Objective: This study evaluated the effectiveness of health literacy interventions aimed at reducing sugar and sugar-sweetened beverage (SSB) intake among Asian populations and identified the common characteristics of effective interventions through a systematic review of randomised and non-randomised studies. Study design: Systematic review of randomised and non-randomised trials. Methods: A systematic search of five databases identified randomised and non-randomised studies on health literacy interventions aimed at reducing sugar and SSB intake among Asian populations. Screening followed predefined criteria, and data extraction captured the intervention type, delivery, duration, and outcomes. Quality was assessed using the Cochrane Risk of Bias-2 and ROBINS-I tools for bias, and the findings were synthesised to identify effective intervention traits and research gaps. Results: Of the eight included studies, three were face-to-face educational, one behavioural, one online, one mobile text messaging, and two front-of-pack (FOP) labelling interventions. Six out of eight studies measured sugar intake, with four assessing SSB intake. Seven studies reported significant dietary improvements. Overall, bias risk was present, with three rated high. Significant inconsistencies in the two studies were further explored. Conclusion: The effectiveness of health literacy interventions in reducing sugar or sugar-sweetened beverage intake was positive, particularly for face-to-face interventions and FOP labels. Available evidence may inform policymaking for the implementation of health promotion for disease prevention and complement standards of care practices for disease management.

Background: Cancer is a growing public health concern in Africa and Asia, where access to effective healthcare and resources is often limited. There is an urgent need for evidence-based cancer control policies in Africa and Asia, along with systems for prevention, early detection, diagnosis and treatment, and palliative care. This emerging issue has garnered growing interest from international institutions but there has been little visible action, and the existing knowledge remains scattered and fragmented. This scoping review aims to explore the breadth and scope of evidence regarding knowledge transfer interventions to enhance cancer care in Africa and Asia. Methods: We conducted a systematic search of Embase, Emcare, ERIC, APA PsycInfo, Medline, and Google Scholar, supplemented by expert bibliographies and references. Peer-reviewed empirical studies in English or French from January 1978 to September 2024 were included. Data were organised using the AIMD (Aims, Ingredients, Mechanism & Delivery) framework. Study quality was presented using the Mixed Methods Appraisal Tool. Results: The scoping review examined seven articles providing evidence on five unique interventions. The interventions included target both decision-makers and health professionals and aim to strengthen evidence-based cancer control policies and implementation strategies. The interventions documented have all been initiated by external actors, mainly international institutions or researchers from high-income countries, in collaboration with African and Asian stakeholders. In addition, some researchers have been involved in participatory research projects designed to enable decision-makers to implement evidence-based cancer control policies and programmes. Conclusions: This scoping review highlights a critical lack of evidence on knowledge transfer interventions in cancer care across Africa and Asia, partly due to limited funding for non-communicable diseases. It calls for the integration of knowledge transfer components into all cancer research and interventions, supported by robust evaluation strategies, to develop evidence-based, economically feasible, and culturally appropriate policies, guidelines and interventions that can be used in nations with limited healthcare resources to improve cancer outcomes.

Background: In the World Health Organization (WHO) geographical region of South-East Asia, the mental health burden of adolescents appears high. Addressing this burden requires development of mental health policies consistent with international standards to assist governance, resource allocation and delivery of mental healthcare effectively. The aim was to identify current national mental health policies/plans/programs/legislation in South-East Asia, assess compliance with international standards and review inclusion of adolescents in these documents. Methods: Searches were conducted on WHO MiNDbank, official government websites, Google and Google Scholar. Documents were compiled and screened, data were extracted and evaluated following WHO Guidelines on Monitoring and Evaluation of Mental Health Policies and Plans. Frequencies of checklist and sub scores were calculated. Data were narratively synthesised. Findings: Fourteen mental health policies/plans/programs/legislation from 8 countries met inclusion criteria. Maldivian and Bangladeshi documents complied the greatest with WHO guidelines. All 8 countries considered adolescents to some extent in their documents. Only Indian documents consulted child health groups during policy development. Intra/Inter sectoral collaboration with child health divisions was highlighted in documents from Sri Lanka, Bangladesh, India and Maldives. Interpretation: Most South-East Asian nations had developed separate national mental health governance documents. However, their incorporation of adolescent mental health is rare and compliance with international standards were inconsistent. Binding mental health legislation separate from health legislation; inclusion of adolescents; addressing resource constraints; and guidelines for mental health policy development catered to low-and-middle-income countries are all essential to address the complex mental health needs of South-East Asian adolescents.

