1
|
Arcos González P, Cabria Fernández J, Gan RK, Fernández Camporro Á, Cernuda Martínez JA. The epidemiological profile of incidence and mortality from epidemics in complex humanitarian emergencies from 1990 to 2022 - A scoping review. Trop Med Int Health 2024; 29:343-353. [PMID: 38481292 DOI: 10.1111/tmi.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
AIM This study aimed to investigate the impact of communicable diseases with epidemic potential in complex emergency (CE) situations, focusing on the epidemiological profile of incidence and mortality and exploring underlying factors contributing to increased epidemic risks. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines, we conducted a scoping review of articles published between 1990 and 2022. The search included terms related to complex emergencies, communicable diseases, outbreaks, and epidemics. We identified 92 epidemics related to CE occurring in 32 different countries. RESULTS Communicable diseases like Shigellosis, Cholera, Measles, Meningococcal meningitis, Yellow Fever, and Malaria caused significant morbidity and mortality. Diarrhoeal diseases, particularly Cholera and Shigellosis, had the highest incidence rates. Shigella specifically had an incidence of 241.0 per 1000 (people at risk), with a mortality rate of 11.7 per 1000, while Cholera's incidence was 13.0 per 1000, with a mortality rate of 0.22 per 1000. Measles followed, with an incidence of 25.0 per 1000 and a mortality rate of 0.76 per 1000. Meningococcal Meningitis had an incidence rate of 1.3 per 1000 and a mortality rate of 0.13 per 1000. Despite their lower incidences, yellow fever at 0.8 per 1000 and malaria at 0.4 per 1000, their high case fatality rates of 20.1% and 0.4% remained concerning in CE. The qualitative synthesis reveals that factors such as water, sanitation, and hygiene, shelter and settlements, food and nutrition, and public health and healthcare in complex emergencies affect the risk of epidemics. CONCLUSION Epidemics during complex emergencies could potentially lead to a public health crisis. Between 1990 and 2022, there have been no statistically significant changes in the trend of incidence, mortality, or fatality rates of epidemic diseases in CE. It is crucial to understand that all epidemics identified in CE are fundamentally preventable.
Collapse
Affiliation(s)
- Pedro Arcos González
- Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Julián Cabria Fernández
- Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Rick Kye Gan
- Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Ángel Fernández Camporro
- Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo, Spain
| | | |
Collapse
|
2
|
Tanue EA, Omam LA, Ayuk GT, Noukeme BM, Metuge A, Nganmou I, Ebob MB, Donovan L, Stratil AS, Counihan H, Nkfusai CN, Hawkings H, Homolova B, Berryman E, Kolawole M, Zoungrana Y, Achu D, Wanji S, Omam EN. A formative cross-sectional study to assess caregiver's health-seeking behaviour and knowledge surrounding malaria, and understand the burden of malaria among children under-five in conflict-affected communities of Cameroon. Malar J 2024; 23:99. [PMID: 38589868 PMCID: PMC11003128 DOI: 10.1186/s12936-024-04902-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Malaria remains a major global health problem often worsened by political instability and armed conflict. The purpose of the study was to explore community knowledge, attitudes and practices on malaria prevention, and to understand the burden of malaria and health-seeking behaviours of caregivers of children under-five in conflict-affected communities of the South West and Littoral Regions of Cameroon. METHODS A cross-sectional survey involving internally displaced persons (IDPS), host population, and their children under-five was conducted across 80 communities. The survey was conducted from May to June 2021. Participants were interviewed using a structured questionnaire. Malaria prevalence for children under-five was determined using rapid diagnostic tests (RDT) on blood samples. Association between variables and displacement status was measured using chi square test and multivariate logistic regression model was fitted to identify factors associated with adequate knowledge on malaria prevention. RESULTS A total of 2386 adults participated in the study and 1543 RDTs were conducted for children under-five. Adequate levels of knowledge and attitudes on malaria prevention was recorded among 1258 (52.9%) of the participants, with very strong evidence to suggest the level to be higher among the host (59.5%) compared to the IDPs (49.5%) and returnees (39.7%) (p < 0.001). Good practices towards malaria prevention was 43.3%, with very strong evidence indicating lower levels among IDPs (42.8%) and returnees (28.5%) compared to the host (49.4%) (p < 0.001). Malaria prevalence for children under-five was 54.0% and adequate health-seeking for suspected episodes of malaria was 53.0%, without any difference among IDPs (51.78%) and returnees (48.7%) compared to host populations (55.4%) (p = 0.154). Multivariate logistic regression model showed that there was quite strong evidence to suggest primary and secondary levels of education have higher odds of having correct knowledge of malaria prevention (adjusted odds ratio (AOR) 1.71, 95% confidence interval (CI): 1.11-2.64, p = 0.015 and AOR 1.80, 95% CI 1.15-2.82, p = 0.010 respectively). There was very strong evidence to suggest that owning a radio or a television was associated with greater odds of having a higher knowledge on malaria prevention (AOR 1.49, 95% CI 1.233-1.81, p = 0.000 and AOR 1.47, 95% CI 1.18-1.84, p = 0.001). CONCLUSION Over half of the population have correct knowledge and attitudes towards malaria prevention but gaps in complete knowledge remained. Some of the caregivers know the correct malaria preventive practices coupled with largely unsatisfactory treatment approaches and reflected by the high prevalence of malaria among their children. In order to effectively treat malaria, innovative strategies should target community participation.
Collapse
Affiliation(s)
- Elvis Asangbeng Tanue
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon.
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon.
| | - Lundi-Anne Omam
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Glennis T Ayuk
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
| | | | - Alain Metuge
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
| | | | - Margaret Besem Ebob
- Reach Out Cameroon, Small Soppo, P.O Box 88, Buea, Cameroon
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Laura Donovan
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Ann-Sophie Stratil
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Helen Counihan
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Claude Ngwayu Nkfusai
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
- Department of Public Health, School of Nursing and Public Health, University of Kwa-Zulu Natal, Durban, South Africa
| | - Helen Hawkings
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Blanka Homolova
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Elizabeth Berryman
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Maxwell Kolawole
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Yakouba Zoungrana
- Malaria Consortium, the Green House, 244-254 Cambridge Heath Rd, London, E2 9DA, UK
| | - Dorothy Achu
- National Malaria Control Programme, Ministry of Public Health, P.O Box 14386, Yaounde, Cameroon
| | - Samuel Wanji
- Department for Microbiology and Parasitology, University of Buea, P.O Box 12, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | | |
Collapse
|
3
|
Kim Y, Shin B, Kim SE, Cajuste B, Kwon JA. A retrospective study on cholera understanding and WASH (water, sanitation, and hygiene) behavior among adolescents in three regions of La Gonâve, Haiti. J Infect Public Health 2024; 17:443-449. [PMID: 38266516 DOI: 10.1016/j.jiph.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/31/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUNDS This study assesses the impact of Water, Sanitation, and Hygiene (WASH) interventions on cholera understanding and hygiene practices in La Gonâve Island, Haiti. It examines the changes after implementing interventions in seven villages across the Downtown, Mountain, and Seaside regions. METHODS A retrospective investigation surveyed 210 school students from each region using a validated questionnaire. It assessed knowledge, attitudes, practices (KAP), and environmental aspects related to cholera and hygiene. Data analysis involved descriptive statistics and chi-square tests. RESULTS The study highlights significant disparities in education levels, toilet ownership, and healthcare access. Challenges in finding public toilets (86.67%) and accessing water sources (67.78%) are consistent across regions, with Seaside facing financial constraints (85.00%) and water cost concerns (91.67%). Attitudes toward hygiene vary, with the Mountain region having the highest 'Never' responses for handwashing (38.89%), and Downtown leading in water treatment practices (11.67%). There is a strong willingness to share health knowledge, particularly in Downtown (100.00%). Seaside (83.33%) and Downtown (73.33%) revealed a higher cholera awareness, while nearly half of Mountain students lacked knowledge (54.44%). CONCLUSIONS This study highlights significant disparities in WASH practices among La Gonâve's adolescents in Downtown, Mountain, and Seaside regions. Urgent interventions are crucial for improving sanitation, ensuring clean water access, and implementing targeted hygiene education, especially in the resource-constrained Mountain and Seaside areas. The findings underscore the vital roles of adolescents and schools in disseminating knowledge, with further research needed to explore intervention differences.
Collapse
Affiliation(s)
- Yuna Kim
- Global Care International, Seoul, the Republic of Korea
| | - Bohye Shin
- The Department of Health Convergence, Graduate School of Ewha Womans University, Seoul, the Republic of Korea
| | | | - Bernard Cajuste
- Oaktree Ministry, Baie-Tortue, Anse-à-Galets, Gonave Island, Haiti
| | - Jeoung A Kwon
- National Cancer Control Institute, National Cancer Center, Goyang, the Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, the Republic of Korea.
| |
Collapse
|
4
|
Simonek T, Zahos H, Mahroof-Shaffi S, Harkensee C. Seasonal patterns of communicable disease incidence and antibiotic prescribing in Moria refugee camp, Greece. J Public Health (Oxf) 2024; 46:41-50. [PMID: 37968097 DOI: 10.1093/pubmed/fdad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/27/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Infectious diseases remain a major risk for refugees living in camps. Limited research has been undertaken into the burden and impact of infections in the current refugee crisis around the Mediterranean.This analysis examines the frequency and incidence rates of common infections, and use of antibiotics at a healthcare facility inside Moria refugee camp on the island of Lesvos, Greece, during the winter and summer seasons of 2019. METHODS This is a retrospective analysis of routinely, prospectively collected service data from the main acute healthcare facility inside Moria camp. RESULTS Of a total of 9601 consultations, 25.16% were for infections (winter: 31.53%, summer: 19.45%). Respiratory, skin and gastrointestinal infections were the most frequent, with incidence rates up to 3.5 times, 50 times and twice as high as those in Western Europe, respectively. Antibiotic prescribing was high (27.7% of all respiratory infections) with high use of broad-spectrum antibiotics (40.2%), raising concerns about induction of antimicrobial resistance. CONCLUSIONS The burden of infectious diseases in refugee camps remains high throughout all seasons. Antimicrobial stewardship programmes should be adapted to refugee camp settings to prevent the development of unnecessary antimicrobial resistance. Improving living conditions and access to healthcare in refugee camps is likely to reduce infection rates and antimicrobial resistance among refugees.
Collapse
Affiliation(s)
- Tomas Simonek
- UNHCR Camp Lesbos Greece, St. Elizabeth University, Namestie, 1 Maja 1, 81000 Bratislava, Slovakia
| | - Helen Zahos
- School of Nursing and Midwifery, Griffith University, Parklands Drive, Southport, QLD 4222, Gold Coast, Australia
| | | | - Christian Harkensee
- Queen Elizabeth Hospital Gateshead, Queen Elizabeth Avenue, Gateshead, NE9 6SX, UK
| |
Collapse
|
5
|
Ghassemi EY, Thorseth AH, Le Roch K, Heath T, White S. Mapping the association between mental health and people's perceived and actual ability to practice hygiene-related behaviours in humanitarian and pandemic crises: A scoping review. PLoS One 2023; 18:e0286494. [PMID: 38096240 PMCID: PMC10721104 DOI: 10.1371/journal.pone.0286494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023] Open
Abstract
Humanitarian crises such as disease outbreaks, conflict and displacement and natural disasters affect millions of people primarily in low- and middle-income countries. Here, they often reside in areas with poor environmental health conditions leading to an increased burden of infectious diseases such as gastrointestinal and respiratory infections. Water, sanitation, and hygiene behaviours are critical to prevent such infections and deaths. A scoping review was conducted to map out what is known about the association between three mental health disorders and people's perceived and actual ability to practice hygiene-related behaviours, particularly handwashing, in humanitarian and pandemic crises. Published and grey literature was identified through database searches, humanitarian-relevant portals, and consultations with key stakeholders in the humanitarian sector. 25 publications were included, 21 were peer-reviewed published articles and four were grey literature publications. Most of the studies were conducted in mainland China (n = 12) and most were conducted in an outbreak setting (n = 20). Six studies found a positive correlation between handwashing and anxiety where participants with higher rates of anxiety were more likely to practice handwashing with soap. Four studies found an inverse relationship where those with higher rates of anxiety were less likely to wash their hands with soap. The review found mixed results for the association between handwashing and depression, with four of the seven studies reporting those with higher rates of depression were less likely to wash their hands, while the remaining studies found that higher depression scores resulted in more handwashing. Mixed results were also found between post-traumatic stress disorder (PTSD) and handwashing. Two studies found that lower scores of PTSD were associated with better hygiene practices, including handwashing with soap. The contradictory patterns suggest that researchers and practitioners need to explore this association further, in a wider range of crises, and need to standardize tools to do so.
