Mayo Clinic, Rochester, Minnesota; Department of Emergency Medicine, Yale University, New Haven, Connecticut. ORCID: https://orcid.org/0000-0001-9254-6884.
Yale University, New Haven, Connecticut.
Am J Disaster Med. 2022;16(4):297-311. doi: 10.5055/ajdm.2021.0412.
Noncommunicable diseases (NCDs) are of increasing prevalence in low- and middle-income countries (LMICs), affected by disasters. Humanitarian actors are increasingly confronted with how to effectively manage NCDs, yet primary focus on this topic is lacking. We conducted a systematic review on the effects of disasters on NCDs in LMICs. Key interventions were identified, and their effects on populations in disaster settings were reviewed.
We electronically searched Medline, PubMed, Global Health, and Social Science Citation Index. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. Eligible articles incorporated core intervention components as defined by the United States Department of Health and Human Services. Key intervention components including target population, phase of crisis, and measured outcomes were extracted and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO (CRD42018088769).
Of the 4,430 identified citations, we identified seven eligible studies. Studies reported on the response (n = 4) and recovery (n = 3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted predeployment risk assessments, performed training and capacity building for healthcare workers, worked in close cooperation with local health services, evaluated individual needs of subpopulations, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline -implementation.
This review highlights the limited quantity and quality of evidence on interventions designed to address NCDs in humanitarian emergencies, with a particular paucity of studies addressing the mitigation and preparedness phases of disaster. While several challenges to NCD management such as insecurity and fluid movement of refugees create inherent challenges to NCD management in disasters, the lack of knowledge and training in NCD management among healthcare providers and the absence of basic medications and supplies for NCD management highlighted in this review are amenable to further intervention.
在受灾害影响的中低收入国家（LMICs），非传染性疾病（NCDs）的发病率不断上升。人道主义行动者越来越多地面临如何有效管理 NCDs 的问题，但对此主题的主要关注却缺乏。我们对灾害对 LMICs 中 NCDs 的影响进行了系统评价。确定了关键干预措施，并审查了它们对灾害环境中人群的影响。
我们在 Medline、PubMed、全球健康和社会科学引文索引中进行了电子检索。我们遵循标准的系统评价方法，对选择、数据提取和偏倚风险评估进行了评估。合格的文章纳入了美国卫生与公众服务部定义的核心干预措施组件。使用主题分析方法提取和综合关键干预措施组件，包括目标人群、危机阶段和测量结果。完整的系统评价已在 PROSPERO（CRD42018088769）上注册。
在 4430 篇被识别的文献中，我们确定了 7 篇合格的研究。研究报告了灾害的应对（n=4）和恢复（n=3）阶段，没有研究报告缓解或备灾阶段。成功的干预措施包括在部署前进行风险评估、对卫生工作者进行培训和能力建设、与当地卫生服务密切合作、评估亚人群的个体需求、促进人道主义和发展行为体之间的任务转移以及在实施指南时具有灵活性。
本综述强调了针对人道主义紧急情况中 NCD 干预措施的有限数量和质量证据，特别是缺乏针对灾害缓解和备灾阶段的研究。尽管不安全和难民流动等 NCD 管理方面的挑战给灾害中的 NCD 管理带来了固有挑战，但本综述中强调的医疗保健提供者缺乏 NCD 管理知识和培训以及缺乏基本的 NCD 管理药物和用品，这些问题都可以进一步加以干预。
