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Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015
  1. Luke N Allen1,
  2. Jessica Pullar1,
  3. Kremlin Khamarj Wickramasinghe1,
  4. Julianne Williams1,
  5. Nia Roberts2,
  6. Bente Mikkelsen3,
  7. Cherian Varghese4,
  8. Nick Townsend1
  1. 1Centre on Population Approaches for NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Health Library, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3Global Coordination Mechanism for Noncommunicable Diseases, WHO, Geneva, Switzerland
  4. 4Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO, Geneva, Switzerland
  1. Correspondence to Dr Kremlin Khamarj Wickramasinghe; kremlinkw{at}gmail.com

Abstract

Background Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs).

Aim To systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs.

Methods We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence.

Results We identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs.

Conclusions We found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.

  • non-communicable diseases
  • best buys
  • low and lower middle income countries
  • developing countries

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Handling editor Sanni Yaya

  • Contributors Project concept: BM, KKW, NT and CV. Study protocol: JP, LA, KKW and NT. Literature search: NR, JP, JW and LA. Data screening: JP, JW, LA, KKW, NR and NT. First draft of the manuscript: LA. Comments and edits: All. The lead author had full access to all the data in the study and final responsibility for the decision to submit for publication.

  • Funding This study was commissioned and funded by the WHO. LA and JP are employed by the Nuffield Department of Population Health through WHO funding, and JW is a DPhil student receiving a scholarship from the same department. NT and KKW’s positions are funded by the British Heart Foundation (006/P&C/CORE/2013/OXFSTATS), and NR is employed by the Bodleian Health Care Libraries.

  • Competing interests CV and BM are employees of WHO. The authors alone are responsible for the content of the publication and the content does not reflect the opinion of the WHO. LA’s position is wholly funded by WHO. KKW and NT is funded by the British Heart Foundation.

  • Ethics approval Ethics committee approval was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All original data are available from the corresponding author.

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