Objectives: This review aimed to map and synthesize existing literature on sex and reproductive education policy implementation in primary and secondary schools in Asia and Africa. Methods: Database searches yielded 24 relevant articles, which underwent thematic analysis. Results: Most studies were conducted in Africa and looked at barriers to implementation. Studies assessing implementation showed it was incomprehensive. Barriers were: policy/curriculum issues, societal opinions, teaching discomfort, lack of educator training, and lack of sufficient economical support. Conclusions: Based on the limited evidence, a cultural shift to reduce stigma seems necessary, alongside teacher and student involvement in policy formulation and implementation monitoring.

BACKGROUND: Cognitive Behavioral Therapy (CBT) has been proven an effective treatment for anxiety disorders. However, CBT still dominantly uses concepts and constructs rooted in Western cultures, and most research focuses on Western populations. It is unsure how this translates to non-Western cultures like Southeast Asia. AIMS: Our objective is to explore which types of cultural adaptations in CBT have been implemented for anxiety disorders in Southeast Asia and their effectiveness. METHODS: We systematically searched PubMed, PsycINFO, Embase, CENTRAL, GARUDA, and Google Scholar for CA-CBT for anxiety disorders in local communities in Southeast Asian countries. Data were analyzed using a narrative approach distinguishing between peripheral and core component adaptations. PROSPERO database preregistration number was CRD42022336376. RESULTS: Seven studies (one randomized controlled trial, three quasi-experimental studies, and three case reports) were selected. Two studies made cultural adaptations in multiple components. Two studies modified core treatment components by incorporating local values in the CBT restructuring process. Three studies conducted cultural adaptation on peripheral treatment components: adaptation to materials and semantics, cultural examples and themes, and session structure. Three studies did not provide detailed information. One RCT study showed better improvement for those who got CA-CBT than those in treatment as usual (TAU). CONCLUSION: The findings suggest some components to consider when conducting cultural adaptation. We could not establish the degree of superiority of CA-CBT over non-CA-CBT nor identify components with the most influence due to the limited number of studies found. Employing standard documentation in reporting trials is also important to increase transparency.

Background: Mental disorders remain the most significant contributor to years lived with disability in South Asia, yet governmental health expenditure on mental health in South Asia remains very low with limited strategic policy development. To strengthen the case for action it is important to better understand the profound economic costs associated with poor mental health. Methods: We conducted a systematic review on the costs of all mental disorders, as well as intentional self-harm and suicide, in the World Bank South Asia Region. Ten global and South Asian databases as well as grey literature sources were searched. Results: 72 studies were identified, including 38 meeting high quality criteria for good reporting of costs. Of these, 27 covered India, five Pakistan, four Nepal and three Bangladesh and Sri Lanka. Most studies focused on depressive disorders (15), psychoses (14) and harmful alcohol use (7); knowledge of economic impacts for other conditions was limited. Profound economic impacts within and beyond health care systems were found. In 15 of 18 studies which included productivity losses to individuals and/or carers, these costs more than outweighed costs of health care. Conclusion: Mental disorders represent a considerable economic burden, but existing estimates are conservative as they do not consider long-term impacts or the full range of conditions. Modelling studies could be employed covering longer time periods and more conditions. Clear distinctions should be reported between out-of-pocket and health system costs, as well as between mental health service-specific and physical health-related costs.

