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.