Stanford University School of Medicine, Stanford, CA, USA.
Department of Surgery, University of Washington, Seattle, WA, USA.
Trop Med Int Health. 2020 Nov;25(11):1332-1352. doi: 10.1111/tmi.13481. Epub 2020 Sep 21.
Mobile pastoralists are one of the last populations to be reached by health services and are frequently missed by health campaigns. Since health interventions among pastoralists have been staged across a range of disciplines but have not yet been systematically characterised, we set out to fill this gap.
We conducted a systematic search in PubMed/MEDLINE, Scopus, Embase, CINAL, Web of Science, WHO Catalog, AGRICOLA, CABI, ScIELO, Google Scholar and grey literature repositories to identify records that described health interventions, facilitators and barriers to intervention success, and factors influencing healthcare utilisation among mobile pastoralists. No date restrictions were applied. Due to the heterogeneity of reports captured in this review, data were primarily synthesised through narrative analysis. Descriptive statistical analysis was performed for data elements presented by a majority of records.
Our search yielded 4884 non-duplicate records, of which 140 eligible reports were included in analysis. 89.3% of reports presented data from sub-Saharan Africa, predominantly in East Africa (e.g. Ethiopia, 30.0%; Kenya, 17.1%). Only 24.3% of reports described an interventional study, while the remaining 75.7% described secondary data of interest on healthcare utilisation. Only two randomised controlled trials were present in our analysis, and only five reports presented data on cost. The most common facilitators of intervention success were cultural sensitivity (n = 16), community engagement (n = 12) and service mobility (n = 11).
Without adaptations to account for mobile pastoralists' unique subsistence patterns and cultural context, formal health services leave pastoralists behind. Research gaps, including neglect of certain geographic regions, lack of both interventional studies and diversity of study design, and limited data on economic feasibility of interventions must be addressed to inform the design of health services capable of reaching mobile pastoralists. Pastoralist-specific delivery strategies, such as combinations of mobile and 'temporary fixed' services informed by transhumance patterns, culturally acceptable waiting homes, community-directed interventions and combined joint human-animal One Health design as well as the bundling of other health services, have shown initial promise upon which future work should build.
流动牧民是最后一批获得医疗服务的人群之一，经常被卫生运动所忽视。由于牧民的健康干预措施已经在多个学科中进行，但尚未系统地进行描述，我们着手填补这一空白。
我们在 PubMed/MEDLINE、Scopus、Embase、CINAL、Web of Science、世界卫生组织目录、AGRICOLA、CABI、SciELO、Google Scholar 和灰色文献存储库中进行了系统搜索，以确定描述流动牧民的健康干预措施、干预成功的促进因素和障碍以及影响医疗保健利用的因素的记录。没有应用日期限制。由于本综述中捕获的报告具有异质性，因此主要通过叙述性分析对数据进行综合。对于大多数记录所呈现的数据元素，进行描述性统计分析。
我们的搜索产生了 4884 份非重复记录，其中 140 份符合条件的报告被纳入分析。89.3%的报告来自撒哈拉以南非洲，主要来自东非（例如，埃塞俄比亚，30.0%；肯尼亚，17.1%）。只有 24.3%的报告描述了干预性研究，而其余 75.7%的报告描述了医疗保健利用的相关次要数据。我们的分析中仅存在两项随机对照试验，仅有五项报告提供了关于成本的数据。干预成功的最常见促进因素包括文化敏感性（n=16）、社区参与（n=12）和服务机动性（n=11）。
如果不进行适应，以考虑流动牧民独特的生存模式和文化背景，正规的医疗服务就会将牧民抛在后面。研究差距包括忽视某些地理区域、缺乏干预研究和研究设计的多样性以及干预经济可行性的数据，必须加以解决，以为有能力为流动牧民提供服务的医疗服务设计提供信息。针对牧民的特定交付策略，例如根据游牧模式组合移动和“临时固定”服务、文化上可接受的候诊室、社区主导的干预措施以及人类-动物联合的一体健康设计以及捆绑其他健康服务，已经显示出初步的成效，未来的工作应在此基础上进行。
