the practice of evaluating epidemic response in humanitarian and low income settings CORD-Papers-2022-06-02 (Version 1)

Title: The practice of evaluating epidemic response in humanitarian and low-income settings: a systematic review
Abstract: BACKGROUND: Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations. However relatively little is known about responses to these epidemics. Robust evaluations can generate evidence on response efforts and inform future improvements. This systematic review aimed to (i) identify epidemics reported in low-income and crisis settings (ii) determine the frequency with which evaluations of responses to these epidemics were conducted (iii) describe the main typologies of evaluations undertaken and (iv) identify key gaps and strengths of recent evaluation practice. METHODS: Reported epidemics were extracted from the following sources: World Health Organization Disease Outbreak News (WHO DON) UNICEF Cholera platform Reliefweb PROMED and Global Incidence Map. A systematic review for evaluation reports was conducted using the MEDLINE EMBASE Global Health Web of Science WPRIM Reliefweb PDQ Evidence and CINAHL Plus databases complemented by grey literature searches using Google and Google Scholar. Evaluation records were quality-scored and linked to epidemics based on time and place. The time period for the review was 20102019. RESULTS: A total of 429 epidemics were identified primarily in sub-Saharan Africa the Middle East and Central Asia. A total of 15424 potential evaluations records were screened 699 assessed for eligibility and 132 included for narrative synthesis. Only one tenth of epidemics had a corresponding response evaluation. Overall there was wide variability in the quality content as well as in the disease coverage of evaluation reports. CONCLUSION: The current state of evaluations of responses to these epidemics reveals large gaps in coverage and quality and bears important implications for health equity and accountability to affected populations. The limited availability of epidemic response evaluations prevents improvements to future public health response. The diversity of emphasis and methods of available evaluations limits comparison across responses and time. In order to improve future response and save lives there is a pressing need to develop a standardized and practical approach as well as governance arrangements to ensure the systematic conduct of epidemic response evaluations in low-income and crisis settings.
Published: 2020-11-03
Journal: BMC Med
DOI: 10.1186/s12916-020-01767-8
DOI_URL: http://doi.org/10.1186/s12916-020-01767-8
Author Name: Warsame Abdihamid
Author link: https://covid19-data.nist.gov/pid/rest/local/author/warsame_abdihamid
Author Name: Murray Jillian
Author link: https://covid19-data.nist.gov/pid/rest/local/author/murray_jillian
Author Name: Gimma Amy
Author link: https://covid19-data.nist.gov/pid/rest/local/author/gimma_amy
Author Name: Checchi Francesco
Author link: https://covid19-data.nist.gov/pid/rest/local/author/checchi_francesco
sha: 1fe41335175211283c2831be7cbff69bf6698293
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 33138813
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/33138813
pmcid: PMC7606030
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7606030
url: https://doi.org/10.1186/s12916-020-01767-8 https://www.ncbi.nlm.nih.gov/pubmed/33138813/
has_full_text: TRUE
Keywords Extracted from Text Content: OECD poliovirus hepatitis E Americas Vibrio cholerae measles Crimean-Congo haemorrhagic Médecins French languages cholera News ( Zika [17 line UK extract Rift Valley polio Rift valley AFRO COVID-19 encephalitis Lassa virus English ES/P010873/. Morhaso-Bello AG Marburg haemorrhagic diphtheria AW Lassa CRD42019150693 Congo Fig. 3 DON [171, 172] FC people https://doi.org/10. epidemic-prone Children anthrax
Extracted Text Content in Record: First 5000 Characters:Background: Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations. However, relatively little is known about responses to these epidemics. Robust evaluations can generate evidence on response efforts and inform future improvements. This systematic review aimed to (i) identify epidemics reported in low-income and crisis settings, (ii) determine the frequency with which evaluations of responses to these epidemics were conducted, (iii) describe the main typologies of evaluations undertaken and (iv) identify key gaps and strengths of recent evaluation practice. Results: A total of 429 epidemics were identified, primarily in sub-Saharan Africa, the Middle East and Central Asia. A total of 15,424 potential evaluations records were screened, 699 assessed for eligibility and 132 included for narrative synthesis. Only one tenth of epidemics had a