Protocol for Systematic Review on Inequity in Child Health Care Service Utilization in Low and Middle-income Countries

Background: One challenge to achieving Millennium Development Goals was inequitable access to quality health services. In order to achieve the Sustainable Development Goals, interventions need to reach underserved populations, it appears that the maternal, newborn and child health goals (MDG 4 and 5) will not be universally achieved. There was early recognition that it could be possible to achieve the health goals while decreasing health inequity, because most of the gains might go to the better-off rather than to the very poor. Method: ology/Design: The current protocol adopts a strategy informed by the guidelines of The Cochrane Handbook for Systematic Reviews. Our systematic review will identify studies in English, provided inclusion of an English abstract - from 2010 onwards till 2020, by searching MEDLINE (PubMed interface), EMBASE (OVID interface), Cochrane Central (OVID interface) and the gray literature. Study selection criteria include research setting, study design, reported outcomes and determinants of interest. Our primary outcome is inequity in utilization of child health care services, and determinants of concern are: 1) socioeconomic status (for example, income, education); 2) geographic determinants (for example, distance to a health center, rural versus urban residence); and 3) demographic determinants (for example, age, ethnicity, religion, and marital status). Screening, data abstraction, and scientific quality assessment will be conducted independently by two reviewers using standardized forms. Where feasible, study results will be combined through meta-analyses to obtain a pooled measure of association between utilization of child health care services and key determinants. Results: will be stratified by income levels (World Bank classification) geographical residence and demographical determinants. Discussion: Our review will inform policy-making with the aim of decreasing inequities in utilization of child health care services. This research will provide evidence on unmet needs for child health care services in LMICs, knowledge gaps and recommendations to health policy planners. Our research will help promote universal coverage of quality child health care services as an integral part of the continuum of maternal and child health care. This protocol will be registered with the Prospero database.