Collapse
Affiliation(s)
- Emily Yasmin Ghassemi
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Astrid Hasund Thorseth
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Sian White
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
6
|
Watson J, Osman IME, Amon-Tanoh M, Deola C, MacDougall A, Cumming O. A cluster-randomised controlled equivalence trial of the Surprise Soap handwashing intervention among older children living in a refugee settlement in Sudan. BMJ Glob Health 2023; 8:e012633. [PMID: 37827726 PMCID: PMC10583099 DOI: 10.1136/bmjgh-2023-012633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/09/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Increasing handwashing with soap (HWWS) among older children in emergency settings can have a large public health impact, however, evidence on what works is limited. One promising approach is the 'Surprise Soap' intervention in which a novel soap with an embedded toy is delivered to children in a short, participatory household session that includes a glitter game and HWWS practice. Here, we evaluate this intervention against a standard intervention in a complex emergency setting. METHODS A cluster-randomised controlled equivalence trial was conducted in Naivasha refugee settlement, Sudan. Blinding was not possible. 203 randomly selected households, with at least one child aged 5-12, were randomised to receive the Surprise Soap intervention (n=101) or a standard intervention comprising a short household session with health messaging and plain soap distribution (n=102). The primary outcome was the proportion of prespecified potential HWWS events observed for children aged 5-12, accompanied by HWWS, at baseline, 4, 12 and 16 weeks post intervention delivery. RESULTS 200 households were included in the analyses: 101 intervention and 99 control. No difference in intervention effectiveness was observed at any follow-up (4 weeks: adjusted rate ratio (RR) 1.2, 95% CI 0.8 to 1.7; 12 weeks: RR 0.8, 95% CI 0.5 to 1.1; 16 weeks: RR 1.1, 95% CI 0.8 to 1.5). However, we observed increased HWWS in both arms at 4 weeks (27 and 23 percentage point increase in the intervention and control arm, respectively) that was sustained at 16 weeks. CONCLUSIONS We find that the Surprise Soap intervention is no more effective at increasing older children's HWWS than a standard, household-level, health-based intervention in this complex humanitarian emergency. There appears to be no marginal benefit in terms of HWWS that would justify the additional cost of implementing the Surprise Soap intervention. Further trials that include a passive control arm are needed to determine the independent effects of each intervention and guide future intervention design.
Collapse
Affiliation(s)
- Julie Watson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Maud Amon-Tanoh
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Amy MacDougall
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
7
|
Topluoglu S, Taylan-Ozkan A, Alp E. Impact of wars and natural disasters on emerging and re-emerging infectious diseases. Front Public Health 2023; 11:1215929. [PMID: 37727613 PMCID: PMC10505936 DOI: 10.3389/fpubh.2023.1215929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 09/21/2023] Open
Abstract
Emerging Infectious Diseases (EIDs) and Re-Emerging Infectious Diseases (REIDs) constitute significant health problems and are becoming of major importance. Up to 75% of EIDs and REIDs have zoonotic origin. Several factors such as the destruction of natural habitats leading humans and animals to live in close proximity, ecological changes due to natural disasters, population migration resulting from war or conflict, interruption or decrease in disease prevention programs, and insufficient vector control applications and sanitation are involved in disease emergence and distribution. War and natural disasters have a great impact on the emergence/re-emergence of diseases in the population. According to a World Bank estimation, two billion people are living in poverty and fragility situations. Wars destroy health systems and infrastructure, curtail existing disease control programs, and cause population movement leading to an increase in exposure to health risks and favor the emergence of infectious diseases. A total of 432 catastrophic cases associated with natural disasters were recorded globally in 2021. Natural disasters increase the risk of EID and REID outbreaks by damaging infrastructure and leading to displacement of populations. A Generic National Action Plan covering risk assessment, mechanism for action, determination of roles and responsibilities of each sector, the establishment of a coordination mechanism, etc. should be developed.
Collapse
Affiliation(s)
- Seher Topluoglu
- Provincial Health Directorate of Ankara, Republic of Türkiye Ministry of Health, Ankara, Türkiye
| | - Aysegul Taylan-Ozkan
- Department of Medical Microbiology, Medical Faculty, TOBB University of Economics and Technology, Ankara, Türkiye
| | - Emine Alp
- Department of Clinical Microbiology and Infectious Diseases, Medical Faculty, Ankara Yildirim Beyazit University, Ankara, Türkiye
| |
Collapse
|
8
|
Sbarra AN, Rolfe S, Haeuser E, Nguyen JQ, Adamu A, Adeyinka D, Ajumobi O, Akunna C, Amusa G, Dahiru T, Ekholuenetale M, Esezobor C, Fowobaje K, Hay SI, Ibeneme C, Ibitoye SE, Ilesanmi O, Kayode G, Krohn K, Lim SS, Medeiros LE, Mohammed S, Nwatah V, Okoro A, Olagunju AT, Olusanya BO, Osarenotor O, Owolabi M, Pickering B, Sufiyan MB, Uzochukwu B, Walker A, Mosser JF. Estimating vaccine coverage in conflict settings using geospatial methods: a case study in Borno state, Nigeria. Sci Rep 2023; 13:11085. [PMID: 37422502 PMCID: PMC10329660 DOI: 10.1038/s41598-023-37947-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling.
Collapse
Affiliation(s)
- Alyssa N Sbarra
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA.
| | - Sam Rolfe
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Emily Haeuser
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Jason Q Nguyen
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Aishatu Adamu
- Community Medicine Department, Bayero University Kano, Kano, Nigeria
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Adeyinka
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Olufemi Ajumobi
- School of Public Health, University of Nevada Reno, Reno, USA
- National Malaria Elimination Program, Federal Ministry of Health, Abuja, Nigeria
| | - Chisom Akunna
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
- Department of Public Health, The Intercountry Centre for Oral Health (ICOH) for Africa, Jos, Nigeria
| | - Ganiyu Amusa
- Department of Medicine, University of Jos, Jos, Nigeria
- Department of Internal Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Tukur Dahiru
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Michael Ekholuenetale
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Christopher Esezobor
- Department of Paediatrics, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Kayode Fowobaje
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
- Child Survival Unit, Centre for African Newborn Health and Nutrition, Ibadan, Nigeria
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Charles Ibeneme
- Department of Public Health and Disease Control, Abia State Ministry of Health, Umuahia, Nigeria
- Nigerian Field Epidemiology and Laboratory Training Program, African Field Epidemiology Network, Abuja, Nigeria
| | | | - Olayinka Ilesanmi
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Gbenga Kayode
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands
| | - Kris Krohn
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Stephen S Lim
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
- Department of Health Metrics Sciences, University of Washington, Seattle, USA
| | - Lyla E Medeiros
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Shafiu Mohammed
- Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
- Department of Healthcare Management, Technical University of Berlin, Berlin, Germany
| | - Vincent Nwatah
- Department of Pediatrics, National Hospital Abuja, Abuja, Nigeria
- Department of International Public Health, University of Liverpool, Liverpool, UK
| | | | - Andrew T Olagunju
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
- Department of Psychiatry, University of Lagos, Lagos, Nigeria
| | | | - Osayomwanbo Osarenotor
- Department of Environmental Management and Toxicology, University of Benin, Benin City, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Brandon Pickering
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | | | - Benjamin Uzochukwu
- Department of Community Medicine, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Ally Walker
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA
| | - Jonathan F Mosser
- Institute for Health Metrics and Evaluation, University of Washington, 3980 15th Ave NE, Seattle, WA, 98105, USA.
- Department of Health Metrics Sciences, University of Washington, Seattle, USA.
| |
Collapse
|
9
|
Eren MF, Kilic SS, Eren AA, Kaplan SO, Teke F, Kutuk T, Bicakci BC, Hathout L, Moningi S, Orio P, Atalar B, Sayan M. Radiation therapy for prostate cancer in Syrian refugees: facing the need for change. Front Public Health 2023; 11:1172864. [PMID: 37325331 PMCID: PMC10264678 DOI: 10.3389/fpubh.2023.1172864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To report the utilization of radiation therapy in Syrian refugee patients with prostate cancer residing in Turkey. Methods and materials A multi-institutional retrospective review including 14 cancer centers in Turkey was conducted to include 137 Syrian refugee patients with prostate cancer treated with radiation therapy (RT). Toxicity data was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Noncompliance was defined as a patient missing two or more scheduled RT appointments. Results Advanced disease, defined as stage III or IV, was reported in 64.2% of patients while androgen deprivation therapy (ADT) was only administrated to 20% of patients. Conventionally fractionated RT with a median number of 44 fractions was delivered to all patients with curative intent (n = 61) while palliative RT (n = 76) was delivered with a median number of 10 fractions. The acute grade 3-4 toxicity rate for the entire cohort was 16%. Noncompliance rate was 42%. Conclusion Most Syrian refugee prostate cancer patients presented with advanced disease however ADT was seldom used. Despite the low treatment compliance rate, conventional fractionation was used in all patients. Interventions are critically needed to improve screening and increase the use of standard-of-care treatment paradigms, including hypofractionated RT and ADT.
Collapse
Affiliation(s)
- Mehmet Fuat Eren
- Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Türkiye
| | - Sarah S. Kilic
- Taussig Cancer Institute, Cancer Center, Cleveland Clinic, Cleveland, OH, United States
| | - Ayfer Ay Eren
- Istanbul Kartal Dr.Lutfi Kirdar Education and Research Hospital, Istanbul, Türkiye
| | | | | | - Tugce Kutuk
- Malatya Education and Research Hospital, Malatya, Türkiye
| | | | - Lara Hathout
- Rutgers Cancer Institute of New Jersey, The State University of New Jersey, New Brunswick, NJ, United States
| | - Shalini Moningi
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter Orio
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Mutlay Sayan
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
10
|
Watson J, Amon-Tanoh MA, Deola C, Haji MA, Sheikh MR, Mohamud FA, Ali SY, MacDougall A, Cumming O. Effect of a novel hygiene intervention on older children's handwashing in a humanitarian setting in Kahda district, Somalia: A cluster-randomised controlled equivalence trial. Int J Hyg Environ Health 2023; 250:114163. [PMID: 37011505 DOI: 10.1016/j.ijheh.2023.114163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Improving handwashing with soap (HWWS) among children in humanitarian emergencies has the potential to reduce the transmission of several important infectious diseases. However, there is limited evidence on which approaches are effective in increasing HWWS among children in humanitarian settings. One recent innovation - the "Surprise Soap" intervention - was shown to be successful in a small-scale efficacy trial in a humanitarian setting in Iraq. This intervention includes soap with embedded toys delivered through a short household session comprising a glitter game, instruction of how and when to wash hands, and HWWS practice. Whilst promising, this approach has not been evaluated at programmatic scale in a complex humanitarian setting. METHODS We conducted a cluster-randomised controlled equivalence trial of the Surprise Soap intervention in IDP camps in Kahda district, Somalia. Proportionate stratified random sampling was employed to recruit 200 households, with at least one child aged 5-12, across the camps. Eligible households were randomly allocated to receive the Surprise Soap intervention (n = 100) or an active comparator handwashing intervention in which plain soap was delivered in a short household session comprising standard health-based messaging and instruction of how and when to wash hands (n = 100). The primary outcome was the proportion of pre-specified occasions when HWWS was practiced by children aged 5-12 years, measured at baseline, 4-weeks, 12 weeks, and 16 weeks post invention delivery. RESULTS HWWS increased in both groups (by 48 percentage points in the intervention group and 51 percentage points in the control group, at the 4-week follow up), however, there was no evidence of a difference in HWWS between the groups at the 4-week (adjusted RR (aRR) = 1.0, 95% CI 0.9-1.1), 12-week (aRR = 1.1, 95% CI 0.9-1.3), or 16-week (aRR = 1.0, 95% CI 0.9-1.2) follow-up. CONCLUSIONS In this complex humanitarian setting, where soap availability and past exposure to handwashing promotion was low, it appears that well-designed, household-level targeted handwashing interventions that include soap provision can increase child HWWS and potentially reduce disease risk, but the Surprise Soap intervention offers no marginal benefit over a standard intervention that would justify the additional costs.
Collapse
|
11
|
Sundaram M, Filion A, Akaribo BE, Stephens PR. Footprint of war: integrating armed conflicts in disease ecology. Trends Parasitol 2023; 39:238-241. [PMID: 36803860 PMCID: PMC10194412 DOI: 10.1016/j.pt.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/18/2023]
Abstract
War is an understudied and yet significant contributor to disease outbreaks, necessitating approaches incorporating conflicts into disease studies. We discuss mechanisms by which war affects disease dynamics, and supply an illustrative example. Lastly, we provide relevant data sources and pathways for incorporating metrics of armed conflict into disease ecology.
Collapse
Affiliation(s)
- Mekala Sundaram
- Department of Integrative Biology, 501 Life Sciences West, Oklahoma State University, Stillwater, OK 74078, USA
| | - Antoine Filion
- Department of Integrative Biology, 501 Life Sciences West, Oklahoma State University, Stillwater, OK 74078, USA.
| | - Benedicta E Akaribo
- Department of Integrative Biology, 501 Life Sciences West, Oklahoma State University, Stillwater, OK 74078, USA
| | - Patrick R Stephens
- Department of Integrative Biology, 501 Life Sciences West, Oklahoma State University, Stillwater, OK 74078, USA
| |
Collapse
|
12
|
Almagro-Moreno S, Martinez-Urtaza J, Pukatzki S. Vibrio Infections and the Twenty-First Century. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1404:1-16. [PMID: 36792868 DOI: 10.1007/978-3-031-22997-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The Vibrionaceae is a highly diverse family of aquatic bacteria. Some members of this ubiquitous group can cause a variety of diseases in humans ranging from cholera caused by Vibrio cholerae, severe septicemia caused by Vibrio vulnificus, to acute gastroenteritis by Vibrio parahaemolyticus. Planet Earth is experiencing unprecedented changes of planetary scale associated with climate change. These environmental perturbations paired with overpopulation and pollution are increasing the distribution of pathogenic Vibrios and exacerbating the risk of causing infections. In this chapter, we discuss various aspects of Vibrio infections within the context of the twenty-first century with a major emphasis on the aforementioned pathogenic species. Overall, we believe that the twenty-first century is posed to be both one full of challenges due to the rise of these pathogens, and also a catalyst for innovative and groundbreaking discoveries.