corresponding response evaluation. Overall, there was wide variability in the quality, content as well as in the disease coverage of evaluation reports. Conclusion: The current state of evaluations of responses to these epidemics reveals large gaps in coverage and quality and bears important implications for health equity and accountability to affected populations. The limited availability of epidemic response evaluations prevents improvements to future public health response. The diversity of emphasis and methods of available evaluations limits comparison across responses and time. In order to improve future response and save lives, there is a pressing need to develop a standardized and practical approach as well as governance arrangements to ensure the systematic conduct of epidemic response evaluations in low-income and crisis settings. Infectious disease epidemics continue to pose a substantial risk globally [1] . Epidemics routinely occur in lowincome and humanitarian settings [2] . Populations in these settings often do not have the resources to effectively respond to epidemics [3] and as a result are at higher risk of increased morbidity and mortality [4] . Globally, more than 700 million people live in lowincome countries [5] , while 2 billion live in fragile or conflict-affected settings [6] . Responses to large-scale epidemics or epidemics of newly emergent pathogens tend to generate global attention and corresponding responses incur scrutiny [7] [8] [9] . However, evidence on responses to smaller-scale epidemics or epidemics involving well-known pathogens (e.g. measles, cholera) for which effective control measures exist is thought to be limited [10] . Evidence from some limited contexts points to weaknesses in responses ranging from detection, investigation to effective and timely response [11, 12] . However, the practice of epidemic response evaluation has not been systematically assessed in low-income and humanitarian settings. Within public health programming, effective evaluations generate critical evidence and allow for systematic understanding, improvement and accountability of health action [13] . We sought to review the extent to which evaluations of epidemic responses are actually conducted in low-income and crisis settings and describe key patterns in evaluation practice. Specifically, we aimed to (i) identify epidemics reported in low-income and crisis settings, by aetiologic agent, over a recent period; (ii) determine the frequency with which evaluations of responses to these epidemics were conducted; (iii) describe the main typologies of evaluations undertaken; and (iv) identify key gaps and strengths of recent evaluation practice, so as to formulate recommendations. This review (PROSPERO registration CRD42019150693) focuses on recent epidemics in low-income settings, defined using the 2018 World Bank criteria [14] , as well as epidemics occurring in settings with ongoing humanitarian responses, as reported in the United Nations Office for the Coordination of Humanitarian Affairs' annual Global Humanitarian Overview. Our search focused on epidemic-prone pathogens commonly occurring in low resource or humanitarian settings and which presented an immediate threat to life. For this reason, our search excluded HIV [15] , tuberculosis [16] and Zika [17] . Epidemics occurring within healthcare settings only or within animal populations were considered outside the scope of this review. In order to capture recent trends and assess contemporary reports, we focused on the period 2010-2019. The following sources were reviewed in order to compile a list of reported epidemics: World Health Organization Disease Outbreak News (WHO DON) [18] , UNICEF Cholera platform [19] , Reliefweb [20] , PROMED [21] and Global Incidence Map [22] . In line with WHO guidance on infectious disease control in emergencies [23] , one suspected case of the following was considered to be an epidemic: acute haemorrhagic fevers (Ebola, Lassa fever, Rift valley fever, Crimean-Congo haemorrhagic fever), anthrax, cho
Keywords Extracted from PMC Text: Médecins News ( intendedOutput French languages Lassa virus epidemic-prone AFRO DON Congo Marburg haemorrhagic anthrax 2013–2016 Zika [17 English OECD encephalitis line Rift valley polio poliovirus cholera hepatitis E Lassa people extract Rift Valley Americas Vibrio cholerae measles Crimean-Congo haemorrhagic CRD42019150693 diphtheria Children COVID-19
