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How primary healthcare workers obtain information during consultations to aid safe prescribing in low-income and lower middle-income countries: a systematic review
  1. Chris Smith1,2,
  2. Michelle Helena van Velthoven1,3,
  3. Nguyen Duc Truong4,5,
  4. Nguyen Hai Nam4,6,
  5. Vũ Phan Anh4,7,
  6. Tareq Mohammed Ali AL-Ahdal4,8,
  7. Osama Gamal Hassan4,9,
  8. Basel Kouz4,10,
  9. Nguyen Tien Huy4,
  10. Malcolm Brewster11,
  11. Neil Pakenham-Walsh11
  1. 1 School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan
  2. 2 Department of Clinical Research, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
  3. 3 Department of Paediatrics, Oxford University, Oxford, Oxfordshire, UK
  4. 4 Nagasaki University, Nagasaki, Japan
  5. 5 Obstetrics and Gynecologic Department, FV Hospital, Ho Chi Minh City, Vietnam
  6. 6 Department of General Surgery, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
  7. 7 Department of Neonatology, Children's Hospital 2, Ho Chi Minh City, Vietnam
  8. 8 Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
  9. 9 Faculty of Medicine, South Valley University, Qena, Egypt
  10. 10 Faculty of Medicine, Damascus University, Damascus, Damascus Governorate, Syria
  11. 11 Healthcare Information For All (HIFA) network, Global Healthcare Information Network, Charlbury, UK
  1. Correspondence to Dr Chris Smith; christopher.smith{at}


Background We systematically reviewed the evidence on how primary healthcare workers obtain information during consultations to support decision-making for prescribing in low and lower middle-income countries.

Methods We searched electronic databases, consulted the Healthcare Information For All network, hand searched reference lists, ran citation searches of included studies and emailed authors of identified papers. Two reviewers extracted data and appraised quality with relevant tools.

Results Of 60 497 records found, 23 studies met our inclusion criteria. Fourteen studies were observational and nine were interventional. Frequently mentioned sources of information were books, leaflets, guidelines, aids and the internet. These sources were sometimes out of date and health workers reported being confused which to use. Internet access varied and even when it was available, use was limited by technical issues. Of the five electronic tools that were assessed, four had positive outcomes. Tools assisted prescribers with medicine selection and dosage calculations, which increased prescribing accuracy. The quality of reporting varied but was overall low.

Discussion Studies indicated a lack of up-to-date and relevant medicine information in low and lower middle-income settings. Internet-based sources appeared to be useful when it is possible to download content for offline use and to update when there is internet access. Electronic tools showed promise, but their accuracy needs to be validated and they should focus on giving actionable advice to guide prescribers.

PROSPERO registration number CRD42018091088.

  • systematic review
  • treatment
  • health education and promotion

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  • CS and MHvV are joint first authors.

  • Handling editor Stephanie M Topp

  • Contributors CS and MHvV jointly wrote the review. MHvV and MB conducted the searches. All the authors screened the references. MHvV and NDT extracted the data and assessed the quality of included studies. CS and NPW provided extensive comments on the review. All authors reviewed the final draft of the review.

  • Funding This work was supported by the Japanese Society for the Promotion of Science (JSPS) and the Healthcare Information For All (HIFA) network.

  • Disclaimer JSPS had no role in this designing and undertaking this systematic review. HIFA helped with the collection, analysis, interpretation of data and in the writing of the report. HIFA had no influence on the study design or in the decision to submit the paper for publication. The corresponding author confirms that he had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval No ethics approval was required. The review will inform efforts that aim to improve the prescribing practices of healthcare workers in low and middle-income countries. Findings were disseminated through the Healthcare Information For All network.

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

  • Data availability statement Data sharing is not applicable as no data sets were generated and/or analysed for this study.