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 conferred 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.

The Impact of Hurricane Maria on Individuals Living with Non-Communicable Disease in Puerto Rico: The experience of 10 communities

“…Lengthy electrical outages (in addition to adverse living conditions) were also widely reported by participants as severely affecting mental health and presenting signi cant long-term challenges for the refrigeration of medicines like insulin and operation of medical equipment. While the effects of power outages on individuals with NCDs has been described in other studies, the extent and duration of these interruptions following Hurricane Maria far surpassed those previously reported, and the implications of long-term power outages for individuals with NCDs, including considerations of fuel supply su ciency to power generators and mental health consequences, has not been adequately described in the literature (47,69,103,105,106). This nding is particularly relevant to communities throughout the U.S. with aging infrastructure, including electrical grids.…”

“…Remote communities with mountainous terrain experienced the greatest impact from these shortages due to extended road blockages that created additional delays in procurement. While there are studies that have reported the impact of medication shortages on individuals with NCDs, there are less studies that have reported similar ndings related to oxygen supplies (12,44,45,47,70,(103)(104)(105)110,111). Many current patient guidelines recommend storing a 3-7-day supply of medications and inform patients about prescription assistance programs, which require access to internet or telephone (17,18).…”

“…Coinciding with these trends, and compounding risk for individuals with NCDs, are the increasing frequency and severity of natural hazards (31)(32)(33)(34)(35) combined with the aging infrastructure of communities across the U.S. (36)(37)(38)(39)(40)(41)(42). Given the trajectory of these demographic, epidemiological and climatological trends, protecting populations with NCDs against natural hazards is ever more pressing (14,15,(43)(44)(45)(46)(47)(48).…”

“…In disaster contexts, populations with NCDs tend to be at greater risk of excess morbidity and mortality due to the exacerbation of their conditions, worsening of contextual conditions, disruptions to their treatments or required diets, inability to operate medical devices, and di culty accessing prescription medications (10,16,45,47,(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62). Victims of large-scale, catastrophic natural disasters that destroy infrastructure, health facilities, and telecommunications are at even greater risk; yet there has been little research to understand the impacts of disasters of this magnitude on individuals with NCDs (2,4,5,47,50,(63)(64)(65). A limited number of studies have shown that individuals with NCDs, including chronic kidney disease, diabetes, and mental health disorders, were severely affected following the 2017 Hurricane Maria in Puerto Rico (44,(66)(67)(68)(69)(70)(71)(72), and one study has estimated that the leading causes of death after Hurricane Maria were due to complications from NCDs such as diabetes, cardiovascular disease, and Alzheimer's (66).…”

A Review of Interventions for Non-Communicable Diseases in Humanitarian Emergencies in Low-and Middle-Income Countries

“…Our aim is to guide allocation of resources, future research, and intervention development. The full systematic review is published elsewhere [15].…”