The burden of acute respiratory infections in crisis-affected populations: a systematic review

Anna Bellos, Kim Mulholland, Katherine L O'Brien, Shamim A Qazi, Michelle Gayer, Francesco Checchi, Anna Bellos, Kim Mulholland, Katherine L O'Brien, Shamim A Qazi, Michelle Gayer, Francesco Checchi

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.

References

    1. Checchi F, Gayer M, Grais RF, Mills EJ. HPN Network Paper 61: Public health in crisis-affected populations: a practical guide for decision-makers. London: Overseas Development Institute; 2007. (accessed August 6 2009)
    1. Human Security Center. The human security report 2005. War and peace in the 21st century. Boston: Oxford University Press; 2005.
    1. Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL. Communicable diseases in complex emergencies: impact and challenges. Lancet. 2004;364(9449):1974–1983. doi: 10.1016/S0140-6736(04)17481-3.
    1. Connolly MA, Ed. Communicable disease control in emergencies: a field manual. Geneva: World Health Organization; 2005.
    1. Mèdecins Sans Frontières. Refugee health: an approach to emergency situations. London: Macmillan Education Ltd; 1997.
    1. The Sphere Project. Volume 2005. revised edition. Geneva: The Sphere Project; 2004. Sphere Handbook. (accessed 6 August 2009)
    1. United Nations High Commissioner for Refugees. Handbook for emergencies. second. Geneva: UNHCR; 2000.
    1. Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bulletin of the World Health Organization. 2004;82:895–903.
    1. Mizgerd JP. Lung infection--a public health priority. PLoS Med. 2006;3(2):e76. doi: 10.1371/journal.pmed.0030076.
    1. Williams BG, Gouws E, Boschi-Pinto C, Bryce J, Dye C. Estimates of world-wide distribution of child deaths from acute respiratory infections. Lancet Infect Dis. 2002;2(1):25–32. doi: 10.1016/S1473-3099(01)00170-0.
    1. Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet. 2005;365(9465):1147–1152. doi: 10.1016/S0140-6736(05)71877-8.
    1. Simoes AF, Cherian T, Chow J, Shahid-Salles S, Laxminarayan R, John TJ. Disease Control Priorities in Developing Countries. second. Washington: Oxford University Press; 2006. Acute Respiratory Infections in Children.
    1. Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization. 2008;86:408–416B. doi: 10.2471/BLT.07.048769.
    1. World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2008. Accessed 8 November 2009.
    1. Mulholland K. Perspectives on the burden of pneumonia in children. Vaccine. 2007;25(13):2394–2397. doi: 10.1016/j.vaccine.2006.09.007.
    1. Rudan I, Lawn J, Cousens S, Rowe AK, Boschi-Pinto C, Tomaskovic L, Mendoza W, Lanata CF, Roca-Feltrer A, Carneiro I, Schellenberg JA, Polasek O, Weber M, Bryce J, Morris SS, Black RE, Campbell H. Gaps in policy-relevant information on burden of disease in children: a systematic review. Lancet. 2005;365(9476):2031–2040. doi: 10.1016/S0140-6736(05)66697-4.
    1. Scott JA, Brooks WA, Peiris JS, Holtzman D, Mulholland EK. Pneumonia research to reduce childhood mortality in the developing world. J Clin Invest. 2008;118(4):1291–1300. doi: 10.1172/JCI33947.
    1. O'Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine OS, Cherian T. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009;374(9693):893–902. doi: 10.1016/S0140-6736(09)61204-6.
    1. Watt JP, Wolfson LJ, O'Brien KL, Henkle E, Deloria-Knoll M, McCall N, Lee E, Levine OS, Hajjeh R, Mulholland K, Cherian T. Hib and Pneumococcal Global Burden of Disease Study Team. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet. 2009;374(9693):903–911. doi: 10.1016/S0140-6736(09)61203-4.
    1. Klugman KP, Chien YW, Madhi SA. Pneumococcal pneumonia and influenza: a deadly combination. Vaccine. 2009;27(Suppl 3):C9–C14. doi: 10.1016/j.vaccine.2009.06.007.
    1. Bellos A. Should mass vaccination with Haemophilus influenzae type b and pneumococcal conjugate vaccines be implemented in forced displacement settings? London School of Hygiene and Tropical Medicine; 2008.
    1. World Health Organization. International Classification of Diseases, version 10. World Health Organization; 2007.
    1. UCDP/PRIO Armed Conflict Dataset, Version 4-2009
    1. Feldstein B, Weiss R. Cambodian Disaster Relief: Refugee Camp Medical Care. American Journal of Public Health. 1982;72(6):589–594. doi: 10.2105/AJPH.72.6.589.
    1. Toole MJ, Bhatia R. A case study of Somali refugees in Hartisheik A Camp, Eastern Ethiopia: health and nutrition profile, July 1988-June 1990. Journal of Refugee Studies. 1992;5(3/4):313–326. doi: 10.1093/jrs/5.3-4.313.
