Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review

Abstract

Care for non-communicable diseases, including hypertension and diabetes (HTN/DM), is recognized as a growing challenge in humanitarian crises, particularly in low- and middle-income countries (LMICs) where most crises occur. There is little evidence to support humanitarian actors and governments in designing efficient, effective, and context-adapted models of care for HTN/DM in such settings. This article aimed to systematically review the evidence on models of care targeting people with HTN/DM affected by humanitarian crises in LMICs. A search of the MEDLINE, Embase, Global Health, Global Indexus Medicus, Web of Science, and EconLit bibliographic databases and grey literature sources was performed. Studies were selected that described models of care for HTN/DM in humanitarian crises in LMICs. We descriptively analysed and compared models of care using a conceptual framework and evaluated study quality using the Mixed Methods Appraisal Tool. We report our findings according to PRISMA guidelines. The search yielded 10 645 citations, of which 45 were eligible for this review. Quantitative methods were most commonly used (n = 34), with four qualitative, three mixed methods, and four descriptive reviews of specific care models were also included. Most studies detailed primary care facility-based services for HTN/DM, focusing on health system inputs. More limited references were made to community-based services. Health care workforce and treatment protocols were commonly described framework components, whereas few studies described patient centredness, quality of care, financing and governance, broader health policy, and sociocultural contexts. There were few programme evaluations or effectiveness studies, and only one study reported costs. Most studies were of low quality. We concluded that an increasing body of literature describing models of care for patients with HTN/DM in humanitarian crises demonstrated the development of context-adapted services but showed little evidence of impact. Our conceptual framework could be used for further research and development of NCD models of care.

Analysis of health overseas development aid for internally displaced persons in low- and middle-income countries

“…‘basic health care’), but it nevertheless appears a major funding shortfall. The very limited ODA for NCDs among IDPs highlights belated donor recognition of the burden of NCDs among conflict-affected and forcibly displaced populations which may be partly attributable to insufficient epidemiological data, limited evidence on costs and models of NCD care, and concerns about costs and complexity of NCD care for forcibly displaced persons ( Jaung et al., 2021 ; Jobanputra et al., 2016 ; Spiegel et al., 2014 ). The implications are that the treatment gap for mental health and psychosocial support will remain extremely large among IDPs (and refugees) ( Roberts et al., 2019 ); and that IDPs (and refugees) will not be able to receive essential life-saving medicines and treatment for NCDs ( Jobanputra et al., 2016 ; Kehlenbrink et al., 2019 ).…”

An inter-humanitarian agency study of diabetes care and surveillance in humanitarian settings

“…2 Despite projections of further increases in the prevalence of diabetes and humanitarian crises, evidence on best practice interventions to guide feasibility and effectiveness of diabetes care delivery in humanitarian settings is lacking. [3][4][5] This was highlighted in the Boston Declaration, which outlined a priority agenda for addressing diabetes in humanitarian crises, including the need for improved data and surveillance. 3 Most data collected by humanitarian organisations, while providing humanitarian assistance, do not feature in academic literature.…”

Factors Influencing the Implementation of Remote Delivery Strategies for Non-Communicable Disease Care in Low- and Middle-Income Countries: A Narrative Review

“…Anecdotally, adaptations to reduce facility-based attendance (referred to here as “remote” care), have included use of e-health, community-based strategies, and adaptations to medicines dispensing. These adaptations have been made in a largely reactive and unsystematic manner, and there is little evidence on how these delivery approaches might work in crisis-affected settings or on factors influencing their implementation [ 9 , 11 , 18 ]. Effective remote delivery approaches may prove useful during further waves of the COVID-19 pandemic, and in other settings of service disruption.…”