Extracted PMC Text Content in Record: First 5000 Characters:Infectious disease epidemics continue to pose a substantial risk globally [1]. Epidemics routinely occur in low-income and humanitarian settings [2]. Populations in these settings often do not have the resources to effectively respond to epidemics [3] and as a result are at higher risk of increased morbidity and mortality [4]. Globally, more than 700 million people live in low-income countries [5], while 2 billion live in fragile or conflict-affected settings [6]. Responses to large-scale epidemics or epidemics of newly emergent pathogens tend to generate global attention and corresponding responses incur scrutiny [7–9]. However, evidence on responses to smaller-scale epidemics or epidemics involving well-known pathogens (e.g. measles, cholera) for which effective control measures exist is thought to be limited [10]. Evidence from some limited contexts points to weaknesses in responses ranging from detection, investigation to effective and timely response [11, 12]. However, the practice of epidemic response evaluation has not been systematically assessed in low-income and humanitarian settings. Within public health programming, effective evaluations generate critical evidence and allow for systematic understanding, improvement and accountability of health action [13]. We sought to review the extent to which evaluations of epidemic responses are actually conducted in low-income and crisis settings and describe key patterns in evaluation practice. Specifically, we aimed to (i) identify epidemics reported in low-income and crisis settings, by aetiologic agent, over a recent period; (ii) determine the frequency with which evaluations of responses to these epidemics were conducted; (iii) describe the main typologies of evaluations undertaken; and (iv) identify key gaps and strengths of recent evaluation practice, so as to formulate recommendations. This review (PROSPERO registration CRD42019150693) focuses on recent epidemics in low-income settings, defined using the 2018 World Bank criteria [14], as well as epidemics occurring in settings with ongoing humanitarian responses, as reported in the United Nations Office for the Coordination of Humanitarian Affairs' annual Global Humanitarian Overview. Our search focused on epidemic-prone pathogens commonly occurring in low resource or humanitarian settings and which presented an immediate threat to life. For this reason, our search excluded HIV [15], tuberculosis [16] and Zika [17]. Epidemics occurring within healthcare settings only or within animal populations were considered outside the scope of this review. In order to capture recent trends and assess contemporary reports, we focused on the period 2010–2019. The following sources were reviewed in order to compile a list of reported epidemics: World Health Organization Disease Outbreak News (WHO DON) [18], UNICEF Cholera platform [19], Reliefweb [20], PROMED [21] and Global Incidence Map [22]. In line with WHO guidance on infectious disease control in emergencies [23], one suspected case of the following was considered to be an epidemic: acute haemorrhagic fevers (Ebola, Lassa fever, Rift valley fever, Crimean-Congo haemorrhagic fever), anthrax, cholera, measles, typhus, plague and polio. For the remainder of the pathogens, we defined an epidemic as an unusual increase in incidence relative to a previously established baseline in a given setting. We reviewed WHO DON narrative reports to extract metadata on location (country), year, month and pathogen. Reliefweb was searched for reported epidemics using the search engine and the disaster type filter. For the PROMED database, only epidemics rated as 3 or higher in the 5-point rating system (which reflected a higher degree of certainty in the scale of the epidemic and its potential severity) and in which incident cases and deaths were reported were considered for inclusion. The Global Incident Map database was searched utilizing the inbuilt search function filtering results that were out of scope (wrong location, pathogen, etc.) at the source. We collated all epidemic records into a single database and removed duplicate reports of the same epidemic based on first date and location of occurrence; duplicated included multiple reports within any given database (e.g. an update on an earlier reported epidemic) and reports of the same epidemic in multiple databases. As phylogenetic or spatio-temporal reconstructions of epidemics were mostly unavailable, we assumed that reports of the same pathogen from within the same country and 4-month period referred to the same single epidemic. We decided to split cross-border epidemics (e.g. the West Africa 2013–2016 Ebola epidemic) into one separate epidemic for each country affected, recognizing that responses would have differed considerably across these countries. We compiled epidemic reports from various sources into one database. For each epidemic, information on location (country), year, month and pathogen was extracted using
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