Collapse
Affiliation(s)
- Salvador Almagro-Moreno
- Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL, USA. .,National Center for Integrated Coastal Research, University of Central Florida, Orlando, FL, USA.
| | - Jaime Martinez-Urtaza
- Department de Genetica I de Microbiologia, Facultat de Biociencies, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Stefan Pukatzki
- Department of Biology, The City College of New York, New York, NY, USA
| |
Collapse
|
13
|
Hauser M, Kabuya JBB, Mantus M, Kamavu LK, Sichivula JL, Matende WM, Fritschi N, Shields T, Curriero F, Kvit A, Chongwe G, Moss WJ, Ritz N, Ippolito MM. Malaria in Refugee Children Resettled to a Holoendemic Area of Sub-Saharan Africa. Clin Infect Dis 2023; 76:e1104-e1113. [PMID: 35640824 PMCID: PMC10169438 DOI: 10.1093/cid/ciac417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Malaria is a leading cause of morbidity and mortality in refugee children in high-transmission parts of Africa. Characterizing the clinical features of malaria in refugees can inform approaches to reduce its burden. METHODS The study was conducted in a high-transmission region of northern Zambia hosting Congolese refugees. We analyzed surveillance data and hospital records of children with severe malaria from refugee and local sites using multivariable regression models and geospatial visualization. RESULTS Malaria prevalence in the refugee settlement was similar to the highest burden areas in the district, consistent with the local ecology and leading to frequent rapid diagnostic test stockouts. We identified 2197 children hospitalized for severe malaria during the refugee crisis in 2017 and 2018. Refugee children referred from a refugee transit center (n = 63) experienced similar in-hospital mortality to local children and presented with less advanced infection. However, refugee children from a permanent refugee settlement (n = 110) had more than double the mortality of local children (P < .001), had lower referral rates, and presented more frequently with advanced infection and malnutrition. Distance from the hospital was an important mediator of the association between refugee status and mortality but did not account for all of the increased risk. CONCLUSIONS Malaria outcomes were more favorable in refugee children referred from a highly outfitted refugee transit center than those referred later from a permanent refugee settlement. Refugee children experienced higher in-hospital malaria mortality due in part to delayed presentation and higher rates of malnutrition. Interventions tailored to the refugee context are required to ensure capacity for rapid diagnosis and referral to reduce malaria mortality.
Collapse
Affiliation(s)
- Manuela Hauser
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jean-Bertin B Kabuya
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Molly Mantus
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luc K Kamavu
- Office of Hospital Administration, Saint Paul's General Hospital, Nchelenge, Zambia
| | - James L Sichivula
- Department of Clinical Sciences, Tropical Diseases Research Centre, Ndola, Zambia
| | - Wycliffe M Matende
- United Nations High Commissioner for Refugees, Country Representation Office, Lusaka, Zambia
| | - Nora Fritschi
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Timothy Shields
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank Curriero
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anton Kvit
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gershom Chongwe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicole Ritz
- Mycobacterial and Migrant Health Research Group, University of Basel Children's Hospital, Basel, Switzerland.,Infectious Disease and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Melbourne, Australia.,Department of Paediatrics and Paediatric Infectious Diseases, Children's Hospital, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Matthew M Ippolito
- Johns Hopkins Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Clinical Pharmacology and Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
14
|
Lopez VK, Nika A, Blanton C, Talley L, Garfield R. Can severity of a humanitarian crisis be quantified? Assessment of the INFORM severity index. Global Health 2023; 19:7. [PMID: 36721202 PMCID: PMC9887746 DOI: 10.1186/s12992-023-00907-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/13/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Those responding to humanitarian crises have an ethical imperative to respond most where the need is greatest. Metrics are used to estimate the severity of a given crisis. The INFORM Severity Index, one such metric, has become widely used to guide policy makers in humanitarian response decision making. The index, however, has not undergone critical statistical review. If imprecise or incorrect, the quality of decision making for humanitarian response will be affected. This analysis asks, how precise and how well does this index reflect the severity of conditions for people affected by disaster or war? RESULTS The INFORM Severity Index is calculated from 35 publicly available indicators, which conceptually reflect the severity of each crisis. We used 172 unique global crises from the INFORM Severity Index database that occurred January 1 to November 30, 2019 or were ongoing by this date. We applied exploratory factor analysis (EFA) to determine common factors within the dataset. We then applied a second-order confirmatory factor analysis (CFA) to predict crisis severity as a latent construct. Model fit was assessed via chi-square goodness-of-fit statistic, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA). The EFA models suggested a 3- or 4- factor solution, with 46 and 53% variance explained in each model, respectively. The final CFA was parsimonious, containing three factors comprised of 11 indicators, with reasonable model fit (Chi-squared = 107, with 40 degrees of freedom, CFI = 0.94, TLI = 0.92, RMSEA = 0.10). In the second-order CFA, the magnitude of standardized factor-loading on the 'societal governance' latent construct had the strongest association with the latent construct of 'crisis severity' (0.73), followed by the 'humanitarian access/safety' construct (0.56). CONCLUSIONS A metric of crisis-severity is a critical step towards improving humanitarian response, but only when it reflects real life conditions. Our work is a first step in refining an existing framework to better quantify crisis severity.
Collapse
Affiliation(s)
- Velma K Lopez
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Curtis Blanton
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leisel Talley
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Richard Garfield
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
15
|
Al-Hussaini M, Al-Ani A, Hammouri M, Al-Huneidy L, Mansour A. Investigating the impact of COVID-19 on patients with cancer from areas of conflict within the MENA region treated at King Hussein Cancer Center. Front Oncol 2023; 13:1088000. [PMID: 36910625 PMCID: PMC9995942 DOI: 10.3389/fonc.2023.1088000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Background There is a paucity of evidence regarding the impact of COVID-19 on cancer care among refugees or patients from areas of conflict. Cancer care for these populations remains fragmented due to resource scarcity and limited infrastructure. Aims To explore the effect of COVID-19 on cancer care among patients from areas of conflict treated at King Hussein Cancer Center (KHCC). Methodology We performed a retrospective chart review of all patients from areas of conflict, treated at KHCC from 2018 to 2021. Patients' demographics and clinical characteristics are presented in the form of descriptive statistics. Interrupted Time Series (ITS) analysis was utilized to investigate the impact of COVID-19 on the number of admissions throughout the study's period. Results A total of 3317 patients from areas of conflict were included in the study. Among these, 1546 were males (46.6%) while 1771 (53.4%) were female. Libyans (34.6%), Palestinians (24.8%), Iraqis (24.5%), Syrians (15.3%), and Sudanese patients (0.9%) constituted our study sample. ITS analysis demonstrated that the start of the COVID-19 lockdown significantly decreased admissions by 44.0% (p = 0.020), while the end of the COVID-19 restriction significantly improved admissions by 43.0% (p = 0.023). Among those with available SEER stages, more than a quarter of patients had distant metastasis (n = 935, 28.2%) irrespective of age and biological sex. Advanced presentations during 2020 had approximately a 16% and 6% increase compared to 2018 and 2019, respectively. Breast cancer (21.4%), hematolymphoid cancers (18.1%), and cancers of the digestive system (16.5%) were the most common cancers among our cohort. Conclusion Restrictions associated with COVID-19 had a significant effect on the number of admissions of patients from areas of conflict. In the long term, this effect may impact the survival outcomes of affected patients.
Collapse
Affiliation(s)
- Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Asem Mansour
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|
16
|
Ogbu TJ, Scales SE, de Almeida MM, van Loenhout JAF, Speybroeck N, Guha-Sapir D. Predictors of exceeding emergency under-five mortality thresholds using small-scale survey data from humanitarian settings (1999 – 2020): considerations for measles vaccination, malnutrition, and displacement status. Arch Public Health 2022; 80:160. [PMID: 35765108 PMCID: PMC9238088 DOI: 10.1186/s13690-022-00916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Quantifying the effect of measles containing vaccine (MCV) coverage and the prevalence of global acute malnutrition (GAM) on mortality levels in populations of displaced and crisis-affected resident children is important for intervention programming in humanitarian emergencies. Methods A total of 1597 surveys containing data on under-five death rate, population status (internally displaced, refugee, or crisis-affected resident), measles containing vaccine coverage, and global acute malnutrition were extracted from the Complex Emergency Database (CE-DAT). Under-five mortality rates were dichotomized to those exceeding critical levels or otherwise. A Bayesian multivariable mixed-effect logistic regression model was used to assess the association between an under-five death rate (U5DR) exceeding this threshold and population status (i.e., internally displaced, refugees or residents), GAM prevalence (proxy for food security), and MCV coverage. Results The prevalence of GAM, MCV and U5DR were higher in internally displaced children (IDC) with values of 14.6%, 69.9% and 2.07 deaths per 10 000 per day, respectively. Refugee populations had lower average under-five mortality rate (0.89 deaths per 10 000 per day), GAM of 12.0% and the highest measles containing vaccine coverage (80.0%). In crisis-affected residents the prevalence of GAM, MCV and average U5DR are 11.1%, 65.5% and 1.20 deaths per 10 000 per day respectively. In mixed-effect logistic model taking 2 deaths per 10 000 children less than five years old per as emergency threshold (Model III); MCV (AOR = 0.66, 95% Highest Density Interval (HDI): 0.57, 0.78), GAM (AOR = 1.79, 95% HDI: 1.52, 2.12) were associated with a reduction of the odds of U5DR exceeding critical level accounting for country-specific levels of variability. The odds of U5DR exceeding critical level (2/10000/day) in crisis-affected resident children and refugees were 0.36 (95% HDI: 0.22, 0.58) and 0.25(95% HDI: 0.11, 0.55) less than amongst IDP children adjusting for GAM and MCV. In considering country specific yearly median U5DR (model IV) the odds of U5DR exceeding twice the median U5DR were associated with MCV (AOR = 0.72, 95% HDI: 0.64, 0.82), GAM (AOR = 1.53, 95%HDI: 1.34, 1.76). The odds of U5DR exceeding critical level in crisis-affected resident children was 0.30(95% HDI: 0.20, 0.45) less than IDP children, after adjusting for MCV and GAM. We found no difference between the odds of U5DR exceeding twice the country level median U5DR in the refugee population compared to the IDPs. Conclusions In this study vaccination coverage and global acute malnutrition (proxy for food security) were associated with U5DR exceeding critical level. The emergency threshold for IDPs and affected residents is significantly different and consistent across the different outcomes, whereas the result is inconsistent for IDPs and refugees. Continued improvement in measles vaccination coverage and reduction of malnutrition in humanitarian emergencies have the potential to minimize the deterioration of mortality level amongst children in emergency settings. To generate a robust understanding of the critical level of child mortality in displaced and affected resident populations, studies accounting for the impact of the duration of displacement, contextual factors in humanitarian settings, and the level of humanitarian assistance provided are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00916-0.
Collapse
|
17
|
Ismail SA, Lam ST, Bell S, Fouad FM, Blanchet K, Borghi J. Strengthening vaccination delivery system resilience in the context of protracted humanitarian crisis: a realist-informed systematic review. BMC Health Serv Res 2022; 22:1277. [DOI: 10.1186/s12913-022-08653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Childhood vaccination is among the most effective public health interventions available for the prevention of communicable disease, but coverage in many humanitarian settings is sub-optimal. This systematic review critically evaluated peer-review and grey literature evidence on the effectiveness of system-level interventions for improving vaccination coverage in protracted crises, focusing on how they work, and for whom, to better inform preparedness and response for future crises.
Methods
Realist-informed systematic review of peer-reviewed and grey literature. Keyword-structured searches were performed in MEDLINE, EMBASE and Global Health, CINAHL, the Cochrane Collaboration and WHOLIS, and grey literature searches performed through the websites of UNICEF, the Global Polio Eradication Initiative (GPEI) and Technical Network for Strengthening Immunization Services. Results were independently double-screened for inclusion on title and abstract, and full text. Data were extracted using a pre-developed template, capturing information on the operating contexts in which interventions were implemented, intervention mechanisms, and vaccination-related outcomes. Study quality was assessed using the MMAT tool. Findings were narratively synthesised.
Results
50 studies were included, most describing interventions applied in conflict or near-post conflict settings in sub-Saharan Africa, and complex humanitarian emergencies. Vaccination campaigns were the most commonly addressed adaptive mechanism (n = 17). Almost all campaigns operated using multi-modal approaches combining service delivery through multiple pathways (fixed and roving), health worker recruitment and training and community engagement to address both vaccination supply and demand. Creation of collaterals through service integration showed generally positive evidence of impact on routine vaccination uptake by bringing services closer to target populations and leveraging trust that had already been built with communities. Robust community engagement emerged as a key unifying mechanism for outcome improvement across almost all of the intervention classes, in building awareness and trust among crisis-affected populations. Some potentially transformative mechanisms for strengthening resilience in vaccination delivery were identified, but evidence for these remains limited.
Conclusion
A number of interventions to support adaptations to routine immunisation delivery in the face of protracted crisis are identifiable, as are key unifying mechanisms (multi-level community engagement) apparently irrespective of context, but evidence remains piecemeal. Adapting these approaches for local system resilience-building remains a key challenge.
Collapse
|
18
|
Preventable Disease, the Case of Colorado: School District Demographics and Childhood Immunizations. Vaccines (Basel) 2022; 10:vaccines10101579. [PMID: 36298445 PMCID: PMC9607491 DOI: 10.3390/vaccines10101579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to evaluate the impact of selected sociodemographic factors on childhood vaccination hesitancy and to define their role according to specific exemptions. This population-based cohort study utilized vaccination rate and sociodemographic data from 1st to 12th grade from 2017 to 2021 for all school districts in Colorado. Data included immunization status and exemptions for each vaccine, race, ethnicity, and free and reduced meal status. Data were evaluated through dimensional analysis and Generalized Linear Mixed Models. School districts with a higher representation of White students had lower immunization rates and use more personal exemptions while school districts with larger Hispanic populations and higher proportions of free and reduced lunches had higher vaccination rates and used more religious exemptions. Black and Pacific Islander populations had higher rates of incomplete vaccination records while Asian American population displayed increased vaccination compliance. Colorado is a robust example of how socioeconomic and cultural differences are important factors with a direct influence on vaccination rates. Future childhood vaccination campaigns and legislation should consider complex socioeconomic and cultural factors.