Objective: Cancer is one of the main causes of death, and cervical cancer is the fourth most common cancer and the fourth leading cause of death from malignancy among women. Knowing the survival rate is used to evaluate the success of current treatments and care. This study was conducted to assess the survival rate of cervical cancer in Asia. Methods: This systematic survey was conducted on four international databases, including Medline/PubMed, ProQuest, Scopus, and Web of Knowledge, and includes manuscripts that were published until the end of August 2021. Selected keywords were searched for international databases including cervical neoplasms [mesh], survival analysis or survival or survival rate, Asian countries (name of countries). The Newcastle-Ottawa Qualitative Evaluation Form was used for cohort studies to evaluate the quality of the articles. The analysis process was performed to evaluate the heterogeneity of the studies using the Cochran test and I2 statistics. Additionally, a meta-regression analysis was performed based on the year of the study. Results: A total of 1956 articles were selected and reviewed based on their title. The results showed that 110 articles met the inclusion criteria. According to the randomized model, the 1, 3, 5, and 10-year survival rates of cervical cancer were 76.62% (95% Confidence Interval (CI), 72.91_80.34), 68.77% (95% CI, 64.32_73.21), 62.34% (95% CI, 58.10_66.59), and 61.60% (95% CI, 52.31_70.89), respectively. Additionally, based on the results of meta-regression analysis, there was an association between the year of the study and the survival rate, elucidating that the survival rate of cervical cancer has increased over the years. Conclusions: Results can provide the basic information needed for effective policy making, and development of public health programs for prevention, diagnosis, and treatment of cervical cancer.

Purpose: Clinical guidelines recommend radiofre-quency ablation (RFA) for eradication of Barrett esophagus in patients with low-grade dysplasia (LGD) and high-grade dysplasia (HGD), but evidence on whether RFA provides good value for money is still sparse. This study evaluates the cost-effectiveness of RFA in Italy. Methods: A Markov model was used to estimate lifelong costs and consequences of disease progression with different treatments. RFA was compared with esophagectomy in the HGD group or endoscopic surveillance in the LGD group. Clinical and quality-of-life parameters were derived from a review of the literature and expert opinions, whereas Italian national tariffs were used as a proxy for costs. Findings: RFA dominated esophagectomy in pa-tients with HGD with a probability of 83%. For patients with LGD, RFA was more effective and more costly than active surveillance (incremental cost-effectiveness ratio, euro6276 per quality-adjusted life-year). At a cost-effectiveness threshold of euro15,272, the probability of RFA being the optimal strategy in this population was close to 100%. Model results were sensitive to the cost of the interventions and utility weights used in the different disease states. Implications: RFA is likely to be the optimal choice for patients with LGD and HGD in Italy. Italy is discussing the implementation of a national program for the health technology assessment of medical devices, requiring more studies to prove value for money of emerging technologies. (Clin Ther. 2023;45:426-436.) & COPY; 2023 Elsevier Inc.

Cervical cancer is a significant public health concern globally, with low and middle-income countries bearing the highest burden, specifically the South Asian region. Therefore, the current scoping review aimed to highlight the factors influencing the implementation of human papillomavirus (HPV) vaccination in South Asia. Adopting the 'Arksey and O'Malley and Levac et al.' methodology, multiple electronic databases were searched to identify relevant records. The results were narratively synthesised and discussed, adopting the Consolidated Framework for Implementation Research (CFIR) model. We identified 527 records, which were assessed for eligibility based on title, abstract, and full text by three reviewers, followed by data extraction of 29 studies included for analysis in the review. Implementing HPV vaccination programs in South Asia faces various challenges, such as economic, health system, financial, health literacy, and sociocultural factors that hinder their successful implementation. To successfully implement the vaccine, a tailored risk communication strategy is necessary for these countries. Knowledge gained from the experience of South Asian nations in implementing the HPV vaccine can assist in policymaking in similar healthcare for advancing the implementation of HPV vaccination.

The reduction of Maternal Mortality Ratio (MMR) remains a global health issue. Although major progress has been achieved in the past 15 years, the ratio is still high, especially in Low Middle-Income Countries. In the Southeast Asian region, most of the countries have not reached the Sustainable Development Goals target yet. Although the countries have several similarities in many aspects, such as community characteristics, cultural context, health systems, and geographical proximity, the MMR in the region presents interesting variations. The scope of this systematic review is to explore published literature on the utilization of maternal health services at the community healthcare centre setting in Southeast Asian countries. The databases PubMed, Web of Science, and Google Scholar were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2000-2020. A total of 1876 records were found, out of which 353 full text were screened. Finally, 27 studies on utilization of maternal health services met the inclusion criteria and were selected for analysis from seven Southeast Asian countries: Cambodia, Indonesia, Lao PDR, Myanmar, The Philippines, Timor Leste and Vietnam. Most of the articles focused on the utilization of maternal health services at primary health care setting. Several themes on maternal health services utilization in the countries emerged, including cultural and socioeconomic factors contributed to the utilization of maternal health services, factors associated with the low utilization of ANC, determinants affected place of delivery and delivery assistance choice. The utilization of maternal health services at primary healthcare setting in seven Southeast Asian countries was identified in a small number of studies. Sociocultural barriers and disparities of health services provision are the major factors associated with low utilization of the services. Further research on strengthening the role of primary healthcare in maternal health services provision is required.

