Barriers to Accessing Pediatric Health Care in Latin America: A Scoping Review

Barriers to Accessing Pediatric Health Care in Latin America: A Scoping Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Barriers to Accessing Pediatric Health Care in Latin America: A Scoping Review Laura María Gómez Trujillo, Laura Katherine Guio Cruz, Juan Sebastián Criales Laguado, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5828056/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Latin America faces multiple barriers to healthcare access, particularly affecting the pediatric population. Factors such as socioeconomic vulnerability, armed conflicts, disasters, and insufficient healthcare spending contribute to these difficulties. The barriers include financial, bureaucratic, and geographical issues, negatively impacting the well-being and development of children. Objective : To identify the barriers to healthcare access in the vulnerable pediatric population of Latin America and recognize effective strategies to overcome them. Methods : An scoping review was conducted in December 2024. A literature search was performed in databases such as BIREME, PubMed, and Scopus, including studies published between 2014 and 2024 in English and Spanish. Specific inclusion and exclusion criteria were applied, and the RAYYAN tool was used to manage the references. Results : Twenty-eight articles met the selection criteria. Of these, 28.57% discussed sociodemographic barriers, highlighting geographical issues and gaps in government support; other articles addressed vaccination, mainly social stigmas and lack of supplies; and 17.8% focused on specific diseases, highlighting the lack of early access and complications. Additionally, 17.8% discussed strategies such as telemedicine to improve healthcare access in remote areas. Conclusion : The barriers to healthcare access in the pediatric population of Latin America are diverse and complex. Telemedicine emerges as a promising strategy, ensuring access, follow-up, and medical consultation, reducing secondary complications due to late or non-existent care for remote communities. Additional studies with robust methodologies are required to improve the applicability of the recommendations. Barriers to Healthcare Services Child Health Primary Healthcare Child Development Pediatrics Figures Figure 1 Figure 2 BACKGROUND Latin America is characterized by having multiple rural areas with high vulnerability risk. According to the Risk Management Index (INFORM), the countries with the highest levels of socioeconomic vulnerability are Guatemala, Haiti, and Honduras (1). The region's healthcare expenditure has represented 6.64% of its gross domestic product (GDP) over the past 20 years, a much lower figure compared to the median of 8.97% in the countries of the Organization for Economic Cooperation and Development (OECD) (6). Additionally, it is estimated that in 15 countries, around 29.3% of the population had unmet healthcare needs, equivalent to approximately 295 million people (2). When discussing health vulnerability, it involves considering multiple causes that create barriers to accessing healthcare. The main barriers include financial, due to the lack of resources to pay for consultations or treatments; bureaucratic, due to coverage or treatment authorization issues; and geographical, due to distances and poor road infrastructure (7). These factors constitute obstacles that prevent vulnerable populations from obtaining the medical care they require, especially the pediatric population, which has been significantly affected for a considerable time (3). According to the Pan American Health Organization (PAHO), around one-third of people in Latin America (29.3%) report not seeking healthcare when needed due to multiple access barriers (3). These barriers disproportionately impact caregivers and, consequently, the dependent pediatric population. The lack of timely and adequate care not only affects their immediate well-being but also has long-term repercussions on their physical, emotional, and cognitive development (4). Furthermore, the pediatric population is especially vulnerable, understood as the inability to effectively resist or cope with threatening phenomena (8). In Latin America, this situation is exacerbated by obstacles to accessing healthcare services, worsened by poverty and inequality. According to UNICEF (5), 81 million children in the region live in poverty, and total family incomes are insufficient to meet basic needs. Additionally, regional reports indicate that factors such as the lack of rural healthcare infrastructure, the shortage of healthcare professionals, and the direct and indirect costs of medical care significantly contribute to this issue (5). It is important to understand that healthcare access is universal, implying that all individuals and communities should have access without any discrimination (5). This review is relevant because it will identify the barriers to healthcare access in vulnerable pediatric populations in Latin America. It also aims to recognize effective strategies that have been proven to overcome these barriers and strive for equal healthcare access, highlighting the use of telemedicine. This tool is utilized in teleconsultation, telepractice, tele-research, and the use of applications by specialists and other healthcare actors (33). In this context, the study aims to analyze previously implemented primary care programs and models, integrating them with the specific barriers affecting the pediatric population in rural areas of Latin America. METHODS An exploratory systematic review was conducted in December 2024 using the methodology proposed by Arksey and O’Malley (5) and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (6). The objective of this study was to identify research conducted in the last 10 years on the barriers to accessing various healthcare services faced by the pediatric population in Latin America and strategies that have reduced this vulnerability through primary healthcare over the years. The process employed for this review is explained below. Search Strategy and Identification of Relevant Studies The search for articles began with the selection of Medical Subject Heading (MeSH) and Health Science Descriptors (DeCs) terms such as: Barriers to Healthcare Access, Child Health, Primary Healthcare, previously defined to answer the exploratory research question, generating different search strategies. The literature search was conducted in virtual databases such as BIREME, PubMed, and Scopus. Filters were applied during the process to limit articles written in English and Spanish, published between 2014 and 2024. Table 1 summarizes the search strategies and filters applied. Table 1 Search strategy used in every database and the applied filters. Database Search Strategy Filters Used PubMed (Barriers of access) AND (primary care) AND (pediatric health) AND (Latinoamerica) Time frame: 2014 to 2024 Language: Spanish and English BIREME (Barriers to health access) OR (Barriers to health services access) AND (Child health) AND (Latin America) OR (America) Time frame: 2014 to 2024 Language: Spanish and English Scopus (barriers AND access AND latin AND america AND health) Time frame: 2014 to 2024 Language: Spanish and English Study Selection After conducting the literature search, all references were filtered and managed through the virtual tool RAYYAN (7). Using this tool and considering the search elements, the study selection was carried out in several steps. Initially, duplicate articles were identified and removed. Then, an initial screening was conducted based solely on the title and abstract of the studies, selecting those with the potential to answer the exploratory question. Thirdly, based on the selection criteria, a second screening was performed with a full-text reading, evaluating the relevance of the articles and their alignment with the proposed objective. Inclusion and Exclusion Criteria The selection criteria were established using the PCC (Population-Concept-Context) strategy proposed by the Joanna Briggs Institute (8). Studies focused on vulnerable pediatric populations in Latin America were included, as well as studies mentioning the use of strategies that have proven effective in overcoming healthcare access barriers in vulnerable regions or those that may present healthcare access barriers. Studies involving pregnant women and/or populations over 18 years old were excluded, as well as case reports, unpublished theses and academic works, and studies related to major cities or high-income countries. Data Extraction and Tabulation Data extraction was performed using a tabulation form, which was constantly adjusted to ensure the quality of the information. Researchers defined variables to collect relevant data from each article included in this study. The extraction and tabulation process were carried out iteratively. Data Collection, Summary, and Reporting of Results Finally, the extracted information was analyzed during data tabulation and organized into relevant subcategories based on the frequency of certain thematic axes such as: sociodemographic barriers, vaccination barriers, barriers in specific diseases, and strategies to overcome them, as these were the most frequent in the analyzed studies. The results were summarized and presented in tables and diagrams, as shown in Table 2 . Table 2 Narrative Synthesis of Results organized by subcategories. Own elaboration. Title Authors Year Country Type of Study Sociodemographic barriers (n = 8) Absenteeism in child health services: a systematic review Machado et al(29) 2023 Brazil Systematic Review A systematic review across 19 databases identified that over 200 million children in developing countries do not reach their potential due to risk factors. Absenteeism from appointments is high (69.4%), influenced by cultural, economic, and organizational barriers. Health education and respectful care improve adherence to child health services. Access to public health services in Latin America, A systematic literature review 2012–2022 Azañedo et al (10) 2022 Peru Systematic Review The health system in Latin America faces challenges due to budget constraints and social inequalities. Inadequate geographical distribution and lack of resources limit equitable access, especially in rural areas. Bureaucracy and lack of funding exacerbate the situation, affecting adolescents and vulnerable communities. Adolescent males in the City of Buenos Aires: gender-based barriers to health care and prevention. Tajer et al (30) 2019 Argentina Qualitative Study The research addresses the difficulty of including the experiences and needs of adolescent males in clinical models. It focuses on identifying and analyzing professional perceptions of their health demands. Adolescence is a period of exploration and self-discovery, crucial for the development of gender identity and sexual orientation. Barriers to access to health services for women and children in Latin America Houghton et al (31) 2022 Argentina Cross-sectional Descriptive Study The study analyzed barriers to accessing health services for women and children in Latin America. It identified healthcare infrastructure, implementing gender equity and empowerment policies, and educational campaigns to change social norms. These solutions aim to increase the use of essential health services and reduce access inequalities. Social Determinants of Access to Health Services for Children with Disabilities Hurtado L et al (32) 2018 Colombia Cross-sectional Descriptive Study The social determinants of access to health services for children with physical disabilities in Buenaventura, Colombia, were analyzed. Barriers identified included lack of installed capacity, availability of services and promotion, as well as administrative, geographical, and mobility obstacles. The study proposed improving healthcare infrastructure and implementing intersectoral policies to address these limitations. Expressions of inequalities in access to health services in Latin America: a scoping review Oliveira, T.S (33) 2024 Brazil Scoping Review Inequalities in access to health services in Latin America over the past ten years were reviewed, analyzing 272 articles. Socioeconomic, sociocultural, and geographical barriers limiting equitable access were identified. The study proposed improving healthcare infrastructure, implementing inclusive policies, and strengthening community education to reduce these inequalities and improve health equity. Integrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities García Sierra et al (34) 2020 Colombia Cross-sectional Descriptive Study The implementation of the Integrated Management of Childhood Illness (IMCI) strategy in 18 Colombian cities was evaluated. Barriers identified included lack of essential medicines, necessary supplies, and second-level care. The study proposed improving resource availability and integrating the health system to reduce fragmentation and improve child care. Knowledge, access and use of the health system by migrant adolescents in Chile: Results of an exploratory study Obach,et al (35) 2020 Chile Qualitative Study The research evaluated the knowledge, access, and use of the health system by migrant adolescents in Santiago, Chile. Barriers identified included migration