A Review of Interventions for Non-Communicable Diseases in Humanitarian Emergencies in Low-and Middle-Income Countries

BackgroundLow-and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by non-communicable diseases (NCDs). Interventions addressing NCDs require humanitarian entities to consider complex challenges such as continuity of care, diagnostics, logistics and cost of care for recurrent or expensive treatments, yet primary focus on the topic is lacking. We conducted a systematic review on the effects of humanitarian disasters on NCDs in LMICs with the primary aim of identifying studies on epidemiology, interventions, and treatment. Key interventions were identified and their effects on populations in disaster settings were reviewed.MethodsA systematic search was conducted in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017. Publications reporting on interventions targeting NCDs during disasters in LMICs were included if they incorporated core intervention components as defined by the United States Department of Health and Human Services. Two separate screeners independently evaluated the titles, abstracts and full text of the eligible articles, with vetting by a third reviewer. Key intervention components including target population, phase of crisis, and measured outcomes among others were extracted into a template and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO(CRD42018088769).ResultsOf 85 articles eligible for the full systematic review, only seven articles describing interventions met inclusion criteria. Studies focused reporting on the response (n=4) and recovery (n=3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted extensive pre-deployment risk assessments to assess the burden and distinct epidemiology of NCDs amongst affected populations, worked in close cooperation with local health services, assessed individual needs of sub-populations in disaster regions in the response phase, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline implementation. Training and capacity building of staff were found to be essential elements of successful interventions due to an assessed lack of experience of healthcare workers in disaster settings with NCDs and successfully allowed for incorporation of community health workers.ConclusionsWe found only limited interventions designed to address NCDs in humanitarian emergencies, with a particular dearth of studies addressing the mitigation and preparedness phases of humanitarian response. Delivering interventions for NCDs in humanitarian emergencies requires improved collaboration between humanitarian and development actors in addition to improved NCD training and capacity building amongst healthcare workers in disasters settings.

Statistical Exploration of the Data for the Georgia Mountain Food Bank

Hunger relief is one of the major needs during humanitarian emergencies. Georgia Mountain Food Bank’s (GMFB) is to address hunger, health, and quality of life by serving those in need throughout North Georgia. GMFB is invited to participate in this project by providing data on the “People in Need” program. GMFB provides the demographic and food picking up information for FY17 & FY18. The data are completely anonymous without any ethical concerns. GMFB would like to obtain a better understanding of the data through mathematics research and analytic study with this project.

Measuring sexual violence stigma in humanitarian contexts: assessment of scale psychometric properties and validity with female sexual violence survivors from Somalia and Syria

Background Valid measures of sexual violence stigma that can be readily incorporated into program monitoring and evaluation systems are needed to strengthen gender-based violence (GBV) services in humanitarian emergencies. This study sought to assess the psychometric properties, construct validity, and measurement invariance of sexual violence stigma scales among female Somali GBV survivors in Kenya and Syrian GBV survivors in Jordan to identify an abbreviated scale that could be used across humanitarian contexts. Methods We administered measures of sexual violence stigma to 209 female survivors of sexual violence aged 15 and older in Kenya and Jordan. Exploratory factor analysis was used to assess the underlying latent structure, and Item Response Theory was used to estimate item difficulty and discrimination parameters to guide efforts to shorten the scales. Differential item functioning (DIF) by site was assessed using Multiple Indicators, Multiple Causes models. Construct validity of the sexual violence stigma scales was assessed by estimating correlations with functional impairment, depression, and disability. Results The sexual violence stigma measure exhibited distinct factor structures among Somali and Syrian GBV survivors. Among Somali survivors, a two-factor model with separate felt (10 items) and enacted (4 items) stigma constructs was identified, with scales for both domains exhibiting good internal consistency (Cronbach’s alpha = 0.93 and 0.88, respectively). In Jordan, a single factor solution was uncovered for a 15-item stigma scale with good internal consistency (alpha = 0.86). The shortened core sexual stigma scale consisting of the 4 items that did not exhibit DIF had a Cronbach’s alpha of 0.82 in Kenya and 0.81 in Jordan. The felt stigma scale in Kenya, the full stigma scale in Jordan, and abbreviated core stigma scales in both countries were meaningfully correlated with depression, while correlations with functional impairment were weaker and inconsistent across scales. Conclusions An abbreviated core set of invariant perceived and internalized sexual violence stigma items demonstrated evidence of construct validity in two diverse settings. The ability of this measure to be efficiently administered as a part of routine program monitoring and evaluation activities, with the potential addition of items from a measurement bank to improve contextual relevance, can facilitate improvements in the delivery and quality of gender-based violence programs in humanitarian emergencies.

Humanitarian emergencies

The field of humanitarian assistance advanced spectacularly over the last half of the twentieth century. Prolonged high-mortality crises common in the Cold War era have become rare, corresponding with an increase in international spending, a healthier world, and the politicization of humanitarian assistance. This has created a completely new environment for relief workers in the twenty-first century. This new environment requires an emphasis on chronic diseases, urban settings, and people displaced within their own country. The relative importance of natural disasters has also resulted in a new set of skills deemed essential for humanitarian relief. The concepts of disaster preparedness, risk management, and disaster recovery have become central to the humanitarian endeavour and often these responsibilities fall on the shoulders of host governments. This chapter reviews the new environment in which humanitarian relief exists, the dominant emerging themes, and some of the promising technical advances.

