Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies
Citation: Hammer CC, Brainard J, Hunter PR. Risk factors and risk factor cascades for communicable disease outbreaks in complex humanitarian emergencies: A qualitative systematic review. BMJ Global Health 2018; 3(4): e000647
What is this? The preparedness and control of the COVID-19 pandemic in complex humanitarian emergencies (CHEs) is a considerable challenge, given the increased risk of communicable disease outbreaks in CHEs. Identifying these risks will help to address them.
In this qualitative systematic review, the authors aimed to identify risk factors and risk factor cascades for communicable disease outbreaks in post-1990 CHEs. They did not restrict their search by language of publication but limited it to literature published between 1994 and 2017 and did their search in May 2017. They included 26 studies (published in English, French and Spanish) in their thematic synthesis.
What was found: The main risk factors for communicable disease outbreaks in complex humanitarian emergencies are poor water, sanitation and hygiene (WASH) conditions; overcrowding, especially in camps; mass population displacement; nutrition (malnutrition, food shortages, food contamination); poor living conditions, especially exposure to indoor air pollution; insecurity; lack inadequacy of infrastructure; poor humanitarian response; environment (weather, vector habitats, increased animal contact, endemic diseases); break down of public health services; and increased HIV-transmission. These risk factors interact with each other, forming complex risk cascades.
Mass population displacement and insecurity are key drivers of risk factors for communicable diseases outbreaks.
Addressing these risk factors for communicable disease outbreaks in CHEs must begin with a rapid, thorough needs assessment to identify the most critical risk factors, for the development of an evidence-based intervention strategy.
What’s uncertain: The best way to perform a risk assessment in CHEs is uncertain and there are important knowledge gaps on the operational and structural barriers affecting these risk assessments.
Entrapment situations, such as in Syria and Yemen, have received insufficient attention.
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