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. 2020 Nov 21;26(43):6891-6908.
doi: 10.3748/wjg.v26.i43.6891.

Crohn's disease in low and lower-middle income countries: A scoping review

Ruma Rajbhandari  1 , Samantha Blakemore  1 , Neil Gupta  2 , Alma J Adler  2 , Christopher Allen Noble  2 , Sara Mannan  1 , Klejda Nikolli  1 , Alison Yih  1 , Sameer Joshi  3 , Gene Bukhman  1
Affiliations

Crohn's disease in low and lower-middle income countries: A scoping review

Ruma Rajbhandari et al. World J Gastroenterol. .

Abstract

Background: While Crohn's disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well established due to a lack of disease registries and diagnostic capacity.

Aim: To describe the published burden, diagnostic/treatment capacity, service utilization, challenges/barriers to individuals with Crohn's in LLMICs and their providers.

Methods: We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed, Embase and World Health Organization Global Index Medicus. Two independent reviewers screened the titles and abstracts of all of the publications found in this search, reviewed selected publications, and extracted relevant data, which underwent descriptive review and was analyzed in Excel.

Results: The database search yielded 4486 publications, 216 of which were determined to be relevant to the research questions. Of all 79 LLMICs, only 21 (26.6%) have publications describing individuals with Crohn's. Overall, the highest number of studies came from India, followed by Tunisia, and Egypt. The mean number of Crohn's patients reported per study is 57.84 and the median is 22, with a wide range from one to 980.

Conclusion: This scoping review has shown that, although there is a severe lack of population-based data about Crohn's in LLMICs, there is a signal of Crohn's in these settings around the world.

Keywords: Crohn’s disease; Diagnostic/Treatment capacity; Low and lower-middle income countries; Scoping review; Service utilization.

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Conflict of interest statement

Conflict-of-interest statement: All the authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Preferred reporting items for systematic reviews and meta-analyses flow diagram depicting the number of studies identified and excluded at each stage of the review process. LLMIC: Lower-middle income countries.
Figure 2
Figure 2
Studies with Crohn’s disease. Low and lower-middle income countries with and without published Crohn’s disease studies (A); summary of studies describing Crohn’s disease cases by world region (B) and low and lower-middle income countries (C).
See this image and copyright information in PMC

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