BACKGROUND: With a diversity in midwifery education across the South-East Asia region, and with the knowledge about the lifesaving competency of the midwife profession, this study's aim is to describe facilitators of and barriers to providing high-quality midwifery education in South-East Asia. METHODS: Inspired by Whittemore and Knafl, we conducted a systematic integrative literature review including the five key stages of problem identification, literature search, data evaluation, data analysis, and presentation of results. The literature searches were conducted in October 2020 in the databases CINAHL, PubMed, and Scopus. A deductive data analysis based on global standards was performed. RESULTS: The search identified 1257 articles, 34 of which were included. Countries in South-East Asia did not fully comply with the ICM global standards. Midwifery education was not separated from that of nursing, and educators lacked formal qualifications in midwifery. Curriculum implementation in the clinical area was a key barrier to achieving learning outcomes. Higher academic education for midwifery educators and mentorship programs facilitated the pedagogic and assessment process, focusing on the abilities of critical thinking, reflection, and decision-making. CONCLUSIONS: Countries in South-East Asia still have a long way to go before they can provide high-quality midwifery education. The identified facilitators can lead to a difference in students' academic achievement and confidence in their clinical work. Coordinated actions will enable the progress in achieving competent midwives matching national health priorities. The findings highlight a need for more research on midwifery education in both theory and practice across the region.

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide. However, current evidence regarding the efficacy and cost-effectiveness of community intervention and health promotion programs for NCDs, specifically hypertension, obesity, diabetes, and dyslipidemia, in East and Southeast Asia has not yet been systematically reviewed. We systematically reviewed the literature from East and Southeast Asian countries to answer 2 clinical questions: (1) do health promotion programs for hypertension, obesity, diabetes, and dyslipidemia reduce cardiovascular events and mortality; and (2) are these programs cost-effective? Methods and Results: Electronic literature searches were performed across Medline, Cochrane Library, and Ichushi using key words and relevant subject headings related to randomized controlled trials, comparative studies, quasi-experimental studies, or propensity score matching that met eligibility criteria that were defined for each question. In all, 3,389 records were identified, of which 12 full-text articles were reviewed. Three papers were from Japan, 7 were from China/Hong Kong Special Administrative Region, and 2 were from South Korea. None were from Southeast Asia. Four papers examined the effect of community intervention or health promotion on the incidence of cardiovascular events or mortality. Eight studies examined the cost-effectiveness of interventions. Conclusions: The literature review revealed that community intervention and health promotion programs for the control of NCDs are a cost-effective means of reducing cardiovascular events and mortality in East Asian countries.

BACKGROUND: Due to language and cultural barriers, people with aphasia from culturally and linguistically diverse (CALD) backgrounds are at risk of disadvantage in their access to comprehensive care. They are at higher risk of poorer inpatient outcomes in addition to challenges in receiving appropriate aphasia assessment and intervention. OBJECTIVES: This study aims to examine the extent and nature of what is known about the inpatient phase of aphasia rehabilitation for CALD stroke survivors and identify potential research gaps in the literature for investigation. METHODS: A scoping review with systematic search was conducted in September 2020 following the PRISMA Scoping Review checklist. Five electronic databases were searched using a combination of terms pertaining to "aphasia," "inpatient care" and "CALD." Key variables were extracted from studies that met the inclusion criteria for analysis. RESULTS: Eighteen studies were yielded. Data regarding the inpatient phase of care indicate that CALD people with aphasia do not always receive comprehensive assessment or intervention in all their languages that may impact their discharge destination and access to community services. Speech-language pathologists (SLPs) report numerous barriers to service provision for this population. No studies investigated the degree and nature of differences in outcomes between CALD and non-CALD stroke survivors with aphasia. CONCLUSIONS: CALD stroke survivors with aphasia inconsistently access SLP services in hospital. Assessment is unlikely to be conducted in patient primary languages and therapy is usually provided in the language of SLPs. Further research is required to determine whether this impacts functional outcomes and health services.

