Emerging outbreaks associated with conflict and failing healthcare systems in the Middle East

Raad, Issam; Chaftari, Anne-Marie; Dib, Rita Wilson; Graviss, Edward A.; Hachem, Ray

doi:10.1017/ice.2018.177

Cited by 42 publications

(34 citation statements)

References 30 publications

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“…Our findings support a recent study that suggested that measles outbreaks among migrants in the European Union were due in part to sub-optimal vaccination coverage [31]. Enhanced cross-border surveillance with targeted screening and treatment of infectious diseases have been demonstrated to improve the health outcomes of forcibly displaced persons before resettlement and is recommended to be pursued in outbreak settings as well [32][33][34][35].…”

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confidence: 87%

Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996–2016

et al. 2020

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Background: The United Nations Refugee Agency (UNHCR) estimates the number of forcibly displaced people increased from 22.7 million people in 1996 to 67.7 million people in 2016. Human mobility is associated with the introduction of infectious disease pathogens. The aim of this study was to describe the range of pathogens in forcibly displaced populations over time using an informal event monitoring system. Methods: We conducted a retrospective analysis of ProMED, a digital disease monitoring system, to identify reports of outbreak events involving forcibly displaced populations between 1996 and 2016. Number of outbreak events per year was tabulated. Each record was assessed to determine outbreak location, pathogen, origin of persons implicated in the outbreak, and suspected versus confirmed case counts. Results: One hundred twenty-eight independent outbreak events involving forcibly displaced populations were identified. Over 840,000 confirmed or suspected cases of infectious diseases such as measles, cholera, cutaneous leishmaniasis, dengue, and others were reported in 48 destination countries/territories. The average rate of outbreak events concerning forcibly displaced persons per total number of reports published on ProMED per year increased over time. The majority of outbreak events (63%) were due to acquisition of disease in the destination country. Conclusion: This study found that reports of outbreak events involving forcibly displaced populations have increased in ProMED. The events and outbreaks detected in this retrospective review underscore the importance of capturing displaced populations in surveillance systems for rapid detection and response.

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Section: Fig 1 Flow Chart Of Search Strategysupporting

confidence: 87%

Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996–2016

et al. 2020

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“…This is much lower than the prevalence reported by similar health facility-based studies in Ethiopia such as Addis Ababa 14.2% [33]. Although the nationwide prevalence of CL is lacking in Ethiopia, there are some community-based cross-sectional surveys showing 2.3-14.0% prevalence [15,23,24,27] from various parts demonstrating remarkable heterogeneity. A meta-analysis and systemic review [37] reported a pooled prevalence of 19.0%.…”

Section: Discussionmentioning

confidence: 71%

Cutaneous leishmaniasis in north-central Ethiopia: trend, clinical forms, geographic distribution, and determinants

Eshetu

Mamo

2020

Trop Med Health

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Background: Cutaneous leishmaniasis (CL), being among the neglected tropical diseases, catches little attention despite its considerable influence. This study aimed at estimating the prevalence and associated factors of CL in Boru Meda Hospital, Dessie town, north-central Ethiopia. Methods: Medical records of patients who attended the Dermatology Department of the Hospital in 2012-May 2018 were assessed. In addition, dermatological patients who were visiting the hospital during the data collection period (November 2017-May 2018) were interviewed to capture socio-demographic, environmental variables, and related factors. The source population was individuals who visited the hospital for skin problems in the stated years and CL positives were the targets. The association between CL and its determinants was tested by logistic regression. Results: CL prevalence was 1.5% showing increasing trend with the year of examination. Localized, diffused, and mucosal CL was evident across the years. Dessie town had the highest prevalence, 291 (32.8%) patients out of 888 cases. The number of examined (29,701) and positives (543, 1.8%) for males was comparable with females, 28,459 and 345 (1.2%), respectively, increasing with age but without significant difference. Dessie town residence (adjusted odds ratio (AOR) 12.2, 95% confidence interval (CI) 2.2-18.6, p = 0.01), no bed net (AOR 9.9, 95% CI 2.7-16.7, p < 0.01), nearby irrigation (AOR 8.1, 95% CI 1.9-12.4, p < 0.01), and travel to CL endemic areas (AOR 13.9, 95% CI 4.4-14.3, p < 0.01) were significantly associated with CL. Conclusion: CL is a growing health problem in Dessie and its surroundings. Known risk factors prevail. Comprehensive parasitological, entomological, and social studies are warranted to better manage the disease.

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“…At a global level, studies show that in a mediumsized country, conflict can increase malnutrition by 3.3%, reduce life expectancy by 1 year, increase infant mortality by up to 10%, and cause other public health problems due to lack of access to drinking water, food and health services [7]. Although the epidemiological profile and burden of disease of countries in conflict has changed in the last decades, infectious diseases like malaria, tuberculosis, leishmaniasis, cholera, acute diarrheal disease and poliomyelitis, continue to be serious problems [8][9][10]. Conflict can also have devastating effects on sexual and reproductive health, neonatal health, mental disorders and noncommunicable diseases, such as cancer, hypertension and diabetes [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia

et al. 2020

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Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.

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Emerging outbreaks associated with conflict and failing healthcare systems in the Middle East

Cited by 42 publications

References 30 publications

Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996–2016

Infectious disease outbreaks among forcibly displaced persons: an analysis of ProMED reports 1996–2016

Cutaneous leishmaniasis in north-central Ethiopia: trend, clinical forms, geographic distribution, and determinants

Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia

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