The practice of evaluating epidemic response in humanitarian and low-income settings: a systematic review

Abstract

Background Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations. However, relatively little is known about responses to these epidemics. Robust evaluations can generate evidence on response efforts and inform future improvements. This systematic review aimed to (i) identify epidemics reported in low-income and crisis settings, (ii) determine the frequency with which evaluations of responses to these epidemics were conducted, (iii) describe the main typologies of evaluations undertaken and (iv) identify key gaps and strengths of recent evaluation practice. Methods Reported epidemics were extracted from the following sources: World Health Organization Disease Outbreak News (WHO DON), UNICEF Cholera platform, Reliefweb, PROMED and Global Incidence Map. A systematic review for evaluation reports was conducted using the MEDLINE, EMBASE, Global Health, Web of Science, WPRIM, Reliefweb, PDQ Evidence and CINAHL Plus databases, complemented by grey literature searches using Google and Google Scholar. Evaluation records were quality-scored and linked to epidemics based on time and place. The time period for the review was 2010–2019. Results A total of 429 epidemics were identified, primarily in sub-Saharan Africa, the Middle East and Central Asia. A total of 15,424 potential evaluations records were screened, 699 assessed for eligibility and 132 included for narrative synthesis. Only one tenth of epidemics had a corresponding response evaluation. Overall, there was wide variability in the quality, content as well as in the disease coverage of evaluation reports. Conclusion The current state of evaluations of responses to these epidemics reveals large gaps in coverage and quality and bears important implications for health equity and accountability to affected populations. The limited availability of epidemic response evaluations prevents improvements to future public health response. The diversity of emphasis and methods of available evaluations limits comparison across responses and time. In order to improve future response and save lives, there is a pressing need to develop a standardized and practical approach as well as governance arrangements to ensure the systematic conduct of epidemic response evaluations in low-income and crisis settings.

Global Health Governance and Health Equity in the Context of COVID-19: A Scoping Review

“…Not centralizing the COVID-19 responses around human rights could be related to the failure to operationalize human rights in institutions and mode of action of the numerous actors in GHG [ 18 ]. Gender mainstreaming in institutions working in the field of GHG especially in emergency response, is required so as to promote equity both at the decision making level as well as at the outcome level [ 19 , 20 ]. Different views and actions on techniques to address equity on the bases of human rights were presented in the studies.…”

Public and health professional epidemic risk perceptions in countries that are highly vulnerable to epidemics: a systematic review

“…Studies from only eighteen of the 62 eligible countries were identified. Diseases that cause frequent epidemics in these settings [ 30 ], such as measles or cholera, received little or no attention. This finding is similar to previous research suggesting that epidemics of common diseases are less likely to be responded to in a timely manner [ 84 ], or to be evaluated [ 30 ].…”

Identifying transferable lessons from cholera epidemic responses by Médecins Sans Frontières in Mozambique, Malawi and the Democratic Republic of Congo, 2015–2018: a scoping review

“…As noted in the search strategy, many of the initial reports retrieved were duplicative as they were from the same outbreaks but written by different authors. This questions if the numerous reports written from one outbreak are an efficient use of human resources, and that there could potentially be other ways of writing to support capturing lessons from outbreak responses [ 16 , 17 , 60 ]. The lack of a systematic structure reduces the utility of the reports to capture useful accounts of responses.…”

“…Whilst cholera responses will always be specific to the geographical and social context, it is important that the operational constraints for delivering timely interventions are documented and evaluated. Previous reviews have shown a dearth of evaluations of epidemic responses, depriving governmental and other response actors of an evidence base for improving practice and a baseline against which to track progress [ 16 , 17 ]. In particular, delayed detection, confirmation and response can considerably dampen the impact of CATI-like approaches, with delays of > 2 weeks expected to result in spill-over beyond the initial outbreak cluster [ 18 ]; interventions that seek to contain outbreaks before they propagate widely, including case-based or localised distribution of hygiene kits [ 19 ] and vaccination [ 20 , 21 ] are particularly dependent on early response, as is case management of cholera cases [ 22 , 23 ].…”