status, the perceived need for adult accompaniment, and experiences of discrimination. The study proposed improving information about the health system, facilitating access to sexual and mental health services, and strengthening the health sector's presence in schools. Barriers due to specific diseases (n = 10) Accessibility in Health: Review on Children with Disabilities in Brazil-Peru-Colombia Dos Santos et al (18) 2019 Brazil Systematic Review 20% of disabilities are congenital. In Latin America, the lack of health services severely affects children with functional diversity. Barriers include motor difficulties, family vulnerability, scarcity of specialized services, lack of information, late diagnoses, and inadequate public policies and infrastructure. Assessment of Access to Primary Health Care among Children and Adolescents Hospitalized Due to Avoidable Conditions Ferrer et al(36) 2016 Brazil Cross-sectional Descriptive Study The study evaluates access to primary health care (PHC) in children and adolescents hospitalized for avoidable conditions. Results show that 65.2% of hospitalizations were for PHC-sensitive conditions. Barriers include inadequate access, preference for emergency services, and professional attitudes that reinforce inappropriate ideas about service use. Challenges in the Provision of Pediatric Palliative Care in Mexico: A Cross-SectionalWeb-Based Survey Grüneberg et al(37) 2024 Mexico Cross-sectional Descriptive Study Research evaluating the challenges in providing pediatric palliative care in Mexico through an online cross-sectional survey. Barriers identified include the lack of home support teams, absence of training centers, and legal and economic protection for parents. The study proposed increasing awareness and improving the education and training of health professionals. Determinants of care seeking for children with pneumonia and diarrhea in Guatemala: implications for intervention strategies Bruce et al(38) 2014 Guatemala Qualitative Study The study analyzed the determinants of care seeking for children with pneumonia and diarrhea in Guatemala. Barriers identified included the distance to health centers, lack of knowledge about danger signs, and perception of disease severity. The study proposed improving community education, increasing accessibility to health services, and strengthening community emergency plans. Effects of the COVID-19 Pandemic on Social Determinants of Families in the Metropolitan Area of Bucaramanga Niederbacher J et al (39) 2023 Colombia Cross-sectional Descriptive Study Research focused on the effects of the pandemic on the social determinants of families in Bucaramanga. Barriers identified included the cancellation of medical appointments, mental health issues, and difficulties accessing virtual educational tools. The study proposed maintaining essential health services and educational programs during health emergencies to mitigate these impacts. Challenges, priorities, barriers to care, and stigma in families of people with autism: Similarities and differences among six Latin American countries Paula et al (28) 2020 Colombia, Argentina, Uruguay, Brazil, Mexico Qualitative Study The study analyzed challenges, priorities, barriers to care, and stigma in families of people with autism in six Latin American countries. Barriers identified included long waiting lists, high treatment costs, and lack of specialized services. The study proposed increasing community awareness, improving education, and strengthening specialized services to address these limitations. Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review Sanchez et al (40) 2022 Colombia, Argentina, Uruguay, Brasil, Mexico Narrative Review This review highlights disparities in access to care for atopic dermatitis in Latin America. Barriers identified included insufficient knowledge of the disease, cultural and linguistic barriers, stigmatization, unequal distribution of resources, and lack of local clinical guidelines. The study proposed improving education, telemedicine, multidisciplinary teams, and locally adapted clinical guidelines. Health status and barriers in health care for children with birth defects born between 2011 and 2017 in two institutions in Cali Imbachi et al (41) 2020 Colombia Retrospective Study A retrospective study evaluating the implementation of the Integrated Management of Childhood Illness (IMCI) strategy in 18 Colombian cities. Barriers identified included lack of essential medicines, necessary supplies, and second-level care. The study proposed improving resource availability and integrating the health system to reduce fragmentation and improve child care. Meeting of the Pediatric Cancer Working Group (Washington, D.C. February 2–3, 2017) Luciani et al (42) 2017 PAHO Member Countries Expert Consensus The meeting of the Pediatric Cancer Working Group in Washington, D.C. (February 2–3, 2017) addressed barriers to early diagnosis and effective treatment of pediatric cancer in Latin America and the Caribbean. Barriers identified included limitations in access to health services, funding, and international collaboration, highlighting the need for sustainable strategies to improve care and reduce inequalities. The Mental Health Care Gap among Children and Adolescents: Data from an epidemiological survey from Four Brazilian Regions Paula et al (43) 2014 Brazil Cross-sectional Descriptive Study The study on the mental health care gap among children and adolescents in four Brazilian regions revealed that only 19.8% of children with psychiatric disorders received care in the past 12 months. Barriers identified included structural, psychosocial, and demographic factors such as gender, school performance, and socioeconomic status. Vaccination barriers (n = 5) Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies Roberti et al (44) 2024 Argentina Qualitative Study This research aims to analyze barriers and facilitators of vaccination in Latin America through a thematic synthesis of qualitative studies. Facilitators include the perception of vaccination as an effective strategy and recommendations from healthcare professionals. Barriers encompass lack of information, structural issues, religious beliefs, and safety concerns. Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life Boing AF et al. (45) 2024 Brazil Cohorts Study The study analyzed racial inequalities in childhood vaccination in Brazil between 2017 and 2018. It identified significant barriers for Black mothers, such as difficulties accessing vaccination centers. The proposed strategies include equitable public policies and improving healthcare services to address these inequalities and ensure timely vaccination. Social considerations affecting acceptance of HPV vaccination in Colombia. A systematic review Palencia-Sánchez et al(46) 2020 Colombia Systematic Review The study reviewed social factors affecting the acceptance of the HPV vaccine in Colombia. It proposed improving education about HPV, strengthening communication between healthcare professionals and the community, and using media as facilitators. It also recommended including the vaccine in insurance plans to improve access. Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011–2021: temporal trend and spatial dependency Palmieri et al (47) 2023 Brazil Ecological Study A retrospective study evaluated the coverage of the MMR (measles, mumps, and rubella) and polio vaccines in Brazil between 2011 and 2021, highlighting a decrease in coverage. It proposed strategies such as awareness campaigns, improving healthcare infrastructure, and policies to increase confidence in vaccines. These solutions aim to address regional disparities and improve vaccination coverage. Vaccination coverage, barriers and vaccine hesitancy in children up to 24 months old: a population survey in a state capital in the Western Amazon Macedo et al (48) 2024 Brasil Cross-sectional Descriptive Study Research that evaluated vaccination coverage, barriers, and hesitancy in children under 24 months in Rio Branco, Acre. It proposed improving vaccine availability, training healthcare professionals, and educational campaigns to combat misinformation. The results showed coverage below 80%, with the meningococcal C vaccine being the least administered on time. Strategies (n = 5) Health system approaches are needed to expand telemedicine use across nine latin american nations LeRouge et al (30) 2019 Argentina, Chile, Colombia, Costa Rica, Guatemala, Mexico, Panamá, Perú, Uruguay Cross-sectional Descriptive Study The study on telemedicine in Latin America examines how the COVID-19 pandemic accelerated the adoption of telemedicine services in the region. Regulatory, legal, and technological barriers are identified, and strategies are proposed to improve infrastructure and training. The results highlight the need for public policies that promote the integration of telemedicine into healthcare systems. Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis Prada SI et al (31) 2024 Colombia Cross-sectional Descriptive Study A study on the telemedicine program "TeleSalud" at a high-complexity hospital in Cali, Colombia, identified key strategies: improving technological infrastructure, training medical staff in digital tools, and establishing clear policies to integrate telemedicine into the healthcare system. These strategies aim to overcome geographical and socioeconomic barriers, optimizing medical care. Use of Web-based Parent-adolescent Health Promotion Program among Puerto Ricans Varas-Díaz et al(32) 2018 Puerto Rico Experimental Study The study evaluated the web program "Cuídalos" to promote health among Puerto Rican parents and adolescents. It proposed improving access to computers and the Internet, and training parents in the use of digital tools. The results showed low participation, highlighting the need for strategies to increase the use of digital health resources and reduce access disparities. Telemedicine: Pediatric Applications Burke Jr et al (33) 2015 USA Narrative Review The research analyzes the use of telemedicine in pediatrics, focusing on children with chronic diseases, those requiring postoperative follow-up, palliative care, and patients from remote areas. It proposes improving technological infrastructure, training healthcare professionals, and establishing appropriate reimbursement policies. The results show an improvement in care and access for these populations. Assessing the use of cell phones to monitor health and nutrition interventions: Evidence from rural Guatemal Ceballos et al (34) 2020 Guatemala Experimental Study This study evaluated the use of mobile phones to monitor health and nutrition interventions in rural Guatemala. It proposed improving mobile phone penetration, sending SMS reminders, and making phone calls to increase response rates. The results showed that phone calls are more effective than SMS, suggesting their use for efficient and real-time data collection. RESULTS From the three databases consulted, 1,538 articles were identified, of which 36 were duplicates, leaving a total of 1,502 manuscripts. During the title and abstract screening, 58 articles were preliminarily identified as meeting the selection criteria. The remaining articles did not address topics related to barriers to healthcare access in the pediatric population or focused on other themes unrelated to the study's objective. Finally, in the full-text screening, it was determined that 28 articles met the selection criteria and answered the exploratory question of the study. The main reason for discarding articles was the inability to access them (n = 15). Further details on the study selection process can be seen in Fig. 1 . The most frequent type of study was cross-sectional descriptive (n = 12, 41.38%), followed by qualitative studies (n = 5, 17.24%) and systematic reviews (n = 4, 13.33%). Other methodologies found included narrative reviews (n = 2, 6.67%), experimental studies (n = 2, 6.67%), cohort studies (n = 2, 6.67%), exploratory systematic reviews (n = 1, 3.33%), ecological studies (n = 1, 3.33%), and expert consensus (n = 1, 3.33%). Additionally, the year with the highest number of publications was 2024 (n = 7, 23%), followed by 2020 (n = 6, 20%). The rest of the publications by year can be seen in Fig. 2. The articles were classified into categories. The first was the identification of sociodemographic barriers. Eight studies addressed these barriers, highlighting the costs associated with healthcare, the ability to pay, and the distance to health centers. Garcia-Sierra et al. mention that critical factors included the location and infrastructure of the centers, associated with transportation difficulties for families (8, 9). These articles emphasize the importance of implementing comprehensive policies and adapting them to each country's specific sociodemographic challenges (8, 9). A recurring concern is the inequality in access to healthcare services, highlighting a disconnection between different actors in the healthcare system and health inequity between high- and low-income populations (10). Some studies also highlighted the importance of geographical distribution and how it can be a barrier to accessing health centers, as transportation costs prevent travel to health centers. It was shown that many families are willing to travel in