BACKGROUND: Asian healthcare professionals hold that patients' families play an essential role in advance care planning. AIM: To systematically synthesize evidence regarding Asian patients' perspectives on advance care planning and their underlying motives. DESIGN: Mixed-method systematic review and the development of a conceptual framework (PROSPERO: CRD42018099980). DATA SOURCES: EMBASE, MEDLINE, Web of Science, and Google Scholar were searched for studies published until July 27, 2020. We included studies concerning seriously-ill Asian patients' perspectives on advance care planning or their underlying motives for engaging or not engaging in it. RESULTS: Thirty-six articles were included; 22 were quantitative and 27 were from high-income countries. Thirty-nine to ninety percent of Asian patients were willing to engage in advance care planning. Our framework highlighted that this willingness was influenced not only by their knowledge of their disease and of advance care planning, but also by their beliefs regarding: (1) its consequences; (2) whether its concept was in accordance with their faith and their families' or physicians' wishes; and (3) the presence of its barriers. Essential considerations of patients' engagement were their preferences: (1) for being actively engaged or, alternatively, for delegating autonomy to others; (2) the timing, and (3) whether or not the conversations would be documented. CONCLUSION: The essential first step to engaging patients in advance care planning is to educate them on it and on their diseases. Asian patients' various beliefs about advance care planning should be accommodated, especially their preferences regarding their role in it, its timing, and its documentation.

Ensuring sustainable consumption and production (SCP) patterns in the Asia region is a high-priority policy issue but challenged by a number of obstacles and the emergence of the coronavirus pandemic in 2020. This article argues that not only conventional policy approaches but also alternative approaches are needed in Asia to decouple socio-economic development and increases in environmental loads from people’s sense of well-being. To achieve human and planetary well-being under the situation of compressed development, four strategic courses of SCP policy are presented. These four courses are SCP policy expansion, enhanced linkage of consumption and production (CP), system transition and bottom-up approaches. Policy makers in Asia should keep these courses of action in mind and utilize opportunities, 13 of which are outlined here, to mainstream SCP. The 13 SCP opportunities, the key words of which include among others experience, genuine wealth, local design, digitalization, infrastructure, indigenous wisdom, collaboration and challenges, indicate entry points for Asian SCP policy development in the 2020s. Finally, based on these, the authors have devised an SCP case matrix and produced 43 example SCP cases for better application of the suggested SCP policy approach in the Asian region.

PURPOSE: One of the most common cancers in Asia is colorectal cancer (CRC). Early diagnosis and timely treatment are necessary for preventing complications and advanced stages of the disease. It is important to evaluate barriers and facilitators of screening in different countries. This systematic review aimed to identify the barriers and facilitators of CRC screening in Asia. METHODS: In this systematic review, for identifying barriers and facilitators of CRC screening, a comprehensive search was conducted in PubMed, Web of Science and Scopus in 12 December 2020. Combination keywords such as colorectal cancer, screening, sigmoidoscopy, colonoscopy, faecal occult blood test, barriers, facilitators and the names of each Asian country were used for searching. Full text original studies in English language were accepted in the review. RESULTS: In total, 36 articles were included in the review. Barriers and facilitators were evaluated. The most common reported barriers were lack of knowledge, fear of result, fear of procedure, fear of pain, lack of awareness, high cost and lack of gastrointestinal symptoms. The most frequent facilitators were having knowledge and awareness of CRC screening, perceived risk and severity, family history of cancer and physician recommendation. CONCLUSION: For promoting success in CRC screening programmes, knowing what the barriers and facilitators are is necessary. Awareness and various personal, professional and social factors have been shown to be the major barriers toward CRC screening in most Asian countries.

