title: Reported availability and gaps of pediatric palliative care in low- and middle-income countries: a systematic review of published data.
abstract: BACKGROUND
  The majority of young people in need of palliative care live in low- and middle-income countries, where curative treatment is less available.
  
  
  OBJECTIVE
  We systematically reviewed published data describing palliative care services available to young people with life-limiting conditions in low- and middle-income countries and assessed core elements with respect to availability, gaps, and under-reported aspects.
  
  
  METHODS
  PubMed, CINAHL, EMBASE (1980-2013), and secondary bibliographies were searched for publications that included patients younger than 25 years with life-limiting conditions and described palliative care programs in low- and middle-income countries. A data extraction checklist considered 15 items across seven domains: access, education/capacity building, health system support, pain management, symptom management, end-of-life care, and bereavement. Data were aggregated by program and country.
  
  
  RESULTS
  Of 1572 records, 238 met criteria for full-text review; 34 qualified for inclusion, representing 30 programs in 21 countries. The median checklist score was 7 (range, 1-14) of 10 reported (range, 3-14). The most pervasive gaps were in national health system support (unavailable in 7 of 17 countries with programs reporting), specialized education (unavailable in 7 of 19 countries with programs reporting), and comprehensive opioid access (unavailable in 14 of 21 countries with programs reporting). Underreported elements included specified practices for pain management and end-of-life support.
  
  
  CONCLUSIONS
  Comprehensive pediatric palliative care provision is possible even in markedly impoverished settings. Improved national health system support, specialized training and opioid access are key targets for research and advocacy. Application of a checklist methodology can promote awareness of gaps to guide program evaluation, reporting, and strengthening.
authors.affiliation: 1 Center for Bioethics and Humanities, and Department of Pediatrics, SUNY Upstate Medical University , Syracuse, New York.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Caruso Brown
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
authors.forename: Justin N
authors.initials: JN
authors.lastname: Baker
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Lam
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D010166:Palliative Care; D010371:Pediatric Nursing / Q000379:methods; D010372:Pediatrics