search of free healthcare services (11). Another category was vaccination barriers. Six articles highlighted the importance of vaccination in the pediatric age. Immunization plays a fundamental role in preventing infectious diseases and reducing child mortality (12). Several studies highlight vaccination strategies as facilitators to prevent diseases. However, Roberti et al. emphasize the lack of information or knowledge in rural areas about the necessary vaccines for each stage of life as a significant barrier in the pediatric population (13). Similarly, Palmieri et al. agree that the lack of vaccine availability, unfavorable beliefs, and misinformation on the subject, especially in rural areas, negatively influence parents' decisions to vaccinate their children (14). Many parents have doubts about vaccine safety, and when seeking answers at their nearest health centers, they report insufficient and confusing information, leading them to seek other sources of information such as the internet, which could deepen misinformation and deprive children of their right to health (13, 14). During the research, articles highlighting specific pathologies were also found, and the most relevant ones were selected to represent some of them. This category began with studies on access to primary healthcare for children and adolescents hospitalized for acute conditions in Brazil and preventable diseases such as pneumonia and diarrhea care in children from rural areas in Guatemala, revealing significant barriers in both contexts (15, 16). In Brazil, external barriers associated with hospitalizations that could have been treated in primary care were identified (15). In Guatemala, the search for formal care for pneumonia and diarrhea was limited, influenced by factors such as lack of emergency plans, perception of disease severity, and distance to health centers (16). Additionally, pathologies related to birth, such as congenital diseases and disabilities, were analyzed (17, 18). Studies have identified some of the gaps in accessing healthcare services in these populations from their vulnerability, highlighting external barriers associated with the Latin American context and its public policies, as well as those related to disability and its associated comorbidities (17, 18). Regarding prevalent pediatric pathologies, articles of significant clinical importance related to pediatric palliative care in Mexico and pediatric cancer management in Latin America were found. In Mexico, the main barriers identified by professionals in care units were the lack of equipment and support networks outside the hospital; regarding the centers, the absence of training centers and continuous education in palliative care was identified (19). The meeting highlighted the high mortality from pediatric cancer in the region of countries associated with PAHO (20). Both studies mention governmental and civil obstacles, highlighting the lack of public policies, lack of unification among governments, civil society, and academic institutions. Additionally, the lack of early diagnostic identification associated with administrative gaps and problems in specialized care was highlighted. Furthermore, studies on the disparity in mental health care for children and adolescents in Brazil and the challenges faced by caregivers of pediatric populations with autism in six Latin American countries were analyzed, examining the most significant obstacles to comprehensive care for these pathologies. In Brazil, it was identified that only 19.8% of the pediatric population with psychiatric disorders consulted mental health services in the last year, with gender, school performance, and socioeconomic level being the main factors associated with lack of access (21). In Latin America, caregivers of children with autism revealed that administrative barriers such as waiting lists, treatment costs, lack of specialized services, and psychosocial barriers such as high levels of stigmatization and discrimination were among the obstacles to obtaining comprehensive care (22). Both studies highlight the gaps in access to specialized mental health services, their follow-up, and the need for strategies to reduce inequalities and stigma in Latin America. Among skin conditions, atopic dermatitis was noted as a neglected pathology in Latin America due to clinical obstacles such as insufficient knowledge about the disease when diagnosing it, lack of local clinical guidelines, complex patient pathways, and limited consultation time; sociodemographic obstacles included cultural and linguistic barriers and patient stigmatization; administrative obstacles included unequal resource distribution (23). Regarding strategies to mitigate healthcare access barriers for the Latin American pediatric population, telemedicine has been a key tool that has gained strength in recent years. Additionally, the implementation of national policies that support and regulate the use of telemedicine requires improving technological infrastructure, especially in rural and underserved areas, to ensure adequate connectivity for patients (24, 25). Furthermore, the importance of providing continuous training to healthcare professionals in the use of telemedicine technologies is highlighted, ensuring they are prepared to integrate these tools into their daily practice (26). Ensuring funding and resources for its implementation guarantees the sustainability of telemedicine programs (27). Finally, the adoption of a comprehensive approach that addresses regulatory, legal, financial, technological, organizational, and human barriers in a coordinated manner is emphasized to maximize the impact of telemedicine and improve access to high-quality healthcare services in the region (24). DISCUSSION This systematic review provides an analysis of the barriers to healthcare access in rural pediatric populations in Latin America, focusing on the various strategies that have been used, and which have been effective in improving healthcare access for this population. It identifies gaps and limitations that are more commonly found in this population, providing recommendations that may help reach a consensus in the future to improve pediatric health. Sociodemographic Barriers in Pediatric Healthcare It is estimated that around 200 million children under the age of 5 living in low- and middle-income countries do not reach their potential due to exposure to environmental, biological, and psychosocial risk factors (11). Several authors agree that geographical barriers hinder children's access to healthcare services, as long distances and insufficient transportation prevent them from reaching health centers (8, 9, 10, 11). This implies that healthcare becomes fragmented, and continuity of care is not maintained, leading parents to take their children to health centers only when they are sick, preventing the proper implementation of health promotion and prevention strategies. Ultimately, this represents a higher risk of developing short- and long-term health complications in children and higher costs for healthcare systems. On the other hand, although the region has a high rate of affiliation with social security systems, the lack of economic resources, excessive bureaucracy, and prolonged response times, combined with the long distances families must travel, further hinder timely healthcare access. Therefore, governments should implement strategies and policies that ensure more equitable access to healthcare services (10, 23). Vaccination Barriers Latin America continues to have low vaccination coverage, which represents a significant public health problem. To achieve broad vaccination coverage, Robierti et al. identify facilitators in vaccination access and some barriers, highlighting the lack of truthful and understandable information, influenced by cultural and religious factors, which makes families and caregivers reluctant to seek this service (29). Additionally, the inability of many families and healthcare systems to meet this need, combined with infrastructure incapable of properly storing these medications, reduces the rates of complete vaccination in children. However, other racial barriers have been identified. Boing et al. found that being of African descent meant that mothers and their children were less likely to have access to vaccination compared to Caucasian mothers and children. It is imperative that governments implement strategies to combat systemic racism in healthcare systems (12). Communities also play an important role in the successful implementation of vaccination programs. An example of this was the stance of a community in Colombia, where misinformation provided by some media outlets made it difficult for parents to accept vaccinating their daughters with the human papillomavirus (HPV) vaccine (31). This highlights the importance of implementing appropriate information campaigns and the impact that communities can have on children's health decisions. Barriers Due to Specific Prevalent Diseases in the Pediatric Population In the region, several studies have analyzed the barriers to healthcare access faced by children with certain medical conditions. While some of these barriers are specific to each disease, many authors agree on the presence of some common barriers for different types of diseases. Firstly, both medical personnel and caregivers have identified a lack of institutional and governmental support due to insufficient human resources or infrastructure to meet the special needs of this population (28), as evidenced by studies conducted on pediatric populations with mental health disorders and cancer (28–31). Furthermore, the education of both parents and healthcare professionals is crucial to reducing the healthcare gap for these children and adolescents. On the one hand, it is important for parents and caregivers to be trained to recognize the warning signs of their children's diseases (16); this means they must understand what the disease is, how it manifests, and how it is treated. To achieve this, healthcare professionals must be prepared and have sufficient knowledge to provide adequate care to children with special health needs and to clarify any doubts caregivers may have. This could be achieved by promoting the creation of new scientific knowledge through local clinical practice guidelines (21, 23). Additionally, considering that Latin America is a culturally and ethnically diverse region, the training of healthcare personnel should not be limited to the clinical aspect alone. It is relevant for healthcare personnel to acquire new knowledge to approach different ethnic contexts more appropriately and thus achieve a greater impact (21, 23). Strategies to Overcome Healthcare Access Barriers in the Latin American Pediatric Population There are strategies that have been implemented to improve healthcare access in Latin America. Since the COVID-19 pandemic, strategies that remain relevant due to their usefulness in addressing geographical, environmental, and economic barriers, such as telemedicine, have been implemented (24). LeRouge et al. have presented this tool as a response to the problem of inequality in access to medical consultations and how it has increased the efficiency of healthcare for non-urgent reasons in primary stages, reducing the number of complications due to lack of care. In the application of this tool in remote communities that have access only by air or sea, several shortcomings were identified to ensure this technology, such as the use of a stable internet network to ensure continuous connectivity (25). Additionally, several authors have identified other areas where these technologies could be further developed, such as expanding modalities in tele-education, teleconsultation, telepractice, and tele-research, using digital applications to strengthen remote and comprehensive healthcare access for all (33) Study Limitations This scoping review is based on a limited number of articles, which may not fully represent the diversity of healthcare access barriers for children and adolescents in rural Latin American regions. An important limitation is the variability in the quality and focus of the studies. Some articles provide robust quantitative data on the magnitude of the identified barriers, while others rely on narratives and qualitative observations. This methodological heterogeneity makes it difficult to compare and synthesize the findings. Therefore, to extrapolate the findings to real-life situations, experimental studies with significant samples and ideally from culturally and ethnically diverse populations are required to achieve results with greater reach and provide more accurate data. Moreover, most studies focus on sociodemographic and vaccination barriers, leaving other barriers related to specific diseases and strategies to mitigate these barriers underexplored. For example, Shibukawa et al. (10) identified significant barriers such as geographical distance and lack of economic resources. However, the review does not delve into how these barriers vary between different subregions or specific populations in Latin America. This could limit the applicability of the recommendations to diverse local contexts. CONCLUSIONS This scoping review identifies various barriers affecting healthcare access for the pediatric population in Latin