OBJECTIVES: To identify and review strategies of providing care for children living with chronic health conditions in low- and middle-income countries. METHODS: 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.
RESULTS: Our search identified 71 papers addressing 8 chronic conditions; two chronic communicable diseases (HIV, TB) accounted for the majority of papers (n=37, 52%). Nine (13%) papers reported 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 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.
CONCLUSIONS: 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 integrated models of care which may be effective in improving outcomes for these children.