Conceptualizing chronic noncommunicable diseases in disaster settings from a gender perspective: A systematic review
DOI:
https://doi.org/10.5055/ajdm.0501Keywords:
gender, disasters, noncommunicable diseases, women, warfare and armed conflicts, noninfectious diseasesAbstract
Objective: Approximately half of all deaths among women and those assigned female at birth in low-and middle-income countries (LMICs) are attributable to noncommunicable diseases (NCDs). LMICs are not only disproportionately affected by NCDs but also experience the largest burden of humanitarian emergencies. Yet the literature describing sex-and gender-based trends in NCDs in disaster settings is limited. This systematic review assesses sex-and gender- based epidemiology, interventions, and treatment of four NCDs (cardiovascular disease, cancer, chronic respiratory disease, and diabetes) in disaster settings using a thematic analysis approach.
Design: Formal search strategies used relevant controlled vocabulary terms and synonymous free-text words and phrases to capture the concepts of NCDs and humanitarian emergencies. We manually identified articles that reported sex-and gender-based differences in NCD epidemiology, healthcare access, or health outcomes among populations in disaster settings. Two separate screeners independently evaluated the titles, abstracts, and full text of the eligible articles, with vetting by a third reviewer.
Results: Women were found to bear a disproportionate burden of NCDs associated with disaster-related stress, care-seeking behaviors, and a lack of empowerment to engage in disease management. Cancers that predominantly affect females were identified as common reasons for seeking care during humanitarian crises. NCDs associated with or exacerbated during pregnancy, such as hypertensive disorders, had lower odds of care and resulted in worse outcomes. Conclusions: Although we found frequent sex-based disparities in the context of healthcare access, disease prevalence, and health outcomes, no study specifically investigated the role of gender or sex in NCD care.
References
World Health Organization: The top 10 causes of death. 2020. Available at https://www.who.int/news-room/fact-sheets/detail/thetop-10-causes-of-death. Accessed December 16, 2023.
Jamison DT: Disease control priorities, 3rd edition: Improving health and reducing poverty. Lancet. 2018; 391(10125): e11-e14. DOI: 10.1016/S0140-6736(15)60097-6.
Bausch FJ, Beran D, Hering H, et al.: Operational considerations for the management of non-communicable diseases in humanitarian emergencies. Confl Health. 2021; 15(1): 9. DOI: 10.1186/s13031-021-00345-w.
Schipper L, Pelling M: Disaster risk, climate change and international development: Scope for, and challenges to, integration. Disasters. 2006; 30(1): 19-38. DOI: 10.1111/j.1467-9523.2006.00304.x.
United Nations: United Nations international strategy for disaster reduction SecretariatGlobal assessment report on disaster risk reduction. Geneva, Switzerland: United Nations International Strategy for Disaster Reduction Secretariat (UNISDR), 2009. Report No.: 9789211320282. Available at https://www.undrr.org/publication/global-assessment-report-disaster-risk-reduction-2009. Accessed December 16, 2023.
Ekzayez A, Alhaj Ahmad Y, Alhaleb H, et al.: The impact of armed conflict on utilisation of health services in North-West Syria: An observational study. Confl Health. 2021; 15(1): 91. DOI: 10.1186/s13031-021-00429-7.
Mowafi H: Conflict, displacement and health in the Middle East. Glob Public Health. 2011; 6(5): 472-487. DOI: 10.1080/17441692.2011.570358.
Hurley R: Who cares for the nine million displaced people of Syria? BMJ. 2013; 347: F7374-F7374. DOI: 10.1136/bmj.f7374.
Muhjazi G, Bashour H, Abourshaid N, et al.: An early warning and response system for Syria. Lancet. 2013; 382(9910): 2066. DOI: 10.1016/S0140-6736(13)62691-4.
Doocy S, Lyles E, Delbiso TD, et al.: Internal displacement and the Syrian crisis: An analysis of trends from 2011-2014. Confl Health. 2015; 9: 33. DOI: 10.1186/s13031-015-0060-7.
