1. Systematic review on the effectiveness of NCD interventions in humanitarian crises
Bayard Roberts
ECOHOST – The Centre for Health and Social Change
London School of Hygiene and Tropical Medicine
2 September 2016

4. Sources: 5 Bibliographic databases, grey literature sources
Aim and methods
Aim: to systematically review evidence on the effectiveness of interventions targeting NCDs during humanitarian crises
Sources: 5 Bibliographic databases, grey literature sources
Eligibility: *Humanitarian crises, inc. forcibly displaced persons *Low- and middle-income countries *Quantitative studies * Quality assessment:
*Newcastle-Ottawa Quality Assessment Scale (observational studies)
*Cochrane Risk of Bias Tool (Experimental studies) PRISMA Guidelines

5. Results

6. Results

7. NCD study findings
Study designs: 1 RCT, 5 cohort, 1 case series, 1 interrupted time series.
Outcomes: Diabetes (N=3), heart failure, hypertension, arthritis, chronic kidney disease, and thalassaemia.
Study settings: Middle East (N=6), Eastern Europe, South Asia.
Mixed clinical results:
E.g. DM – majority often not receiving proper checks, poor blood glucose results, insufficient checks, DM complications poorly screened.
E.g. Hypertension – better results than DM e.g. Blood pressure targets, screening .
Value of cohort monitoring through digital surveillance systems
Value of disease-management protocols
Value of algorithm-based interventions
Algorithm-based interventions: heart failure study in Georgia, and diabetes care with Palestinian refugees in Jordan.

8. But… Strength and quality of evidence generally limited
Outcome reporting weak
Reliance on observational study designs
Limited use of control groups
Biases with missing data
Inadequate patient-follow-up
Confounding poorly addressed
Gaps
No studies on costs or feasibility of interventions
No studies on integrated care (e.g. with mental health, HIV, TB)
No studies on effectiveness on health promotion
Not clear or established diagnostic procedures

9. Only descriptive analysis, rather than meta-analysis
Review limitations
Only descriptive analysis, rather than meta-analysis
Only went back to 1980
Only quantitative studies included
Possibility of grey literature held by agencies
1997 was first study (Tibetan refugees RCT)

10. Slightly off topic…other reviews on prevention
Evidence on patterns of alcohol and tobacco use and control:
Alcohol: 22 eligible studies; risk-factors of trauma exposure & mental disorders; 0 assessed intervention effectiveness; 6 rated high quality.
Tobacco: 39 eligible studies; trauma exposure risk-factor; 0 assessed intervention effectiveness; 2 rated high quality.
Lo J, Patel P, Roberts B. A systematic review on tobacco use among civilian populations affected by armed conflict. Tobacco Control. 2016; 25.
Lo J, Patel P, Shultz J, Ezard N, Roberts B. A systematic review on harmful alcohol use among civilian populations affected by armed conflict in low- and middle-income countries (under review)
Alcohol: Why should we care?
Risk-factors: stressors/depression/ptsd > alcohol; daily stressors/bordeom/>alcohol
Effects: NCDs, mental health, SGBV.
Broader influences: urbanisation, alcogenic environment etc
Almost all were cross-sectional studies.

11. Key messages Very limited data
Potential for electronic surveillance registries
Need for more studies, particularly with controls
More economic studies

12. Thank you!