Collapse
|
19
|
White S, Heath T, Mutula AC, Dreibelbis R, Palmer J. How are hygiene programmes designed in crises? Qualitative interviews with humanitarians in the Democratic Republic of the Congo and Iraq. Confl Health 2022; 16:45. [PMID: 36056391 PMCID: PMC9438112 DOI: 10.1186/s13031-022-00476-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 08/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hygiene behaviour change programmes are complex to design. These challenges are heightened during crises when humanitarian responders are under pressure to implement programmes rapidly despite having limited information about the local situation, behaviours and opinions-all of which may also be rapidly evolving. METHODS We conducted in-depth interviews with 36 humanitarian staff involved in hygiene programme design in two crisis-affected settings-one a conflict affected setting (Iraq) and the other amid a cholera outbreak (Democratic Republic of the Congo). Interviews explored decision-making in each phase of the humanitarian project cycle and were thematically analysed. RESULTS Participants considered the design and implementation of hygiene programmes in crises to be sub-optimal. Humanitarians faced sector-specific challenges as well as more general constraints associated with operating within the humanitarian system. Programme-design decisions were made naturalistically and relied heavily on the intuitions and assumptions of senior staff. National organisations were often side-lined from programme design processes despite being in a better position to gather situational data. Consequently, programme design and decision-making processes adopted by humanitarians were similar across the two settings studied and led to similar types of hygiene promotion activities being delivered. CONCLUSION Hygiene programming in crises-affected settings could be strengthened by initiatives targeted at supporting humanitarian staff during the pre-implementation programme design phase. This may include rapid assessment tools to better understand behavioural determinants in crisis-affected contexts; the use of a theory of change to inform the selection of programme activities; and funding mechanisms which encourage equitable partnerships, phased programming, regular adaptation and have programmatic components targeted at sustainability and sector capacity building. Initiatives aimed at sector reform should be cognisant of inter and intra-organisational dynamics, the ways that expertise is created and valued by the sector, and humanitarian habits and norms that arise in response to system constraints and pressures. These micro-organisational processes affect macro-level outcomes related to programme quality and acceptability and determine or limit the roles of national actors in programme design processes.
Collapse
Affiliation(s)
- Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Thomas Heath
- Independent Consultant, Goma, Democratic Republic of the Congo
| | | | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jennifer Palmer
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
20
|
Tarnas MC, Desai AN, Parker DM, Almhawish N, Zakieh O, Rayes D, Whalen-Browne M, Abbara A. Syndromic surveillance of respiratory infections during protracted conflict: experiences from northern Syria 2016-2021. Int J Infect Dis 2022; 122:337-344. [PMID: 35688310 DOI: 10.1016/j.ijid.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Northern Syria faces a large burden of influenza-like illness (ILI) and severe acute respiratory illness (SARI). This study aimed to investigate the trends of Early Warning and Response Network (EWARN) reported ILI and SARI in northern Syria between 2016 and 2021 and the potential impact of SARS-CoV-2. METHODS We extracted weekly EWARN data on ILI/ SARI and aggregated cases and consultations into 4-week intervals to calculate case positivity. We conducted a seasonal-trend decomposition to assess case trends in the presence of seasonal fluctuations. RESULTS It was observed that 4-week aggregates of ILI cases (n = 5,942,012), SARI cases (n = 114,939), ILI case positivity, and SARI case positivity exhibited seasonal fluctuations with peaks in the winter months. ILI and SARI cases in individuals aged ≥5 years surpassed those in individuals aged <5 years in late 2019. ILI cases clustered primarily in Aleppo and Idlib, whereas SARI cases clustered in Aleppo, Idlib, Deir Ezzor, and Hassakeh. SARI cases increased sharply in 2021, corresponding with a severe SARS-CoV-2 wave, compared with the steady increase in ILI cases over time. CONCLUSION Respiratory infections cause widespread morbidity and mortality throughout northern Syria, particularly with the emergence of SARS-CoV-2. Strengthened surveillance and access to testing and treatment are critical to manage outbreaks among conflict-affected populations.
Collapse
Affiliation(s)
- Maia C Tarnas
- University of California, Population Health and Disease Prevention, Irvine, CA, USA.
| | - Angel N Desai
- University of California, Davis Medical Center, Sacramento, CA, USA
| | - Daniel M Parker
- University of California, Population Health and Disease Prevention, Irvine, CA, USA
| | | | - Omar Zakieh
- Imperial College, Department of Infection, London, UK
| | - Diana Rayes
- Syria Public Health Network, London, UK; Johns Hopkins University, Department of International Health, Baltimore, MD, USA
| | | | - Aula Abbara
- Imperial College, Department of Infection, London, UK; Syria Public Health Network, London, UK
| |
Collapse
|
21
|
Conzatti A, Kershaw T, Copping A, Coley D. A review of the impact of shelter design on the health of displaced populations. JOURNAL OF INTERNATIONAL HUMANITARIAN ACTION 2022; 7:18. [PMID: 37519834 PMCID: PMC9425791 DOI: 10.1186/s41018-022-00123-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 06/22/2022] [Indexed: 08/01/2023]
Abstract
There are currently millions of displaced people encamped in low-quality shelters that jeopardise the health of these displaced populations. These shelters, which exhibit poor thermal regulation and air quality, are often inhabited by households for several years. Recently, the internal environment of shelters has been recognised as a determinant of the health of the occupants and the indoor air quality (IAQ) and internal temperatures have been identified as critical factors affecting occupants' health. Attempts by researchers and private companies to develop healthier shelter solutions have mainly prioritised factors such as rapid deployment, transportability and sustainability. Via a systematic bibliometric analysis of the existing literature, this review examines the impact of shelters' internal environment on occupant health. Self-reports and building simulation are the most common methodologies reported in the literature, but there is a disconnect between the reported shelter issues and their impact on health. This is likely due to the multifaceted and site-specific factors analysed. Indoor air quality, thermal comfort and overcrowding are the most commonly identified shelter issues, which are strongly related to the presence of infectious and airborne diseases. An analysis of the available literature indicates that there is still a lack of clear guidance linking shelter quality to health. Moreover, evidence of the impact of shelters on health is harder to find, and there is a gap regarding the metrics and the methodology used to evaluate shelter quality. Therefore, further research is necessary to provide evidence of the impact of shelter design on health through transdisciplinary approaches.
Collapse
Affiliation(s)
- Anna Conzatti
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - Tristan Kershaw
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - Alexander Copping
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| | - David Coley
- Department of Architecture and Civil Engineering, University of Bath, Claverton Down, Bat, UK
| |
Collapse
|
22
|
Chipeta MG, Kumaran EPA, Browne AJ, Hamadani BHK, Haines-Woodhouse G, Sartorius B, Reiner RC, Dolecek C, Hay SI, Moore CE. Mapping local variation in household overcrowding across Africa from 2000 to 2018: a modelling study. Lancet Planet Health 2022; 6:e670-e681. [PMID: 35932787 PMCID: PMC9364142 DOI: 10.1016/s2542-5196(22)00149-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Household overcrowding is a serious public health threat associated with high morbidity and mortality. Rapid population growth and urbanisation contribute to overcrowding and poor sanitation in low-income and middle- income countries, and are risk factors for the spread of infectious diseases, including COVID-19, and antimicrobial resistance. Many countries do not have adequate surveillance capacity to monitor household overcrowding. Geostatistical models are therefore useful tools for estimating household overcrowding. In this study, we aimed to estimate household overcrowding in Africa between 2000 and 2018 by combining available household survey data, population censuses, and other country-specific household surveys within a geostatistical framework. METHODS We used data from household surveys and population censuses to generate a Bayesian geostatistical model of household overcrowding in Africa for the 19-year period between 2000 and 2018. Additional sociodemographic and health-related covariates informed the model, which covered 54 African countries. FINDINGS We analysed 287 surveys and population censuses, covering 78 695 991 households. Spatial and temporal variability arose in household overcrowding estimates over time. In 2018, the highest overcrowding estimates were observed in the Horn of Africa region (median proportion 62% [IQR 57-63]); the lowest regional median proportion was estimated for the north of Africa region (16% [14-19]). Overall, 474·4 million (95% uncertainty interval [UI] 250·1 million-740·7 million) people were estimated to be living in overcrowded conditions in Africa in 2018, a 62·7% increase from the estimated 291·5 million (180·8 million-417·3 million) people who lived in overcrowded conditions in the year 2000. 48·5% (229·9 million) of people living in overcrowded conditions came from six African countries (Nigeria, Ethiopia, Democratic Republic of the Congo, Sudan, Uganda, and Kenya), with a combined population of 538·3 million people. INTERPRETATION This study incorporated survey and population censuses data and used geostatistical modelling to estimate continent-wide overcrowding over a 19-year period. Our analysis identified countries and areas with high numbers of people living in overcrowded conditions, thereby providing a benchmark for policy planning and the implementation of interventions such as in infectious disease control. FUNDING UK Department of Health and Social Care, Wellcome Trust, Bill & Melinda Gates Foundation.
Collapse
Affiliation(s)
- Michael G Chipeta
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK; African Institute for Development Policy, Lilongwe, Malawi
| | - Emmanuelle P A Kumaran
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Annie J Browne
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Bahar H Kashef Hamadani
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Georgina Haines-Woodhouse
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Robert C Reiner
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Christiane Dolecek
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Catrin E Moore
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK; Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK.
| |
Collapse
|
23
|
A blueprint for eliminating cholera by 2030. Nat Med 2022; 28:1747-1749. [DOI: 10.1038/s41591-022-01898-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
Ratnayake R, Peyraud N, Ciglenecki I, Gignoux E, Lightowler M, Azman AS, Gakima P, Ouamba JP, Sagara JA, Ndombe R, Mimbu N, Ascorra A, Welo PO, Mukamba Musenga E, Miwanda B, Boum Y, Checchi F, Edmunds WJ, Luquero F, Porten K, Finger F. Effectiveness of case-area targeted interventions including vaccination on the control of epidemic cholera: protocol for a prospective observational study. BMJ Open 2022; 12:e061206. [PMID: 35793924 PMCID: PMC9260795 DOI: 10.1136/bmjopen-2022-061206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Cholera outbreaks in fragile settings are prone to rapid expansion. Case-area targeted interventions (CATIs) have been proposed as a rapid and efficient response strategy to halt or substantially reduce the size of small outbreaks. CATI aims to deliver synergistic interventions (eg, water, sanitation, and hygiene interventions, vaccination, and antibiotic chemoprophylaxis) to households in a 100-250 m 'ring' around primary outbreak cases. METHODS AND ANALYSIS We report on a protocol for a prospective observational study of the effectiveness of CATI. Médecins Sans Frontières (MSF) plans to implement CATI in the Democratic Republic of the Congo (DRC), Cameroon, Niger and Zimbabwe. This study will run in parallel to each implementation. The primary outcome is the cumulative incidence of cholera in each CATI ring. CATI will be triggered immediately on notification of a case in a new area. As with most real-world interventions, there will be delays to response as the strategy is rolled out. We will compare the cumulative incidence among rings as a function of response delay, as a proxy for performance. Cross-sectional household surveys will measure population-based coverage. Cohort studies will measure effects on reducing incidence among household contacts and changes in antimicrobial resistance. ETHICS AND DISSEMINATION The ethics review boards of MSF and the London School of Hygiene and Tropical Medicine have approved a generic protocol. The DRC and Niger-specific versions have been approved by the respective national ethics review boards. Approvals are in process for Cameroon and Zimbabwe. The study findings will be disseminated to the networks of national cholera control actors and the Global Task Force for Cholera Control using meetings and policy briefs, to the scientific community using journal articles, and to communities via community meetings.
Collapse
Affiliation(s)
- Ruwan Ratnayake
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Epicentre, Paris, France
| | | | | | | | | | - Andrew S Azman
- Médecins Sans Frontières, Geneva, Switzerland
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | | | | | | | | | - Placide Okitayemba Welo
- Programme National d'Elimination du Choléra et de lutte contre les autres Maladies Diarrhéiques, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Berthe Miwanda
- Institut National de Recherche Biologique, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Francesco Checchi
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - W John Edmunds
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Francisco Luquero
- Epicentre, Paris, France
- GAVI the Vaccine Alliance, Geneva, Switzerland
| | | | | |
Collapse
|
25
|
Sayan M, Eren MF, Kilic SS, Kotek A, Kaplan SO, Duran O, Cukurcayır F, Babalıoglu I, Or OD, Ozturk GA, Eroglu C, Teke F, Kurtul N, Kutuk T, Bicakci BC, Senyurek S, Aktan M, Mamidanna S, Ohri N, Haffty B, Atalar B. Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey. BMC Cancer 2022; 22:532. [PMID: 35550042 PMCID: PMC9097407 DOI: 10.1186/s12885-022-09558-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT. Methods In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined. Results We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06–2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43–5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance. Conclusions Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.
