人道主义卫生干预措施的效果：2013 年至 2021 年期间发表文献的系统评价。
Effectiveness of humanitarian health interventions: a systematic review of literature published between 2013 and 2021.
机构信息
International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
出版信息
BMJ Open. 2023 Jul 20;13(7):e068267. doi: 10.1136/bmjopen-2022-068267.
OBJECTIVES
To provide a thorough mapping of the current quality and depth of evidence examining the effectiveness of health interventions in humanitarian settings in low and middle-income countries published in peer-reviewed journals since 2013.
METHODS
We searched MEDLINE, Embase and Global Health for English language peer-reviewed literature published from May 2013 through April 2021 to analyse the strength of evidence on health interventions' effectiveness in humanitarian settings in low and middle-income countries across nine thematic areas. Quality was assessed using standardised criteria and critical appraisal tools based on study design.
RESULTS
A total of 269 publications were included in this review. The volume of publications increased since the first Elrha Humanitarian Health Evidence Review in 2013, but non-communicable diseases and water, sanitation and hygiene remain the areas with the most limited evidence base on intervention effectiveness in addition to injury and rehabilitation. Economic evaluations continued to constitute a small proportion (5%) of studies. Half of studies had unclear risk of bias, while 28% had low, 11% moderate and 11% high risk of bias. Despite increased diversity in studied interventions, variations across and within topics do not necessarily reflect the health issues of greatest concern or barriers to quality service delivery in humanitarian settings.
CONCLUSIONS
Despite an increasing evidence base, the challenge of implementing high-quality and well-reported humanitarian health research persists as a critical concern. Improvements in reporting and intervention description are needed as are study designs that allow for attribution, standard indicators and longer term follow-up and outcome measures. There is a clear need to prioritise expansion of cross-cutting topics, namely health service delivery, health systems and cost-effectiveness.
PROSPERO REGISTRATION NUMBER
CRD42021254408.
目的
全面梳理 2013 年以来在同行评议期刊上发表的关于低中等收入国家人道主义环境下卫生干预措施有效性的现有证据的质量和深度。
方法
我们检索了 MEDLINE、Embase 和全球卫生数据库，以分析 2013 年 5 月至 2021 年 4 月期间以英语发表的关于低中等收入国家人道主义环境下卫生干预措施有效性的同行评议文献，涵盖九个主题领域。使用基于研究设计的标准化标准和关键评估工具评估质量。
结果
本综述共纳入 269 篇文献。自 2013 年首次进行 Elrha 人道主义卫生证据综述以来，发表的文献数量有所增加，但除了伤害和康复领域外，非传染性疾病和水、环境卫生和个人卫生仍然是干预措施有效性证据基础最薄弱的领域。经济评估仍然只占研究的一小部分（5%）。半数研究的偏倚风险不明确，28%的研究为低风险，11%为中风险，11%为高风险。尽管研究干预措施的多样性有所增加，但不同主题和主题内的差异并不一定反映人道主义环境中最关注的健康问题或提供高质量服务的障碍。
结论
尽管证据基础不断增加，但实施高质量和报告良好的人道主义卫生研究仍然是一个关键问题。需要改进报告和干预措施描述，以及允许归因、标准指标以及更长时间的随访和结果测量的研究设计。显然需要优先扩大跨领域主题，即卫生服务提供、卫生系统和成本效益。
PROSPERO 注册号：CRD42021254408。
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