Hammer Charlotte Christiane, Brainard Julii, Hunter Paul R
Norwich Medical School, University of East Anglia Faculty of Medicine and Health Sciences, Norwich, UK.
BMJ Glob Health. 2018 Jul 6;3(4):e000647. doi: 10.1136/bmjgh-2017-000647. eCollection 2018.
Communicable diseases are a major concern during complex humanitarian emergencies (CHEs). Descriptions of risk factors for outbreaks are often non-specific and not easily generalisable to similar situations. This review attempts to capture relevant evidence and explore whether it is possible to better generalise the role of risk factors and risk factor cascades these factors may form.
A systematic search of the key databases and websites was conducted. Search terms included terms for CHEs (United Nations Office for the Coordination of Humanitarian Affairs definition) and terms for communicable diseases. Due to the types of evidence found, a thematic synthesis was conducted.
26 articles met inclusion criteria. Key risk factors include crowded conditions, forced displacement, poor quality shelter, poor water, sanitation and hygiene, lack of healthcare facilities and lack of adequate surveillance. Most identified risk factors do not relate to specific diseases, or are specific to a group of diseases such as diarrhoeal diseases and not to a particular disease within that group. Risk factors are often listed in general terms but are poorly evidenced, not contextualised and not considered with respect to interaction effects in individual publications. The high level of the inter-relatedness of risk factors became evident, demonstrating risk factor cascades that are triggered by individual risk factors or clusters of risk factors.
CHEs pose a significant threat to public health. More rigorous research on the risk of disease outbreaks in CHEs is needed, from a practitioner and from an academic point of view.
在复杂人道主义紧急情况（CHEs）期间，传染病是一个主要问题。对疫情爆发风险因素的描述往往不具体，且不易推广到类似情况。本综述试图收集相关证据，并探讨是否有可能更好地概括风险因素的作用以及这些因素可能形成的风险因素级联。
对主要数据库和网站进行了系统检索。检索词包括CHEs（联合国人道主义事务协调厅定义）的相关词汇和传染病的相关词汇。由于所发现证据的类型，进行了主题综合分析。
26篇文章符合纳入标准。关键风险因素包括拥挤的环境、被迫流离失所、劣质住所、水、环境卫生和个人卫生条件差、缺乏医疗设施以及缺乏充分的监测。大多数已确定的风险因素与特定疾病无关，或特定于一组疾病，如腹泻病，而不是该组中的某一种特定疾病。风险因素通常以笼统的术语列出，但证据不足、未结合具体情况，且在个别出版物中未考虑相互作用的影响。风险因素之间高度的相互关联性变得明显，表明存在由单个风险因素或风险因素集群引发的风险因素级联。
CHEs对公共卫生构成重大威胁。需要从从业者和学术角度对CHEs中疾病爆发的风险进行更严格的研究。
