literature review meaning in nepali

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In Nepali literature, constructive criticism is rare

Manushree Mahat

Bina Theeng Tamang is refreshingly straightforward. Sitting on her scooter, the whooshing sound of the wind holds no candle to her loud and bold voice. She talks about her role as a teacher and vice-principal at a government school, her background in health studies despite her desire to study Nepali literature, and her 28 years living in Budanilkantha. Our conversation flowed effortlessly, even before we had reached the cafe.

Tamang is both an author and a teacher. She teaches multiple subjects at her school, although Nepali and health is her forte. She prides herself as an educator, but it is writing and literature that has carved her name in the literary spheres. She has published three books: a short story collection titled ‘Chuki’, ‘Rato Ghar’, which is a poetry collection, and ‘Yambunera’, her second short story collection.

When did books and reading first enter your life?

Books and reading became a part of my life in Hetauda, where there was a variety of literature available. Although there weren’t many books in the market back then, comics were a common sight. In today’s world, phones, televisions, and the Internet offer endless entertainment options. But during my childhood, things were different. We would spend hours playing and talking with friends and neighbours, or we would read. For me, books held a special appeal.

Our school had a library where I would borrow and read books. I remember feeling a bit overwhelmed by thick books, so I opted for the smaller, thinner ones. Two books, ‘Sumnima’ and ‘Basanti’, left a lasting impression on me. I confess, I miss the books from the old days. It seems that modern literature lacks the same depth and impact it once had.

Why do you feel that literature these days is lacklustre?

I believe modern literature often falls short because its characters are forgettable. When I reflect on the books I’ve read over the years, it’s the characters from early literary works that have stayed with me. For instance, Sakambari from ‘Sirish Ko Phool’ remains vivid in my memory due to her defiance of societal norms. The way these characters were crafted makes me wish I had written them myself. Sadly, such memorable characterisations are scarce in today’s literature.

Additionally, I think literature could flourish in a more intricate way through critique. In Nepali literature, meaningful criticism is rare. However, it's a critique that provides writers with a nuanced understanding of their work. The challenge lies in finding a balance between praising an author and harshly criticising their work. If we create an environment that supports writers while encouraging them to acknowledge the flaws in their writing, we can certainly expect better, more relatable literary works.

What feedback did you get from your audience after your works were published?

I noticed a lack of constructive criticism in the feedback for my own work. Those closest to me praised my writing, which made me feel happy, but there were a few instances where someone delved into the intricacies of my writing, pointing out its flaws. Looking back at my earlier works, I now see deficiencies in my writing and characterisation. There's also a segment of my readership that doesn't accept me as a Nepali author.

I believe writers and readers can create a space where they appreciate and critique written words without being too extreme.

Do you think writers with different values can find common ground in expressing their opinions on each other’s works?

Certainly. Unfortunately, this isn't often practised in our society.

Anton Chekov and Maxim Gorky, for example, critiqued each other’s works yet maintained a strong friendship. However, finding such balance is challenging in our circles. The world is diverse, and differing opinions shouldn't lead to personal attacks. It's as if we fear each other's opinions to the extent that honesty and sincerity are sidelined.

Writers benefit from unbiased opinions and constructive criticism. Genuine friendships with authors who offer honest feedback, rather than just praise, are valuable and sincere relationships worth cherishing.

You talked about the lack of critique in Nepali literature. What role do you think the media plays in providing a platform for authors?

The media plays a crucial role in promoting authors, especially in launching their careers. I remember when I started writing, authors featured in newspapers would create a buzz. Sometimes, people didn't even know what they had written; their photo was just there.

I too hoped to see my stories in newspapers, but it was tough, especially initially. Media often favours established authors and hesitates to support new writers. Once you've published your first work and received positive feedback, navigating the publishing industry becomes easier. But finding a platform for that debut, the first piece is challenging.

What challenges have you observed in the literary community?

Being a writer isn't the most stable job. We constantly learn, enhance our writing skills, and explore new topics and themes. There isn't much money in writing, making it nearly impossible to rely solely on it for a living.

I'm a teacher, which provides stability. However, in my decade-long writing career, my mind is always occupied. Characters and words from my stories linger, even when I'm at home. I don't just unwind; my thoughts are filled with my literary creations.

That's why I believe being a writer requires a strong heart and a genuine passion for the craft.

What motivates you to keep writing despite the challenges faced by the writing community?

It’s my identity. I want to leave my mark on the world, and writing is my means to achieve that. Once I began writing, there was no turning back. My books reflect this; I embed a part of myself in my stories.

Why did you choose to name your collection ‘Yambunera’?

This choice is deeply connected to my identity. I believe writers, much like politicians, engage in politics, but our power lies in our pen, not politics. I use language to delve into identity politics, and that's where ‘Yambuneru’ comes in. ‘Yambu’ means Kathmandu, and I want people to recognise that. Yambu is my foundation; it’s my home. I want this intrinsic part of me to hold value for others too. Some people don't see me merely as a Nepali language writer; they label me as a Tamang writer. I am both—a Tamang and a Nepalese woman and writer. I want my stories to echo that truth.

Bina Theeng Tamang’s book recommendations:

Grapes of Wrath

Author: John Steinback

Publisher: The Viking Press

Set in Oklahoma in the 1960s, Grapes of Wrath is a story about the economic struggles of farmers whose cropshave been destroyed by a dust bowl. The first line of this book is captivating and sets up the story about the dark life of the people desperately seeking a better life.

Crime and Punishment

Author: Fyodor Dostoevsky

Publisher: The Russian Messenger

This is a fascinating story about Raskolnikov, who commits a heinous act of murder. I think it’s a testament to Dostoevsky’s writing that we sympathise so much with Raskolnikov’s character despite what he’s done.

