Protocol for systematic review and meta-analysis: magnitude, reasons, associated factors, and implications of the out-of-pocket expenditure during pregnancy

Abstract

Objectives: Health-related out-of-pocket expenditure (OOPE) impedes utilization for maternal health care. We aim to systematically review the magnitude, reasons, associated factors, and implications of OOPE during pregnancy.

Study design: The study design is a protocol for systematic review and meta-analysis.

Methods: A comprehensive literature search will be conducted with the electronic databases of PubMed, Web of Science, Scopus, Cochrane, Trip, Social care online, IDEAS, EconPapers, ERIC, and EconStor. A manual search will be carried out for the reference lists of eligible studies and reviews. The search strategy will include combining two key blocks of terms, namely: 'pregnancy' and 'OOPE,' using database-specific subject headings and text words. Two independent reviewers will screen and assess data quality and extract data for synthesis. Any disagreements during any stage will be determined by consensus with the involvement of a third reviewer. The 'Mixed methods appraisal tool' will be adapted for the quality appraisal of the eligible studies. A narrative synthesis will be provided for the reasons, associated factors, and implications of OOPE, and a meta-analysis will be conducted for the magnitude of OOPE. Furthermore, a subgroup analysis will be done with countries with different income levels and health care policies.

Trial registration: PROSPERO 2020 CRD42020168566.

Keywords: Magnitude; Meta-analysis; Out-of-pocket expenditure; Pregnancy; Systematic review.