Collapse
Affiliation(s)
- Mutlay Sayan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street. ASB1 - L2, Boston, MA, 02115, USA.
| | - Mehmet Fuat Eren
- Marmara University Pendik Education and Research Hospital, Istanbul, Turkey
| | | | - Ayse Kotek
- Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | | | - Ozge Duran
- Sanliurfa Mehmet Akif Inan Education and Research Hospital, Sanliurfa, Turkey
| | | | | | | | | | | | | | | | - Tugce Kutuk
- Malatya Education and Research Hospital, Malatya, Turkey
| | | | - Sukran Senyurek
- Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey
| | | | - Swati Mamidanna
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nisha Ohri
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Bruce Haffty
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | | |
Collapse
|
26
|
Correlates of the country differences in the infection and mortality rates during the first wave of the COVID-19 pandemic: evidence from Bayesian model averaging. Sci Rep 2022; 12:7099. [PMID: 35501339 PMCID: PMC9058748 DOI: 10.1038/s41598-022-10894-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
The COVID-19 pandemic resulted in great discrepancies in both infection and mortality rates between countries. Besides the biological and epidemiological factors, a multitude of social and economic criteria also influenced the extent to which these discrepancies appeared. Consequently, there is an active debate regarding the critical socio-economic and health factors that correlate with the infection and mortality rates outcome of the pandemic. Here, we leverage Bayesian model averaging techniques and country level data to investigate whether 28 variables, which describe a diverse set of health and socio-economic characteristics, correlate with the final number of infections and deaths during the first wave of the coronavirus pandemic. We show that only a few variables are able to robustly correlate with these outcomes. To understand the relationship between the potential correlates in explaining the infection and death rates, we create a Jointness Space. Using this space, we conclude that the extent to which each variable is able to provide a credible explanation for the COVID-19 infections/mortality outcome varies between countries because of their heterogeneous features.
Collapse
|
27
|
White S, Heath T, Khalid Ibrahim W, Ihsan D, Blanchet K, Curtis V, Dreibelbis R. How is hygiene behaviour affected by conflict and displacement? A qualitative case study in Northern Iraq. PLoS One 2022; 17:e0264434. [PMID: 35239702 PMCID: PMC8893612 DOI: 10.1371/journal.pone.0264434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 02/10/2022] [Indexed: 12/30/2022] Open
Abstract
This research aimed to qualitatively explore whether the determinants of handwashing behaviour change according to the duration of displacement or the type of setting that people are displaced to. We conducted an exploratory qualitative study in three different post-conflict settings in Northern Iraq–a long-term displacement camp, a short-term displacement camp, and villages where people were returning to post the conflict. We identified 33 determinants of handwashing in these settings and, of these, 21 appeared to be altered by the conflict and displacement. Determinants of handwashing behaviour in the post-conflict period were predominantly explained by disruptions to the physical, psychological, social and economic circumstances of displaced populations. Future hygiene programmes in post-conflict displacement settings should adopt a holistic way of assessing determinants and design programmes which promote agency, build on adaptive norms, create an enabling environment and which are integrated with other aspects of humanitarian response.
Collapse
Affiliation(s)
- Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Thomas Heath
- Operations Department, Action Contre la Faim, Paris, France
| | - Waleed Khalid Ibrahim
- Independent Researcher, Nutrition and Dietetics Department, College of Medical Technology, Cihan University, Erbil, Kurdistan Region of Iraq
| | - Dilveen Ihsan
- Independent Researcher, Dohuk, Kurdistan Region of Iraq
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, Université de Genève, Geneva, Switzerland
| | - Val Curtis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
28
|
Chen SJ, Walker PJ, Mulholland K, Graham HR. Childhood pneumonia in humanitarian emergencies in low- and middle-income countries: A systematic scoping review. J Glob Health 2022; 12:10001. [PMID: 35425592 PMCID: PMC8980764 DOI: 10.7189/jogh.12.10001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Humanitarian emergencies increase many risk factors for pneumonia, including disruption to food, water and sanitation, and basic health services. This review describes pneumonia morbidity and mortality among children and adolescents affected by humanitarian emergencies. Methods We searched MEDLINE, EMBASE, and PubMed databases for publications reporting pneumonia morbidity or mortality among children aged 1 month to 17 years in humanitarian emergencies (eg, natural disaster, armed conflict, displacement) in low- and middle-income countries (LMICs). Results We included 23 papers published between January 2000 and July 2021 from 23 countries, involving refugee/displaced persons camps (n = 5), other conflict settings (n = 14), and natural disaster (n = 3). Population pneumonia incidence was high for children under 5 years of age (73 to 146 episodes per 100 patient-years); 6%-29% met World Health Organization (WHO) criteria for severe pneumonia requiring admission. Pneumonia accounted for 13%-34% of child and adolescent presentations to camp health facilities, 7%-48% of presentations and admissions to health facilities in other conflict settings, and 12%-22% of admissions to hospitals following natural disasters. Pneumonia related deaths accounted for 7%-30% of child and adolescent deaths in hospital, though case-fatality rates varied greatly (0.5%-17.2%). The risk for pneumonia was greater for children who are: recently displaced, living in crowded settings (particularly large camps), with deficient water and sanitation facilities, and those who are malnourished. Conclusion Pneumonia is a leading cause of morbidity and mortality in children and adolescents affected by humanitarian emergencies. Future research should address population-based pneumonia burden, particularly for older children and adolescents, and describe contextual factors to allow for more meaningful interpretation and guide interventions.
Collapse
Affiliation(s)
- Sally Jiasi Chen
- Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Patrick Jb Walker
- Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Kim Mulholland
- Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Hamish R Graham
- Centre for International Child Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
29
|
Weaver AK, Head JR, Gould CF, Carlton EJ, Remais JV. Environmental Factors Influencing COVID-19 Incidence and Severity. Annu Rev Public Health 2022; 43:271-291. [PMID: 34982587 PMCID: PMC10044492 DOI: 10.1146/annurev-publhealth-052120-101420] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Emerging evidence supports a link between environmental factors-including air pollution and chemical exposures, climate, and the built environment-and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission and coronavirus disease 2019 (COVID-19) susceptibility and severity. Climate, air pollution, and the built environment have long been recognized to influence viral respiratory infections, and studies have established similar associations with COVID-19 outcomes. More limited evidence links chemical exposures to COVID-19. Environmental factors were found to influence COVID-19 through four major interlinking mechanisms: increased risk of preexisting conditions associated with disease severity; immune system impairment; viral survival and transport; and behaviors that increase viral exposure. Both data and methodologic issues complicate the investigation of these relationships, including reliance on coarse COVID-19 surveillance data; gaps in mechanistic studies; and the predominance of ecological designs. We evaluate the strength of evidence for environment-COVID-19 relationships and discuss environmental actions that might simultaneously address the COVID-19 pandemic, environmental determinants of health, and health disparities.
Collapse
Affiliation(s)
- Amanda K Weaver
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA; ,
| | - Jennifer R Head
- Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA;
| | - Carlos F Gould
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA;
- Department of Earth System Science, Stanford University, Stanford, California, USA
| | - Elizabeth J Carlton
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz, Aurora, Colorado, USA;
| | - Justin V Remais
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA; ,
| |
Collapse
|
30
|
The utilisation of vaccines in humanitarian crises, 2015-2019: A review of practice. Vaccine 2022; 40:2970-2978. [PMID: 35341644 DOI: 10.1016/j.vaccine.2022.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The risk factors that emerge with the onset and protraction of humanitarian crises leave populations at a heightened risk of excess morbidity and mortality from vaccine-preventable diseases (VPDs). There is currently little clarity on which vaccines are being used in crises throughout the world, and whether vaccination decisions correspond to local disease threats. This review aimed to collect and analyse such information. METHODS We reviewed vaccination services from January 2015 to June 2019 across all 25 humanitarian responses that had an activated coordination mechanism during this period. A range of online sources and informants within the humanitarian sector were consulted to compile data on which vaccines were provided in each crisis, and the modality and timing of vaccine provision. The package of vaccination services since the start of each crisis was then compared with local disease burden (baseline + excess due to crisis-emergent risk factors). RESULTS The range of vaccines used in humanitarian crises appears limited. When offered, vaccines were primarily delivered through the pre-existing routine schedule, with few supplementary actions taken in recognition of the need for rapidly enhancing population immunity. Vaccine packages mostly did not address the actual range of VPDs that likely accounted for substantial disease risk. CONCLUSIONS This review suggests inconsistencies and inequities in vaccine provision to crisis-affected populations. A consistent, standardised and broader approach to vaccine use in crises is needed.
Collapse
|
31
|
Integrated primary health care services in two protracted refugee camp settings at the Thai-Myanmar border 2000-2018: trends on mortality and incidence of infectious diseases. Prim Health Care Res Dev 2022; 23:e17. [PMID: 35314017 PMCID: PMC8991080 DOI: 10.1017/s1463423622000044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aim: This study aimed to assess the health outcome of four epidemic-prone infectious diseases, in the context of a Primary Health Care project implemented in a protracted refugee setting along the Thai–Myanmar border. Background: Refugees settled at the Thai–Myanmar border are fully dependent on support for health services, shelter, food, education, water, and sanitation. The Non-Governmental Organization Malteser International developed an integrated Primary Health Care program in close cooperation with trained camp residents over 25 years in the two settlements under its supervision. The project has been funded by the European Commission Civil Protection and Humanitarian Aid Operations (DG ECHO). Methods: This was a retrospective primary health care project evaluation. All-cause mortality; morbidity trends in malaria, lower respiratory tract infections (LRTIs), watery diarrhea, and dysentery; and health service utilization covering a time span of 18 years were assessed. Programmatic changes in the Primary Health Care (PHC) project and events with a potential effect on health of the target population were examined. Findings: Despite the continuous drain of trained health care workers, the volatile influx of refugees, and the isolated location of the two camps, the initial basic curative health care developed into an integrated and comprehensive PHC project including a SPHERE-compliant water, sanitation, and hygiene program. Malaria, LRTIs, watery diarrhea, and dysentery morbidity dropped twelve, three, two, and fivefold, respectively, over the 18-year period evaluated while the health services utilization dropped from 7.1 to 2.9 consultations per refugee/year. The international community may face situations where integration of refugees into the health services of the host country is not possible. In such a context, integrated and evidence-based PHC adequately funded and implemented by one health agency is an effective and relevant approach to reduce the infectious diseases burden under the constraints of semipermanent living conditions.
Collapse
|
32
|
Nguna J, Okethwangu D, Kabwama SN, Aliddeki DM, Kironde SK, Birungi D, Eurien D, Ario AR, Lukoye D, Kasozi J, Cegielski PJ. Factors associated with poor treatment outcomes among tuberculosis patients in Kyangwali Refugee Settlement, Uganda, 2016-2017. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000152. [PMID: 36962487 PMCID: PMC10022256 DOI: 10.1371/journal.pgph.0000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 07/06/2022] [Indexed: 11/19/2022]
Abstract
Communicable diseases, alone or in combination with malnutrition, account for most deaths in complex emergencies including refugee settings. Tuberculosis and HIV/AIDS are increasingly becoming an important cause of morbidity and mortality in refugee settings. We described the treatment outcomes of TB patients and explored factors associated with treatment outcomes among TB patients attending two facilities in Kyangwali Refugee Settlement in Kikuube District, 2016-2017. We abstracted data on laboratory-confirmed patient data from TB registers from 2016 to 2017, in Kikuube Health Centre IV and Rwenyawawa Health Centre II, both located in Kyangwali Refugee Settlement. We abstracted data on socio-demographic variables including age and sex. Other variables were height, weight, final treatment outcomes, demographics, HIV status, TB treatment category, and history of TB. Treatment outcomes were categorized into favorable (including patients who were cured or those who completed treatment) and unfavorable (those in whom treatment failed, those who died, those lost to follow-up, or those not evaluated). We used logistic regression to identify factors associated with unfavorable treatment outcomes. We identified a total of 254 TB patients with a median age of 36 (IQR 26-48) years; 69% (175) were male and 54% (137) were refugees. The median weight was 50.4 kg (range 4-198). Overall, 139 (55%) had favorable outcomes while 115 (45%) had unfavorable outcomes. Refugees formed 53% (71) of those with favorable outcomes and 47% (63) of those with unfavorable outcomes 63(47%). We found that increasing age was statistically associated with unfavorable outcomes, while diagnosis with MDR-TB was associated with decreased odds for unfavorable treatment outcomes. The treatment success rate was lower compared to 85% recommended by WHO. However, the rates are similar to that reported by other studies in Uganda. Innovative approaches to improve treatment success rates with particular focus on persons aged 41-80 years should be devised.
Collapse
Affiliation(s)
- Joyce Nguna
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Denis Okethwangu
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | | | | | | | - Doreen Birungi
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Daniel Eurien
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
| | | | - Julius Kasozi
- United Nations High Commission for Refugees, Kampala, Uganda
| | - Peter J Cegielski
- Division of Global HIV and TB, Global TB Branch, US Centers for Diseases Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
33
|
Thomas PJM, Rosenberg-Jansen S, Jenks A. Moving beyond informal action: sustainable energy and the humanitarian response system. JOURNAL OF INTERNATIONAL HUMANITARIAN ACTION 2021; 6:21. [PMID: 38624740 PMCID: PMC8566662 DOI: 10.1186/s41018-021-00102-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/24/2021] [Indexed: 04/17/2024]
Abstract
Energy and humanitarian action have long been uneasy bedfellows. In the field, many humanitarian practitioners lack the time or remit to engage with a complex issue such as energy, and the topic to date has received relatively little attention from the private, development and academic sectors. This paper hopes to provide more clarity on energy in forced displacement settings by analysing how energy is interwoven with the humanitarian cluster system. This paper has two aims: (1) to assess existing evidence in the sector and explain the links between energy and each of the humanitarian clusters and (2) to provide recommendations on how humanitarian response efforts can transition from informal action to a comprehensive response on sustainable energy provision. This paper is the first to investigate the role of energy using the cluster system as a framework and contributes to a rapidly evolving field of research and practice on energy in humanitarian contexts. Our analysis demonstrates that energy is not fully integrated within humanitarian programme planning. Further, it highlights pathways for improving humanitarian outcomes enabled by improved energy practices. We identify ten ways clusters can integrate action on energy to support crisis-affected communities.