America, allowing them to be grouped into categories such as sociodemographic barriers, vaccination barriers, barriers related to specific diseases, and strategies to mitigate them. It also highlights telemedicine as a key strategy to improve access in remote areas, allowing families to consult with healthcare professionals specialized in pediatric care, ensuring timely and effective interventions for children. However, its effectiveness depends on internet availability, adequately trained healthcare personnel, and the necessary infrastructure to provide this type of care. Nevertheless, the study presented limitations such as the limited number of reviewed articles and the variability in the quality and focus of the included studies. Additionally, robust methodologies and significant samples are required to ensure the applicability of the recommendations and not underestimate practical challenges such as the implementation of various technological strategies like telemedicine. Declarations AUTHOR CONTRIBUTIONS LMGT: Conceptualization, Methodology, Formal analysis, Investigation, Writing – Original Draft, Writing, Review & Editing, Visualization. LKGC AND JSCL: Formal analysis, Investigation, Data Curation, Writing Original Draft and Review & Editing, Visualization. Erwin Hernándo Hernández: Methodology, Visualization, Supervision, Project administration and Funding acquisition. Ethics approval This study was approved by the Ethics Committee from the Universidad de La Sabana. Availability of data and materials Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was funded by the Universidad de La Sabana (Project MED-342-2023). Acknowledgements Not applicable. References UNICEF. INDICE DE GESTIÓN DE RIESGOS PARA AMÉRICA LATINA Y EL CARIBE Actualización INFORM-LAC 2018 Femke [Date] [Course title] [Internet]. [cited 2024 Dec 4]. Available from: https://www.unicef.org/lac/media/1601/file ANALIZAR Y SUPERAR LAS BARRERAS DE ACCESO PARA FORTALECER LA ATENCIÓN PRIMARIA DE SALUD: Síntesis de resultados y recomendaciones. 2023. Departamento Nacional de Planeación de Colombia DNP. Barreras de acceso a la salud. 2022. Organización Panamericana de la Salud. Salud Universal. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol [Internet]. 2005;8(1):19–32. Available from: https://doi.org/10.1080/1364557032000119616 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467–73. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan—a web and mobile app for systematic reviews. Syst Rev [Internet]. 2016;5(1):210. Available from: https://doi.org/10.1186/s13643-016-0384-4 Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: JBI Manual for Evidence Synthesis. JBI; 2024. García Sierra AM, Ocampo Cañas JA. Integrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities. BMC Public Health. 2020 Dec 16;20(1):1122. Azañedo CMG, Alvarado BGR, Mendoza Castillo ÁLLF, Pollack WEI, Puscan MWV. Access to public health services in Latin America, A systematic literature review 2012–2022. In: Proceedings of the LACCEI international Multi-conference for Engineering, Education and Technology. Latin American and Caribbean Consortium of Engineering Institutions; 2022. Shibukawa BMC, Rissi GP, Uema RTB, Furtado MD, Merino M de FGL, Higarashi IH. Absenteeism in child health services: a systematic review. Vol. 76, Revista Brasileira de Enfermagem. Associacao Brasilerira de Enfermagem; 2023. Boing AF, Boing AC, França AP, Moraes JC de, Silva AI da, Ramos Jr. AN, et al. Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life. Epidemiologia e Serviços de Saúde. 2024;33(spe2). Roberti J, Ini N, Belizan M, Alonso JP. Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies. Cad Saude Publica. 2024;40(6). Palmieri IGS, Lima LV de, Pavinati G, Silva JAP, Marcon SS, Sato APS, et al. Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011–2021: temporal trend and spatial dependency. Revista Brasileira de Epidemiologia. 2023;26. Ferrer APS, Grisi SJFE. Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions. Rev Assoc Med Bras. 2016 Sep 1;62(6):513–22. Bruce N, Pope D, Arana B, Shiels C, Romero C, Klein R, et al. Determinants of Care Seeking for Children With Pneumonia and Diarrhea in Guatemala: Implications for Intervention Strategies. Am J Public Health. 2014 Apr;104(4):647–57. Imbachi LF, Ibañez LM, Hurtado-Villa P. Estado de salud y barreras en la atención de niños con defectos congénitos nacidos entre el 2011 y el 2017 en dos instituciones de salud de Cali. Biomédica. 2020 Mar 1;40(1):34–42. Dos Santos DBC, Vázquez-Ramos V, Da Costa Cunha Oliveira C, López-Arellano O. Accessibility in the area of health: A review of children with disabilities in Brazil- Peru-Colombia. Revista Latinoamericana de Ciencias Sociales, Ninez y Juventud. 2019;17(2):1–20. Grüneberg ES, Ramos-Guerrero J, Pastrana T. Challenges in the Provision of Pediatric Palliative Care in Mexico: A Cross-Sectional Web-Based Survey. J Palliat Care. 2024 Jan 13;39(1):58–67. Organización Panamericana de la Salud. https://www.paho.org/es/temas/salud-universal. 2024. Salud Universal. Available from: https://www.paho.org/es/temas/salud-universal Paula CS, Bordin IAS, Mari JJ, Velasque L, Rohde LA, Coutinho ESF. The Mental Health Care Gap among Children and Adolescents: Data from an Epidemiological Survey from Four Brazilian Regions. PLoS One. 2014 Feb 18;9(2):e88241. Paula CS, Cukier S, Cunha GR, Irarrázaval M, Montiel-Nava C, Garcia R, et al. Challenges, priorities, barriers to care, and stigma in families of people with autism: Similarities and differences among six Latin American countries. Autism. 2020 Nov 27;24(8):2228–42. Sánchez J, Ale IS, Angles MV, Fogelbach GG, Jansen AM, Takaoka R, et al. Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review. Dermatol Ther (Heidelb). 2023 Feb 23;13(2):399–416. Prada SI, Toro JJ, Peña-Zárate EE, Libreros-Peña L, Alarcón J, Escobar MF. Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis. BMJ Open. 2024 May 1;14(5):e084447. Libreros-Peña L, Quintero JA, Gelves A, Alarcón J, Morales S, Escobar MF, et al. Telemedicine consultation for emergency patients’ attention: a clinical experience from a high complex university hospital from Latin America. BMC Health Serv Res. 2023 Dec 1;23(1). LeRouge CM, Gupta M, Corpart G, Arrieta A. Health System Approaches Are Needed To Expand Telemedicine Use Across Nine Latin American Nations. Health Aff. 2019 Feb;38(2):212–21. LeRouge CM, Gupta M, Corpart G, Arrieta A. Health System Approaches Are Needed To Expand Telemedicine Use Across Nine Latin American Nations. Health Aff. 2019 Feb;38(2):212–21. Paula CS, Cukier S, Cunha GR, Irarrázaval M, Montiel-Nava C, Garcia R, et al. Challenges, priorities, barriers to care, and stigma in families of people with autism: Similarities and differences among six Latin American countries. Autism. 2020 Nov 27;24(8):2228–42. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5828056","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":403729160,"identity":"b39e94ff-93ff-463e-9a7d-6401ce1c7ce7","order_by":0,"name":"Laura María Gómez Trujillo","email":"","orcid":"","institution":"Universidad de La Sabana","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"María Gómez","lastName":"Trujillo","suffix":""},{"id":403729161,"identity":"e703b3a1-ffde-4e26-9886-ead652e78c5e","order_by":1,"name":"Laura Katherine Guio Cruz","email":"","orcid":"","institution":"Universidad de La Sabana","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"Katherine Guio","lastName":"Cruz","suffix":""},{"id":403729162,"identity":"0b7fc880-00d5-4ff9-8c4e-f7f5d9734e44","order_by":2,"name":"Juan Sebastián Criales Laguado","email":"","orcid":"","institution":"Universidad de La Sabana","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Sebastián Criales","lastName":"Laguado","suffix":""},{"id":403729163,"identity":"7c0df6c9-e2a4-4678-a14c-721d131bae9b","order_by":3,"name":"Erwin Hernando Hernández Rincón","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYJCCA4wNDHIMDEASiMBAghgtxqRpAalMbIAyCGvhlz5jeLhwx730Dbebmz/83GGXx9/AfPA2D4OdHC4tkn05BodnninO3XDnYJtk75nkYokDbMnWPAzJxri0GJzh3XCYty0hd8ONxDYG3jbmxIYDPGbSPAwHEhtwaLGHakk3uJHY/PFvW33i/AP83/BqMeCBaEkAammQ5m07nLjhAA8bXi0SZ/g/gLQYzgQ6TFr2zPHEjYfZjC3nGOD2C38PW/JnoBZ5vhvpjz++3VGdOO9488MbbypwhxgWwAx2MAkaRsEoGAWjYBRgAADT1VsZJ3cicQAAAABJRU5ErkJggg==","orcid":"","institution":"Universidad de La Sabana","correspondingAuthor":true,"prefix":"","firstName":"Erwin","middleName":"Hernando Hernández","lastName":"Rincón","suffix":""}],"badges":[],"createdAt":"2025-01-14 14:53:03","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5828056/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5828056/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":74427718,"identity":"43086575-a9f1-476f-851f-04346bb8d0e2","added_by":"auto","created_at":"2025-01-22 08:15:24","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":46010,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA Flow diagram.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5828056/v1/9a82c4a87af6bc72e9e291e9.png"},{"id":74427717,"identity":"4bab2f0c-5fd9-4863-ae53-fc23ebe2d522","added_by":"auto","created_at":"2025-01-22 08:15:24","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37168,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eNumber of Publications by year.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5828056/v1/ca44d90feefbeddaa7dd5ce0.png"},{"id":74428216,"identity":"7a12f688-9541-43a8-a1e8-303ffd8b23fc","added_by":"auto","created_at":"2025-01-22 08:23:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1282173,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5828056/v1/a3f9badf-f108-4e2e-a51e-9017f18d9ce7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Barriers to Accessing Pediatric Health Care in Latin America: A Scoping Review","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eLatin America is characterized by having multiple rural areas with high vulnerability risk. According to the Risk Management Index (INFORM), the countries with the highest levels of socioeconomic vulnerability are Guatemala, Haiti, and Honduras (1). The region's healthcare expenditure has represented 6.64% of its gross domestic product (GDP) over the past 20 years, a much lower figure compared to the median of 8.97% in the countries of the Organization for Economic Cooperation and Development (OECD) (6). Additionally, it is estimated that in 15 countries, around 29.3% of the population had unmet healthcare needs, equivalent to approximately 295\u0026nbsp;million people (2).\u003c/p\u003e \u003cp\u003eWhen discussing health vulnerability, it involves considering multiple causes that create barriers to accessing healthcare. The main barriers include financial, due to the lack of resources to pay for consultations or treatments; bureaucratic, due to coverage or treatment authorization issues; and geographical, due to distances and poor road infrastructure (7). These factors constitute obstacles that prevent vulnerable populations from obtaining the medical care they require, especially the pediatric population, which has been significantly affected for a considerable time (3).\u003c/p\u003e \u003cp\u003eAccording to the Pan American Health Organization (PAHO), around one-third of people in Latin America (29.3%) report not seeking healthcare when needed due to multiple access barriers (3). These barriers disproportionately impact caregivers and, consequently, the dependent pediatric population. The lack of timely and adequate care not only affects their immediate well-being but also has long-term repercussions on their physical, emotional, and cognitive development (4).\u003c/p\u003e \u003cp\u003eFurthermore, the pediatric population is especially vulnerable, understood as the inability to effectively resist or cope with threatening phenomena (8). In Latin America, this situation is exacerbated by obstacles to accessing healthcare services, worsened by poverty and inequality. According to UNICEF (5), 81\u0026nbsp;million children in the region live in poverty, and total family incomes are insufficient to meet basic needs. Additionally, regional reports indicate that factors such as the lack of rural healthcare infrastructure, the shortage of healthcare professionals, and the direct and indirect costs of medical care significantly contribute to this issue (5).\u003c/p\u003e \u003cp\u003eIt is important to understand that healthcare access is universal, implying that all individuals and communities should have access without any discrimination (5). This review is relevant because it will identify the barriers to healthcare access in vulnerable pediatric populations in Latin America. It also aims to recognize effective strategies that have been proven to overcome these barriers and strive for equal healthcare access, highlighting the use of telemedicine. This tool is utilized in teleconsultation, telepractice, tele-research, and the use of applications by specialists and other healthcare actors (33). In this context, the study aims to analyze previously implemented primary care programs and models, integrating them with the specific barriers affecting the pediatric population in rural areas of Latin America.