s12885-025-13586-2.
Socio-economic inequalities significantly impact paediatric cancer survival. The review aims to elucidate the facilitators and barriers influencing the availability and accessibility of essential medicines for childhood cancer (EMCC) in low- and lower-middle-income countries (LLMICs).
This systematic review was conducted adhering to the PRISMA guidelines. Peer- reviewed primary studies, national/regional reports, and policy documents published in the English language were included through a thorough literature search using three electronic databases: MEDLINE, EMBASE, and CINAHL. Review questions were framed according to the ECLIPS framework. Children under 19 years of age living in LLMICs diagnosed with any malignancy were the client group. The quality of the included studies was assessed using the mixed methods appraisal tool. Data is presented as a narrative synthesis. Enablers and barriers were discussed based on the World Health Organization (WHO) health system building blocks.
Out of the 29 articles retrieved for full-text screening, the final synthesis included nine articles. Six were based on quantitative, two on mixed-method research, and one was a review article. These studies represented 26 LLMICs from several continents (Africa, Asia, and America). The alignment of the National Essential Medicine Lists (NEMLs) with the World Health Organization Essential Medicine List for Children (WHO EMC) varied from 40%- 60%. Overall stock out rate ranged from 17 to 100%. Stock out rate was higher in the public sector than in the private sector. International partnerships, policy changes, and financing strategies are some of the key enablers identified. Barriers included inadequate global drug production, high drug costs, weak regulatory enforcement, poor supply chain management, and insufficient health information systems.
The findings of our review revealed the failure of LLMICs to meet the WHO- recommended target of 80% availability for EMCCs. The availability and accessibility of EMCC in LLMICs are hindered by multiple systemic barriers despite several enabling strategies. Addressing these challenges requires coordinated global efforts and local initiatives to ensure equitable access to childhood cancer treatments in LLMICs.
CRD42022334156.
社会经济不平等对儿童癌症生存率有重大影响。本综述旨在阐明影响低收入和中低收入国家（LLMICs）儿童癌症基本药物（EMCC）供应和可及性的促进因素和障碍。
本系统综述遵循PRISMA指南进行。通过使用三个电子数据库（MEDLINE、EMBASE和CINAHL）进行全面的文献检索，纳入了同行评审的原发性研究、国家/地区报告以及以英文发表的政策文件。根据ECLIPS框架构建综述问题。居住在LLMICs且被诊断患有任何恶性肿瘤的19岁以下儿童为研究对象群体。使用混合方法评估工具评估纳入研究的质量。数据以叙述性综合的形式呈现。基于世界卫生组织（WHO）卫生系统的组成部分讨论了促进因素和障碍。
在检索到的29篇进行全文筛选的文章中，最终综合分析纳入了9篇文章。其中6篇基于定量研究，2篇基于混合方法研究，1篇为综述文章。这些研究代表了来自几大洲（非洲、亚洲和美洲）的26个LLMICs。国家基本药物清单（NEMLs）与世界卫生组织儿童基本药物清单（WHO EMC）的一致性在40%至60%之间。总体缺货率在17%至100%之间。公共部门的缺货率高于私营部门。确定的一些关键促进因素包括国际伙伴关系、政策变化和融资策略。障碍包括全球药品产量不足、药品成本高、监管执法不力、供应链管理不善以及卫生信息系统不足。
我们综述的结果显示，LLMICs未能达到WHO建议的EMCCs 80%的供应目标。尽管有一些促进策略，但LLMICs中EMCC的供应和可及性受到多种系统性障碍的阻碍。应对这些挑战需要全球协调努力和地方举措，以确保LLMICs中儿童癌症治疗的公平可及性。
PROSPERO注册号：CRD42022334156。
