Delivering infectious disease interventions to women and children in conflict settings: a systematic review

Meteke, Sarah; Stefopulos, Marianne; Als, Daina; Gaffey, Michelle F; Kamali, Mahdis; Siddiqui, Fahad Javaid; Munyuzangabo, Mariella; Jain, Reena; Shah, Shailja; Radhakrishnan, Amruta; Ataullahjan, Anushka; Bhutta, Zulfiqar A

doi:10.1136/bmjgh-2019-001967

Cited by 19 publications

(17 citation statements)

References 175 publications

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“…A large proportion of children unvaccinated for MCV live in remote rural and conflict-affected areas. In these places, flexible approaches developed at the local level such as multiple rounds of vaccination using mobile teams [ 55 ] can be used during lulls in fighting [ 56 , 57 ]. Resources need to be decentralized to facilitate district-level decision-making and rapid action when access to previously difficult areas is possible.…”

Section: Discussionmentioning

confidence: 99%

Vaccination strategies for measles control and elimination: time to strengthen local initiatives

Cutts

Ferrari

Krause

et al. 2021

BMC Med

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Background Through a combination of strong routine immunization (RI), strategic supplemental immunization activities (SIA) and robust surveillance, numerous countries have been able to approach or achieve measles elimination. The fragility of these achievements has been shown, however, by the resurgence of measles since 2016. We describe trends in routine measles vaccine coverage at national and district level, SIA performance and demographic changes in the three regions with the highest measles burden. Findings WHO-UNICEF estimates of immunization coverage show that global coverage of the first dose of measles vaccine has stabilized at 85% from 2015 to 19. In 2000, 17 countries in the WHO African and Eastern Mediterranean regions had measles vaccine coverage below 50%, and although all increased coverage by 2019, at a median of 60%, it remained far below levels needed for elimination. Geospatial estimates show many low coverage districts across Africa and much of the Eastern Mediterranean and southeast Asian regions. A large proportion of children unvaccinated for MCV live in conflict-affected areas with remote rural areas and some urban areas also at risk. Countries with low RI coverage use SIAs frequently, yet the ideal timing and target age range for SIAs vary within countries, and the impact of SIAs has often been mitigated by delays or disruptions. SIAs have not been sufficient to achieve or sustain measles elimination in the countries with weakest routine systems. Demographic changes also affect measles transmission, and their variation between and within countries should be incorporated into strategic planning. Conclusions Rebuilding services after the COVID-19 pandemic provides a need and an opportunity to increase community engagement in planning and monitoring services. A broader suite of interventions is needed beyond SIAs. Improved methods for tracking coverage at the individual and community level are needed together with enhanced surveillance. Decision-making needs to be decentralized to develop locally-driven, sustainable strategies for measles control and elimination.

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Section: Discussionmentioning

confidence: 99%

Vaccination strategies for measles control and elimination: time to strengthen local initiatives

Cutts

Ferrari

Krause

et al. 2021

BMC Med

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“…Nevertheless, many of the central messages from this review -including the value of recruiting local staff to improve trust and vaccination uptake, flexibility in service delivery modes (including the use of mobile services), and use of electronic systems to strengthen supply chain management and health intelligence -support findings from reviews and guidance elsewhere (81,83,85). Findings also suggest that SIAs, as integrative interventions, can have important and wide-ranging effects not just on vaccination uptake, but also on wider system capacity through e.g.…”

Section: Summary Of Key Findingsmentioning

confidence: 84%

“…A number of systematic reviews have been published in recent years addressing the effectiveness of interventions in humanitarian settings, some including data on vaccination delivery (80,81), and there is now a large body of evidence considering the effectiveness of interventions to improve vaccination coverage from community level upwards in low-and middle-income settings more generally (e.g. 16).…”