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eAn exploratory systematic review was conducted in December 2024 using the methodology proposed by Arksey and O\u0026rsquo;Malley (5) and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (6). The objective of this study was to identify research conducted in the last 10 years on the barriers to accessing various healthcare services faced by the pediatric population in Latin America and strategies that have reduced this vulnerability through primary healthcare over the years. The process employed for this review is explained below.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy and Identification of Relevant Studies\u003c/h2\u003e \u003cp\u003eThe search for articles began with the selection of Medical Subject Heading (MeSH) and Health Science Descriptors (DeCs) terms such as: Barriers to Healthcare Access, Child Health, Primary Healthcare, previously defined to answer the exploratory research question, generating different search strategies.\u003c/p\u003e \u003cp\u003eThe literature search was conducted in virtual databases such as BIREME, PubMed, and Scopus. Filters were applied during the process to limit articles written in English and Spanish, published between 2014 and 2024. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the search strategies and filters applied.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSearch strategy used in every database and the applied filters.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDatabase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSearch Strategy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFilters Used\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePubMed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Barriers of access) AND (primary care) AND (pediatric health) AND (Latinoamerica)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime frame: 2014 to 2024\u003c/p\u003e \u003cp\u003eLanguage: Spanish and English\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBIREME\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Barriers to health access) OR (Barriers to health services access) AND (Child health) AND (Latin America) OR (America)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime frame: 2014 to 2024\u003c/p\u003e \u003cp\u003eLanguage: Spanish and English\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScopus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(barriers AND access AND latin AND america AND health)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTime frame: 2014 to 2024\u003c/p\u003e \u003cp\u003eLanguage: Spanish and English\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Selection\u003c/h3\u003e\n\u003cp\u003eAfter conducting the literature search, all references were filtered and managed through the virtual tool RAYYAN (7). Using this tool and considering the search elements, the study selection was carried out in several steps. Initially, duplicate articles were identified and removed. Then, an initial screening was conducted based solely on the title and abstract of the studies, selecting those with the potential to answer the exploratory question. Thirdly, based on the selection criteria, a second screening was performed with a full-text reading, evaluating the relevance of the articles and their alignment with the proposed objective.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eThe selection criteria were established using the PCC (Population-Concept-Context) strategy proposed by the Joanna Briggs Institute (8). Studies focused on vulnerable pediatric populations in Latin America were included, as well as studies mentioning the use of strategies that have proven effective in overcoming healthcare access barriers in vulnerable regions or those that may present healthcare access barriers. Studies involving pregnant women and/or populations over 18 years old were excluded, as well as case reports, unpublished theses and academic works, and studies related to major cities or high-income countries.\u003c/p\u003e\n\u003ch3\u003eData Extraction and Tabulation\u003c/h3\u003e\n\u003cp\u003eData extraction was performed using a tabulation form, which was constantly adjusted to ensure the quality of the information. Researchers defined variables to collect relevant data from each article included in this study. The extraction and tabulation process were carried out iteratively.\u003c/p\u003e\n\u003ch3\u003eData Collection, Summary, and Reporting of Results\u003c/h3\u003e\n\u003cp\u003eFinally, the extracted information was analyzed during data tabulation and organized into relevant subcategories based on the frequency of certain thematic axes such as: sociodemographic barriers, vaccination barriers, barriers in specific diseases, and strategies to overcome them, as these were the most frequent in the analyzed studies. The results were summarized and presented in tables and diagrams, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNarrative Synthesis of Results organized by subcategories. Own elaboration.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType of Study\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eSociodemographic barriers (n\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsenteeism in child health services: a systematic review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMachado et al(29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSystematic Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA systematic review across 19 databases identified that over 200\u0026nbsp;million children in developing countries do not reach their potential due to risk factors. Absenteeism from appointments is high (69.4%), influenced by cultural, economic, and organizational barriers. Health education and respectful care improve adherence to child health services.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccess to public health services in Latin America, A systematic literature review 2012\u0026ndash;2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAza\u0026ntilde;edo et al (10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePeru\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSystematic Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe health system in Latin America faces challenges due to budget constraints and social inequalities. Inadequate geographical distribution and lack of resources limit equitable access, especially in rural areas. Bureaucracy and lack of funding exacerbate the situation, affecting adolescents and vulnerable communities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdolescent males in the City of Buenos Aires: gender-based barriers to health care and prevention.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTajer et al (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eArgentina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQualitative Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe research addresses the difficulty of including the experiences and needs of adolescent males in clinical models. It focuses on identifying and analyzing professional perceptions of their health demands. Adolescence is a period of exploration and self-discovery, crucial for the development of gender identity and sexual orientation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarriers to access to health services for women and children in Latin America\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHoughton et al (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eArgentina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study analyzed barriers to accessing health services for women and children in Latin America. It identified healthcare infrastructure, implementing gender equity and empowerment policies, and educational campaigns to change social norms. These solutions aim to increase the use of essential health services and reduce access inequalities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Determinants of Access to Health Services for Children with Disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHurtado L et al (32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe social determinants of access to health services for children with physical disabilities in Buenaventura, Colombia, were analyzed. Barriers identified included lack of installed capacity, availability of services and promotion, as well as administrative, geographical, and mobility obstacles. The study proposed improving healthcare infrastructure and implementing intersectoral policies to address these limitations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExpressions of inequalities in access to health services in Latin America: a scoping review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOliveira, T.S (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eScoping Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInequalities in access to health services in Latin America over the past ten years were reviewed, analyzing 272 articles. Socioeconomic, sociocultural, and geographical barriers limiting equitable access were identified. The study proposed improving healthcare infrastructure, implementing inclusive policies, and strengthening community education to reduce these inequalities and improve health equity.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGarc\u0026iacute;a Sierra et al (34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe implementation of the Integrated Management of Childhood Illness (IMCI) strategy in 18 Colombian cities was evaluated. Barriers identified included lack of essential medicines, necessary supplies, and second-level care. The study proposed improving resource availability and integrating the health system to reduce fragmentation and improve child care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge, access and use of the health system by migrant adolescents in Chile: Results of an exploratory study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eObach,et al (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQualitative Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe research evaluated the knowledge, access, and use of the health system by migrant adolescents in Santiago, Chile. Barriers identified included migration status, the perceived need for adult accompaniment, and experiences of discrimination. The study proposed improving information about the health system, facilitating access to sexual and mental health services, and strengthening the health sector's presence in schools.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBarriers due to specific diseases (n\u0026thinsp;=\u0026thinsp;10)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccessibility in Health: Review on Children with Disabilities in Brazil-Peru-Colombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDos Santos et al (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSystematic Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20% of disabilities are congenital. In Latin America, the lack of health services severely affects children with functional diversity. Barriers include motor difficulties, family vulnerability, scarcity of specialized services, lack of information, late diagnoses, and inadequate public policies and infrastructure.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment of Access to Primary Health Care among Children and Adolescents Hospitalized Due to Avoidable Conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFerrer et al(36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study evaluates access to primary health care (PHC) in children and adolescents hospitalized for avoidable conditions. Results show that 65.2% of hospitalizations were for PHC-sensitive conditions. Barriers include inadequate access, preference for emergency services, and professional attitudes that reinforce inappropriate ideas about service use.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChallenges in the Provision of Pediatric Palliative Care in Mexico: A Cross-SectionalWeb-Based Survey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGr\u0026uuml;neberg et al(37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMexico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eResearch evaluating the challenges in providing pediatric palliative care in Mexico through an online cross-sectional survey. Barriers identified include the lack of home support teams, absence of training centers, and legal and economic protection for parents. The study proposed increasing awareness and improving the education and training of health professionals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeterminants of care seeking for children with pneumonia and diarrhea in Guatemala: implications for intervention strategies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBruce et al(38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGuatemala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQualitative Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study analyzed the determinants of care seeking for children with pneumonia and diarrhea in Guatemala. Barriers identified included the distance to health centers, lack of knowledge about danger signs, and perception of disease severity. The study proposed improving community education, increasing accessibility to health services, and strengthening community emergency plans.