Autobiographies of Maxim Gorky

Author: Maxim Gorky

Year: 1913-1923

Publisher: Citadel Press

The book delves into the life of the author Maxim Gorky in a way that evokes despair at the difficult life Gorky had to live. Reading Gorky’s novels and being privy to the person that he was, was interesting and saddening.

The Vegetarian

Author: Han Kang

Publisher: Portobello Books (English)

The Vegetarian tells the story of a woman who decides to stop eating meat and the tragic events that follow through the perspectives of her husband, brother-in-law and sister. I was captivated by the beautiful writing, which skillfully highlighted the importance of feminism.

Author: Tarasankar Bandyopadhyay

Publisher: Bharatiya Jnanpith

Ganadevta portrays the challenges faced by Indian villagers. Its realistic and detailed writing vividly captures the characters’ dimensions and struggles, unfolding their stories in a deliberate and moving manner

Manushree Mahat Manushree Mahat is a reporter at The Kathmandu Post covering social issues. Before moving to the social beat, Mahat was an intern covering culture and lifestyle for the Post.

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Natural language processing for Nepali text: a review

• Published: 27 October 2021
• Volume 55 , pages 3401–3429, ( 2022 )

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• Tej Bahadur Shahi   ORCID: orcid.org/0000-0002-0616-3180 1 , 2 &
• Chiranjibi Sitaula 3 , 4  

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Because of the proliferation of Nepali textual documents online, researchers in Nepal and overseas have started working towards its automated analysis for quick inferences, using different machine learning (ML) algorithms, ranging from traditional ML-based algorithms to recent deep learning (DL)-based algorithms. However, researchers are still unaware about the recent trends of NLP research direction in the Nepali language. In this paper, we survey different natural language processing (NLP) research works with associated resources in Nepali language. Furthermore, we organize the NLP approaches, techniques, and application tasks used in the Nepali language processing using the comprehensive taxonomy for each of them. Finally, we discuss and analyze based on such assimilated information for further improvement in NLP research works in the Nepali language. Our thorough survey bestows the detailed backgrounds and motivations to researchers, which not only opens up new potential avenues but also ushers towards further progress of NLP research works in the Nepali language.

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A Comprehensive Study on Natural Language Processing, It’s Techniques and Advancements in Nepali Language

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Shahi, T.B., Sitaula, C. Natural language processing for Nepali text: a review. Artif Intell Rev 55 , 3401–3429 (2022). https://doi.org/10.1007/s10462-021-10093-1

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Gender, Sexuality, and Indian Cinema: Queer Visuals

Anil Pradhan , Pema Gyalchen Tamang

Despite the developments in queer and sexuality studies in India, there exists a glaring gap in the field of research on queer texts (literary, cinematic, etc.) from the hills of Darjeeling (in West Bengal) and Sikkim, India. This chapter explores existing forms of visual representation of queerness and non-heteronormative sexualities in in the Hills, in an attempt to initiate a discussion on visual queer cultures in/of the Hills. Specifically, the chapter interrogates how such visual texts are utilised by queer individuals from the Hills to challenge the heteronormative and heteropatriarchal societal and cultural strictures of the region, while refashioning queer visual culture in the Indian-Nepali context. The discussion in the chapter is divided into three main sections. The first one focuses on “Mohan ra Madan” (2022), the first queer-themed short film from Sikkim, and discusses how both the potential and threats of rurality impacts queer subjects and gay romance in the villages of Sikkim. The second section analyses “Awaz” (2022), the first queer-themed music video from Darjeeling, and “Sanjh ko Pal” (2022), the first short film from Darjeeling with lesbian romance as the main plot; the focus is on the representation of discrimination of queer individuals at urban workspaces and the call for action against it, and how same-sex romance set in rural spaces can be analysed to have a queer-positive message when looked at through the lens of a queer ecofeminist perspective. The third section focuses on Xorem Chen Tamang, a popular queer influencer from Darjeeling, and a couple of music videos starring Xorem to highlight how they have used such platforms to reimagine the ‘normal’ when it comes to popular visual media content and its consumption in the Hills. Through a focus on the expression and representation of queerness in visual texts in Nepali, it is the first study to elicit subjective understanding of queerness and non-heteronormative sexualities specific to the Darjeeling and Sikkim Hills and provides an entry point into doing queer visual culture studies in this under-represented and neglected region of India.

Dr. Bornali N . Dowerah

The dimension of Indian young adult literature is far away from the mainstream literature. Nevertheless, there have been few known contributions of writers of post Raj like R. K. Narayan, Ruskin Bond and Mulk Raj Anand but it is not certain that their target readers are exclusively meant for adolescent readership. In fact, their readership is not directed by anybody in the Indian scenario. Since last decades there have been a tremendous change in the arena of young adult literature and that is the depiction of queer characters in the Indian English fiction. Here the word 'queer' has been used as an umbrella term for the LGBT community. Two novels "Slightly Burnt"(2014) by Payal Dhar and "Talking of Muskaan" (2014) by Himanjali Sankar have been selected for analysing queer spaces as exemplary of contemporary young adult Indian English fiction. Extending through the methodology of queer theory this article interrogates the narrative voices that claim heterogeneity as normal against homosexuality. Moreover, an attempt has been made to study and bring out the element of ambivalence delineated in the authorial voice, queer representations and the adolescent perspective.

