Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Milken Institute School of Public Health, George Washington University, Washington, DC, USA; Doctors of the World USA, New York, NY, USA.
Lancet. 2021 Feb 6;397(10273):543-554. doi: 10.1016/S0140-6736(21)00133-1. Epub 2021 Jan 24.
Existing global guidance for addressing women's and children's health and nutrition in humanitarian crises is not sufficiently contextualised for conflict settings specifically, reflecting the still-limited evidence that is available from such settings. As a preliminary step towards filling this guidance gap, we propose a conflict-specific framework that aims to guide decision makers focused on the health and nutrition of women and children affected by conflict to prioritise interventions that would address the major causes of mortality and morbidity among women and children in their particular settings and that could also be feasibly delivered in those settings. Assessing local needs, identifying relevant interventions from among those already recommended for humanitarian settings or universally, and assessing the contextual feasibility of delivery for each candidate intervention are key steps in the framework. We illustratively apply the proposed decision making framework to show what a framework-guided selection of priority interventions might look like in three hypothetical conflict contexts that differ in terms of levels of insecurity and patterns of population displacement. In doing so, we aim to catalyse further iteration and eventual field-testing of such a decision making framework by local, national, and international organisations and agencies involved in the humanitarian health response for women and children affected by conflict.
现有的针对人道主义危机中妇女和儿童健康与营养问题的全球指导意见，没有充分针对冲突环境进行具体情况调整，这反映出从这种环境中获取的证据仍然有限。作为填补这一指导空白的初步步骤，我们提出了一个针对冲突的框架，旨在为关注受冲突影响的妇女和儿童健康与营养问题的决策者提供指导，以便优先考虑在其特定环境中解决妇女和儿童死亡率和发病率主要原因的干预措施，并且这些干预措施在这些环境中也具有可行性。评估当地需求、从已经针对人道主义环境或普遍推荐的干预措施中确定相关干预措施、评估每个候选干预措施在当地实施的可行性，是该框架的关键步骤。我们举例说明了拟议的决策框架的应用，以展示在三个假设的冲突环境中，根据不安全程度和人口流离失所模式的不同，框架指导下的优先干预措施选择可能是什么样子。这样做的目的是为参与受冲突影响的妇女和儿童人道主义卫生应对的地方、国家和国际组织和机构进一步推动这种决策框架的迭代和最终现场测试。