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffects of the COVID-19 Pandemic on Social Determinants of Families in the Metropolitan Area of Bucaramanga\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNiederbacher J et al (39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eResearch focused on the effects of the pandemic on the social determinants of families in Bucaramanga. Barriers identified included the cancellation of medical appointments, mental health issues, and difficulties accessing virtual educational tools. The study proposed maintaining essential health services and educational programs during health emergencies to mitigate these impacts.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChallenges, priorities, barriers to care, and stigma in families of people with autism: Similarities and differences among six Latin American countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaula et al (28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia, Argentina, Uruguay, Brazil, Mexico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQualitative Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study analyzed challenges, priorities, barriers to care, and stigma in families of people with autism in six Latin American countries. Barriers identified included long waiting lists, high treatment costs, and lack of specialized services. The study proposed increasing community awareness, improving education, and strengthening specialized services to address these limitations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSanchez et al (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia, Argentina, Uruguay, Brasil, Mexico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNarrative Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThis review highlights disparities in access to care for atopic dermatitis in Latin America. Barriers identified included insufficient knowledge of the disease, cultural and linguistic barriers, stigmatization, unequal distribution of resources, and lack of local clinical guidelines. The study proposed improving education, telemedicine, multidisciplinary teams, and locally adapted clinical guidelines.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth status and barriers in health care for children with birth defects born between 2011 and 2017 in two institutions in Cali\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImbachi et al (41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRetrospective Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA retrospective study evaluating the implementation of the Integrated Management of Childhood Illness (IMCI) strategy in 18 Colombian cities. Barriers identified included lack of essential medicines, necessary supplies, and second-level care. The study proposed improving resource availability and integrating the health system to reduce fragmentation and improve child care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeeting of the Pediatric Cancer Working Group (Washington, D.C. February 2\u0026ndash;3, 2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLuciani et al (42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePAHO Member Countries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExpert Consensus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe meeting of the Pediatric Cancer Working Group in Washington, D.C. (February 2\u0026ndash;3, 2017) addressed barriers to early diagnosis and effective treatment of pediatric cancer in Latin America and the Caribbean. Barriers identified included limitations in access to health services, funding, and international collaboration, highlighting the need for sustainable strategies to improve care and reduce inequalities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe Mental Health Care Gap among Children and Adolescents: Data from an epidemiological survey from Four Brazilian Regions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaula et al (43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study on the mental health care gap among children and adolescents in four Brazilian regions revealed that only 19.8% of children with psychiatric disorders received care in the past 12 months. Barriers identified included structural, psychosocial, and demographic factors such as gender, school performance, and socioeconomic status.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaccination barriers (n\u0026thinsp;=\u0026thinsp;5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoberti et al (44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eArgentina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQualitative Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThis research aims to analyze barriers and facilitators of vaccination in Latin America through a thematic synthesis of qualitative studies. Facilitators include the perception of vaccination as an effective strategy and recommendations from healthcare professionals. Barriers encompass lack of information, structural issues, religious beliefs, and safety concerns.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRacial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoing AF et al. (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCohorts Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study analyzed racial inequalities in childhood vaccination in Brazil between 2017 and 2018. It identified significant barriers for Black mothers, such as difficulties accessing vaccination centers. The proposed strategies include equitable public policies and improving healthcare services to address these inequalities and ensure timely vaccination.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial considerations affecting acceptance of HPV vaccination in Colombia. A systematic review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalencia-S\u0026aacute;nchez et al(46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSystematic Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study reviewed social factors affecting the acceptance of the HPV vaccine in Colombia. It proposed improving education about HPV, strengthening communication between healthcare professionals and the community, and using media as facilitators. It also recommended including the vaccine in insurance plans to improve access.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccination coverage of triple viral and poliomyelitis in Brazil, 2011\u0026ndash;2021: temporal trend and spatial dependency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalmieri et al (47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEcological Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA retrospective study evaluated the coverage of the MMR (measles, mumps, and rubella) and polio vaccines in Brazil between 2011 and 2021, highlighting a decrease in coverage. It proposed strategies such as awareness campaigns, improving healthcare infrastructure, and policies to increase confidence in vaccines. These solutions aim to address regional disparities and improve vaccination coverage.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccination coverage, barriers and vaccine hesitancy in children up to 24 months old: a population survey in a state capital in the Western Amazon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMacedo et al (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrasil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eResearch that evaluated vaccination coverage, barriers, and hesitancy in children under 24 months in Rio Branco, Acre. It proposed improving vaccine availability, training healthcare professionals, and educational campaigns to combat misinformation. The results showed coverage below 80%, with the meningococcal C vaccine being the least administered on time.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStrategies (n\u0026thinsp;=\u0026thinsp;5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth system approaches are needed to expand telemedicine use across nine latin american nations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeRouge et al (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eArgentina, Chile, Colombia, Costa Rica, Guatemala, Mexico, Panam\u0026aacute;, Per\u0026uacute;, Uruguay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study on telemedicine in Latin America examines how the COVID-19 pandemic accelerated the adoption of telemedicine services in the region. Regulatory, legal, and technological barriers are identified, and strategies are proposed to improve infrastructure and training. The results highlight the need for public policies that promote the integration of telemedicine into healthcare systems.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImpact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrada SI et al (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eColombia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCross-sectional Descriptive Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA study on the telemedicine program \"TeleSalud\" at a high-complexity hospital in Cali, Colombia, identified key strategies: improving technological infrastructure, training medical staff in digital tools, and establishing clear policies to integrate telemedicine into the healthcare system. These strategies aim to overcome geographical and socioeconomic barriers, optimizing medical care.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of Web-based Parent-adolescent Health Promotion Program among Puerto Ricans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaras-D\u0026iacute;az et al(32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePuerto Rico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExperimental Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe study evaluated the web program \"Cu\u0026iacute;dalos\" to promote health among Puerto Rican parents and adolescents. It proposed improving access to computers and the Internet, and training parents in the use of digital tools. The results showed low participation, highlighting the need for strategies to increase the use of digital health resources and reduce access disparities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelemedicine: Pediatric Applications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurke Jr et al (33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNarrative Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThe research analyzes the use of telemedicine in pediatrics, focusing on children with chronic diseases, those requiring postoperative follow-up, palliative care, and patients from remote areas. It proposes improving technological infrastructure, training healthcare professionals, and establishing appropriate reimbursement policies. The results show an improvement in care and access for these populations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessing the use of cell phones to monitor health and nutrition interventions: Evidence from rural Guatemal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCeballos et al (34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGuatemala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eExperimental Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eThis study evaluated the use of mobile phones to monitor health and nutrition interventions in rural Guatemala. It proposed improving mobile phone penetration, sending SMS reminders, and making phone calls to increase response rates. The results showed that phone calls are more effective than SMS, suggesting their use for efficient and real-time data collection.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFrom the three databases consulted, 1,538 articles were identified, of which 36 were duplicates, leaving a total of 1,502 manuscripts. During the title and abstract screening, 58 articles were preliminarily identified as meeting the selection criteria. The remaining articles did not address topics related to barriers to healthcare access in the pediatric population or focused on other themes unrelated to the study's objective. Finally, in the full-text screening, it was determined that 28 articles met the selection criteria and answered the exploratory question of the study. The main reason for discarding articles was the inability to access them (n\u0026thinsp;=\u0026thinsp;15). Further details on the study selection process can be seen in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The most frequent type of study was cross-sectional descriptive (n\u0026thinsp;=\u0026thinsp;12, 41.38%), followed by qualitative studies (n\u0026thinsp;=\u0026thinsp;5, 17.24%) and systematic reviews (n\u0026thinsp;=\u0026thinsp;4, 13.33%). Other methodologies found included narrative reviews (n\u0026thinsp;=\u0026thinsp;2, 6.67%), experimental studies (n\u0026thinsp;=\u0026thinsp;2, 6.67%), cohort studies (n\u0026thinsp;=\u0026thinsp;2, 6.67%), exploratory systematic reviews (n\u0026thinsp;=\u0026thinsp;1, 3.33%), ecological studies (n\u0026thinsp;=\u0026thinsp;1, 3.33%), and expert consensus (n\u0026thinsp;=\u0026thinsp;1, 3.33%). Additionally, the year with the highest number of publications was 2024 (n\u0026thinsp;=\u0026thinsp;7, 23%), followed by 2020 (n\u0026thinsp;=\u0026thinsp;6, 20%). The rest of the publications by year can be seen in Fig.\u0026nbsp;2.