A Systematic Review of Non-Pharmacological Interventions for Reducing Paediatric MRI Sedation Rates in an African Hospital Setting

Title: A Systematic Review of Non-Pharmacological Interventions for Reducing Paediatric MRI Sedation Rates in an African Hospital Setting Paediatric magnetic resonance imaging (MRI) frequently requires sedation or general anaesthesia to obtain diagnostic images, which introduces patient risks and increases demands on healthcare resources. In African hospital settings, where resources are often constrained, identifying effective non-pharmacological strategies to reduce sedation use is a significant clinical and operational priority. This systematic review aimed to synthesise evidence on the effectiveness of specific non-pharmacological interventions—namely, child-life specialist programmes and MRI noise-reduction protocols—for reducing sedation rates in children. The objective was to evaluate their applicability and potential impact within a representative African hospital context. A systematic search of multiple electronic databases was conducted following PRISMA guidelines. Peer-reviewed studies investigating child-life interventions and/or technical noise-reduction methods for paediatric MRI were included. Study screening, selection, and data extraction were performed independently by two reviewers. The quality of included studies was appraised using appropriate critical assessment tools. The review identified a limited but consistent body of evidence supporting the efficacy of combined interventions. A key theme was that a multi-faceted approach yielded the greatest benefit. Specifically, the integration of a dedicated child-life programme with tailored noise-reduction techniques was associated with a reported reduction in sedation rates of up to 40% in comparable settings. Evidence suggests that implementing structured, non-pharmacological interventions can significantly decrease the need for sedation in children undergoing MRI, with a combined strategy appearing most effective. However, the direct transferability of these findings to resource-variable African contexts requires careful consideration of local infrastructure and training capacities. Hospitals in similar African settings should consider piloting integrated child-life and noise-reduction programmes, adapted to local resources. Further primary research is needed within Africa to validate these interventions' effectiveness and to develop context-specific implementation guidelines. Investment in staff training and sustainable programme design is essential. paediatric MRI, sedation reduction, non-pharmacological interventions, child-life specialist, noise-reduction protocols, Africa, systematic review. This review consolidates available evidence on specific non-pharmacological strategies for paediatric MRI, providing a focused synthesis to inform practice and research priorities within African radiology departments.