Rajaratnam JK, Marcus JR, Flaxman AD, et al.: Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970-2010: A systematic analysis of progress towards millennium development goal 4. Lancet. 2010; 375(9730): 1988-2008. DOI: 10.1016/S0140-6736(10)60703-9.
Bonita R, Beaglehole R: Women and NCDs: Overcoming the neglect. Glob Health Action. 2014; 7(1): 23742. DOI: 10.3402/gha.v7.23742.
Risberg G, Johansson EE, Hamberg K: A theoretical model for analysing gender bias in medicine. Int J Equity Health. 2009; 8(1): 28. DOI: 10.1186/1475-9276-8-28.
Lee YS, Behn M, Rexrode KM: Women’s health in times of emergency: We must take action. J Womens Health (Larchmt). 2021; 30(3): 289-292. DOI: 10.1089/jwh.2020.8600.
Zeid S, Gilmore K, Khosla R, et al.: Women’s, children’s, and adolescents’ health in humanitarian and other crises. BMJ. 2015; 351: H4346. DOI: 10.1136/bmj.h4346.
Patel P, Meagher K, El Achi N, et al.: Having more women humanitarian leaders will help transform the humanitarian system’: Challenges and opportunities for women leaders in conflict and humanitarian health. Confl Health. 2020; 14(1): 84. DOI: 10.1186/s13031-020-00330-9.
World Health Organization: The injury chartbook: A graphical overview of the global burden of injuries. 2002. Available at https://www.who.int/publications/i/item/the-injury-chart-book-a-graphicaloverview-ofthe-global-burden-of-injuries. Accessed December 16, 2023.
Ngaruiya C, Bernstein R, Leff R, et al.: Systematic review on chronic noncommunicable disease in disaster settings. BMC Public Health. 2022; 22(1): 1234. DOI: 10.1186/s12889-022-13399-z.
Glennerster R, Hodson N: Confused out of care: Unanticipated consequences of a ‘hostile environment’. J Med Ethics. 2020; 46(3): 163-167. DOI: 10.1136/medethics2019-105634.
Redwood-Campbell LJ, Riddez L: Post-tsunami medical care: Health problems encountered in the international committee of the red cross hospital in Banda Aceh, Indonesia. Prehosp Disaster Med. 2006; 21(1): s1-s7.
Abukhdeir HF, Caplan LS, Reese L, et al.: Factors affecting the prevalence of chronic diseases in Palestinian people: An analysis of data from the Palestinian Central Bureau of Statistics. East Mediterr Health J. 2013; 19(4): 307-313.
Armenian HK, Melkonian AK, Hovanesian AP: Long term mortality and morbidity related to degree of damage following the 1988 earthquake in Armenia. Am J Epidemiol. 1998; 148(11): 1077-1084.
Khader A, Farajallah L, Shahin Y, et al.: Hypertension and treatment outcomes in Palestine refugees in United Nations relief and works agency primary health care clinics in Jordan. Trop Med Int Health. 2014; 19(10): 1276-1283. DOI: 10.1111/tmi.12356.
Yusef JI: Management of diabetes mellitus and hypertension at UNRWA primary health care facilities in Lebanon. East Mediterr Health J. 2000; 6(2-3): 378-390.
Bergovec M, Heim I, Vasilj I, et al.: Acute coronary syndrome and the 1992-1995 war in Bosnia And Herzegovina: A 10-year retrospective study. Mil Med. 2005; 170(5): 431-434.
Marjanovic K, Soldo-Butkovic S, Kralj M, et al.: The incidence of stroke in Baranya county (East Croatia). Coll Antropol. 2003; 27(2): 547-554.
Sibai AM, Fletcher A, Hills M, et al.: Non-communicable disease mortality rates using the verbal autopsy in a cohort of Middle aged and older populations in Beirut during wartime, 1983-93. J Epidemiol Community Health. 2001; 55(4): 271-276.
