Health interventions among mobile pastoralists: a systematic review to guide health service design

OBJECTIVE; : Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterized, we set out to fill this gap.; METHODS; : We conducted a systematic search in PubMed/MEDLINE, Scopus, EMBASE, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar, and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilization among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesized through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records.; RESULTS; : Our search yielded 4,884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilization. Only two randomized controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n=16), community engagement (n=12), and service mobility (n=11).; CONCLUSION; : Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and "temporary fixed" services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions, and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.