Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review

Introduction Non-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies. Methods We systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC). Results A total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC. Conclusion Overall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.


Appendix 1 Inclusion criteria for non-communicable disease
As outlined in the manuscript the list of non-communicable diseases was taken from the WHO Global Health Estimates (WHO, 2016) and Global Burden of Disease project (IHME, 2018).
During the review process all four authors spent some time discussing which papers should be included based on the health condition of focus in the paper. One contentious area may be the inclusion of child and maternal malnutrition, under which three studies were included in the review (Botteman and Detzel, 2015;Dainelli et al., 2017;Vosti et al., 2015). The WHO Global Health Estimates and GBD places nutritional deficiencies under "Communicable, maternal, perinatal and nutritional conditions", rather than non-communicable diseases. However, given the central role played by in-utero and early-life diet on the noncommunicable disease burden in later life (WHO, 2018), as well as its potentially inequitable impact across population subgroups (Di Cesare et al., 2013), the authors deemed it reasonable to include the above studies of nutritional interventions in the review. There were other conditions, such as HPV infection and acute rheumatic fever, which are not noncommunicable diseases but were included due to their substantial impact on the noncommunicable disease burden -through cervical cancer (Guerrero et al., 2015;Levin et al., 2015;Mo et al., 2017;Setiawan et al., 2016) and rheumatic heart disease (Watkins et al., 2015;2016), respectively.

Web of Science
Each category combined with "AND". Restricted to English and year 2015 or later. Search run on 10 th May 2018 Search 1 -model type TS=("operation* research")OR TS=(model* NEAR/5 (mathematical or quer* or inventory or scheduling or demand or forecast* or comput* or network or stochastic or decision* or delivery or simulation or optimi?ation or non-linear or linear or Markov or cost-effectiveness or agent-based)) OR TS=(optimi?ation$ NEAR/5 (mathematical or nonlinear or non-linear or linear or network or discrete or multicriteria or multi-criteria or stochastic or problem or minimi?ation or location or allocation)) OR TS=(simulation NEAR/3 (comput* or discrete or agent-based or system$)) Search 2 -geographic focus TS=("Developing countr*" or "low-income countr*" or "middle-income countr*" or "developing world" or "developing nation" or "low-resource setting*" or "resource-constrained setting*" or "resource-poor setting*" or "limited-resource setting*" or "resource-limited setting*" or "under-developed countr*" or "least-developed countr*" or "less-developed countr*" or LMIC* or Africa* or (Asia* NEAR/2 south) or (Asia NEAR/2 east) or "latin America*" or "central America*" or "south america*" or caribbean or "middle east" or AFGHANISTAN or ALBANIA or ALGERIA or "AMERICAN SAMOA" or ANGOLA or ARGENTINA or ARMENIA or AZERBAIJAN or BANGLADESH or BELARUS or BELIZE or BENIN or BHUTAN or BOLIVIA or "BOSNIA AND HERZEGOVINA" or BOTSWANA or BRAZIL or BULGARIA or "BURKINA FASO" or BURUNDI or "CABO VERDE" or CAMBODIA or CAMEROON or "CENTRAL AFRICAN REPUBLIC" or CHAD or CHINA or COLOMBIA or COMOROS or "CONGO, DEM. REP." or "CONGO, REP." or "COSTA RICA" or "COTE D'IVOIRE" or CUBA or DJIBOUTI or DOMINICA or "DOMINICAN REPUBLIC" or ECUADOR or "EGYPT" or "EL SALVADOR" or "EQUATORIAL GUINEA" or "ERITREA" or "ETHIOPIA" or FIJI or GABON or "THE GAMBIA" or GEORGIA or GHANA or GRENADA or GUATEMALA or GUINEA or GUINEA-BISSAU or GUYANA or HAITI or HONDURAS or INDIA or INDONESIA or IRAN or IRAQ or JAMAICA or JORDAN or KAZAKHSTAN or KENYA or KIRIBATI or KOREA or KOSOVO or KYRGYZ* or LAO or LAOS or LEBANON or LESOTHO or LIBERIA or LIBYA or MACEDONIA or MADAGASCAR or MALAWI or MALAYSIA or MALDIVES or MALI or "MARSHALL ISLANDS" or MAURITANIA or MAURITIUS or MEXICO or MICRONESIA or MOLDOVA or MONGOLIA or MONTENEGRO or MOROCCO or MOZAMBIQUE or MYANMAR or NAMIBIA or NEPAL or NICARAGUA or NIGER or NIGERIA or PAKISTAN or PANAMA or "PAPUA NEW GUINEA" or PARAGUAY or PERU or PHILIPPINES or ROMANIA or RUSSIA* or RWANDA or SAMOA or "SAO TOME AND PRINCIPE" or SENEGAL or SERBIA or "SIERRA LEONE" or "SOLOMON ISLANDS" or SOMALIA or "SOUTH AFRICA" or "SOUTH SUDAN" or "SRI LANKA" or "ST. LUCIA" or "ST. VINCENT AND THE GRENADINES" or SUDAN or SURINAME or SWAZILAND or "SYRIAN ARAB REPUBLIC" or TAJIKISTAN or TANZANIA or THAILAND or "TIMOR-LESTE" or TOGO or TONGA or TUNISIA or TURKEY or TURKMENISTAN or TUVALU or UGANDA or UKRAINE or UZBEKISTAN or VANUATU or VENEZUELA or VIETNAM or "WEST BANK AND GAZA" or YEMEN or ZAMBIA or ZIMBABWE) Search 3 -relating to health TS=(health* or medical or hospital or clinic* or treatment) OR AD=(health or hlth) Search 4 -relating to decision/policy making TS=(polic* or decision-mak* or decision-support or decision-process or decision-aid* or implement* or impact) or AD=(policy) Search 5 -relating to NCD TS=(NCD* or "noncommunicable disease" or "non-communicable disease" or "chronic disease" or "chronic illness" or Scopus Keyword search. TITLE-ABS-KEY search, where KEY includes author keywords and controlled indexed terms in searched databases. Scopus automatically searches plural versions of words, as well as US-UK spelling variations. Each category combined with "AND". Restricted to English and year 2015 or later. Search run on 10 th May 2018 Model types TITLE-ABS-KEY("operation* research") OR TITLE-ABS-KEY(model* W/5 (mathematical or queu* or inventory or scheduling or demand or forecast* or comput* or network or stochastic or decision* or delivery or simulation or optimization or non-linear or nonlinear or linear or Markov or cost-effectiveness or agent-based)) OR TITLE-ABS-KEY(optimization W/5 (mathematical or nonlinear or non-linear or linear or network or discrete or multicriteria or multi-criteria or stochastic or problem or minimization or maximization or location or allocation)) OR TITLE-ABS-KEY(simulation W/3 (comput* or discrete or agent-based or system$)) Geographic focus TITLE-ABS-KEY("low-resource setting*" or "resource-constrained setting*" or "resource-poor setting*" or "limitedresource setting*" or "resource-limited setting*" or Africa* or (Asia* W/2 south) or (Asia W/2 east) or "latin America*" or "central America*" or "south america*" or caribbean or "west indies" or "middle east") TITLE-ABS-KEY((countr* or nation* or population* or world) W/0 (developing or "less* developed" or "under developed" or "least-developed" or underdeveloped or "middle income" or "middle-income" or "low-income" or "low* income" or underserved or "under served" or deprived or poor*)) TITLE-ABS-KEY(econom* W/0 (developing or "less* developed" or "under developed" or underdeveloped or "middle income" or middle-income or "low* income" or low-income)) TITLE-ABS-KEY(low* W/0 (gdp or gnp or "gross domestic" or "gross national")) TITLE-ABS-KEY(lmic* or "third world" or "lami countr*" or "transitional countr*")

