The burden of acute respiratory infections in crisis-affected populations: a systematic review |
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Authors: | Anna Bellos Kim Mulholland Katherine L O'Brien Shamim A Qazi Michelle Gayer Francesco Checchi |
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Institution: | (1) Disease Control in Humanitarian Emergencies, World Health Organization, Geneva, Switzerland;(2) Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK;(3) Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA;(4) Newborn and Child Health and Development, World Health Organization, Geneva, Switzerland;(5) Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK |
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Abstract: | Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious
diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian
sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of
relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional
morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification
of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural
disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age
group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee
camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional
mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are
difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to
provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI
prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case
management and vaccine strategies will help to reduce disease burden. |
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