Section: Summary Of Key Findingsmentioning

confidence: 99%

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

Ismail¹,

Lam²,

Bell³

et al. 2022

Preprint

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BackgroundChildhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improving vaccination coverage in protracted crises, focusing on how they work, and for whom, to better inform preparedness and response for future crises.MethodsRealist-informed systematic review of peer-reviewed and grey literature. Keyword-structured searches were performed in MEDLINE, EMBASE and Global Health, CINAHL, the Cochrane Collaboration and WHOLIS, and grey literature searches performed through the websites of UNICEF, the Global Polio Eradication Initiative (GPEI) and Technical Network for Strengthening Immunization Services. Results were independently double-screened for inclusion on title and abstract, and full text. Data were extracted using a pre-developed template, capturing information on the operating contexts in which interventions were implemented, intervention mechanisms, and vaccination-related outcomes. Study quality was assessed using the MMAT tool. Findings were narratively synthesised.Results50 studies were included, most describing interventions applied in conflict or near-post conflict settings in sub-Saharan Africa, and complex humanitarian emergencies. Vaccination campaigns were the most commonly addressed adaptive mechanism (n=17). Almost all campaigns operated using multi-modal approaches combining service delivery through multiple pathways (fixed and roving), health worker recruitment and training and community engagement to address both vaccination supply and demand. Creation of collaterals through service integration showed generally positive evidence of impact on routine vaccination uptake by bringing services closer to target populations and leveraging trust that had already been built with communities. Robust community engagement emerged as a key unifying mechanism for outcome improvement across almost all of the intervention classes, in building awareness and trust among crisis-affected populations. Some potentially transformative mechanisms for strengthening resilience in vaccination delivery were identified, but evidence for these remains limited.ConclusionA number of interventions to support adaptations to routine immunisation delivery in the face of protracted crisis are identifiable, as are key unifying mechanisms (multi-level community engagement) apparently irrespective of context, but evidence remains piecemeal. Adapting these approaches for local system resilience-building remains a key challenge.

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“…This systematic review on nutritional interventions is a part of series of reviews in conflict settings which includes delivery of mental health, sexual and reproductive health and other interventions in conflict settings. [11][12][13][14][15][16][17][18] This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (online supplemental appendix 1), 19 and its protocol is registered with PROSPERO (the international prospective register of systematic reviews, www. crd.…”

Section: Methodsmentioning

confidence: 99%

Delivering nutrition interventions to women and children in conflict settings: a systematic review

et al. 2021

Self Cite

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BackgroundLow/middle-income countries (LMICs) face triple burden of malnutrition associated with infectious diseases, and non-communicable diseases. This review aims to synthesise the available data on the delivery, coverage, and effectiveness of the nutrition programmes for conflict affected women and children living in LMICs.MethodsWe searched MEDLINE, Embase, CINAHL, and PsycINFO databases and grey literature using terms related to conflict, population, and nutrition. We searched studies on women and children receiving nutrition-specific interventions during or within five years of a conflict in LMICs. We extracted information on population, intervention, and delivery characteristics, as well as delivery barriers and facilitators. Data on intervention coverage and effectiveness were tabulated, but no meta-analysis was conducted.ResultsNinety-one pubblications met our inclusion criteria. Nearly half of the publications (n=43) included population of sub-Saharan Africa (n=31) followed by Middle East and North African region. Most publications (n=58) reported on interventions targeting children under 5 years of age, and pregnant and lactating women (n=27). General food distribution (n=34), micronutrient supplementation (n=27) and nutrition assessment (n=26) were the most frequently reported interventions, with most reporting on intervention delivery to refugee populations in camp settings (n=63) and using community-based approaches. Only eight studies reported on coverage and effectiveness of intervention. Key delivery facilitators included community advocacy and social mobilisation, effective monitoring and the integration of nutrition, and other sectoral interventions and services, and barriers included insufficient resources, nutritional commodity shortages, security concerns, poor reporting, limited cooperation, and difficulty accessing and following-up of beneficiaries.DiscussionDespite the focus on nutrition in conflict settings, our review highlights important information gaps. Moreover, there is very little information on coverage or effectiveness of nutrition interventions; more rigorous evaluation of effectiveness and delivery approaches is needed, including outside of camps and for preventive as well as curative nutrition interventions.PROSPERO registration numberCRD42019125221.

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Delivering infectious disease interventions to women and children in conflict settings: a systematic review

Cited by 19 publications

References 175 publications

Vaccination strategies for measles control and elimination: time to strengthen local initiatives

Vaccination strategies for measles control and elimination: time to strengthen local initiatives

Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review

Delivering nutrition interventions to women and children in conflict settings: a systematic review

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