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

Abstract

BackgroundIn recent years, more than 120 million people each year have needed urgent humanitarian assistance and protection. Armed conflict has profoundly negative consequences in communities. Destruction of civilian infrastructure impacts access to basic health services and complicates widespread emergency responses. The number of conflicts occurring is increasing, lasting longer and affecting more people today than a decade ago. The number of children living in conflict zones has been steadily increasing since the year 2000, increasing the need for health services and resources. This review systematically synthesised the indexed and grey literature reporting on the delivery of trauma and rehabilitation interventions for conflict-affected populations.MethodsA systematic search of literature published from 1 January 1990 to 31 March 2018 was conducted across several databases. Eligible publications reported on women and children in low and middle-income countries. Included publications provided information on the delivery of interventions for trauma, sustained injuries or rehabilitation in conflict-affected populations.ResultsA total of 81 publications met the inclusion criteria, and were included in our review. Nearly all of the included publications were observational in nature, employing retrospective chart reviews of surgical procedures delivered in a hospital setting to conflict-affected individuals. The majority of publications reported injuries due to explosive devices and remnants of war. Injuries requiring orthopaedic/reconstructive surgeries were the most commonly reported interventions. Barriers to health services centred on the distance and availability from the site of injury to health facilities.ConclusionsTraumatic injuries require an array of medical and surgical interventions, and their effective treatment largely depends on prompt and timely management and referral, with appropriate rehabilitation services and post-treatment follow-up. Further work to evaluate intervention delivery in this domain is needed, particularly among children given their specialised needs, and in different population displacement contexts.PROSPERO registration numberCRD42019125221.

Retrospective observational study of characteristics of persons with amputations accessing International Committee of the Red Cross (ICRC) rehabilitation centres in five conflict and postconflict countries

“…The dearth of quality publications in such contexts underlines the mismatch between existing research and where the burden of disease is. 26 …”

“…Where existing, data was compared with published prevalence studies from similar contexts. The dearth of quality publications in such contexts underlines the mismatch between existing research and where the burden of disease is 26…”

“…This starts with affected populations in the countries themselves who remain largely unknown, contrary to the well-studied veterans from HIC who sustained conflict-related amputations abroad 22–24. Complex traumatic amputations and their sequalae in conflict-affected and mine-affected areas are known to be a huge challenge 4 25 26. Adding to this, and with profound consequences, is the increasing global burden of type 2 diabetes mellitus (T2D) 27…”

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

“…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.…”

Gender equity in global injury research—A case example from Bangladesh

“…5 However, along with this struggle to maximize or optimize outcomes, some sub-strata of the affected population that are not perceived to be significantly affected from an epidemiological perspective are often given lower priority in large-scale public health interventions for unintentional traumatic injuries. 1,6,7 For instance, twice as many men suffer fatal injuries annually, and many countries implement targeted public health interventions to reduce injury for this specific group. 8 While this approach is impactful for reducing mortality among males, an unintended consequence of this strategy is a limited health system focus on injuries among females.…”