TITLE-ABS-KEY(The names of all countries included in the World Bank LMIC classification 2018)
Health TITLE-ABS-KEY(health* or medical or hospital or clinic* or treatment) or AFFIL(health)

Decision-/policy-making
TITLE-ABS-KEY(polic* or decision-mak* or decision-support or decision-process or decision-aid* or implement* or impact) OR AFFIL(policy) NCDs TITLE-ABS-KEY(NCD* or "noncommunicable disease" or "non-communicable disease" or "chronic disease" or "chronic illness" or "cardiovascular disease" or stroke or "heart attack" or cancer* or "respiratory disease*" or "chronic obstructive pulmonary disease" or COPD or asthma or diabet* or alcohol or drink* or smok* or tobacco or "physical inactivity" or "unhealthy diet" or obes* or "mental health" or hypertension or depression or Neoplasm* or "Musculoskeletal disease" or "Digestive system disease" or "Stomatognathic disease" or "Respiratory tract disease" or "Otorhinolaryngologic disease" or "Nervous system disease" or "Eye disease" or "Male urogenital disease" or "Female urogenital disease" or "pregnancy complications" or "Hemic and lymphatic disease" or "Congenital disease" or "hereditary disease" or "neonatal disease" or "Congenital abnormalities" or "hereditary abnormalities" or "neonatal abnormalities" or "Skin disease" or "connective tissue disease" or "Nutritional disease" or "metabolic disease" or "Endocrine system disease" or "Immune system disease" or "Mental disorder" or "bone disease" or "joint disease" or "rheumatic disease" or "liver disease" or "pancreatic disease" or "mouth disease" or "lung disease" or "central nervous system disease" or "neuromuscular disease" or "vision disorder" or "heart disease" or "vascular disease" or "anemia" or "blood coagulation disorder" or "thyroid disease" or "autoimmune disease") Embase Ovid Embase -Search run on 10 th May 2018 (model* adj5 (mathematical or queu* or inventory or scheduling or demand or forecast* or comput* or network or stochastic or decision* or delivery or simulation or optimi#ation or linear or nonlinear or non-linear or Markov or costeffectiveness or agent-based)) OR (optimi#ation$1 adj5 (mathematical or nonlinear or non-linear or linear or network or discrete or multi-criteria or multicriteria or stochastic or problem or minimi#ation or maximi#ation or location or allocation)) OR (simulation adj3 (comput* or discrete or agent-based or system$1))).ti,ab.