Runas Journal of Education & Culture, Vol. 2, No. 4

Anil Pradhan

In The Field of Cultural Production: Essays on Art and Literature, sociologist Pierre Bourdieu puts forward the idea that culture is discursively produced and that the field that informs, constitutes, and problematizes cultural production is crucial towards understanding how cultural transactions, dynamics, and politics work. Since literature is a key marker of society's outlook on and reception of sensitive subjects like non-heteronormativity, this article focuses on the queer literary field-LGBTQ+-related texts and publication-in/of contemporary India. To this end, I look into trends in publication of Indian queer literary texts in English since 1976 through Bourdieu's concept of the cultural production of the field of queer literature and consider popular texts like Shikhandi: And Other Queer Tales They Don't Tell You; Our Impossible Love; She Swiped Right into my Heart, and read them vis-àvis Bourdieu's theorization, in order to conceptualize an idea about how texts and contexts interact with each other towards (re-)producing and (re-)constructing contemporary queer culture(s) in the Indian context.

Lapis Lazuli, Vol. 9, No.1

The idea that the discourses and the praxes of sexualities need to be critically interrogated, problematized, and rethought of has gained ground in the recent past, and the issue of ‘modernity’ has come to occupy one of the key positions that inform and complicate this project. However, the singular idea of ‘modernity’ is both inadequate and detrimental towards the plurality of modernities in the non-West, necessitating a rethinking through what Dilip Gaonkar and Charles Taylor theorize as ‘alternative modernities.’ In this context, research on the modernities of ‘queer’ sexualities can be re-oriented through a consideration of what has been theorized as the ‘post-queer’ by Peter Jackson, David Ruffolo, and Adam Green. This paper considers ‘alternative modernities’ and the ‘post-queer’ co-relationally and attempts at interrogating the idea of a multivalent post-queer modernity through a discussion of some key queer literary and critical texts published in the past two decades in India.

Srija Sanyal

Queerness or rather queer sexuality in India has always been the favourite child of debate and discussions. Queer identity in India has always suffered through the dilemma of to be or not to be. As Dasgupta puts it, " Identities are complicated to begin with and become more complicated when relating them to nation and sexuality ". Given the diversity of India in terms of not only culture but ethnicity as well, Indian sexual identities are the product of " Mulipicitous effects and perceptions of tradition, modernity, colonization and globalization " (Dasgupta, 2011) that are more often in conflict with each other than in a harmonious synthesis. The main argument of this paper is to trace a lineage of queerness in India both in terms of its representation in literature by analyzing The Editor (1893) and The Housewife (1891) by Rabindranath Tagore; Lihaaf (1941) by Ismat Chugtai; and R. Raja Rao's The Boyfriend (2003), and how it prevailed in reality or the societal perception of the same. Providing a literature review by building a bridge in between the ancient and the contemporary India, the paper attempts to trace the missing links of when and how queerness went behind the curtains only to reappear in front of a more complicated, confused and probably a more rigid audience.

Brinda Bose

This chapter on South Asian writing in The Cambridge History of Gay and Lesbian Literature (published by CUP, December 2014) maps the LGBT politics of writing in the region as the battle against Section 377 of the Indian Penal Code continues to define its modes of existence and engagement.

QUEST JOURNALS

PARIPEX-INDIAN JOURNAL OF RESEARCH

Gaganjot Kaur

It has been widely observed that LGBT Literature in India is scarce compared to its foreign counterpart. One of the major reasons for this is the archaic and deep rooted institutional 'othering' that is meted out to the individuals belonging to this community. This research paper deals with the literature of the few authors who have so eloquently written about LGBTQ stories and the ordeals they have to face to publish their works in a (still very) homophobic and transphobic India. This paper has been written with the sole intention of providing a one-stop information hub about the evolution of LGBTQ Literature in India.

Palak Madan

Decolonial Subversions SI 'Vernacular Cultures of South Asia'

Decolonial Subversions

One of the most interesting supernatural ontologies in the pan-Nepalese narrative folklore is definitely that of the Kichkannī. An ethereal feminine spirit of elegant beauty and vampire who steals one's life breath, the Kichkannī is at the center of an astonishingly rich narrative complex that allows us to question the realms of gender in the sexualized imaginaries of contemporary Nepal. The Kichkannī represents the dissatisfied ātmā (soul, Self) of an unmarried virgin girl (Nep. kanyā), who decided to commit suicide without having been able to satisfy her sexual desire. In other cases, the Kichkannī may also originate from the ātmā of a girl who, having been raped and, as a result of this forced and violent sexual act, having become pregnant, decided to kill herself. Alongside this supernatural being, a unique ethnographic document highlighted a folk-belief concerning her 'othered sexed' counterpart: the Domāse, the spirit of a hĩjaḍa, a transsexual or transgender person, who committed suicide because he could not fulfill his sexual desires. I propose to reconsider the narrative folklore around these supernatural beings, which are embedded in beliefs and narrative practices, in order to question the sociocultural processes by which gendered and sexual identities are produced.

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literature review

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समीक्षाको अर्थ

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review copy

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nepali literature

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meaning of review

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entering flat review.

पुर्ण समीक्षा प्रवेश गर्दै छु ।

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next - review account

खाता मेट्नुहुन्छ ?

meaning of book review

पुस्तक समीक्षा को अर्थ

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not using flat review.

पुर्ण समीक्षा प्रयोग भएको छैन ।

also post this review to:

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review live region announcement.

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समीक्षाको बारेमा सुन्दरी palar

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enters and exits flat review mode.

पूर्ण समीक्षा मुद्रामा प्रवेस र बहिर्गमन गर्छ ।

moves flat review to the bottom left.

पूर्ण समीक्षा देब्रे पुछारमा जान्छ ।

citeseer: scientific literature digital library

citeseer: वैज्ञानिक साहित्य डिजिटल लाइब्रेरीquery

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समतल पुनरावलोकनलाई रेखालो अन्त्यमा सार्दछ ।

review what other people see on your profile

तपाईंको प्रोफाइलमा अन्य मानिसहरूले के देख्छन् समीक्षा गर्नुहोस्

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moves flat review to the previous item or word.

