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The search strategy on this contextual factor captured a large number of related peer-reviewed articles (3141), the vast majority of which (3114) either did not discuss humanitarian crises or did not consider the impact of urbanisation on a public health intervention during crisis.
There is little available evidence assessing the impact of urbanisation on the effectiveness of healthcare interventions during humanitarian crises (27 papers).
There is increasing interest in the identification of health challenges particular to humanitarian crises in urban settings and the development of appropriate policies to address these, with 24/27 (89%) of all studies conducted since 1980 being published in the last decade.
The majority of available evidence is of low to moderate quality: 7/27 (26%) of papers were from category C evidence, 9/27 (33%) were from category B, and 11/27 (41%) were from category A.
All studies were observational. 17/27 (63%) of studies were purely descriptive in design and of these four were comparative. The remaining 10/27 (37%) employed a cross-sectional design and of these also four were comparative. Of all the comparative studies, 5/8 (63%) compared urban with rural settings, 2/8 (25%) compared general and IDP populations within urban settings, and one study compared two computer models to predict flood extent in an urban setting.
The majority of location-identified research on the influence of urbanisation on humanitarian crises was conducted in Asia (12/27, 44%), possibly due to the fact that Asia has been projected to lead the urban population growth over the coming decades and it is also the geographic region of the world most prone to natural disasters. 6/27 (22%) further studies considered urban settings across multiple different countries and regions.
Evidence for the different types of humanitarian crises focused heavily on natural disasters: 16/27 (59%) considered these, in particular floods (6/16) and earthquakes (6/16); 7/27 (23%) considered armed-conflict; and one paper evaluated both natural disasters and armed-conflict. A third and distinct category of humanitarian crisis – situations of “urban violence” – was identified by the literature: 3/27 (11%) focused specifically on this environment.
Most papers 22/27 (81%) considered the general population, 2/27 (7%) considered both the general population and IDPs, and one (4%) considered only IDPs. 2/27 (7%) of papers considered refugee populations.
As defined by this contextual factor, all papers considered urban settings. Of these, 6/27 (22%) considered rural settings in addition, and 5/6 (83%) of these conducted comparative analysis between these two environments. 3/27 (11%) further papers specifically identified the urban setting of study as “slums”.
Evidence for the influence of urbanisation on public health interventions during humanitarian crises concentrated around three main themes. The first, identified in 7/27 (26%) of studies, is the relative greater vulnerability of urban environments to excess mortality as a result of both natural disasters such as floods and droughts, as well as armed conflict. The second theme, identified in 7/27 (26%) further studies, are the particular health challenges faced by urban environments during humanitarian crises, including access to healthcare; collapse of the health system and the management of NCDs; food security; sanitation and diarrhoeal disease; and the detrimental impact of poverty on health. Thirdly, 3/27 (11%) studies identified a relatively greater capacity of urban environments for recovery in the areas of health access, mental health and urban infrastructure.
Regarding the types of public health interventions, 13/27 (48%) articles focused on care planning, 9/27 (33%) on disaster preparedness, 3/27 (11%) on use of existing health services, and 2/27 (7%) on a combination of these interventions.
Access to healthcare was the health-related topic most studied regarding urbanisation (10/27, 37%). 5/27 (19%) studies considered mental health, 5/27 (19%) considered nutrition and food security, 3/27 (11%) considered water, sanitation and hygiene, and 2/27 (7%) considered NCDs.
Concerning stage of crisis, only 4/27 (15%) of studies focused on the acute phase, 5/27 (19%) on early recovery, and the vast majority (18/27, 67%) on chronic situations.
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