Collapse
Affiliation(s)
| | | | - Aimee Jenks
- United Nations Institute for Training and Research, UNITAR, Palais des Nations, CH-1211 Geneva 10, Switzerland
| |
Collapse
|
34
|
Challenges of Providing Health Care in Complex Emergencies: A Systematic Review. Disaster Med Public Health Prep 2021; 17:e56. [PMID: 34725022 DOI: 10.1017/dmp.2021.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Providing health care in times of complex emergencies (CEs) is one of the most vital needs of people. CEs are situations in which a large part of the population is affected by social unrest, wars, and food shortages. This systematic review study was conducted to identify the challenges of health-care delivery in CEs. We searched terms related to health-care delivery and CEs in PubMed, Web of Sciences, Science Direct, and Google scholar databases, as well as Persian databases SID and Magiran. The searching keywords included: "Health Care, Complex Crises, War, Humanitarian, Refugees, Displaced Persons, Health Services, and Challenges." Of 409 records, we selected 6 articles based on the Preferred Reporting Items for Systematic Reviews (PRISMA) checklist. Studies were analyzed through qualitative content analysis. The results show that CEs affect health-care delivery in 4 primary areas: the workforce, infrastructure, information access, and organization of health services. These areas can pose potential threats for health-care providers and planners at times of emergencies. Thus, they should be informed about these challenges to strengthen the health-care system.
Collapse
|
35
|
Chepkurui V, Amponsah-Dacosta E, Haddison EC, Kagina BM. Characterization of National Immunization Programs in the Context of Public Health Emergencies: A Case Study of 13 Countries in the WHO Africa Region. Front Public Health 2021; 9:736532. [PMID: 34650952 PMCID: PMC8505981 DOI: 10.3389/fpubh.2021.736532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
Multiple public health emergencies (PHEs) experienced annually in the World Health Organisation (WHO) Africa region affect the provision of health services, including immunization. However, there is limited information on the performance of national immunization programs (NIPs) in WHO Africa countries that experience PHEs. This study assessed PHEs (armed conflicts, disasters, and disease outbreaks) and the performance of NIPs using global and regional immunization targets outlined for the Decade of Vaccines. Thirteen beneficiary countries of PHE mitigation funds from the African Public Health Emergency Fund were used as case studies. Data on PHEs and immunization indicators between 2010 and 2019 in selected countries were extracted from different PHE databases and the WHO/UNICEF immunization database, respectively. The data were stratified by country and summarized using descriptive statistics. Mann-Whitney U test was done to determine the association between the frequency of PHEs and the performance of NIPs. There were 175 disease outbreaks, 288 armed conflicts, and 318 disasters in the examined countries between 2010 and 2019. The Democratic Republic of Congo had the highest total PHE count (n = 208), while Liberia had the lowest (n = 20). Only three of the 13 countries had a median coverage value for the third dose of the combined Diphtheria, Tetanus, and Pertussis vaccine (DTP3) that had attained the target for ≥90% immunization coverage. Higher counts of armed conflict and total PHEs were associated with not meeting immunization targets for national DTP3 coverage of ≥90% and Maternal and Neonatal Tetanus elimination, p < 0.01. It was clear that in the WHO Africa region, PHEs are prevalent, irrespective of a country’s level of immunization maturity, and have the potential to derail the progress of NIPs in the absence of effective interventions. As we transition toward the Immunization Agenda 2030, we recommend that the WHO Africa region prioritizes interventions to mitigate the impacts of PHEs on NIPs.
Collapse
Affiliation(s)
- Viola Chepkurui
- Faculty of Health Science, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edina Amponsah-Dacosta
- Faculty of Health Science, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Benjamin Mugo Kagina
- Faculty of Health Science, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
36
|
The Influence of War and Conflict on Infectious Disease: A Rapid Review of Historical Lessons We Have Yet to Learn. SUSTAINABILITY 2021. [DOI: 10.3390/su131910783] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Armed conflicts degrade established healthcare systems, which typically manifests as a resurgence of preventable infectious diseases. While 70% of deaths globally are now from non-communicable disease; in low-income countries, respiratory infections, diarrheal illness, malaria, tuberculosis, and HIV/AIDs are all in the top 10 causes of death. The burden of these infectious diseases is exacerbated by armed conflict, translating into even more dramatic long-term consequences. This rapid evidence review searched electronic databases in PubMed, Scopus, and Web of Science. Of 381 identified publications, 73 were included in this review. Several authors indicate that the impact of infectious diseases increases in wars and armed conflicts due to disruption to surveillance and response systems that were often poorly developed to begin with. Although the true impact of conflict on infectious disease spread is not known and requires further research, the link between them is indisputable. Current decision-making management systems are insufficient and only pass the baton to the next unwary generation.
Collapse
|
37
|
Faruque ASG, Khan AI, Nahar B, Islam SMR, Hossain MN, Abdullah SA, Khan SH, Hossain MS, Khan FH, Prajapati M, Widiati Y, Hasan ASMM, Kim M, Musto J, Vandenent M, Clemens JD, Ahmed T. Cholera outbreak in Forcibly Displaced Myanmar National (FDMN) from a small population segment in Cox's Bazar, Bangladesh, 2019. PLoS Negl Trop Dis 2021; 15:e0009618. [PMID: 34550972 PMCID: PMC8457470 DOI: 10.1371/journal.pntd.0009618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background Bangladesh experienced a sudden, large influx of forcibly displaced persons from Myanmar in August 2017. A cholera outbreak occurred in the displaced population during September-December 2019. This study aims to describe the epidemiologic characteristics of cholera patients who were hospitalized in diarrhea treatment centers (DTCs) and sought care from settlements of Forcibly Displaced Myanmar Nationals (FDMN) as well as host country nationals during the cholera outbreak. Methods Diarrhea Treatment Center (DTC) based surveillance was carried out among the FDMN and host population in Teknaf and Leda DTCs hospitalized for cholera during September-December 2019. Results During the study period, 147 individuals with cholera were hospitalized. The majority, 72% of patients reported to Leda DTC. Nearly 65% sought care from FDMN settlements. About 47% of the cholera individuals were children less than 5 years old and 42% were aged 15 years and more. Half of the cholera patients were females. FDMN often reported from Camp # 26 (45%), followed by Camp # 24 (36%), and Camp # 27 (12%). Eighty-two percent of the cholera patients reported watery diarrhea. Some or severe dehydration was observed in 65% of cholera individuals. Eighty-one percent of people with cholera received pre-packaged ORS at home. About 88% of FDMN cholera patients reported consumption of public tap water. Pit latrine without water seal was often used by FDMN cholera individuals (78%). Conclusion Vigilance for cholera patients by routine surveillance, preparedness, and response readiness for surges and oral cholera vaccination campaigns can alleviate the threats of cholera. Bangladesh observed a large-scale arrival of forcibly displaced individuals from Myanmar in August 2017. The Bangladesh Government, UN agencies, and international and national non-governmental organizations responded immediately with extensive humanitarian response. However, threats of cholera outbreaks were prevailing. The Government of Bangladesh as lead, with technical support from icddr,b collaborating with international agencies undertook a massive oral cholera vaccination (OCV) campaign immediately as a pre-emptive measure to alleviate threats of the cholera outbreak. Despite that mass OCV campaign, threats of cholera outbreak were existing due to new arrivals of the displaced population with compromised host susceptibility, frequent visits to settlements by Bangladesh nationals without exposure to OCV, and the declining vaccine immunity among OCV recipients as well as an increasing number of cohort children without any exposure to OCV. The population faced a cholera outbreak during September-December 2019. This study aims to describe the characteristics of cholera patients, their care-seeking pattern, camp-wise distribution, source of drinking water, sanitation facility, OCV status, and share the experiences from effective interventions to prevent a cholera outbreak. Vigilance for cholera patients by routine surveillance, preparedness for both preventive and control measures, and response readiness for surges and OCV campaigns can alleviate the threats of cholera.
Collapse
Affiliation(s)
- Abu S. G. Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | | | - Baitun Nahar
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - M. Nasif Hossain
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | | | | | | | | | - Yulia Widiati
- UNICEF Bangladesh, Cox’s Bazar Field Office, Cox’s Bazar, Bangladesh
| | | | - Minjoon Kim
- UNICEF Bangladesh Country Office, Cox’s Bazar, Bangladesh
| | - Jennie Musto
- World Health Organization, Cox’s Bazar, Bangladesh
| | - Maya Vandenent
- UNICEF Bangladesh Country Office, Cox’s Bazar, Bangladesh
| | - John David Clemens
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
- UCLA Fielding School of Public Health, Los Angeles, California, United States of America
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| |
Collapse
|
38
|
Abstract
This paper investigates the extent to which armed conflict influences the weight of young children in the Democratic Republic of the Congo. Exploiting the variation across districts in exposure to armed conflict and the within-district variation in the timing of whether the child was exposed to armed conflict due to birth timing within a difference-in-differences framework, we detect adverse impacts of conflict exposure to child weight. Specifically, experiencing armed conflict makes children weigh less for their age and weigh less for their height by 0.20 and 0.24 standard deviations, respectively. Armed conflict also increases the probability of children being underweight and wasted by 4.7 and 2.7 percentage points, respectively. Our heterogeneity analyses reveal that children of disadvantaged backgrounds, i.e., those born to low-educated mothers, poor mothers, and rural mothers, tend to be disproportionately affected. Our study calls for effective measures to mitigate the detrimental repercussions of armed conflict.
Collapse
|
39
|
Ekezie W, Myles P, Murray RL, Bains M, Timmons S, Pritchard C. Self-reported diseases and their associated risk factors among camp-dwelling conflict-affected internally displaced populations in Nigeria. J Public Health (Oxf) 2021; 43:e171-e179. [PMID: 32776153 DOI: 10.1093/pubmed/fdaa114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/11/2020] [Accepted: 06/26/2020] [Indexed: 11/14/2022] Open
Abstract
Background Conflict in Nigeria displaced millions of people, and some settled in camp-like locations within the country. Evidence on the association between living conditions and health outcomes among these populations are limited. This study investigated the risk factors associated with illnesses among camp-dwelling internally displaced persons (IDPs) in northern Nigeria. Methods A cross-sectional study was conducted in nine camps in 2016. Self-reported data on socio-demography, resource utilization and disease outcomes were collected. Association between health conditions and various factors, including sanitation and healthcare access, was investigated. Results Data from 2253 IDPs showed 81.1% (CI = 79.5-82.7) experienced one or more health conditions; however, over 20% did not access healthcare services. Most common diseases were malaria, fever, typhoid and diarrhoea. Multivariable logistic regression presented as adjusted odds ratios(aOR) and 95% confidence intervals(CIs) showed factors significantly associated with increased likelihood of illnesses included being female (aOR = 1.53;CI = 1.19-1.96), overcrowding (aOR = 1.07;CI = 1.00-1.36), long-term conditions (aOR = 2.72;CI = 1.88-3.94), outdoor defecation (aOR = 2.37;CI = 1.14-4.94) and presence of disease-causing vectors (aOR = 3.71;CI = 1.60-8.60). Conclusion Most diseases in the camps were communicable. Modifiable risk factors such as overcrowding and poor toilet facilities were associated with increased poor health outcomes. This evidence highlights areas of high priority when planning humanitarian public health interventions.
Collapse
Affiliation(s)
- Winifred Ekezie
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Puja Myles
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Manpreet Bains
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, Nottingham NG8 1BB, UK
| | - Catherine Pritchard
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| |
Collapse
|
40
|
Savioli G, Ceresa I, Guarnone R, Muzzi A, Novelli V, Ricevuti G, Iotti G, Bressan M, Oddone E. Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to “Access Block”. West J Emerg Med 2021; 22:860-870. [PMID: 35354013 PMCID: PMC8328174 DOI: 10.5811/westjem.2021.2.49611] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Healthcare patterns change during disease outbreaks and pandemics. Identification of modified patterns is important for future preparedness and response. Emergency department (ED) crowding can occur because of the volume of patients waiting to be seen, which results in delays in patient assessment or treatment and impediments to leaving the ED once treatment is complete. Therefore, ED crowding has become a growing problem worldwide and represents a serious barrier to healthcare operations. Methods This observational study was based on a retrospective review of the epidemiologic and clinical records of patients who presented to the Foundation IRCCS Policlinic San Matteo in Pavia, Italy, during the coronavirus disease 2019 (COVID-19) outbreak (February 21–May 1, 2020, pandemic group). The methods involved an estimation of the changes in epidemiologic and clinical data from the annual baseline data after the start of the COVID-19 pandemic. Results We identified reduced ED visits (180 per day in the control period vs 96 per day in the pandemic period; P < 0.001) during the COVID-19 pandemic, irrespective of age and gender, especially for low-acuity conditions. However, patients who did present to the ED were more likely to be hemodynamically unstable, exhibit abnormal vital signs, and more frequently required high-intensity care and hospitalization. During the pandemic, ED crowding dramatically increased primarily because of an increased number of visits by patients with high-acuity conditions, changes in patient management that prolonged length of stay, and increased rates of boarding, which led to the inability of patients to gain access to appropriate hospital beds within a reasonable amount of time. During the pandemic, all crowding output indices increased, especially the rates of boarding (36% vs 57%; P < 0.001), “access block” (24% vs 47%; P < 0.001), mean boarding time (640 vs 1,150 minutes [min]; P 0.001), mean “access block” time (718 vs 1,223 min; P < 0.001), and “access block” total time (650,379 vs 1,359,172 min; P < 0.001). Conclusion Crowding in the ED during the COVID-19 pandemic was due to the inability to access hospital beds. Therefore, solutions to this lack of access are required to prevent a recurrence of crowding due to a new viral wave or epidemic.