अघिल्लो वस्तु वा शब्दमा समतल पुनरावलोकन सार्दछ ।

a relevant review was conducted by whitby et al.

ह्विट्बी et al द्वारा एक सान्दर्भिक समीक्षा सञ्चालन गरिएको थियो।

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पूर्ण समीक्षा मुनि रहेका सामाग्रीहरूलाई क्लिपपाटीमा थप गर्छ ।

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What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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Open Access

Peer-reviewed

Research Article

Financial hardship among patients suffering from neglected tropical diseases: A systematic review and meta-analysis of global literature

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Visualization, Writing – original draft

Affiliations Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America, Department of Social and Administrative Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand

Roles Conceptualization, Data curation, Formal analysis, Investigation, Validation, Writing – review & editing

Affiliations Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America, School of Pharmacy, Sungkyunkwan University, Suwon, South Korea

Roles Investigation, Writing – review & editing

Affiliation Corvaxan Foundation, Villanova, Pennsylvania, United States of America

Roles Conceptualization, Writing – review & editing

Affiliation Department of Global Programme for Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland

Roles Conceptualization, Funding acquisition, Project administration, Writing – review & editing

* E-mail: [email protected]

Affiliations Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America, IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, United States of America

• Chanthawat Patikorn, 
• Jeong-Yeon Cho, 
• Joshua Higashi, 
• Xiao Xian Huang, 
• Nathorn Chaiyakunapruk

• Published: May 13, 2024
• https://doi.org/10.1371/journal.pntd.0012086
• Peer Review
• Reader Comments

Introduction

Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs.

We searched PubMed, EMBASE, EconLit, OpenGrey, and EBSCO Open Dissertations, for articles reporting financial hardship caused by NTDs from database inception to January 1, 2023. We summarized the study findings and methodological characteristics. Meta-analyses were performed to pool the prevalence of CHS. Heterogeneity was evaluated using the I 2 statistic.

Ten out of 1,768 studies were included, assessing CHS (n = 10) and impoverishment (n = 1) among 2,761 patients with six NTDs (Buruli ulcer, chikungunya, dengue, visceral leishmaniasis, leprosy, and lymphatic filariasis). CHS was defined differently across studies. Prevalence of CHS due to OOP costs was relatively low among patients with leprosy (0.0–11.0%), dengue (12.5%), and lymphatic filariasis (0.0–23.0%), and relatively high among patients with Buruli ulcers (45.6%). Prevalence of CHS varied widely among patients with chikungunya (11.9–99.3%) and visceral leishmaniasis (24.6–91.8%). Meta-analysis showed that the pooled prevalence of CHS due to OOP costs of visceral leishmaniasis was 73% (95% CI; 65–80%, n = 2, I 2 = 0.00%). Costs of visceral leishmaniasis impoverished 20–26% of the 61 households investigated, depending on the costs captured. The reported costs did not capture the financial burden hidden by the abandonment of seeking healthcare.

NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. To develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.

Author summary

Neglected tropical diseases (NTDs) mainly affect underprivileged populations, potentially resulting in catastrophic health spending (CHS) and impoverishment from out-of-pocket (OOP) costs. This systematic review aimed to summarize the financial hardship caused by NTDs. We found that NTDs lead to a substantial number of households facing financial hardship. CHS risk due to direct OOP costs was relatively low among patients with leprosy (0.0–11.0%), dengue (12.5%), and lymphatic filariasis (0.0–23.0%), and relatively high among patients with Buruli ulcers (45.6%). CHS risk varied widely among patients with chikungunya (11.9–99.3%) and visceral leishmaniasis (24.6–91.8%). Costs of visceral leishmaniasis impoverished 20–26% of 61 households, depending on the costs captured. Nevertheless, financial hardship caused by NTDs was not comprehensively evaluated in the literature. Therefore, to develop evidence-informed strategies to minimize the financial hardship caused by NTDs, studies should evaluate the factors contributing to financial hardship across household characteristics, disease stages, and treatment-seeking behaviors.

Citation: Patikorn C, Cho J-Y, Higashi J, Huang XX, Chaiyakunapruk N (2024) Financial hardship among patients suffering from neglected tropical diseases: A systematic review and meta-analysis of global literature. PLoS Negl Trop Dis 18(5): e0012086. https://doi.org/10.1371/journal.pntd.0012086

Editor: Yoel Lubell, Mahidol-Oxford Tropical Medicine Research Unit, THAILAND

Received: November 7, 2023; Accepted: March 20, 2024; Published: May 13, 2024

Copyright: © 2024 Patikorn et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.

Funding: This study is funded by the Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland. XXH, as an employee of the World Health Organization, contributed to this study in terms of study design, data interpretation, and report writing.

Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests:XXH works for the World Health Organization. The author alone is responsible for the views expressed in this publication and does not necessarily represent the decisions, policies, or views of the World Health Organization.

In 2021, the World Health Organization (WHO) reported that 1.65 billion people required treatment and care for neglected tropical diseases (NTDs) as they faced humanistic, social, and economic burdens incurred by the diseases. NTDs are a diverse group of diseases that mainly affect underprivileged communities in tropical and subtropical areas [ 1 ]. NTDs predominantly affect disadvantaged populations in low- and middle-income countries (LMICs) due to the lack of timely access to affordable care. It has been reported that every low-income country is affected by at least five NTDs [ 2 ]. Even worse, impoverishment serves as a structural determinant. At the same time, it is a consequence of NTDs due to the direct and indirect costs incurred [ 3 ]. Therefore, the WHO has advocated in their recent NTDs 2021–2023 roadmap that NTDs must be overcome to attain Sustainable Development Goals (SDGs) and ensure Universal Health Coverage (UHC). The NTDs 2021–2030 roadmap targets that 90% of the population at risk are protected against catastrophic out-of-pocket (OOP) health spending caused by NTDs [ 1 ].