\u003c/p\u003e\n\u003cp\u003eThe articles were classified into categories. The first was the identification of sociodemographic barriers. Eight studies addressed these barriers, highlighting the costs associated with healthcare, the ability to pay, and the distance to health centers. Garcia-Sierra et al. mention that critical factors included the location and infrastructure of the centers, associated with transportation difficulties for families (8, 9). These articles emphasize the importance of implementing comprehensive policies and adapting them to each country's specific sociodemographic challenges (8, 9). A recurring concern is the inequality in access to healthcare services, highlighting a disconnection between different actors in the healthcare system and health inequity between high- and low-income populations (10). Some studies also highlighted the importance of geographical distribution and how it can be a barrier to accessing health centers, as transportation costs prevent travel to health centers. It was shown that many families are willing to travel in search of free healthcare services (11).\u003c/p\u003e\n\u003cp\u003eAnother category was vaccination barriers. Six articles highlighted the importance of vaccination in the pediatric age. Immunization plays a fundamental role in preventing infectious diseases and reducing child mortality (12). Several studies highlight vaccination strategies as facilitators to prevent diseases. However, Roberti et al. emphasize the lack of information or knowledge in rural areas about the necessary vaccines for each stage of life as a significant barrier in the pediatric population (13). Similarly, Palmieri et al. agree that the lack of vaccine availability, unfavorable beliefs, and misinformation on the subject, especially in rural areas, negatively influence parents' decisions to vaccinate their children (14). Many parents have doubts about vaccine safety, and when seeking answers at their nearest health centers, they report insufficient and confusing information, leading them to seek other sources of information such as the internet, which could deepen misinformation and deprive children of their right to health (13, 14).\u003c/p\u003e\n\u003cp\u003eDuring the research, articles highlighting specific pathologies were also found, and the most relevant ones were selected to represent some of them. This category began with studies on access to primary healthcare for children and adolescents hospitalized for acute conditions in Brazil and preventable diseases such as pneumonia and diarrhea care in children from rural areas in Guatemala, revealing significant barriers in both contexts (15, 16). In Brazil, external barriers associated with hospitalizations that could have been treated in primary care were identified (15). In Guatemala, the search for formal care for pneumonia and diarrhea was limited, influenced by factors such as lack of emergency plans, perception of disease severity, and distance to health centers (16).\u003c/p\u003e\n\u003cp\u003eAdditionally, pathologies related to birth, such as congenital diseases and disabilities, were analyzed (17, 18). Studies have identified some of the gaps in accessing healthcare services in these populations from their vulnerability, highlighting external barriers associated with the Latin American context and its public policies, as well as those related to disability and its associated comorbidities (17, 18).\u003c/p\u003e\n\u003cp\u003eRegarding prevalent pediatric pathologies, articles of significant clinical importance related to pediatric palliative care in Mexico and pediatric cancer management in Latin America were found. In Mexico, the main barriers identified by professionals in care units were the lack of equipment and support networks outside the hospital; regarding the centers, the absence of training centers and continuous education in palliative care was identified (19). The meeting highlighted the high mortality from pediatric cancer in the region of countries associated with PAHO (20). Both studies mention governmental and civil obstacles, highlighting the lack of public policies, lack of unification among governments, civil society, and academic institutions. Additionally, the lack of early diagnostic identification associated with administrative gaps and problems in specialized care was highlighted.\u003c/p\u003e\n\u003cp\u003eFurthermore, studies on the disparity in mental health care for children and adolescents in Brazil and the challenges faced by caregivers of pediatric populations with autism in six Latin American countries were analyzed, examining the most significant obstacles to comprehensive care for these pathologies. In Brazil, it was identified that only 19.8% of the pediatric population with psychiatric disorders consulted mental health services in the last year, with gender, school performance, and socioeconomic level being the main factors associated with lack of access (21). In Latin America, caregivers of children with autism revealed that administrative barriers such as waiting lists, treatment costs, lack of specialized services, and psychosocial barriers such as high levels of stigmatization and discrimination were among the obstacles to obtaining comprehensive care (22). Both studies highlight the gaps in access to specialized mental health services, their follow-up, and the need for strategies to reduce inequalities and stigma in Latin America.\u003c/p\u003e\n\u003cp\u003eAmong skin conditions, atopic dermatitis was noted as a neglected pathology in Latin America due to clinical obstacles such as insufficient knowledge about the disease when diagnosing it, lack of local clinical guidelines, complex patient pathways, and limited consultation time; sociodemographic obstacles included cultural and linguistic barriers and patient stigmatization; administrative obstacles included unequal resource distribution (23).\u003c/p\u003e\n\u003cp\u003eRegarding strategies to mitigate healthcare access barriers for the Latin American pediatric population, telemedicine has been a key tool that has gained strength in recent years. Additionally, the implementation of national policies that support and regulate the use of telemedicine requires improving technological infrastructure, especially in rural and underserved areas, to ensure adequate connectivity for patients (24, 25). Furthermore, the importance of providing continuous training to healthcare professionals in the use of telemedicine technologies is highlighted, ensuring they are prepared to integrate these tools into their daily practice (26). Ensuring funding and resources for its implementation guarantees the sustainability of telemedicine programs (27). Finally, the adoption of a comprehensive approach that addresses regulatory, legal, financial, technological, organizational, and human barriers in a coordinated manner is emphasized to maximize the impact of telemedicine and improve access to high-quality healthcare services in the region (24).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis systematic review provides an analysis of the barriers to healthcare access in rural pediatric populations in Latin America, focusing on the various strategies that have been used, and which have been effective in improving healthcare access for this population. It identifies gaps and limitations that are more commonly found in this population, providing recommendations that may help reach a consensus in the future to improve pediatric health.\u003c/p\u003e\n\u003ch3\u003eSociodemographic Barriers in Pediatric Healthcare\u003c/h3\u003e\n\u003cp\u003eIt is estimated that around 200\u0026nbsp;million children under the age of 5 living in low- and middle-income countries do not reach their potential due to exposure to environmental, biological, and psychosocial risk factors (11). Several authors agree that geographical barriers hinder children's access to healthcare services, as long distances and insufficient transportation prevent them from reaching health centers (8, 9, 10, 11). This implies that healthcare becomes fragmented, and continuity of care is not maintained, leading parents to take their children to health centers only when they are sick, preventing the proper implementation of health promotion and prevention strategies. Ultimately, this represents a higher risk of developing short- and long-term health complications in children and higher costs for healthcare systems. On the other hand, although the region has a high rate of affiliation with social security systems, the lack of economic resources, excessive bureaucracy, and prolonged response times, combined with the long distances families must travel, further hinder timely healthcare access. Therefore, governments should implement strategies and policies that ensure more equitable access to healthcare services (10, 23).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eVaccination Barriers\u003c/h2\u003e \u003cp\u003eLatin America continues to have low vaccination coverage, which represents a significant public health problem. To achieve broad vaccination coverage, Robierti et al. identify facilitators in vaccination access and some barriers, highlighting the lack of truthful and understandable information, influenced by cultural and religious factors, which makes families and caregivers reluctant to seek this service (29). Additionally, the inability of many families and healthcare systems to meet this need, combined with infrastructure incapable of properly storing these medications, reduces the rates of complete vaccination in children. However, other racial barriers have been identified. Boing et al. found that being of African descent meant that mothers and their children were less likely to have access to vaccination compared to Caucasian mothers and children. It is imperative that governments implement strategies to combat systemic racism in healthcare systems (12). Communities also play an important role in the successful implementation of vaccination programs. An example of this was the stance of a community in Colombia, where misinformation provided by some media outlets made it difficult for parents to accept vaccinating their daughters with the human papillomavirus (HPV) vaccine (31). This highlights the importance of implementing appropriate information campaigns and the impact that communities can have on children's health decisions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eBarriers Due to Specific Prevalent Diseases in the Pediatric Population\u003c/h2\u003e \u003cp\u003eIn the region, several studies have analyzed the barriers to healthcare access faced by children with certain medical conditions. While some of these barriers are specific to each disease, many authors agree on the presence of some common barriers for different types of diseases. Firstly, both medical personnel and caregivers have identified a lack of institutional and governmental support due to insufficient human resources or infrastructure to meet the special needs of this population (28), as evidenced by studies conducted on pediatric populations with mental health disorders and cancer (28\u0026ndash;31). Furthermore, the education of both parents and healthcare professionals is crucial to reducing the healthcare gap for these children and adolescents. On the one hand, it is important for parents and caregivers to be trained to recognize the warning signs of their children's diseases (16); this means they must understand what the disease is, how it manifests, and how it is treated. To achieve this, healthcare professionals must be prepared and have sufficient knowledge to provide adequate care to children with special health needs and to clarify any doubts caregivers may have. This could be achieved by promoting the creation of new scientific knowledge through local clinical practice guidelines (21, 23). Additionally, considering that Latin America is a culturally and ethnically diverse region, the training of healthcare personnel should not be limited to the clinical aspect alone. It is relevant for healthcare personnel to acquire new knowledge to approach different ethnic contexts more appropriately and thus achieve a greater impact (21, 23).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStrategies to Overcome Healthcare Access Barriers in the Latin American Pediatric Population\u003c/h2\u003e \u003cp\u003eThere are strategies that have been implemented to improve healthcare access in Latin America. Since the COVID-19 pandemic, strategies that remain relevant due to their usefulness in addressing geographical, environmental, and economic barriers, such as telemedicine, have been implemented (24). LeRouge et al. have presented this tool as a response to the problem of inequality in access to medical consultations and how it has increased the efficiency of healthcare for non-urgent reasons in primary stages, reducing the number of complications due to lack of care. In the application of this tool in remote communities that have access only by air or sea, several shortcomings were identified to ensure this technology, such as the use of a stable internet network to ensure continuous connectivity (25). Additionally, several authors have identified other areas where these technologies could be further developed, such as expanding modalities in tele-education, teleconsultation, telepractice, and tele-research, using digital applications to strengthen remote and comprehensive healthcare access for all (33)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eThis scoping review is based on a limited number of articles, which may not fully represent the diversity of healthcare access barriers for children and adolescents in rural Latin American regions. An important limitation is the variability in the quality and focus of the studies. Some articles provide robust quantitative data on the magnitude of the identified barriers, while others rely on narratives and qualitative observations. This methodological heterogeneity makes it difficult to compare and synthesize the findings. Therefore, to extrapolate the findings to real-life situations, experimental studies with significant samples and ideally from culturally and ethnically diverse populations are required to achieve results with greater reach and provide more accurate data.