Collapse
Affiliation(s)
- Gabriele Savioli
- Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy; University of Pavia, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Pavia, Italy
| | - Iride Ceresa
- Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy
| | - Roberta Guarnone
- Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy
| | - Alba Muzzi
- Fondazione IRCCS Policlinico San Matteo, Medical Direction, Pavia, Italy
| | - Viola Novelli
- Fondazione IRCCS Policlinico San Matteo, Medical Direction, Pavia, Italy
| | - Giovanni Ricevuti
- University of Pavia, Department of Drug Science, Pavia, Italy; Saint Camillus International University of Health Sciences, Department of Drug Science, Rome, Italy
| | - Giorgio Iotti
- Fondazione IRCCS Policlinico San Matteo, Intensive Care Unit, Pavia, Italy
| | - Maria Bressan
- Fondazione IRCCS Policlinico San Matteo, Department of Emergency Medicine, Pavia, Italy
| | - Enrico Oddone
- University of Pavia, Department of Public Health, Experimental and Forensic Medicine, Pavia, Italy
| |
Collapse
|
41
|
Gallandat K, Jeandron A, Ross I, Mufitini Saidi J, Bashige Rumedeka B, Lumami Kapepula V, Cousens S, Allen E, MacDougall A, Cumming O. The impact of improved water supply on cholera and diarrhoeal diseases in Uvira, Democratic Republic of the Congo: a protocol for a pragmatic stepped-wedge cluster randomised trial and economic evaluation. Trials 2021; 22:408. [PMID: 34154636 PMCID: PMC8215491 DOI: 10.1186/s13063-021-05249-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/03/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Diarrhoeal disease remains a leading cause of mortality and morbidity worldwide. Cholera alone is estimated to cause 95,000 deaths per year, most of which occur in endemic settings with inadequate water access. Whilst a global strategy to eliminate cholera by 2030 calls for investment in improved drinking water services, there is limited rigorous evidence for the impact of improved water supply on endemic cholera transmission in low-income urban settings. Our protocol is designed to deliver a pragmatic health impact evaluation of a large-scale water supply intervention in Uvira (Democratic Republic of the Congo), a cholera transmission hotspot. METHODS/DESIGN A stepped-wedge cluster randomised trial (SW-CRT) was designed to evaluate the impact of a large-scale drinking water supply intervention on cholera incidence among the 280,000 inhabitants of Uvira. The city was divided into 16 clusters, where new community and household taps will be installed following a randomised sequence over a transition period of up to 8 weeks in each cluster. The primary trial outcomes are the monthly incidence of "confirmed" cholera cases (patients testing positive by rapid detection kit) and of "suspected" cholera cases (patients admitted to the cholera treatment centre). Concurrent process and economic evaluations will provide further information on the context, costs, and efficiency of the intervention. DISCUSSION In this protocol, we describe a pragmatic approach to conducting rigorous research to assess the impacts of a complex water supply intervention on severe diarrhoeal disease and cholera in an unstable, low-resource setting representative of cholera-affected areas. In particular, we discuss a series of pre-identified risks and linked mitigation strategies as well as the value of combining different data collection methods and preparation of multiple analysis scenarios to account for possible deviations from the protocol. The study described here has the potential to provide robust evidence to support more effective cholera control in challenging, high-burden settings. TRIAL REGISTRATION This trial is registered on clinicaltrials.gov ( NCT02928341 , 10th October 2016) and has received ethics approval from the London School of Hygiene and Tropical Medicine (8913, 10603) and from the Ethics Committee from the School of Public Health, University of Kinshasa, Democratic Republic of the Congo (ESP/CE/088/2015).
Collapse
Affiliation(s)
- Karin Gallandat
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Aurélie Jeandron
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian Ross
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Jaime Mufitini Saidi
- Ministère de la Santé Publique, Division Provinciale de la Santé Publique, District Sanitaire d'Uvira, Uvira, South Kivu, Democratic Republic of the Congo
| | - Baron Bashige Rumedeka
- Ministère de la Santé Publique, Division Provinciale de la Santé Publique, District Sanitaire d'Uvira, Uvira, South Kivu, Democratic Republic of the Congo
| | - Vercus Lumami Kapepula
- Department of Hydrology, Centre de Recherche en Hydrobiologie, Uvira, South Kivu, Democratic Republic of the Congo
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Amy MacDougall
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
42
|
Thorseth AH, Heath T, Sisay A, Hamo M, White S. An exploratory pilot study of the effect of modified hygiene kits on handwashing with soap among internally displaced persons in Ethiopia. Confl Health 2021; 15:35. [PMID: 33947443 PMCID: PMC8097963 DOI: 10.1186/s13031-021-00368-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background Internally displaced persons fleeing their homes due to conflict and drought are particularly at risk of morbidity and mortality from diarrhoeal diseases. Regular handwashing with soap (HWWS) could substantially reduce the risk of these infections, but the behaviour is challenging to practice while living in resource-poor, informal settlements. To mitigate these challenges, humanitarian aid organisations distribute hygiene kits, including soap and handwashing infrastructure. Our study aimed to assess the effect of modified hygiene kits on handwashing behaviours among internally displaced persons in Moyale, Ethiopia. Methods The pilot study evaluated three interventions: providing liquid soap; scented soap bar; and the inclusion of a mirror in addition to the standard hygiene kit. The hygiene kits were distributed to four study arms. Three of the arms received one of the interventions in addition to the standard hygiene kit. Three to six weeks after distribution the change in behaviour and perceptions of the interventions were assessed through structured observations, surveys and focus group discussions. Results HWWS was rare at critical times for all study arms. In the liquid soap arm, HWWS was observed for only 20% of critical times. This result was not indicated significantly different from the control arm which had a prevalence of 17% (p-value = 0.348). In the mirror and scented soap bar intervention arms, HWWS prevalence was 11 and 10%, respectively. This was indicated to be significantly different from the control arm. Participants in the focus group discussions indicated that liquid soap, scented soap bar and the mirror made handwashing more desirable. In contrast, participants did not consider the soap bar normally distributed in hygiene kits as nice to use. Conclusion We found no evidence of an increased prevalence of handwashing with soap following distribution of the three modified hygiene kits. However, our study indicates the value in better understanding hygiene product preferences as this may contribute to increased acceptability and use among crisis-affected populations. The challenges of doing research in a conflict-affected region had considerable implications on this study’s design and implementation. Trial registration The trial was registered at www.ClinicalTrials.gov 6 September 2019 (reg no: NCT04078633). Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00368-3.
Collapse
Affiliation(s)
- Astrid Hasund Thorseth
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | - Mare Hamo
- Action Against Hunger, Addis Ababa, Ethiopia
| | - Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
43
|
Singh V, Dashti A, Mavigner M, Chahroudi A. Latency Reversal 2.0: Giving the Immune System a Seat at the Table. Curr HIV/AIDS Rep 2021; 18:117-127. [PMID: 33433817 PMCID: PMC7985101 DOI: 10.1007/s11904-020-00540-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW For most people living with HIV (PLWH), treatment with effective antiretroviral therapy (ART) results in suppression of viremia below the limit of detection of clinical assays, immune reconstitution, reduced immune activation, avoidance of opportunistic infections, and progression to AIDS. However, ART alone is not curative, and HIV persists in a non-replicating, latent form. In this review, we provide a historical perspective on non-specific latency reversal approaches (LRA 1.0) and summarize recent advances in latency reversal strategies that target specific signaling pathways within CD4+ T cells or other immune cells to induce expression of latent HIV (immune-based latency reversal, or LRA 2.0). RECENT FINDINGS The HIV reservoir is primarily composed of latently infected CD4+ T cells carrying integrated, replication-competent provirus that can give rise to rebound viremia if ART is stopped. Myeloid lineage cells also contribute to HIV latency in certain tissues; we focus here on CD4+ T cells as a sufficient body of evidence regarding latency reversal in myeloid cells is lacking. The immunomodulatory LRA 2.0 approaches we describe include pattern recognition receptor agonists, immune checkpoint inhibitors, non-canonical NF-kB stimulation, and transient CD8+ lymphocyte depletion, along with promising combination strategies. We highlight recent studies demonstrating robust latency reversal in nonhuman primate models. While significant strides have been made in terms of virus reactivation from latency, initial hopes for latency reversal alone to result in a reduction of infected cells, through viral cytopathic effect or an unboosted immune system, have not been realized and it seems clear that even effective latency reversal strategies will need to be paired with an approach that facilitates immune recognition and clearance of cells containing reactivated virus.
Collapse
Affiliation(s)
- Vidisha Singh
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Amir Dashti
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Maud Mavigner
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Ann Chahroudi
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA.
- Yerkes National Primate Research Center, Emory University Atlanta, Atlanta, GA, USA.
| |
Collapse
|
44
|
Cooper B, Behnke NL, Cronk R, Anthonj C, Shackelford BB, Tu R, Bartram J. Environmental health conditions in the transitional stage of forcible displacement: A systematic scoping review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 762:143136. [PMID: 33153751 DOI: 10.1016/j.scitotenv.2020.143136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 10/10/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
In 2019, 30,000 people were forced to leave their homes due to conflict, persecution, and natural disaster each day. Eighty-five percent of refugees live in developing countries, and they often face underfunded and inadequate environmental health services. Many displaced persons live in camps and other temporary settlements long after the displacement event occurs. However, there is little evidence on environmental health conditions in the transitional phase-defined by the United Nations High Commissioner for Refugees as six months to two years after displacement. To address this gap in research, we conducted a systematic scoping review of environmental health conditions, exposures, and outcomes in transitional displacement settings, as well as reported obstacles and recommendations for improvement. Eighty-eight publications met the inclusion criteria. Water supply was the most frequently discussed environmental health topic. Overcrowding was the most common risk factor reported, Vibrio cholerae was the most common pathogen reported, and diarrhea was the most commonly reported health outcome. Obstacles and recommendations were categorized as institutional, political or implementation-based. Identified knowledge gaps included minimal information on setting logistics and on topics such as menstrual hygiene, oral hygiene and fomite contamination. In order to improve environmental health conditions in transitional displacement settings, all levels of government and non-governmental organizations should increase collaboration to improve resource provision. This study is the first to report on environmental health conditions in this important time of transition between the emergency and protracted stages of displacement.
Collapse
Affiliation(s)
- Brittany Cooper
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Nikki L Behnke
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Ryan Cronk
- ICF, 2635 Meridian Pkwy Suite 200, Durham, NC 27713.
| | - Carmen Anthonj
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
| | - Brandie Banner Shackelford
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Raymond Tu
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States
| | - Jamie Bartram
- The Water Institute at UNC, Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7431, Chapel Hill, NC 27599, United States; School of Civil Engineering, University of Leeds, Woodhouse Ln, Woodhouse, Leeds LS2 9DY, United Kingdom
| |
Collapse
|
45
|
Parry AE, Kirk MD, Durrheim DN, Olowokure B, Colquhoun S, Housen T. Emergency response and the need for collective competence in epidemiological teams. Bull World Health Organ 2021; 99:351-358. [PMID: 33958823 PMCID: PMC8061673 DOI: 10.2471/blt.20.276998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To determine the challenges met by, and needs of, the epidemiology emergency response workforce, with the aim of informing the development of a larger survey, by conducting key informant interviews of public health experts. Methods We defined our study population as public health experts with experience of epidemiology deployment. Using purposive sampling techniques, we applied random number sampling to shortlists of potential interviewees provided by key organizations to obtain 10 study participants; we identified three additional interviewees through snowballing. The same interviewer conducted all key informant interviews during May-August 2019. We thematically analysed de-identified transcripts using a qualitative data analysis computer software package. Findings Despite our interviewees having a wide range of organizational and field experience, common themes emerged. Interviewees reported a lack of clarity in the definition of an emergency response epidemiologist; the need for a broader range of skills; and inadequate leadership and mentoring in the field. Interviewees identified the lack of interpersonal skills (e.g. communication) and a lack of career progression options as limitations to the effectiveness of emergency response. Conclusion The epidemiology emergency response workforce is currently not achieving collective competence. The lack of a clear definition of the role must be addressed, and leadership is required to develop teams in which complementary skills are harmonized and those less experienced can be mentored. Epidemiology bodies must consider individual professional accreditation to ensure that the required skills are being achieved, as well as enabling continual professional development.