BACKGROUND: The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs. METHODS: We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available. RESULTS: A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or "low-tech" care must also remain available. CONCLUSIONS: The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

AIMS: This review aims to explore the extant literature on the current utilization of ACP in Kisin order to obtain a comprehensive understanding of their health disparities and to determine evidence-based best practices to integrate culturally-competent ACP for EOL care of KIs. DESIGN: A systematic integrative review of the literature Data Sources: Four electronic databases including PubMed, the Cumulative Index of Nursing and Allied Health Literature, the Cochrane Library, and Embase. METHOD: The detailed search strategy for databases implicated a combination of MeSH keywords and associated terms, which can be found in Table A. Results: Three themes emerged in relation to fundamental components in the integration of culturally-competent ACP for EOL of KIs: (1) cultural characteristics of KIs; (2) disparities in ethnic-oriented ACP and EOL care resources in KIs; and (3) KIs’ perspectives on ACP. CONCLUSION: The findings of this review indicate that culturally-competent ACP resources for KIs are presently quite insufficient. It is determined that much future research is needed on how culturally-competent ACP can best augment the quality of EOL care for KIs, and on how specific interventions can effectively implement ACP in community settings. Impact: Such ongoing research dedicated to the development of feasible culturally competent practice guidelines is anticipated to markedly reduce health disparities and promote ACP in KIs. The recommendations in this review may support Korean primary HCPs, Korean health care center administrators, Korean health maintenance organizations (HMOs), Korean advance care nurse practitioners in hospice and palliative care, and nurse researchers in their work.

Introduction: The COVID-19 pandemic has impacted biopsychosocial health and wellbeing globally. Pre-pandemic studies suggest a high prevalence of common mental disorders, including anxiety and depression in South Asian countries, which may aggravate during this pandemic. This systematic meta-analytic review was conducted to estimate the pooled prevalence of anxiety and depression in South Asian countries during the COVID-19 pandemic. Method: We systematically searched for cross-sectional studies on eight major bibliographic databases and additional sources up to October 12, 2020, that reported the prevalence of anxiety or depression in any of the eight South Asian countries. A random-effects model was used to calculate the pooled proportion of anxiety and depression. Results: A total of 35 studies representing 41,402 participants were included in this review. The pooled prevalence of anxiety in 31 studies with a pooled sample of 28,877 was 41.3% (95% confidence interval [CI]: 34.7-48.1, I 2 = 99.18%). Moreover, the pooled prevalence of depression was 34.1% (95% CI: 28.9-39.4, I 2 = 99%) among 37,437 participants in 28 studies. Among the South Asian countries, India had a higher number of studies, whereas Bangladesh and Pakistan had a higher pooled prevalence of anxiety and depression. No studies were identified from Afghanistan, Bhutan, and Maldives. Studies in this review had high heterogeneity, high publication bias confirmed by Egger's test, and varying prevalence rates across sub-groups. Conclusion: South Asian countries have high prevalence rates of anxiety and depression, suggesting a heavy psychosocial burden during this pandemic. Clinical and public mental health interventions should be prioritized alongside improving the social determinants of mental health in these countries. Lastly, a low number of studies with high heterogeneity requires further research exploring the psychosocial epidemiology during COVID-19, which may inform better mental health policymaking and practice in South Asia.

Governance has been highlighted as an important building block underpinning the process of mental health integration into primary healthcare. This qualitative systematic review aims to identify the governance issues faced by countries in the Sub-Saharan Africa and South Asia Region in the implementation of integrated primary mental healthcare. PRISMA guideline was used to conduct a systematic search of relevant studies from 4 online databases that were filtered according to inclusion and exclusion criteria. Using the Critical Appraisal Skills Program (CASP) Qualitative Checklist, a quality appraisal of the selected articles was performed. By drawing upon institutional theory, data was extracted based on a pre-constructed matrix. The CERQual approach synthesized evidence and rank confidence level as low, moderate or high for 5 key findings. From 567 references identified, a total of 8 studies were included. Respondents were policymakers or implementers involved in integrated primary mental healthcare from the national, state, and district level. Overall, the main governance issues identified were a lack of leadership and mental health prioritization; inadequate financing and human resource capacity; and negative mental health perceptions/attitudes. The implication of the findings is that such issues must be addressed for long-term health system performance. This can also improve policymaking for better integration of primary mental health services into the health systems of countries in the Sub-Saharan and South Asia region.