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

Table 4 Most frequently reported diagnostic, management, access, and financial challenges and barriers to Crohn’s patients and providers in low and lower-middle income countries

Provider diagnostic challenges	Number of countries	Number of studies
Difficulty differentiating between Crohn’s and ITB	10	36
Low disease index of suspicion/clinical awareness due to perceived rarity of Crohn’s leads to underdiagnosis	8	17
Lack of quality diagnostic facilities and investigational modalities	8	14
Difficulty differentiating between Crohn’s and other infectious diseases	7	16
Difficulty differentiating between Crohn’s and UC	5	7
Diagnosis of Crohn’s made on histological exam of resected colon	2	3
Lack of reliable TB testing modalities	2	2
Provider Management Challenges
Use of biologics is limited due to cost	1	3
High risk of TB infection reactivation in patients treated with biologics	1	1
Patient Access Barriers
Lack of access to high quality health care services	4	9
Lack of education/knowledge about disease	3	3
Lack of access to Crohn’s medications	1	1
Patient Financial Barriers
Patients unable to afford treatment in general (medications and surgeries)	6	9
High cost of diagnostic testing	3	4
Lack of insurance coverage	2	4
Patients unable to afford biologics	1	3

ITB: Intestinal tuberculosis; TB: Tuberculosis; UC: Ulcerative colitis.