Collapse
Affiliation(s)
- Amy Elizabeth Parry
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Babatunde Olowokure
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samantha Colquhoun
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
| | - Tambri Housen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
| |
Collapse
|
46
|
An analysis of compounding factors of epidemics in complex emergencies: a system dynamics approach. JOURNAL OF HUMANITARIAN LOGISTICS AND SUPPLY CHAIN MANAGEMENT 2021. [DOI: 10.1108/jhlscm-07-2020-0063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PurposeThis study aims to describe the compounding factors in a complex emergency, which exacerbate a cholera epidemic among vulnerable populations due to supply chain disruptions. Basic needs such as food, medicine, water, sanitation and hygiene commodities are critical to reduce the incidence rate of cholera and control the spread of infection. Conflicts cause damage to infrastructure, displace vulnerable populations and restrict the flow of goods from both commercial and humanitarian organizations. This study assesses the underlying internal and external factors that either aggravate or mitigate the risk of a cholera outbreak in such settings, using Yemen as a case study.Design/methodology/approachThis study adopts a system dynamics methodology to analyze factors that influence cholera outbreaks in the context of the Yemeni Civil War. A causal loop diagram with multiple components was constructed to represent the complexities of humanitarian situations that require critical decision-making. The model was built using data from humanitarian organizations, non-governmental organizations and practitioners, along with literature from academic sources. Variables in the model were confirmed through semi-structured interviews with a field expert.FindingsCompounding factors that influenced the cholera outbreak in Yemen are visualized in a causal loop diagram, which can improve the understanding of relationships where numerous uncertainties exist. A strong link exists between humanitarian response and the level of infrastructure development in a country. Supply chains are affected by constraints deriving from the Yemeni conflict, further inhibiting the use of infrastructure, which limits access to basic goods and services. Aligning long-term development objectives with short-term humanitarian response efforts can create more flexible modes of assistance to prevent and control future outbreaks.Research limitations/implicationsThe model focuses on the qualitative aspects of system dynamics to visualize the logistics and supply chain-related constraints that impact cholera prevention, treatment and control through humanitarian interventions. The resulting causal loop diagram is bounded by the Yemen context; thus, an extension of the model adapted for other contexts is recommended for further study.Practical implicationsThis study presents a systematic view of dynamic factors existing in complex emergencies that have cause-and-effect relationships. Several models of cholera outbreaks have been used in previous studies, primarily focusing on the modes and mechanisms of transmission throughout a population. However, such models typically do not include other internal and external factors that influence the population and context at the site of an outbreak. This model incorporates those factors from a logistics perspective to address the distribution of in-kind goods and cash and voucher assistance.Social implicationsThis study has been aligned with six of the United Nations Sustainable Development Goals (SDGs), using their associated targets in the model as variables that influence the cholera incidence rate. Recognizing that the SDGs are interlinked, as are the dynamic factors in complex humanitarian emergencies, the authors have chosen to take an interdisciplinary approach to consider social, economic and environmental factors that may be impacted by this research.Originality/valueThis paper provides an insight into the underlying inter-relations of internal and external factors present in the context of a cholera outbreak in a complex crisis. Supply chains for food; water, sanitation and hygiene; and health products are crucial to help prevent, control and treat an outbreak. The model exposes vulnerabilities in the supply chain, which may offer guidance for decision makers to improve resilience, reduce disruptions and decrease the severity of cholera outbreaks.
Collapse
|
47
|
Saidu Y, Vouking M, Njoh AA, Bachire HB, Tonga C, Mofor R, Bayiha C, Ewane L, Cornelius C, Mbida NDD, Abizou MB, Njie VM, Nzuobontane D. The effect of the ongoing civil strife on key immunisation outcomes in the North West and South West regions of Cameroon. Confl Health 2021; 15:8. [PMID: 33568157 PMCID: PMC7877013 DOI: 10.1186/s13031-021-00341-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 01/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Civil strife has long been recognized as a significant barrier in the fight against vaccine preventable diseases in several parts of the world. However, little is known about the impact of the ongoing civil strife on the immunisation system in the Northwest (NW) and Southwest (SW) regions of Cameroon, which erupted in late 2016. In this paper, we assessed the effect of the conflict on key immunisation outcomes in the North West and South West regions of Cameroon. METHODS Data were obtained from the standard EPI data reporting tool, the District Vaccine and Data Management Tool (DVDMT), from all the districts in the two regions. Completed forms were then reviewed for accuracy prior to data entry at central level. Summary statistics were used to estimate the variables of interest for each region for the years 2016 (pre-conflict) and 2019 (during conflict). RESULTS In the two regions, the security situation has deteriorated in almost all districts, which in turn has disrupted basic healthcare delivery in those areas. A total of 26 facilities were destroyed and 11 healthcare workers killed in both regions. Reported immunisation coverage rates for key antigens including, BCG, DPT-3 and MR, witnessed a dramatic decline between 2016 and 2019, ranging from 22% points decline for BCG in the NW and to 42% points decline for DPT-3 in the SW. Similarly, the proportion of districts with DPT-3 coverage of at least 80% dropped from 75% in 2016 to 11% in 2019 in the NW. In the SW this proportion dropped from 16% in 2016 to 0 % in 2019. CONCLUSION Our data demonstrates the marked negative impact of the ongoing civil strife on key immunisation outcomes in the two regions and the country at large. This decline could amplify the risk of vaccine preventable diseases vaccine preventable diseases outbreaks in the two regions. Besides the ongoing actions to contain the crises, effective strategies for reaching children in the conflict zones as well as the internally displaced population are needed. There is also the need to rebuild destroyed facilities as well as to protect health facilities and staff from targeted violence.
Collapse
Affiliation(s)
- Yauba Saidu
- Clinton Health Access Initiative, Cameroon Country Office, Third floor, Y-building, Rue 1775, Nouvelle Route Bastos, Yaoundé, Cameroon.
- Institute for Global Health, University of Siena, Siena, Italy.
| | - Marius Vouking
- Central Technical Group, Expanded Programme on Immunisation, Ministry of Public Health, Yaoundé, Cameroon
- Center for the Development of Best Practices in Health, Central Hospital Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Andreas Ateke Njoh
- Regional Technical Group, Expanded Programme on Immunisation, South West Regional Delegation for Public Health, Buea, Cameroon
- Faculty of Science, University of Buea, Buea, Cameroon
| | - Hassan Ben Bachire
- Central Technical Group, Expanded Programme on Immunisation, Ministry of Public Health, Yaoundé, Cameroon
| | - Calvin Tonga
- Central Technical Group, Expanded Programme on Immunisation, Ministry of Public Health, Yaoundé, Cameroon
| | - Roberts Mofor
- Regional Technical Group, Expanded Programme on Immunisation, North West Regional Delegation for Public Health, Bamenda, Cameroon
| | - Christain Bayiha
- Central Technical Group, Expanded Programme on Immunisation, Ministry of Public Health, Yaoundé, Cameroon
| | - Leonard Ewane
- Central Technical Group, Expanded Programme on Immunisation, Ministry of Public Health, Yaoundé, Cameroon
| | - Chebo Cornelius
- Regional Technical Group, Expanded Programme on Immunisation, North West Regional Delegation for Public Health, Bamenda, Cameroon
| | - Ndi Daniel Daddy Mbida
- Regional Technical Group, Expanded Programme on Immunisation, South West Regional Delegation for Public Health, Buea, Cameroon
| | | | - Victor Mbome Njie
- Ministry of Public Health, Yaoundé, Cameroon
- Department of Public Health, University of Buea, Buea, Cameroon
| | - Divine Nzuobontane
- Clinton Health Access Initiative, Cameroon Country Office, Third floor, Y-building, Rue 1775, Nouvelle Route Bastos, Yaoundé, Cameroon
| |
Collapse
|
48
|
Mala P, Abubakar A, Takeuchi A, Buliva E, Husain F, Malik MR, Tayyab M, Elnoserry S. Structure, function and performance of Early Warning Alert and Response Network (EWARN) in emergencies in the Eastern Mediterranean Region. Int J Infect Dis 2021; 105:194-198. [PMID: 33556613 PMCID: PMC8068565 DOI: 10.1016/j.ijid.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
The outbreak detection function was undermined by inclusion of non-epidemic diseases. Adoption of electronic platforms expanded coverage of hard-to-reach areas. Conflict emergencies limited coverage, despite progress due to electronic solutions. The EWARN is being retained far longer than expected in protracted emergencies.
Introduction The Eastern Mediterranean Region (EMR) has experienced several protracted humanitarian crises. The affected population are served by eight Early Warning Alert and Response Network (EWARN) systems for outbreak detection and response. This study aimed to compare structure, function and performance of the systems’ adherence to current guidance, and noted emerging lessons. Methods This study included a review of published and unpublished literature, a structured survey and interviews. Results Findings showed that all systems adhered to basic EWARN structure. Four of eight systems had electronic platforms, while one was implementing one. Regarding key EWARN function of outbreak detection: of the 35 health conditions, 26 were communicable diseases and nine were non-communicable; two systems focused on epidemic-prone diseases. Half the systems achieved ≥60% population coverage, five achieved ≥80% reporting timeliness, six achieved ≥80% reporting completeness, and seven achieved verification of ≥80% of alerts of suspected outbreaks. Conclusion The findings showed that the systems followed the EWARN structure, while increasing adoption of electronic platforms. Performance, including timeliness and completeness of reporting, and timely verification of alerts were optimal for most of the systems. However, population coverage was low for most of the systems, and the EWARN’s primary focus of outbreak detection was undermined by the increasing number of non-epidemic diseases.
Collapse
Affiliation(s)
- Peter Mala
- World Health Organization, Geneva, Switzerland.
| | | | | | - Evans Buliva
- WHO Regional Office for the Eastern Mediterranean, Egypt
| | | | | | | | | |
Collapse
|
49
|
Ali SI, Ali SS, Fesselet JF. Evidence-based chlorination targets for household water safety in humanitarian settings: Recommendations from a multi-site study in refugee camps in South Sudan, Jordan, and Rwanda. WATER RESEARCH 2021; 189:116642. [PMID: 33246215 DOI: 10.1016/j.watres.2020.116642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 06/11/2023]
Abstract
The current Sphere guideline for water chlorination in humanitarian emergencies fails to reliably ensure household water safety in refugee camps. We investigated post-distribution chlorine decay and household water safety in refugee camps in South Sudan, Jordan, and Rwanda between 2013-2015 with the goal of demonstrating an approach for generating site-specific and evidence-based chlorination targets that better ensure household water safety than the status quo Sphere guideline. In each of four field studies we conducted, we observed how water quality changed between distribution and point of consumption. We implemented a nonlinear optimization approach for the novel technical challenge of modelling post-distribution chlorine decay in order to generate estimates on what free residual chlorine (FRC) levels must be at water distribution points, in order to provide adequate FRC protection up to the point of consumption in households many hours later at each site. The site-specific FRC targets developed through this modelling approach improved the proportion of households having sufficient chlorine residual (i.e., ≥0.2 mg/L FRC) at the point of consumption in three out of four field studies (South Sudan 2013, Jordan 2014, and Rwanda 2015). These sites tended to be hotter (i.e., average mid-afternoon air temperatures >30°C) and/or had poorer water, sanitation, and hygiene (WASH) conditions, contributing to considerable chlorine decay between distribution and consumption. Our modelling approach did not work as well where chlorine decay was small in absolute terms (Jordan 2015). In such settings, which were cooler (20 to 30°C) and had better WASH conditions, we found that the upper range of the current Sphere chlorination guideline (i.e., 0.5 mg/L FRC) provided sufficient residual chlorine for ensuring household water safety up to 24 hours post-distribution. Site-specific and evidence-based chlorination targets generated from post-distribution chlorine decay modelling could help improve household water safety and public health outcomes in refugee camp settings where the current Sphere chlorination guideline does not provide adequate residual protection. Water quality monitoring in refugee/IDP camps should shift focus from distribution points to household points of consumption in order to monitor if the intended public health goal of safe water at the point of consumption is being achieved.
Collapse
Key Words
- Abbreviations
- CDC, Centers for Disease Control
- Chlorine decay
- DBP, Disinfection By-product
- FRC, Free residual chlorine
- GDWQ, Guidelines for Drinking-Water Quality
- Humanitarian response
- IDP, Internally displaced person
- LMIC, Low- and middle-income country
- MSF, Médecins Sans Frontières
- NTU, Nephelometric turbidity units
- Public health
- Refugee camp
- Safe water
- UNHCR, United Nations High Commissioner for Refugees
- WASH, Water, sanitation, and hygiene
- WHO, World Health Organization
- Water treatment
Collapse
Affiliation(s)
- Syed Imran Ali
- Dahdaleh Institute for Global Health Research, York University, 88 The Pond Road, M3J 1P3, Toronto, Canada; Médecins sans Frontières, Plantage Middenlaan 14, 1018 DD Amsterdam, Netherlands; Development Impact Lab, University of California, Berkeley, Blum Hall #5570, Berkeley, CA, USA.
| | - Syed Saad Ali
- Dahdaleh Institute for Global Health Research, York University, 88 The Pond Road, M3J 1P3, Toronto, Canada
| | | |
Collapse
|
50
|
Torondel B, Khan R, Larsen TH, White S. Evaluating the Efficacy of the Supertowel™ as a Handwashing Product: A Simulation of Real-World Use Conditions. Am J Trop Med Hyg 2021; 104:1554-1561. [PMID: 33534745 PMCID: PMC8045667 DOI: 10.4269/ajtmh.20-1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
The Supertowel is a fabric treated with a permanent antimicrobial bonding and has been designed as a soap alternative in emergency situations. The Supertowel has been shown to be as efficacious as handwashing with soap and water when tested under controlled laboratory conditions. It has also been shown to be a practical, acceptable, and desirable product among crisis-affected populations. The aim of this study was to test whether the Supertowel remains as efficacious when used under conditions which mimic real-world hand cleaning in challenging settings. Two rounds of laboratory tests, with 16 volunteers in each, were conducted to test the efficacy of the Supertowel when used for a shorter duration, when less wet, when used with contaminated water, when visibly dirty, and when dry. Volunteers pre-contaminated their hands with nonpathogenic Escherichia coli. Comparisons were made between hand cleaning with the Supertowel and the reference condition (normally handwashing with soap), using a crossover design. The Supertowel was marginally less efficacious than handwashing with soap when used for 15 seconds (P = 0.04) but as efficacious at 30 and 60 seconds durations. All the other Supertowel conditions were as efficient as their reference comparisons meaning that the Supertowel can effectively remove pathogens from hands when it is wet, damp, or completely dry, when it is used with contaminated water, when visibly dirty with mud and/or oil.
Collapse
Affiliation(s)
- Belen Torondel
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rummana Khan
- Department of Microbiology, KET’s Scientific Research Centre, Mumbai, India
| | | | - Sian White
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|