Financial hardship is usually quantified as catastrophic health spending (CHS) (as known as catastrophic health expenditure) and impoverishment. CHS is the proportion of households with OOP costs incurred by a specific disease that exceed a specific threshold of the total household income or expenditure (budget share approach) or non-subsistent household expenditure (capacity-to-pay approach). Impoverishment is when the OOP costs push households below the poverty line [ 4 – 6 ]. CHS and impoverishment are well-established indicators for the financial risk protection of the healthcare system, which was an essential dimension of the UHC as indicated under the SDG 3.8.2 indicators [ 1 , 7 ].

Financial hardship poses a greater challenge for individuals affected by NTDs, as they frequently reside in poverty before the onset of the disease. To evaluate the long-term economic risk imposed by health spending on NTDs, it is important to understand the coping strategies of this population. Literature has shown that coping strategies, such as seeking financial assistance through loans or selling their assets, could push households into or further into poverty if it impacts their productivity [ 8 ]. Thus, providing coverage to these groups effectively strengthens the financial risk protection of the health system [ 7 ]. Since some types of NTD are closely related to financial hardship, improving their financial protection may help attain UHC, especially for LMICs [ 9 ].

Financial protection is an essential indicator for NTDs and UHC; however, there was limited research on the financial hardship of NTDs. Although many studies addressed the question of the economic burden of NTDs, there is no systematic review and meta-analysis summarizing the financial hardship faced by the population affected by NTDs. Therefore, to fill this knowledge gap and build a baseline for the NTDs roadmap’s financial risk protection indicator, this study aimed to summarize the prevalence and magnitude of financial hardship among patients suffering from NTDs. Additionally, we assessed the methodologies of quantifying CHS and impoverishment incurred by NTDs.

Scope of the review

The protocol of this systematic review was registered with PROSPERO (CRD42023385627) [ 10 ]. This study was reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline ( S1 PRISMA Checklist) [ 11 ]. Differences from the original review protocol are described with rationale ( S1 Table ).

This systematic literature review focused on 20 diseases selected as NTDs by WHO: Buruli ulcer, Chagas disease, dengue and chikungunya, dracunculiasis (Guinea-worm disease), echinococcosis, foodborne trematodiases, human African trypanosomiasis (sleeping sickness), leishmaniasis, leprosy (Hansen’s disease), lymphatic filariasis, mycetoma, chromoblastomycosis and other deep mycoses, onchocerciasis (river blindness), rabies, scabies and other ectoparasitoses, schistosomiasis, soil-transmitted helminthiases, snakebite envenoming, taeniasis/cysticercosis, trachoma, and yaws and other endemic treponematoses [ 12 ].

Outcomes of interest of this systematic review were the prevalence and magnitude of victims who faced financial hardship caused by NTDs, including CHS, impoverishment, and coping strategies.

Search strategy and selection process

We searched three bibliographic databases, PubMed, EMBASE, and EconLit, to identify articles reporting financial hardship among patients suffering from NTDs from any country indexed from database inception to January 1, 2023. We also searched for grey literature in two databases, OpenGrey and EBSCO Open Dissertations. The search terms used were ( Disease name and its synonyms ) AND (catastroph* OR impoverish* OR coping OR economic consequence* OR out-of-pocket OR "out of pocket" OR ((household OR family OR patient AND (cost* OR spending OR expen*))), that was adapted to match the search techniques of each database. A full search strategy is shown in S2 Table . There was no language restriction applied in this systematic review. A supplemental search was performed by tracking citation and snowballing the eligible articles’ reference list.

Two reviewers (CP and JYC) independently performed the study selection. They screened the titles and abstracts of identified articles from database searches for relevance. Potentially relevant articles were sought for full-text articles. We requested the authors for full-text articles or reports of highly relevant articles without full-text articles, such as conference abstracts. The retrieved full-text articles were selected based on the eligibility criteria. Discrepancies arising during study selection were resolved by discussion with the third reviewer (NC).

Eligibility criteria

We included empirical studies reporting CHS, impoverishment, or coping strategies incurred by NTDs using primary data collection.

Data extraction

We developed a data extraction sheet by performing a pilot test of extracting five randomly selected articles and refining it until finalization. Two reviewers (CP and JYC) independently performed data extraction. Another reviewer (JH) checked the extracted data for correctness. Any discrepancies were resolved by discussion among reviewers.

Study findings and methodological characteristics extracted from the eligible articles are as follows: first author, publication year, NTDs, study setting, study design, sample characteristics, sample size, data collection period, data collection methods, time horizon, a perspective of the analysis, discount rate, costing year, reported currency, cost units, the definition of CHS and impoverishment, prevalence and magnitude of CHS and impoverishment incurred, economic consequences and coping strategies of financial hardship. Corresponding authors of the eligible articles were contacted to request individual patient-level data. However, we received no response.

The financial risk protection metric is intended to capture only the OOP costs for medical services (e.g., treatment and diagnosis costs). However, some studies considered certain types of direct non-medical costs (e.g., transportation, food, and accommodation costs) and indirect costs (e.g., productivity and income losses) when quantifying financial hardship. Some studies also included informal care costs, such as traditional medicine, as OOP costs [ 6 ]. Thus, our systematic review categorized costs extracted from the eligible studies as direct costs (OOP costs) and indirect costs. Direct costs were further categorized as direct medical costs and direct non-medical costs. The combination of direct costs and indirect costs was categorized as total costs.

