Bypassing Primary healthcare for maternal and child-health serviceas in low-and middle-income countries: a systematic review
1
Knoweldge Management Directorate, Armauer Hansen Research Instituite, Addis Ababa, Ethiopia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
Evidence of bypassing primary healthcare in LMICs is lacking. This study aimed to review the extent of bypassing primary healthcare for maternal and child health (MCH) services in LMICs. PubMed, Google scholar and CINAHL databases from January, 2009 to 2024search was conducted and only English language was used. Critical appraisal tool was used to assess quality of studies. Egger’s test and I2 statistical analysis were used to check publication bias and heterogeneity of studies, respectively. Sub-group analysis across regions and services was also conducted. Sensitivity test was also conducted. All analysis was done using STATA v-14 software. PROSPERO registered this study with registry number CRD420212356380.A total of 40 studies were qualified for the extensive review and finally 25 studies were included in the meta-analysis. Nineteen studies were from Africa and six studies were from Asia. In this review, a total of 19,178 clients were included. Almost all studies design were a cross-sectional design. Bypassing primary health care for overall MCH and child-birth was 61% (95% CI: 52% to 68%) and 57 % (95% CI: 47% to 68%) in LMICs, respectively. Overall bypassing for MCH shows difference across regions with 55% and 62 % in Asia & Africa, respectively. Clinical competency and quality of care were the most important factors. Participants reside in 5km and married were likely to bypass. Nevertheless, education, ante-partum care visits, and age factors had no role on the extent of bypassing. Extent of bypassing primary health care for MCH services was significant. Expanding financial investments and introducing suitable policies to address bypassing and retention of clients is essential. Additionally to affordable cost services, functional referral linkage and feedback system, capacity building and deploying health work force, availing drugs, transportation, training, education opportunities, strengthening financing, health insurance, companion & respectful care should be designed, integrated & implemented.
Evidence of bypassing primary healthcare in LMICs is lacking. This study aimed to review the extent of bypassing primary healthcare for maternal and child health (MCH) services in LMICs. PubMed, Google scholar and CINAHL databases from January, 2009 to 2024search was conducted and only English language was used. Critical appraisal tool was used to assess quality of studies. Egger’s test and I2 statistical analysis were used to check publication bias and heterogeneity of studies, respectively. Sub-group analysis across regions and services was also conducted. Sensitivity test was also conducted. All analysis was done using STATA v-14 software. PROSPERO registered this study with registry number CRD420212356380.A total of 40 studies were qualified for the extensive review and finally 25 studies were included in the meta-analysis. Nineteen studies were from Africa and six studies were from Asia. In this review, a total of 19,178 clients were included. Almost all studies design were a cross-sectional design. Bypassing primary health care for overall MCH and child-birth was 61% (95% CI: 52% to 68%) and 57 % (95% CI: 47% to 68%) in LMICs, respectively. Overall bypassing for MCH shows difference across regions with 55% and 62 % in Asia & Africa, respectively. Clinical competency and quality of care were the most important factors. Participants reside in 5km and married were likely to bypass. Nevertheless, education, ante-partum care visits, and age factors had no role on the extent of bypassing. Extent of bypassing primary health care for MCH services was significant. Expanding financial investments and introducing suitable policies to address bypassing and retention of clients is essential. Additionally to affordable cost services, functional referral linkage and feedback system, capacity building and deploying health work force, availing drugs, transportation, training, education opportunities, strengthening financing, health insurance, companion & respectful care should be designed, integrated & implemented.
| eISSN: | 2654-1459 |
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