Hult M, Tornhammar P, Ueda P, et al.: Hypertension, diabetes and overweight: Looming legacies of the Biafran famine. PLoS One. 2010; 5(10): e13582. DOI: 10.1371/journal.pone.0013582.
Hung KK, Lam EC, Chan EY, et al.: Disease pattern and chronic illness in rural China: The Hong Kong Red Cross basic health clinic after 2008 Sichuan earthquake. Emerg Med Australas. 2013; 25(3): 252-259. DOI: 10.1111/1742-6723.12080.
Kallab MG: Management of hypertension and diabetes for the Syrian refugees and host community in selected health facilities in Lebanon. Field Exchange Emerg Nutr Network. 2015; 50: 68-72.
Markoglou AI, Hatzitolios G, Savopoulos C, et al.: Epidemiologic characteristics of hypertension in the civilians of Kosovo after the war. Cent Eur J Public Health. 2005; 13(2): 61-65.
Mateen FJ, Carone M, Al-Saedy H, et al.: Medical conditions among Iraqi refugees in Jordan: Data from the United Nations refugee assistance information system. Bull World Health Organ. 2012; 90(6): 444-451. DOI: 10.2471/BLT.11.097048.
Miric D, Giunio L, Bozic I, et al.: Trends in myocardial infarction in Middle Dalmatia during the war in Croatia. Mil Med. 2001; 166(5): 419-421.
Mousa HS, Yousef S, Riccardo F, et al.: Hyperglycaemia, hypertension and their risk factors among Palestine refugees served by UNRWA. East Mediterr Health J. 2010; 16(6): 609-614.
Otoukesh S, Mojtahedzadeh M, Sherzai D, et al.: A retrospective study of demographic parameters and major health referrals among Afghan refugees in Iran. Int J Equity Health. 2012; 11(82): 82.
Sibai AM, Yount KM, Fletcher A: Marital status, intergenerational co-residence and cardiovascular and all-cause mortality among middle-aged and older men and women during wartime in Beirut: gains and liabilities. Soc Sci Med. 2007; 64(1): 64-76.
Sun XC, Zhou XF, Chen S, et al.: Clinical characteristics of hypertension among victims in temporary shield district after Wenchuan earthquake in China. Eur Rev Med Pharmacol Sci. 2013; 17(7): 912-916.
Vasilj I, Bergovec M, Kvesic A, et al.: Acute coronary syndrome frequency in Western Herzegovina over the fifteen year period (1987-2001). Coll Antropol. 2006; 30(4): 915-919.
Tomic V, Petrovic O, Petrov B, et al.: Hypertensive disorders in pregnancy: A 5-year analysis of the wartime and postwar period in South Western region of Bosnia and Herzegovina. Coll Antropol. 2009; 33(Suppl. 2): 115-119.
Chan EY, Kim J: Chronic health needs immediately after natural disasters in middle-income countries: The case of the 2008 Sichuan, China earthquake. Eur J Emerg Med. 2011; 18(2): 111-114. DOI: 10.1097/MEJ.0b013e32833dba19.
Chan EYY, Griffiths S: Comparison of health needs of older people between affected rural and urban areas after the 2005 Kashmir, Pakistan earthquake. Prehosp Disaster Med. 2009; 24(5): 365-371.
Huynh ML, Raab SS, Suba EJ: Association between war and cervical cancer among Vietnamese women. Int J Cancer. 2004; 110(5): 775-777.
Khan SM, Jawad G, Shagufta N, et al.: Cancer in North West Pakistan and Afghan refugees. J Pak Med Assoc. 1997; 47(4): 122-124.
Li QD, Li H, Li FJ, et al.: Nutrition deficiency increases the risk of stomach cancer mortality. BMC Cancer. 2012; 12: 315. DOI: 10.1186/1471-2407-12-315.
Marom T, Segal D, Erlich T, et al.: Ethical and clinical dilemmas in patients with head and neck tumors visiting a field hospital in the Philippines. Am J Disaster Med. 2014; 9(3): 211-219.
