Assessing Barriers to Primary Prevention of Cardiovascular Diseases in Low and Middle-Income Countries: A Systematic Review

Abstract

The incidence of cardiovascular diseases (CVDs) in low- and middle-income countries (LMICs) has greatly increased. Previously dominated by infectious diseases, LMICs are the new epicentre of CVDs. CVD is a common problem amongst the population in the African continent; however, many countries in LMICs lack the resources to stem the rise of CVDs. A systematic review was conducted between March and July 2023 to assess barriers to the primary prevention of CVDs in studies conducted in LMICs. Online databases, such as Embase, Cochrane, Scopus, and MEDLINE, were consulted. Keywords included primary prevention, cardiovascular diseases, diabetes, weight loss, and physical fitness, all of which focused on LMICs. To enrich the literature review, efforts were made to check other listed references and more papers were retrieved. The inclusion criteria were countries in LMICs, CVD, full-text, and peer-reviewed journals. Qualitative and quantitative studies were included. Exclusion criteria included high-income countries, secondary prevention, and research unrelated to CVDs, such as barriers in oncology or mental health. A total of 1089 papers were retrieved from the search engines. After applying the exclusion criteria for LMICs, only 186 papers were retained. A further search for quality, relevance, and duplicity reduced the qualifying number to 50 papers. Further efforts to retrieve the data and examine the quality of the studies resulted in 18 final selected studies. Three categories emerged based on the type of barriers: physician barriers, patient barriers, and health system barriers. Evidently, in several LMICs, guidelines for CVD prevention were lacking, and too much emphasis was placed on secondary prevention at the expense of primary prevention, a lack of human resources, and inadequate infrastructure. Overworked healthcare providers were unable to allocate adequate time to the patients. There was no shared decision-making process. Patient barriers included lack of motivation, no symptoms, low level of education, no insurance, long physical distances to the facilities, and inadequate medication or stock out. Some of the major barriers included closing and opening hours, poor operating space, inadequate funding from the government or donors, and lack of electronic medical services. There are many barriers to accessing primary prevention services for CVDs. These barriers can be divided into patient, physician, or health system barriers. More research needs to be conducted in LMICs to address the increasing risk factors for CVDs. Greater investment is required by national governments to provide more resources. Task shifting and shared decision-making are some of the quick wins.