title: Assessing evidence of inequalities in access to medication for diabetic populations in low- and middle-income countries: a systematic review.
abstract: BACKGROUND
  Inequalities in access to medications among people diagnosed with diabetes inlow- and middle-income countries (LMICs) is a public health concern since untreated diabetes can lead to severe complications and premature death.
  
  
  OBJECTIVE
  To assess evidence of inequalities in access to medication for diabetes in adult populations of people with diagnosed diabetes in LMICs.
  
  
  METHODS
  We conducted a systematic review of the literature using the PRISMA-Equity guidelines. A search of five databases - PubMed, Cochrane, CINAHL, PsycINFO, and EMBASE - was conducted from inception to November 2015. Using deductive content analysis, information extracted from the selected articles was analysed according to the PRISMA-Equity guidelines, based on exposure variables (place of residence, race/ethnicity, occupation, gender, religion, education, socio-economic status, social capital, and others).
  
  
  RESULTS
  Fifteen articles (seven quantitative and eight qualitative studies) are included in this review. There were inconsistent findings between studies conducted in different countries and regions although financial and geographic barriers generally contributed to inequalities in access to diabetes medications. The poor, those with relatively low education, and people living in remote areas had less access to diabetes medications. Furthermore, we found that the level of government political commitment through primary health care and in the provision of essential medicines was an important factor in promoting access to medications.
  
  
  CONCLUSIONS
  The review indicates that inequalities exist in accessing medication among diabetic populations, although this was not evident in all LMICs. Further research is needed to assess the social determinants of health and medication access for people with diabetes in LMICs.
authors.affiliation: Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.|CREDOS (Creative Development Strategies) Institute, Jakarta, Indonesia.
authors.forename: Yodi
authors.initials: Y
authors.lastname: Christiani
authors.affiliation: Pharmaceutical Care Research Unit, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.
authors.forename: Teerapon
authors.initials: T
authors.lastname: Dhippayom
authors.affiliation: Center of Pharmaceutical Outcomes Research, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.|School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia.|School of Pharmacy, University of Wisconsin, Madison, WI, USA.|School of Population Health, University of Queensland, Brisbane, QLD, Australia; nathorn.chaiyakunapruk@monash.edu.
authors.forename: Nathorn
authors.initials: N
authors.lastname: Chaiyakunapruk
keywords: access to medication; diabetes; inequalities; low- and middle-income countries; progress