McKenzie ED, Spiegel P, Khalifa A, et al.: Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: A retrospective cohort study 2012-2013. Confl Health. 2015; 9(10). DOI: 10.1186/s13031-015-0038-5.
Milojkovic M, Pajtler M, Rubin M: Influence of the war in Croatia on the frequency of gynecological cancer in the university hospital Osijek in the period from 1985 to 2002. Coll Antropol. 2005; 29(2): 573-578.
Shamseddine A, Sibai AM, Gehchan N, et al.: Cancer incidence in postwar Lebanon: Findings from the first national population-based registry, 1998. Ann Epidemiol. 2004; 14(9): 663-668.
Telarovic S, Telarovic S, Relja M, et al.: Impact of war on central nervous system tumors incidence—A 15-year retrospective study in Istria county, Croatia. Coll Antropol. 2006; 30(1): 149-155.
Ebling B, Majnaric-Trtica L, Gmajnic R, et al.: Psycho-social aspects of measures aimed at decreasing prevalence of chronic diseases in the population of returnees in the Osijek region, Croatia. Coll Antropol. 2007; 31(2): 441-450.
Abul AT, Nair PC, Behbehanei NA, et al.: Hospital admissions and death rates from asthma in Kuwait during pre- and post-Gulf war periods. Ann Allergy Asthma Immunol. 2001; 86(4): 465-468.
El-Sharif N, Abdeen Z, Qasrawi R, et al.: Asthma prevalence in children living in villages, cities and refugee camps in Palestine. Eur Respir J. 2002; 19(6): 1026-1034.
Guha-Sapir D, van Panhuis WG, Lagoutte J: Patterns of chronic and acute diseases after natural disasters—A study from the international committee of the Red Cross field hospital in Banda Aceh after the 2004 Indian Ocean tsunami. Trop Med Int Health. 2007; 12(11): 1338-1341. DOI: 10.1111/j.1365-3156.2007.01932.x.
Kunii O, Kanagawa S, Yajima I, et al.: The 1997 haze disaster in Indonesia: Its air quality and health effects. Arch Environ Health. 2002; 57(1): 16-22. DOI: 10.1080/00039890209602912.
Mirsadraee M, Mozaffari A, Attaran D: Prevalence of asthma in children of chemical warfare victims. Iran J Pediatr. 2011; 21(3): 294-300.
Naumova EN, Yepes H, Griffiths JK, et al.: Emergency room visits for respiratory conditions in children increased after Guagua Pichincha volcanic eruptions in April 2000 in Quito, Ecuador observational study: Time series analysis. Environ Health. 2007; 6(21): DOI: 10.1186/1476-069X-6-21.
Wright RJ, Fay ME, Suglia SF, et al.: War-related stressors are associated with asthma risk among older Kuwaitis following the 1990 Iraqi invasion and occupation. J Epidemiol Community Health. 2010; 64(7): 630-635. DOI: 10.1136/jech.2009.090795.
Sofeh ASA, Khan AS, Khan MA: Diabetes mellitus and its concomitant disorders in Afghan refugees residing in Peshawar, Pakistan. J Postgrad Med Inst. 2004; 18(3): 359-367.
An C, Zhang Y, Yu L, et al.: Long-term impact of earthquake stress on fasting glucose control and diabetes prevalence among Chinese adults of Tangshan. Int J Clin Exp Med. 2014; 7(11): 4441-4447.
Ramachandran A, Snehalatha C, Yamuna A, et al.: Stress and undetected hyperglycemia in Southern Indian coastal population affected by tsunami. J Assoc Physicians India. 2006; 54: 109-112.
Eljedi A, Mikolajczyk RT, Kraemer A, et al.: Health-related quality of life in diabetic patients and controls without diabetes in refugee camps in the Gaza Strip: A cross-sectional study. BMC Public Health. 2006; 6: 268.
