Barriers and facilitators to pediatric pain assessment and management in sub-Saharan Africa: A scoping review

Background Chronic pain affects up to one-third of children in Sub-Saharan Africa (SSA) yet remains frequently under-treated due to systemic barriers in assessment and management. While caregiver involvement and validated tools support care in high-income settings, there is limited region-specific evidence to guide pediatric pain practices in SSA. Aim To map and synthesize existing literature on the barriers and facilitators of pediatric pain assessment and management in SSA. Methods Following Arksey and O’Malley's framework and PRISMA-ScR guidelines, we conducted a search across multiple databases and Google Scholar for studies published between January 2014 and August 2025. Data was analyzed using qualitative content analysis. Results Eighteen studies from ten SSA countries were included. Common barriers in SSA included lack of formal training, absence of standardized assessment tools, limited medication availability, particularly opioids, staff shortages, and cultural reluctance to report pain. Facilitators in SSA included non-pharmacological interventions, specialized training, access to guidelines, positive professional attitudes, and caregiver involvement. Conclusion Pediatric pain care in SSA is shaped by systemic challenges as well as emerging strengths. Addressing training gaps, enhancing institutional support, and ensuring reliable access to essential medicines are central to improving care. Implications for practice Region-specific, multidisciplinary interventions aligned with WHO and Sustainable Development Goal 3 should integrate pediatric pain education into training programs, adopt appropriate assessment tools, ensure medication availability, strengthen supply chains, and involve caregivers. Tailored interventions, grounded in SSA-specific evidence, are essential for equitable and effective pediatric pain care.