A systematic review of effective strategies for chronic disease management in humanitarian settings; opportunities and challenges

Authors

Ramin Asgary, George Washington University, 950 New Hampshire Ave, Washington, D.C., USA; Weill Cornell Medical College, 420 East 70(th) St, New York, NY, USA. Electronic address: ga263@columbia.edu.
Victoria Garland, Lenox Hill Hospital of Northwell Health, Hofstra University, New York, USA. Electronic address: vfg6@cornell.edu.
Vicky Ro, Columbia University Vagelos College of Physicians and Surgeons, New York, USA. Electronic address: vir7010@nyp.org.
Judy Carole Stribling, Weill Cornell Medical College, 420 East 70(th) St, New York, NY, USA. Electronic address: jcs2002@med.cornell.edu.
Ronald Waldman, George Washington University, 950 New Hampshire Ave, Washington, D.C., USA. Electronic address: ronwaldman@gwu.edu.

Document Type

Journal Article

Publication Date

8-1-2022

Journal

Preventive medicine

Volume

161

DOI

10.1016/j.ypmed.2022.107154

Keywords

Cardiovascular; Diabetes; Disaster; Healthcare; Humanitarian; Hypertension; cancer

Abstract

Large number of people with non-communicable diseases (NCDs) face barriers to adequate healthcare in humanitarian settings. We conducted a systematic literature review in MEDLINE/PubMed, Web of Science, EMBASE/DARE, Cochrane, and grey literature from 1990 to 2021 to evaluate effective strategies in addressing NCDs (diabetes, cardiovascular diseases, COPD, cancer) in humanitarian settings. From 2793 articles, 2652 were eliminated through title/abstract screening; 141 articles were reviewed in full; 93 were eliminated for not meeting full criteria. Remaining 48 articles were reviewed qualitatively to assess populations, settings, interventions, outcome, and efficacy and effectiveness; 38 studies addressed treatments, 9 prevention, and 7 epidemiology. Prevention studies broadly addressed capacity-building. Treatment and epidemiology studies largely addressed hypertension and diabetes. Interventions included web-based/mobile health strategies, pharmacy-level interventions, portable imaging, and capacity building including physical clinics, staff training, forging collaborations, guideline development, point-of-care labs, health promotion activities, EMR, and monitoring interventions. Collaboration between academia and implementing agencies was limited. Models of care were largely not well-described and varied between studies due to contextual constraints. Barriers to interventions included financial, logistical, organizational, sociocultural, and security. Cancer care is significantly understudied. Simplified care models adapted to contexts and program evaluations of implemented strategies could address gaps in applied research. Inherent challenges in humanitarian settings pose unavoidable perils to evidence generation which requires a shift in research mindset to match aspirations with practicality, research collaborations at the inception of projects, reworking of desired conventional level of research evidence considering resource-intense constraints (HR, time, cost), and adapted research tools, methods, and procedures.

APA Citation

Asgary, Ramin; Garland, Victoria; Ro, Vicky; Stribling, Judy Carole; and Waldman, Ronald, "A systematic review of effective strategies for chronic disease management in humanitarian settings; opportunities and challenges" (2022). GW Authored Works. Paper 1250.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1250

Department

Global Health