A review of interventions for noncommunicable diseases in humanitarian emergencies in low- and middle-income countries

Abstract

Objective: Noncommunicable diseases (NCDs) are of increasing prevalence in low- and middle-income countries (LMICs), affected by disasters. Humanitarian actors are increasingly confronted with how to effectively manage NCDs, yet primary focus on this topic is lacking. We conducted a systematic review on the effects of disasters on NCDs in LMICs. Key interventions were identified, and their effects on populations in disaster settings were reviewed.

Design: We electronically searched Medline, PubMed, Global Health, and Social Science Citation Index. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. Eligible articles incorporated core intervention components as defined by the United States Department of Health and Human Services. Key intervention components including target population, phase of crisis, and measured outcomes were extracted and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO (CRD42018088769).

Results: Of the 4,430 identified citations, we identified seven eligible studies. Studies reported on the response (n = 4) and recovery (n = 3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted predeployment risk assessments, performed training and capacity building for healthcare workers, worked in close cooperation with local health services, evaluated individual needs of subpopulations, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline implementation.

Conclusions: This review highlights the limited quantity and quality of evidence on interventions designed to address NCDs in humanitarian emergencies, with a particular paucity of studies addressing the mitigation and preparedness phases of disaster. While several challenges to NCD management such as insecurity and fluid movement of refugees create inherent challenges to NCD management in disasters, the lack of knowledge and training in NCD management among healthcare providers and the absence of basic medications and supplies for NCD management highlighted in this review are amenable to further intervention.