Quality assessment

Two reviewers independently assessed the eligible articles’ quality (CP and JYC). Any discrepancies were resolved by consensus among the reviewers. To the best of our knowledge, there is no risk-of-bias assessment tool for economic burden studies. Hence, we assessed the quality of the eligible articles using the cost-of-illness evaluation checklist by Larg and Moss [ 13 ].

Data synthesis

A narrative synthesis was performed to summarize study findings, methodological characteristics, and the quality of the eligible studies. The identified countries were categorized based on the World Bank’s income levels and regions [ 14 ].

Statistical analysis

We performed meta-analyses to calculate the pooled prevalence of households experiencing financial hardship. However, this was possible only for studies that quantified financial hardship using the same measurement definition for a particular NTD. For example, we performed a meta-analysis to calculate the pooled prevalence of households experiencing CHS due to visceral leishmaniasis based on two studies that defined CHS as direct costs exceeding 10% of annual household income [ 8 , 15 ]. The remaining studies were not meta-analyzed due to the differences in the definitions of CHS. We estimated the pooled prevalence of CHS and 95% confidence intervals (CI) using a random-effects model under the DerSimonian and Laird approach [ 16 ]. Effect sizes were computed using each study’s Freeman–Tukey double-arcsine-transformed proportion. This variance-stabilizing transformation is particularly preferable when the proportions are close to 0 or 1 [ 17 ]. p < .05 was considered statistically significant in 2-sided tests.

Heterogeneity was evaluated by observing the forest plots and using the I 2 statistic that estimated the proportion of variability in a meta-analysis that is explained by differences between the included trials rather than by sampling error. Subgroup analyses were performed to explore possible causes of heterogeneity among study results. Publication bias was assessed using the funnel plot asymmetry test and the Egger regression asymmetry test [ 18 ]. Statistical analyses were conducted using Stata version 18.0 (Stata Corporation).

Patient and public involvement

Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.

Overall characteristics of the included studies

A total of 1,768 articles were identified from the search, of which 10 studies were included ( Fig 1 ) [ 8 , 15 , 19 – 26 ]. A list of excluded studies with reasons is presented in S3 Table . These studies quantified financial hardship among 2,761 patients in five LMICs (India, Nepal, Nigeria, Sudan, and Vietnam) who had been diagnosed with six out of the WHO’s 20 NTDs, including Buruli ulcer [ 20 ], chikungunya [ 21 , 26 ], dengue [ 22 ], visceral leishmaniasis [ 8 , 15 , 25 ], leprosy [ 19 , 23 ], and lymphatic filariasis [ 24 ]. Table 1 provides a summary of the study characteristics. We found no major concern in the quality of the included studies ( S4 Table )

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Financial hardship caused by NTDs was quantified as CHS (10 studies) [ 8 , 15 , 19 – 26 ], and impoverishment (1 study) [ 8 ]. All studies were conducted in LMICs with a focus on South Asia (7 studies) [ 8 , 19 , 21 , 23 – 26 ], Sub-Saharan Africa (2 studies) [ 15 , 20 ], East Asia & Pacific (1 study) [ 22 ]. Patients were mostly identified using a hospital-based approach (7 studies) [ 8 , 15 , 19 , 20 , 22 , 23 , 25 ], with active case-finding intervention implemented in two of those studies [ 20 , 23 ]. Five studies reported that patients sought informal healthcare, such as traditional healers, ayurveda, and homeopathy [ 19 – 21 , 25 , 26 ].

Costs captured in the financial hardship were direct medical costs (10 studies, 100%) [ 8 , 15 , 19 – 26 ], direct non-medical costs (9 studies, 90%) [ 8 , 15 , 19 – 21 , 23 – 26 ], and indirect costs (7 studies, 70%) [ 8 , 15 , 19 , 21 , 23 , 25 , 26 ], as summarized in Table 2 . These costs were captured with a different timeframe, including during a disease episode [ 8 , 15 , 20 , 21 , 25 , 26 ], during hospitalization in an intensive care unit [ 22 ], monthly costs with a maximum recall period of 3 years [ 19 ], per one outpatient visit in the last 6 months [ 23 ], and per one hospitalization episode in the last year and per one outpatient visit in the last 15 days [ 24 ]. Abandonment of healthcare seeking due to financial burden was not reflected in the reported costs as the included studies captured only patients who sought healthcare.

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The health insurance systems or special programs covered some of the costs. The costs for diagnosis and treatment of visceral leishmaniasis were provided free of charge to patients under the publicly financed health insurance system in Nepal [ 8 , 25 ] and Sudan [ 15 ]. In Nigeria, international development partners funded a special program that provided free diagnosis and treatment of Buruli ulcers, as well as accommodation, school funding, and basic allowance [ 20 ]. Additionally, the Indian government had a special program that provides financial assistance to families of patients affected by leprosy [ 19 ]. However, patients in India had to pay high OOP costs for medical services for leprosy [ 19 , 23 ], chikungunya [ 21 , 26 ], and lymphatic filariasis [ 24 ]. Similarly, patients in Vietnam also paid high OOP costs for the medical treatment of dengue [ 22 ]. For more details, refer to Table 3 .

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Financial hardship among patients suffering from NTDs

Catastrophic health spending..

CHS was variedly defined across studies in terms of types of costs (medical costs, medical and transportation costs, direct costs, indirect costs, or total costs), thresholds (5%, 10%, 15%, 25%, 30%, 40%, or 100%), timeframe (monthly, quarterly, or annual), household resources (income, consumption expenditure, national average annual household expenditure, or international poverty line) and perspective (household or individual). All studies used the budget share approach to quantify CHS. The most commonly used definitions of CHS caused by NTDs were direct costs of a disease episode exceeding 10% of annual household income (3 studies) [ 8 , 15 , 20 ] and total costs of a disease episode exceeding 10% of annual household income (3 studies) [ 8 , 15 , 25 ]. CHS that included only the direct medical costs was reported in two studies [ 8 , 22 ].

