Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review

Abstract

Background Non-pharmaceutical interventions (NPIs) are a crucial suite of measures to prevent and control infectious disease outbreaks. Despite being particularly important for crisis-affected populations and those living in informal settlements, who typically reside in overcrowded and resource limited settings with inadequate access to healthcare, guidance on NPI implementation rarely takes the specific needs of such populations into account. We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability, feasibility, and effectiveness of NPIs among crisis-affected populations and informal settlements. Methods We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility, acceptability, and effectiveness of NPIs in crisis-affected populations and informal settlements. We performed quality assessments of each study using a standardised questionnaire. We analysed the data to produce descriptive summaries according to a number of categories: date of publication; geographical region of intervention; typology of crisis, shelter, modes of transmission, NPI, research design; study design; and study quality. Results Our review included 158 studies published in 85 peer-reviewed articles. Most research used low quality study designs. The acceptability, feasibility, and effectiveness of NPIs was highly context dependent. In general, simple and cost-effective interventions such as community-level environmental cleaning and provision of water, sanitation and hygiene services, and distribution of items for personal protection such as insecticide-treated nets, were both highly feasible and acceptable. Logistical, financial, and human resource constraints affected both the implementation and sustainability of measures. Community engagement emerged as a strong factor contributing to the effectiveness of NPIs. Conversely, measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable, despite apparent effectiveness. Conclusions Overall, the evidence base was variable, with substantial knowledge gaps which varied between settings and pathogens. Based on the current landscape, robust evidence-based guidance is not possible, and a research agenda is urgently required that focusses on these specific vulnerable populations. Although implementation of NPIs presents unique practical challenges in these settings, it is critical that such an agenda is put in place, and that the lessons learned from historical and present experiences are documented to build a firm evidence base. Graphical Abstract

The impact of social and environmental extremes on cholera time varying reproduction number in Nigeria

“…In a recent review on the implementation of non-pharmaceutical cholera interventions, there was generally a high acceptance of several WASH interventions. Despite this, education was key and building community relationships is needed to achieve this, such as understanding cultural differences and barriers 38 . This is especially important in areas with conflict, where trust between the government and residents may have been lost 31 .…”

Investigation of and Strategies to Control the Final Cluster of the 2018–2020 Ebola Virus Disease Outbreak in the Eastern Democratic Republic of Congo

“…However, such quarantining could substantially negatively impact the health, well-being, and livelihoods of those affected, as was observed during previous EVD outbreaks and the ongoing COVID-19 pandemic [ 27–29 ]. Therefore, such a strategy requires clear communication and effective engagement with those persons affected and the surrounding community to maximize acceptance and the chances of successful implementation [ 28 , 30 ].…”

Investigation of, and strategies to control the final cluster of the 2018-2020 Ebola virus disease outbreak in eastern Democratic Republic of Congo

“…Community confinement likely helped to rapidly control this outbreak and could be considered as a measure in other outbreaks, especially in early stages, which present the best opportunities for successful interruption of transmission. However, such quarantining could substantially negatively impact the health, well-being, and livelihoods of those affected, as was observed during previous EVD outbreaks and the ongoing COVID-19 pandemic [27][28][29]. Therefore, such a strategy requires clear communication and effective engagement with those persons affected and the surrounding community to maximize acceptance and the chances of successful implementation [28,30].…”

“…However, such quarantining could substantially negatively impact the health, well-being, and livelihoods of those affected, as was observed during previous EVD outbreaks and the ongoing COVID-19 pandemic [27][28][29]. Therefore, such a strategy requires clear communication and effective engagement with those persons affected and the surrounding community to maximize acceptance and the chances of successful implementation [28,30].…”