Systematic review on chronic non-communicable disease in disaster settings

Abstract

Background Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. Methods A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). Results Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. Conclusions An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.

Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020

“…Our study also revealed that more than half of the refugee health research grants focused on mental health as their primary research without equal emphasis on other aspects of health among refugees, including chronic and infectious diseases . US-resettled refugees have a high burden of chronic noncommunicable disease and face major barriers to managing these conditions compared with native-born populations . Our study underscores the need to expand NIH-funded refugee health research beyond focusing only on mental health, which comprised the main topic area of almost half of all NIH-supported refugee health research.…”

Projeto Saúde Brumadinho: aspectos metodológicos e perfil epidemiológico dos participantes da linha de base da coorte

“…Em relação ao diagnóstico médico prévio para as condições investigadas, as prevalências foram relativamente superiores ao reportado na RMBH e em MG. Essa maior prevalência pode estar relacionada ao desastre ocorrido no município, considerando que alguns estudos demonstram maior carga de doenças após um grande evento 3,4,6,7,[37][38][39] , mas também se deve considerar a cobertura universal da ESF no município 19 , o que pode aumentar o acesso aos serviços e ao diagnóstico médico 40,41 , sobretudo se a população passou a buscar mais esse serviço após o desastre.…”

Brumadinho Health Project: methodological aspects and epidemiological profile of participants in the cohort baseline

“…Regarding previous medical diagnoses for the conditions investigated, the prevalence was relatively higher than that reported in the MRBH and Minas Gerais. This higher prevalence may be related to the disaster, considering that some studies show a greater burden of disease after a major event 3,4,6,7,[37][38][39] , but one should also consider the universal coverage of the FHS in the municipality 19 , which can increase access to services and medical diagnosis 40,41 , especially if the population started to seek this service more after the event.…”