We summarized the prevalence of households experiencing CHS and the magnitude of CHS, determined as the percentage of the costs of NTDs as a share of income, in Table 4 . The prevalence and magnitude of CHS varied depending on the definitions of CHS, disease duration (episodic or chronic), and thresholds used (≤10% or >10%). Overall, the direct costs of NTDs resulted in a wide range of households experiencing CHS. CHS was generally low among patients with leprosy (0.0–11.0%) [ 19 , 23 ], dengue (12.5%) [ 22 ], and lymphatic filariasis (0.0–23.0%) [ 24 ], and relatively high among patients with Buruli ulcers (45.6%) [ 20 ]. CHS varied widely among patients with chikungunya (11.9–99.3%) [ 21 , 26 ] and visceral leishmaniasis (24.6–91.8%) [ 8 , 15 , 25 ].

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Meta-analyses were performed to pool the prevalence of CHS in studies reporting CHS using the same measurement definition in a particular CHS. This was only possible for visceral leishmaniasis, in which CHS was quantified as direct costs of a disease episode exceeding 10% of annual household income in two studies [ 8 , 15 ], and total costs exceeding 10% of annual household income in three studies [ 8 , 15 , 25 ].

The pooled prevalence of CHS, defined as direct costs exceeding 10% of annual household income, was 73% (95% CI; 65–80%, n = 2, I 2 = 0.00%), as shown in Fig 2A . Egger’s test (P = 0.80) indicated no evidence of small-study effects. Visual inspection of the funnel plot indicated no evidence of publication bias ( S1A Fig ).

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The pooled prevalence of CHS, defined as total costs exceeding 10% of annual household income, was 74% (95% CI; 49–93%, n = 3, I 2 = 94.72%), as shown in S2 Fig . We explored the source of heterogeneity by visual inspection of the forest plot. We found that the source of heterogeneity was the differences in the treatment of visceral leishmaniasis, where sodium stibogluconate was used in two studies [ 8 , 15 ], and miltefosine in one study [ 25 ]. Therefore, we performed a subgroup meta-analysis based on different treatments, as shown in Fig 2B . We removed one study [ 25 ] from the meta-analysis to investigate the publication bias without the presence of heterogeneity. Egger’s test (P = 0.81) indicated no evidence of small-study effects. Visual inspection of the funnel plot indicated no evidence of publication bias ( S1B Fig ).

Impoverishment.

Impoverishment was investigated in one study in patients with visceral leishmaniasis, which defined impoverishment as annual household income falling below the poverty line after paying for treatment [ 8 ]. Costs of visceral leishmaniasis impoverished 20–26% of the 61 households investigated, depending on the costs captured (20% medical costs, 21% medical and transportation costs, 26% direct costs), as shown in Table 2 .

Coping strategies

Four studies reported coping strategies used by patients to pay the costs of NTDs. These strategies included using savings (71–100% of patients), taking out loans (32–80%), selling livestock or other assets (17–32%), or borrowing money (0–23%), as shown in Table 2 . However, these studies did not distinguish between coping strategies used by patients who experienced CHS and those who did not [ 8 , 19 , 24 , 25 ].

Cost drivers and determinants of financial hardship

To understand the cost drivers of financial hardship caused by NTDs, we analyzed the percentage share of types of costs captured in the direct costs. The findings are presented in Fig 3 . Direct medical costs were the primary cost driver in nine studies [ 8 , 19 – 21 , 23 – 26 ]. However, one study identified food and transportation costs as the main cost drivers [ 15 ].

Abbreviation: ENL–erythema nodosum leprosum. Tripathy et al, 2020 [ 24 ]; Tiwari et al, 2018 [ 23 ]; Chandler et al, 2015 [ 19 ]; Uranw et al, 2013 [ 25 ], Meheus et al, 2013 [ 15 ], Adhikari et al, 2009 [ 8 ], McBride et al, 2019[ 22 ], Vijayakumar et al, 2013 [ 26 ], Gopalan et al, 2009 [ 21 ], Chukwu et al, 2017 [ 20 ] .

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Determinants of CHS were assessed in one study among patients with Buruli ulcers. The study concluded that neither age, gender, rural/urban location, education, occupation, religion, nor patient income group was a determinant of CHS [ 20 ]. There was no study investigating determinants of impoverishment.

NTDs primarily impact populations with limited financial means, yet the literature addressing the financial hardship caused by NTDs is relatively scarce. Our systematic review revealed that there were only ten studies covering six NTDs. We discovered that many households are facing financial hardship as a result of NTDs, despite having access to publicly funded healthcare systems or special NTD programs. The costs related to NTDs resulted in significant financial hardship for these households, mainly due to the high OOP costs associated with medical treatment. Even in situations where drugs used to treat NTDs were provided free of charge, the costs for supportive care, medical procedures, transportation, and food were still high and could have a devastating financial impact on these households. Moreover, these financial hardship indicators might not fully reflect the financial risk of the population affected by NTDs because many live in poverty or even extreme poverty. Victims of NTDs are usually those who are socially disadvantaged. They need to make trade-offs between suffering from the disease and seeking healthcare because not all victims can afford the costs of NTDs, especially OOP costs for medical treatment and transportation, which could lead to the abandonment of healthcare [ 1 – 3 ].