\u003c/p\u003e \u003cp\u003eMoreover, most studies focus on sociodemographic and vaccination barriers, leaving other barriers related to specific diseases and strategies to mitigate these barriers underexplored. For example, Shibukawa et al. (10) identified significant barriers such as geographical distance and lack of economic resources. However, the review does not delve into how these barriers vary between different subregions or specific populations in Latin America. This could limit the applicability of the recommendations to diverse local contexts.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis scoping review identifies various barriers affecting healthcare access for the pediatric population in Latin America, allowing them to be grouped into categories such as sociodemographic barriers, vaccination barriers, barriers related to specific diseases, and strategies to mitigate them. It also highlights telemedicine as a key strategy to improve access in remote areas, allowing families to consult with healthcare professionals specialized in pediatric care, ensuring timely and effective interventions for children. However, its effectiveness depends on internet availability, adequately trained healthcare personnel, and the necessary infrastructure to provide this type of care.\u003c/p\u003e \u003cp\u003eNevertheless, the study presented limitations such as the limited number of reviewed articles and the variability in the quality and focus of the included studies. Additionally, robust methodologies and significant samples are required to ensure the applicability of the recommendations and not underestimate practical challenges such as the implementation of various technological strategies like telemedicine.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLMGT:\u0026nbsp;\u003c/strong\u003eConceptualization, Methodology, Formal analysis, Investigation, Writing \u0026ndash; Original Draft, Writing, Review \u0026amp; Editing, Visualization. \u003cstrong\u003eLKGC AND JSCL:\u003c/strong\u003e Formal analysis, Investigation, Data Curation, Writing Original Draft and Review \u0026amp; Editing, Visualization.\u003cstrong\u003e\u0026nbsp;Erwin Hern\u0026aacute;ndo Hern\u0026aacute;ndez:\u0026nbsp;\u003c/strong\u003eMethodology, Visualization, Supervision, Project administration and Funding acquisition.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee from the Universidad de La Sabana.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the Universidad de La Sabana (Project MED-342-2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e UNICEF. INDICE DE GESTI\u0026Oacute;N DE RIESGOS PARA AM\u0026Eacute;RICA LATINA Y EL CARIBE Actualizaci\u0026oacute;n INFORM-LAC 2018 Femke [Date] [Course title] [Internet]. [cited 2024 Dec 4]. Available from: https://www.unicef.org/lac/media/1601/file\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e ANALIZAR Y SUPERAR LAS BARRERAS DE ACCESO PARA FORTALECER LA ATENCI\u0026Oacute;N PRIMARIA DE SALUD: S\u0026iacute;ntesis de resultados y recomendaciones. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Departamento Nacional de Planeaci\u0026oacute;n de Colombia DNP. Barreras de acceso a la salud. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Organizaci\u0026oacute;n Panamericana de la Salud. Salud Universal.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Arksey H, O\u0026rsquo;Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol [Internet]. 2005;8(1):19\u0026ndash;32. Available from: https://doi.org/10.1080/1364557032000119616\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Tricco AC, Lillie E, Zarin W, O\u0026rsquo;Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan\u0026mdash;a web and mobile app for systematic reviews. Syst Rev [Internet]. 2016;5(1):210. Available from: https://doi.org/10.1186/s13643-016-0384-4\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: JBI Manual for Evidence Synthesis. JBI; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Garc\u0026iacute;a Sierra AM, Ocampo Ca\u0026ntilde;as JA. Integrated Management of Childhood Illnesses implementation-related factors at 18 Colombian cities. BMC Public Health. 2020 Dec 16;20(1):1122.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Aza\u0026ntilde;edo CMG, Alvarado BGR, Mendoza Castillo \u0026Aacute;LLF, Pollack WEI, Puscan MWV. Access to public health services in Latin America, A systematic literature review 2012\u0026ndash;2022. In: Proceedings of the LACCEI international Multi-conference for Engineering, Education and Technology. Latin American and Caribbean Consortium of Engineering Institutions; 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Shibukawa BMC, Rissi GP, Uema RTB, Furtado MD, Merino M de FGL, Higarashi IH. Absenteeism in child health services: a systematic review. Vol. 76, Revista Brasileira de Enfermagem. Associacao Brasilerira de Enfermagem; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Boing AF, Boing AC, Fran\u0026ccedil;a AP, Moraes JC de, Silva AI da, Ramos Jr. AN, et al. Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life. Epidemiologia e Servi\u0026ccedil;os de Sa\u0026uacute;de. 2024;33(spe2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Roberti J, Ini N, Belizan M, Alonso JP. Barriers and facilitators to vaccination in Latin America: a thematic synthesis of qualitative studies. Cad Saude Publica. 2024;40(6).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Palmieri IGS, Lima LV de, Pavinati G, Silva JAP, Marcon SS, Sato APS, et al. Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011\u0026ndash;2021: temporal trend and spatial dependency. Revista Brasileira de Epidemiologia. 2023;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Ferrer APS, Grisi SJFE. Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions. Rev Assoc Med Bras. 2016 Sep 1;62(6):513\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Bruce N, Pope D, Arana B, Shiels C, Romero C, Klein R, et al. Determinants of Care Seeking for Children With Pneumonia and Diarrhea in Guatemala: Implications for Intervention Strategies. Am J Public Health. 2014 Apr;104(4):647\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Imbachi LF, Iba\u0026ntilde;ez LM, Hurtado-Villa P. Estado de salud y barreras en la atenci\u0026oacute;n de ni\u0026ntilde;os con defectos cong\u0026eacute;nitos nacidos entre el 2011 y el 2017 en dos instituciones de salud de Cali. Biom\u0026eacute;dica. 2020 Mar 1;40(1):34\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Dos Santos DBC, V\u0026aacute;zquez-Ramos V, Da Costa Cunha Oliveira C, L\u0026oacute;pez-Arellano O. Accessibility in the area of health: A review of children with disabilities in Brazil- Peru-Colombia. Revista Latinoamericana de Ciencias Sociales, Ninez y Juventud. 2019;17(2):1\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Gr\u0026uuml;neberg ES, Ramos-Guerrero J, Pastrana T. Challenges in the Provision of Pediatric Palliative Care in Mexico: A Cross-Sectional Web-Based Survey. J Palliat Care. 2024 Jan 13;39(1):58\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Organizaci\u0026oacute;n Panamericana de la Salud. https://www.paho.org/es/temas/salud-universal. 2024. Salud Universal. Available from: https://www.paho.org/es/temas/salud-universal\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Paula CS, Bordin IAS, Mari JJ, Velasque L, Rohde LA, Coutinho ESF. The Mental Health Care Gap among Children and Adolescents: Data from an Epidemiological Survey from Four Brazilian Regions. PLoS One. 2014 Feb 18;9(2):e88241.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Paula CS, Cukier S, Cunha GR, Irarr\u0026aacute;zaval M, Montiel-Nava C, Garcia R, et al. Challenges, priorities, barriers to care, and stigma in families of people with autism: Similarities and differences among six Latin American countries. Autism. 2020 Nov 27;24(8):2228\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e S\u0026aacute;nchez J, Ale IS, Angles MV, Fogelbach GG, Jansen AM, Takaoka R, et al. Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review. Dermatol Ther (Heidelb). 2023 Feb 23;13(2):399\u0026ndash;416.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Prada SI, Toro JJ, Pe\u0026ntilde;a-Z\u0026aacute;rate EE, Libreros-Pe\u0026ntilde;a L, Alarc\u0026oacute;n J, Escobar MF. Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis. BMJ Open. 2024 May 1;14(5):e084447.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Libreros-Pe\u0026ntilde;a L, Quintero JA, Gelves A, Alarc\u0026oacute;n J, Morales S, Escobar MF, et al. Telemedicine consultation for emergency patients\u0026rsquo; attention: a clinical experience from a high complex university hospital from Latin America. BMC Health Serv Res. 2023 Dec 1;23(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e LeRouge CM, Gupta M, Corpart G, Arrieta A. Health System Approaches Are Needed To Expand Telemedicine Use Across Nine Latin American Nations. Health Aff. 2019 Feb;38(2):212\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e LeRouge CM, Gupta M, Corpart G, Arrieta A. Health System Approaches Are Needed To Expand Telemedicine Use Across Nine Latin American Nations. Health Aff. 2019 Feb;38(2):212\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Paula CS, Cukier S, Cunha GR, Irarr\u0026aacute;zaval M, Montiel-Nava C, Garcia R, et al. Challenges, priorities, barriers to care, and stigma in families of people with autism: Similarities and differences among six Latin American countries. Autism. 2020 Nov 27;24(8):2228\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Barriers to Healthcare Services, Child Health, Primary Healthcare, Child Development, Pediatrics","lastPublishedDoi":"10.21203/rs.3.rs-5828056/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5828056/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Latin America faces multiple barriers to healthcare access, particularly affecting the pediatric population. Factors such as socioeconomic vulnerability, armed conflicts, disasters, and insufficient healthcare spending contribute to these difficulties. The barriers include financial, bureaucratic, and geographical issues, negatively impacting the well-being and development of children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To identify the barriers to healthcare access in the vulnerable pediatric population of Latin America and recognize effective strategies to overcome them.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: An scoping review was conducted in December 2024. A literature search was performed in databases such as BIREME, PubMed, and Scopus, including studies published between 2014 and 2024 in English and Spanish. Specific inclusion and exclusion criteria were applied, and the RAYYAN tool was used to manage the references.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Twenty-eight articles met the selection criteria. Of these, 28.57% discussed sociodemographic barriers, highlighting geographical issues and gaps in government support; other articles addressed vaccination, mainly social stigmas and lack of supplies; and 17.8% focused on specific diseases, highlighting the lack of early access and complications. Additionally, 17.8% discussed strategies such as telemedicine to improve healthcare access in remote areas.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The barriers to healthcare access in the pediatric population of Latin America are diverse and complex. Telemedicine emerges as a promising strategy, ensuring access, follow-up, and medical consultation, reducing secondary complications due to late or non-existent care for remote communities. Additional studies with robust methodologies are required to improve the applicability of the recommendations.\u003c/p\u003e","manuscriptTitle":"Barriers to Accessing Pediatric Health Care in Latin America: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-22 08:15:20","doi":"10.21203/rs.3.rs-5828056/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4dd3f647-aca2-455f-960c-020fc9b18711","owner":[],"postedDate":"January 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-22T08:15:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-22 08:15:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5828056","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5828056","identity":"rs-5828056","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}