McNatt Zahirah Z
Department of Community Health and Social Medicine, University of Global Health Equity, Kigali Heights, Plot 772, KG 7 Ave., 5th floor, P.O. Box 6955, Kigali, Rwanda.
2Mailman School of Public Health, Department of Population and Family Health, Columbia University, 60 Haven Avenue B3, New York, 10032 USA.
Confl Health. 2020 Feb 18;14:9. doi: 10.1186/s13031-020-0255-4. eCollection 2020.
More than 5.5 million Syrian refugees have fled violence and settled in mostly urban environments in neighboring countries. The Middle East and North Africa (MENA) region accounts for 6% of the global population but 25% of the population are 'of concern' to the UN Refugee Agency. In addition to large amounts of forced migration, the region is also undergoing an epidemiologic transition towards a heavier burden of noncommunicable diseases (NCDs), which in 2018 accounted for 74% of all deaths in the region. To address NCD needs globally, a myriad of policies and interventions have been implemented in low-income stable country settings. However, little is known about which policies and interventions are currently being implemented or are best suited for refugee hosting countries across the Middle East and North Africa.
A scoping review of peer-reviewed literature was conducted to identify policies and interventions implemented in the Middle East and North Africa to address the needs of urban refugees with noncommunicable diseases.
This scoping review identified 11 studies from Jordan, Lebanon, Iran, West Bank, Gaza and Syria. These studies addressed three foci of extant work, (1) innovative financing for expensive treatments, (2) improvements to access and quality of treatment and, (3) efforts to prevent new diagnoses and secondary complications. All interventions targeted refugee populations including Palestinians, Sudanese, Syrians, Afghans and Iraqis.
The scoping review highlighted five key findings. First, very few studies focused on the prevention of noncommunicable diseases among displaced populations. Second, several interventions made use of health information technologies, including electronic medical records and mHealth applications for patients. Third, the vast majority of publications were solely focused on tackling NCDs through primary care efforts. Fourth, the literature was very sparse in regard to national policy development, and instead favored interventions by NGOs and UN agencies. Last, the perspectives of refugees were notably absent.
Opportunities exist to prioritize prevention efforts, scale up eHealth interventions, expand access to secondary and tertiary services, address the scarcity of research on national policy, and incorporate the perspectives of affected persons in the broader discourse.
超过550万叙利亚难民逃离暴力，大多在邻国的城市环境中定居。中东和北非（MENA）地区占全球人口的6%，但联合国难民署“关注”的人口占25%。除了大量的被迫迁移外，该地区还在经历流行病学转变，非传染性疾病（NCDs）负担加重，2018年非传染性疾病占该地区所有死亡人数的74%。为满足全球对非传染性疾病的需求，在低收入稳定国家环境中已实施了大量政策和干预措施。然而，对于中东和北非地区的难民收容国目前正在实施哪些政策和干预措施，或者哪些政策和干预措施最适合这些国家，人们知之甚少。
对同行评审文献进行范围综述，以确定中东和北非地区为满足城市难民非传染性疾病需求而实施的政策和干预措施。
该范围综述确定了来自约旦、黎巴嫩、伊朗、约旦河西岸、加沙和叙利亚的11项研究。这些研究涉及现有工作的三个重点，（1）为昂贵治疗提供创新融资，（2）改善治疗的可及性和质量，以及（3）预防新诊断和继发性并发症的努力。所有干预措施都针对难民群体，包括巴勒斯坦人、苏丹人、叙利亚人、阿富汗人和伊拉克人。
范围综述突出了五个主要发现。第一，很少有研究关注流离失所人群中非传染性疾病的预防。第二，一些干预措施利用了健康信息技术，包括电子病历和面向患者的移动健康应用程序。第三，绝大多数出版物仅专注于通过初级保健努力应对非传染性疾病。第四，关于国家政策制定的文献非常稀少，相反，更倾向于非政府组织和联合国机构的干预措施。最后，明显缺乏难民的观点。
存在机会将预防工作列为优先事项，扩大电子健康干预措施的规模，扩大二级和三级服务的可及性，解决国家政策研究稀缺的问题，并将受影响者的观点纳入更广泛的讨论中。