Alabed S, Guul A, Crighton C, et al.: An assessment of diabetes care in Palestinian refugee camps in Syria. Avicenna J Med. 2014; 4(3): 66-70. DOI: 10.4103/2231-0770.133337.
Ali-Shtayeh MS, Jamous RM, Jamous RM: Complementary and alternative medicine use amongst Palestinian diabetic patients. Complement Ther Clin Pract. 2012; 18(1): 16-21. DOI: 10.1016/j.ctcp.2011.09.001.
AlKasseh AS, Zaki NM, Aljeesh YI, et al.: Risk factors of gestational diabetes mellitus in the refugee population in Gaza Strip: A case-control study. East Mediterr Health J. 2014; 19: S12-S18.
Gilder ME, Zin TW, Wai NS, et al.: Gestational diabetes mellitus prevalence in Maela refugee camp on the Thai-Myanmar border: A clinical report. Glob Health Action. 2014; 7: 23887.
Habtu E, Gill G, Tesfaye S: Characteristics of insulin requiring diabetes in rural Northern Ethiopia—A possible link with malnutrition? Ethiop Med J. 1999; 37(4): 263-267.
Khader A, Ballout G, Shahin Y, et al.: Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan. Public Health Action. 2013; 3(4): 259-264. DOI: 10.5588/pha.13.0083.
Khader A, Ballout G, Shahin Y, et al.: Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of E-health over 3 years in Jordan. Trop Med Int Health. 2014; 19(2): 219-223. DOI: 10.1111/tmi.12241.
Khader A, Farajallah L, Shahin Y, et al.: Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan. Trop Med Int Health. 2012; 17(12): 1569-1576. DOI: 10.1111/j.1365-3156.2012.03097.x.
Lumey LH, Khalangot MD, Vaiserman AM: Association between type 2 diabetes and prenatal exposure to the Ukraine famine of 1932-33: A retrospective cohort study. Lancet Diabetes Endocrinol. 2015; 3(10): 787-794. DOI: 10.1016/s2213-8587(15)00279-x.
Wagner J, Keuky L, Fraser-King L, et al.: Training Cambodian village health support guides in diabetes prevention: Effects on guides’ knowledge and teaching activities over 6 months. Int J Behav Med. 2016; 23(2): 162-167.
Hussein J: Non-communicable diseases during pregnancy in low and middle income countries. Obstet Med. 2017; 10(1): 26-29. DOI: 10.1177/1753495X16684709.
van Oosterhout REM, de Boer AR, Maas A, et al.: Sex differences in symptom presentation in acute coronary syndromes: A systematic review and meta-analysis. J Am Heart Assoc. 2020; 9(9): e014733. DOI: 10.1161/jaha.119.014733.
Vogel B, Acevedo M, Appelman Y, et al.: The lancet women and cardiovascular disease commission: Reducing the global burden by 2030. Lancet. 2021; 397(10292): 2385-2438. DOI: 10.1016/s0140-6736(21)00684-x.
Wu J, Xiao J, Li T, et al.: A cross-sectional survey on the health status and the health-related quality of life of the elderly after flood disaster in Bazhong city, Sichuan, China. BMC Public Health. 2015; 15: 163. DOI: 10.1186/s12889-015-1402-5.
Pedrinelli R, Ballo P, Fiorentini C, et al.: Hypertension and acute myocardial infarction: An overview. J Cardiovasc Med (Hagerstown). 2012; 13(3): 194-202. DOI: 10.2459/JCM.0b013e3283511ee2.
Powell-Wiley TM, Poirier P, Burke LE, et al.: Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2021; 143(21): e984-e1010. DOI: 10.1161/cir.0000000000000973.
Koliaki C, Liatis S, Kokkinos A: Obesity and cardiovascular disease: Revisiting an old relationship. Metabolism. 2019; 92: 98-107. DOI: 10.1016/j.metabol.2018.10.011.
