Abstract
Background Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment.
Methods A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769).
Results Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferred worse morbidity.
Conclusions An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
The authors received no specific funding for this work.
Author Declarations
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We completed a systematic review and do not require IRB review. Reviews, meta-analyses, or descriptions of educational materials do not involve human subjects and do not require IRB review.
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Data Availability
All data generated or analyzed during this study are included in this published article and its supplementary information files. The study is registered at PROSPERO (CRD42018088769).
List of Abbreviations
- AMI
- Acute Myocardial Infarction
- BMI
- Body Mass Index
- CAT
- COPD Assessment Tool
- COPD
- Chronic Obstructive Pulmonary Disease CVD: Cardiovascular Disease
- DALYs
- Disability Adjusted Life Years
- DM
- Diabetes Mellitus
- ECC
- Exceptional Care Committee
- EMRO
- Eastern Mediterranean Region
- HICs
- High Income Countries
- HPV
- Human Papillomavirus
- HRQOL
- Health-Related Quality of Life
- HTN
- Hypertension
- ICRC
- International Committee of the Red Cross
- IFG
- Impaired Fasting Glucose
- LDL
- Low Density Lipoprotein
- LMICs
- Low and Middle-Income Countries
- NCDs
- Non-Communicable Diseases
- MRDM
- Malnutrition Related Diabetes Mellitus
- MeSH
- Medical Subject Heading
- NGOs
- Non-Governmental Organisations
- OR
- Odds Ratio
- SEA
- South East Asia
- UNHCR
- United Nations High Commissioner for Refugees
- UNISDR
- United Nations Office for Disaster Risk Reduction
- UNRWA
- United Nations Relief and Works Agency
- WHO
- World Health Organization
- WHOQOL-BREF
- World Health Organization Quality of Life Questionnaire
- WP
- Western Pacific