Towards an integrated model for supervision for mental health and psychosocial support in humanitarian emergencies: A qualitative study

Background Despite recent advances in the development and provision of mental health and psychosocial support (MHPSS) in humanitarian settings, inadequate supervision remains a significant barrier to successful implementation. The present study sought to incorporate broad stakeholder engagement as part of the first phase of development of a new Integrated Model for Supervision (IMS) for use within MHPSS and protection services in humanitarian emergencies. Methods Semi-structured interviews were conducted with 26 global mental health professionals. Data was analysed thematically, using a combination of inductive and deductive methods. Codes and themes were validated through co-author cross-checks and through a webinar with an expert advisory group. Results Results reinforce the importance of effective supervision to enhance the quality of interventions and to protect supervisees’ wellbeing. Participants generally agreed that regular, supportive supervision on a one-to-one basis and as a separate system from line management, is the ideal format. The interviews highlight a need for guidance in specific areas, such as monitoring and evaluation, and navigating power imbalances in the supervisory relationship. Several approaches to supervision were described, including some solutions for use in low-resource situations, such as group, peer-to-peer or remote supervision. Conclusion An integrated model for supervision (IMS) should offer a unified framework encompassing a definition of supervision, consolidation of best practice, and goals and guidance for the supervisory process.

Priorities for addressing substance use disorder in humanitarian settings

Background Populations affected by humanitarian emergencies are vulnerable to substance (alcohol and other drug) use disorders, yet treatment and prevention services are scarce. Delivering substance use disorder treatment services in humanitarian settings is hampered by limited guidance around the preparation, implementation, and evaluation of substance use disorder treatment programs. This study aims to identify and prioritize key gaps and opportunities for addressing substance use disorder in humanitarian settings. Methods UNODC convened a consultation meeting (n = 110) in coordination with UNHCR and WHO and administered an online survey (n = 34) to, thirteen program administrators and policymakers, eleven service providers, nine researchers, and one person with lived experience to explore best practices and challenges to addressing substance use disorder in diverse populations and contexts. Participants presented best practices for addressing substance use disorder, identified and ranked challenges and opportunities for improving the delivery of substance use disorder treatment interventions, and provided recommendations for guidelines that would facilitate the delivery of substance use disorder treatment services in humanitarian emergencies. Results Participants agreed on key principles for delivering substance use disorder treatment in humanitarian settings that centered on community engagement and building trust, integrated service delivery models, reducing stigma, considering culture and context in service delivery, and an ethical ‘do no harm’ approach. Specific gaps in knowledge that precluded the delivery of appropriate substance use disorder treatment include limited knowledge of the burden and patterns of substance use in humanitarian settings, the effectiveness of substance use disorder treatment services in humanitarian settings, and strategies for adapting and implementing interventions for a given population and humanitarian context. Participants emphasized the need to strengthen awareness and commitment related to the burden of substance use disorder treatment interventions among communities, practitioners, and policymakers in humanitarian settings. Conclusions Results from this consultation process highlight existing gaps in knowledge related to the epidemiology and treatment of substance use disorders in humanitarian emergencies. Epidemiological, intervention, and implementation research as well as operational guidance are needed to fill these gaps and improve access to substance use treatment services in humanitarian settings.

Survey of violence against women at a refugee settlement in Uganda

Sexual and gender-based violence (SGBV) can have long-term repercussions on the mental and physical health of survivors. The threat of SGBV increases for women and girls in times of crisis and is on the rise in humanitarian emergencies. For example, women in refugee camps are at risk of SGBV. Associate Professor Tamaki Hatano is working to promote awareness of this situation and help establish a future where SGBV is eradicated. In her work, she conducts interviews with female refugees in order to hear their stories and learn of their experiences. At present, Hatano is studying the Kiryandongo Refugee Settlement in Uganda. Although her work has been interrupted by the COVID-19 pandemic, in 2015 and 2016 she visited the Settlement and interviewed 30 women. In doing so, she found that SGBV, including rape and violence in the form of theft and threats, is pervasive. This work also highlighted the impact of SGBV on physical and psychological health and how it can alter life paths. This work confirmed to Hatano that there is a need for improved systems in place, including the establishment of a culture in which women feel safe reporting SGBV and also feel assured that their experiences will be taken seriously and that they will be protected. In enhancing awareness and understanding of SGBV, Hatano envisions a future where it is eradicated.

Exploring the relationship between Humanitarian Emergencies and Human Trafficking

This article aims to explore the connection between humanitarian emergencies and human trafficking by conducting a narrative review of secondary sources. The search strategy for this narrative review included a number of relevant key terms. As humanitarian emergencies are likely to occur in the future, this paper investigates studies about conflict, disease outbreak, and natural disasters to provide further insight on the relationship between humanitarian emergencies and human trafficking.