The research findings have shown that merely providing funding for treatments of NTDs is insufficient for protecting those affected by NTDs from financial hardship. Therefore, it is crucial to strengthen the entire healthcare system to effectively address the challenges of NTDs and provide financial protection to the victims. Additionally, it is important to encourage and engage communities to change the behavior of those affected by NTDs so that they seek medical assistance at appropriate healthcare facilities instead of relying on traditional healers or not seeking care at all. Our research also supports the need for an economic framework to guide NTD investments [ 27 ]. The ability to prioritize investments, informed partially by economic parameters, may appeal to a broad set of stakeholders and help facilitate the process of building coalitions to achieve the WHO’s goal that 90% of the at-risk population is protected against financial hardship caused by NTDs [ 1 ].

Although there is no consensus regarding the estimation approach and thresholds in quantifying CHS, it is important to note that these differences can significantly impact the findings and consequently impact the applications and implications of the findings [ 6 , 28 ]. We found that CHS was variedly defined across studies in terms of estimation approach, types of costs, thresholds, timeframe, household resources, and perspective. Our review revealed that 90% of the included studies captured direct non-medical costs as part of the OOP costs [ 8 , 15 , 19 – 21 , 23 – 26 ]. Furthermore, Seventy percent of the included studies considered indirect costs in quantifying financial hardship [ 8 , 15 , 19 , 21 , 23 , 25 , 26 ]. This approach aligned with an indicator called “catastrophic costs” that has emerged in tuberculosis studies. Catastrophic costs occur when the total healthcare costs, including direct and indirect costs, exceed 20% of the annual household income [ 28 ]. This indicator could be a more comprehensive measure of the overall financial burden of NTDs on the household beyond just the OOP costs which will be useful when evaluating and monitoring different healthcare policies and interventions to mitigate financial hardship caused by NTDs.

The findings of this systematic review and meta-analysis should be interpreted under the following limitations. The included studies in our review only focused on patients who sought healthcare, so the financial burden of those who did not seek healthcare was not captured in the reported OOP costs. This means that people who could not afford healthcare may have been excluded from these studies. Moreover, we could not perform meta-analyses of the prevalence of CHS on all identified NTDs due to differences in how CHS was quantified across studies and lack of access to individual patient-level data.

Hence, we highlighted some methodological considerations to guide future studies on financial hardship among households suffering from NTDs to gain a better understanding of the neglected public health issues and to inform the development of strategies of what to address to tackle the financial burden of NTDs. Firstly, methods to quantify financial hardship should be coherent to allow comparability across studies. For instance, CHS and impoverishment should be defined and measured in a relevant manner to the nature of the NTD, including estimation approach, thresholds, types of costs, timeframe, household resources, and perspective. Secondly, subgroup analyses should be conducted to evaluate the determinants of financial hardship across household characteristics (e.g., income, socioeconomic status) or phases of disease (e.g., disease onset, treatment seeking, diagnosis, treatment, post-treatment). Lastly, coping strategies should be assessed among those who did and did not experience financial hardship to understand the economic consequences of financial hardship across subgroups.

NTDs can be a devastating burden on households, not only in terms of physical and mental health but also financially. NTDs lead to a substantial number of households facing financial hardship. However, financial hardship caused by NTDs was not comprehensively evaluated in the literature. Furthermore, OOP costs represented only a partial picture of the financial hardship the population affected by NTDs faces. To mitigate this financial hardship, it is imperative to conduct thorough research to identify the factors contributing to it. Future research should consider various household characteristics, such as income, education level, and geographic location, as well as the different disease stages, from onset to treatment completion. Future studies should also investigate the hidden financial burden due to the abandonment of healthcare-seeking to capture the economic burden and opportunity costs of those who did not seek healthcare. By carefully examining these factors, researchers and decision-makers can gain insight into the specific challenges faced by households affected by NTDs and develop targeted interventions to alleviate financial hardships. Ultimately, these studies can help inform the development of strategies to reduce the burden of NTDs on households and improve overall health outcomes.

Supporting information

S1 prisma checklist. prisma checklist..

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S1 Table. Differences from original review protocol.

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S2 Table. Full search strategy.

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S3 Table. Excluded studies with reasons.

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S4 Table. Quality assessment using Larg, A., and Moss, J. R. (2011) Cost-of-illness studies: a guide to critical evaluation.

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S1 Fig. Assessment of publication bias.

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S2 Fig. Forest plot of pooled proportion of catastrophic health spending defined as total costs exceeding 10% of annual household income.

https://doi.org/10.1371/journal.pntd.0012086.s007

Acknowledgments

The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

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Literature review meaning in english, meaning of "literature review".

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माफ गर्नुहोला, अंग्रेजी शब्द भेटिएन । विस्तारै यी शब्दहरुलाई राख्दै जानेछौ ।

नेपालीबाट अंग्रेजी हो कि अंग्रेजीबाट नेपाली हो, त्यो राम्रोसँग चेक गर्नुहोस् ।

शब्दको अर्थ नभेटिनुको निम्न कारण हुन सक्छः

• शब्द (literature review) लाई अंग्रेजी रोमनमा नलेखिएको । हाम्रो डाटाबेसमा हामीले सबै नेपाली अक्षरलाई अंग्रेजी रोमनमा राखेका छौँ । जस्तो 'मन' लाई 'man' भनेर खोज्नुपर्छ ।
• तपाईले टाइप गर्दै जाँदा सिस्टमले सुझाव दिँदै जान्छ । जस्तैः sm टाइप गर्नुभयो भने स्मरण, स्मरण शक्ति, स्मरणीय लाई "Smaran", "Smaran shakti", "Smaraniya" भनेर सुझाव दिन्छ । यदि तपाईले खोजेको शब्द भेटिएमा त्यसलाई क्लिक गरेर शब्दको अंग्रेजी खोज्न सक्नुहुन्छ ।

यो शब्दलाई अंग्रेजीमा के भन्छन् कमेन्टमा लेख्नुहोस्

• सरजमिन मुचुल्का
• वडा अध्यक्ष