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4 Results for Health Topics

4.1 Communicable disease control

4.1.1 Communicable Disease Control

  • A total of 16,239 peer-reviewed articles related to communicable diseases (CD), of which the vast majority (16,153) either did not address humanitarian crises or the impact of an intervention. A total of 165 peer reviewed articles covering 192 interventions met the inclusion criteria.
  • There was little available grey literature, of which none met the inclusion criteria.
  • Slightly over half of the selected papers (92/165) included a test of statistical significance between CD interventions and health outcomes (category A). An additional 39 (39/165) papers measured CD interventions and health outcomes without a test of statistical significance (category B). A final 34 (34/165) papers simply reported interventions and only anecdotal relationships to outcomes (category C).
  • The analysis presented below relates to the 131 category A and B papers.
  • There has been increasing interest in CD interventions in humanitarian crises over the past two decades; 80 (53%) papers have been published since 2000. However, increased number of publications is not correlated with increased quality (Figure 6). Of the 131 category A and B papers, 72 out of 92 (73%) category A papers were deemed high quality and 20 (27%) were deemed moderate quality; no category A papers were deemed of low quality. Sixteen out of 39 (41%) category B papers were deemed to be of moderate quality, while 23 out of 39 (59%) papers were deemed to be of low quality; no category B papers were deemed high quality.
  • Randomized controlled trials (59/131, 45%) were most commonly employed, followed by cohort (34/131, 26%), before and after cross-sectional (22/131, 17%), and non random trial (10/131, 8%) designs. Economic studies (5/131, 4%) were relatively uncommon in this sector. The majority of the study designs employed allowed for higher quality evidence, and for the ascertainment of outcomes over time (including response to the interventions under study).
  • Most studies occurred in Africa (49/131, 38%) and Southeast Asia (50/131, 39%), followed by South Asia (20%); only 4% of research occurred in Latin America (2%) and the Middle East (2%) (Figure 7).
  • Most studies occurred in armed conflicts (118/131, 90%); only 10% (13/131) occurred in natural disasters (Figure 8). Of those in conflict zones, 64% (74/116) were with refugees, 12% (14/116) with IDPs and 24% (28/116) with the general population. Conversely, most (13/15, 87%) natural disaster studies were conducted with the general population, and 2 (2/15, 13%) were with refugees.
  • Most (76/116, 65%) studies in conflict settings were conducted in camps, 20% (23/116) were in mixed urban/rural settings, 10% (12/116) in urban settings, and 5% (5/116) in rural settings. Of the 15 studies in natural disasters, 5 (33%) were in mixed urban/rural settings, 5 (33%) in rural settings, 3 (23%) in camps, and 2 (11%) in a rural setting.
  • 18 different diseases were addressed (Figure 9). Malaria (62/131, 47%) accounted for nearly half of all communicable disease research, most of it high quality, in this setting. This was followed by diseases including tuberculosis (25/131, 19%), measles (17/131, 13%), cholera (6/131, 4%), diphtheria/tetanus/pertussis (6/131, 4%), polio (6/131, 4%), visceral leishmaniasis (5/131, 4%), and diarrhoea (4/131, 4%). Pneumonia is considered one of the most important contributors to morbidity and mortality in these settings and populations, but no paper
    explicitly addressed interventions against pneumonia.
  • The 131 studies in categories A and B covered 192 interventions (Figure 10). Of these, the most common intervention was anti-malarial use (61/192, 32%). Vaccination – e.g., MMR, DPT, polio – was employed in nearly 20% of intervention studies in this setting, followed by vector control interventions (17%, 33/192), most often against malaria. Directly observed therapy short course (DOTS) was used in 16% (21/131) of the studies, with 5% of tuberculosis studies conducted in the pre-DOTS era (4/131). Other common interventions included antihelminths (9%, 12/131), oral rehydration (7/131, 5%) and sodium stibobluconate (6/131, 4%).

Most (104/131, 82%) of the studies were in the acute crisis stage, 21 (14%) were in the early recovery stage, and 6 (4%) in the stabilized stage (Figure 11). No studies were conducted during the preparedness stage.

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