Kautzky-Willer A, Harreiter J, Pacini G: Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev. 2016; 37(3): 278-316. DOI: 10.1210/er.2015-1137.
Garawi F, Devries K, Thorogood N, et al.: Global differences between women and men in the prevalence of obesity: Is there an association with gender inequality? Eur J Clin Nutr. 2014; 68(10): 1101-1106. DOI: 10.1038/ejcn.2014.86.
Crespo-Sancho C: Can gender equality prevent violent conflict? World Bank. 2018. Available at https://blogs.worldbank.org/dev4peace/can-gender-equality-preventviolent-conflict. Accessed December 16, 2023.
Antman EM, Anbe DT, Armstrong PW, et al.: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction–executive summary: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation. 2004; 110(5): 588-636.
Herrick JB: Clinical features of sudden obstruction of the coronary arteries. JAMA. 1912; LIX(23): 2015-2022.
Ndubuisi NE: Noncommunicable diseases prevention in low- and middle-income countries: An overview of health in all policies (HiAP). Inquiry. 2021; 58: 46958020927885. DOI: 10.1177/0046958020927885.
Mungo C, Ibrahim S, Bukusi EA, et al.: Scaling up cervical cancer prevention in Western Kenya: Treatment access following a community-based HPV testing approach. Int J Gynaecol Obstet. 2021; 152(1): 60-67. DOI: 10.1002/ijgo.13171.
Mungo C, Osongo CO, Ambaka J, et al.: Feasibility and acceptability of smartphone-based cervical cancer screening among HIV-positive women in Western Kenya. JCO Glob Oncol. 2021; 7: 686-693. DOI: 10.1200/GO.21.00013.
Ngaruiya C, Sobowale K, Annamalai A: Reverse innovation in mental health: Review and recommendations. Glob J Community Psychol Practice. 2021; 12(4). DOI: 10.17161/gjcpp.v12i4.20636.
Thandar MM, Kiriya J, Shibanuma A, et al.: Women’s knowledge on common noncommunicable diseases and nutritional need during pregnancy in three townships of Ayeyarwaddy region, Myanmar: A cross-sectional study. Trop Med Health. 2019; 47(1): 12. DOI: 10.1186/s41182-019-0137-x.
Ramos Jaraba SM, Quiceno Toro N, Ochoa Sierra M, et al.: Health in conflict and post-conflict settings: Reproductive, maternal and child health in Colombia. Confl Health. 2020; 14: 33. DOI: 10.1186/s13031-020-00273-1.
Hinneh T, Jahn A, Agbozo F: Barriers to screening, diagnosis and management of hyperglycaemia in pregnancy in Africa: A systematic review. Int Health. 2022; 14: 211-221. DOI: 10.1093/inthealth/ihab054.
Ortega FB, Lavie CJ, Blair SN: Obesity and cardiovascular disease. Circ Res. 2016; 118(11): 1752-1770. DOI: 10.1161/circresaha.115.306883.
Smith J: Overcoming the ‘tyranny of the urgent’: Integrating gender into disease outbreak preparedness and response. Gender Dev. 2019; 27(2): 355-369. DOI: 10.1080/13552074.2019.1615288.
Editorial: Violence against women in Syria. Lancet. 2013; 382(9908): 1858. DOI: 10.1016/S0140-6736(13)62612-4.
Ben Taleb Z, Bahelah R, Fouad FM, et al.: Syria: Health in a country undergoing tragic transition. Int J Public Health. 2015; 60(Suppl. 1): 63-72. DOI: 10.1007/s00038-014-0586-2.
Chynoweth SK, Onyango MA, Gallagher MC, et al.: Women’s and children’s health in conflict settings: Build on existing efforts. Lancet. 2021; 397(10288): 1879. DOI: 10.1016/S0140-6736(21)00932-6.
Arie S: Polio outbreak leads to calls for a ‘vaccination ceasefire’ in Syria. BMJ. 2013; 347: F6682. DOI: 10.1136/bmj.f6682.
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