    1. Babille M, De Colombani P, Guerra R, Zagaria N, Zanetti C. Post-emergency epidemiological surveillance in Iraqi-Kurdish refugee camps in Iran. Disasters. 1994;18(1):58–75. doi: 10.1111/j.1467-7717.1994.tb00285.x.
    1. From the Centers for Disease Control and Prevention. International notes: surveillance of health status of Bhutanese refugees--Nepal, 1992. JAMA. 1992;269(7):846–850.
    1. Marfin AA, Moore J, Collins C, Biellik R, Kattel U, Toole MJ, Moore PS. Infectious disease surveillance during emergency relief to Bhutanese refugees in Nepal. JAMA. 1994;272(5):377–381. doi: 10.1001/jama.272.5.377.
    1. Centers for Disease C, Prevention. Health status of displaced persons following Civil War--Burundi, December 1993-January 1994. MMWR Morb Mortal Wkly Rep. 1994;43(38):701–703.
    1. Centers for Disease C, Prevention. Morbidity and mortality surveillance in Rwandan refugees--Burundi and Zaire, 1994. MMWR Morb Mortal Wkly Rep. 1996;45(5):104–107.
    1. Dowell SF, Toko A, Sita C, Piarroux R, Duerr A, Woodruff BA. Health and nutrition in centers for unaccompanied refugee children. Experience from the 1994 Rwandan refugee crisis. JAMA. 1995;273(22):1802–1806. doi: 10.1001/jama.273.22.1802.
    1. Surveillance of communicable diseases among Kosovar refugees, Albania, April-June 1999. Weekly Epidemiological Record. 1999;74(37):308.
    1. Kondaj R. Management of refugee crisis in Albania during the 1999 Kosovo conflict. Croat Med J. 2002;43(2):190–194.
    1. Ruiz E, Puges X, Artigues J, Garcia De Olalla P, Castellsague X, Jansa J. [Health intervention in an Albanian-Kosovar refugees camp] Gac Sanit. 2001;15(4):356–358.
    1. Gonzalez Galnares M, Guiscafre Gallardo H, Moreno Altamirano L, Avila Lopez F, Martinez Garcia MdC, Flores Huerta S, Vazquez Carrasco JL, Munoz Hernandez O. Transmissible diseases of Guatemalan refugees and rural Mexicans in Chiapas state. Salud Publica de Mexico. 1987;29(1):41–48.
    1. Diaz T, Achi R. Infectious diseases in a Nicaraguan refugee camp in Costa Rica. Trop Doct. 1989;19(1):14–17.
    1. Morgan WA. Experience of a clinic for Afghan refugees in Pakistan. West J Med. 1988;149(2):234–238.
    1. Elias CJ, Alexander BH, Sokly T. Infectious Disease Control in a Long-Term Refugee Camp: The Role of Epidemiologic Surveillance and Investigation. American Journal of Public Health. 1990;80(7):824–828. doi: 10.2105/AJPH.80.7.824.
    1. Fontanet AL, McCauley RG, Coyette Y, Larchiver F, Bennish ML. Incidence, management, and outcome of childhood empyema: a prospective study of children in Cambodian refugee camps. Am J Trop Med Hyg. 1993;49(6):789–798.
    1. Taylor WR. Measles in Vietnamese Refugee Children in Hong Kong. Epidemiology and Infection. 1999;122(3):441–446. doi: 10.1017/S0950268899002447.
    1. Orach CG. Morbidity and mortality amongst southern Sudanese in Koboko refugee camps, Arua District, Uganda. East Afr Med J. 1999;76(4):195–199.
    1. Accorsi S, Fabiani M, Lukwiya M, Ravera M, Costanzi A, Ojom L, Paze E, Manenti F, Anguzu P, Dente M, Declich S. Italian-Ugandan AIDS Cooperation Programme. Impact of insecurity, the AIDS epidemic, and poverty on population health: disease patterns and trends in Northern Uganda. Am J Trop Med Hyg. 2001;64(3):214–221.
    1. Accorsi S, Fabiani M, Nattabi B, Corrado B, Iriso R, Ayella EO, Pido B, Onek PA, Ogwang M, Declich S. The disease profile of poverty: morbidity and mortality in northern Uganda in the context of war, population displacement and HIV/AIDS. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2005;99(3):226–233. doi: 10.1016/j.trstmh.2004.09.008.
    1. Pinto A, Saeed M, El Sakka H, Rashford A, Colombo A, Valenciano M, Sabatinelli G. Setting up an early warning system for epidemic-prone diseases in Darfur: a participative approach. Disasters. 2005;29(4):310–322. doi: 10.1111/j.0361-3666.2005.00294.x.
    1. Sodemann M, Veirum J, Biai S, Nielsen J, Bale C, Jakobsen MS, Gustafson P, Aaby P. Reduced case fatality among hospitalized children during a war in Guinea-Bissau: a lesson in equity. Acta Paediatrica. 2004;93(7):959–964. doi: 10.1080/08035250410025564.
    1. Prasad AN. Disease profile of children in Kabul: the unmet need for health care. J Epidemiol Community Health. 2006;60(1):20–23. doi: 10.1136/jech.2005.040147.
    1. Stevens JC, Reilley B, Hargreaves S, Sattar A. A year in Afghanistan - Herat hospital paediatric ward. British Journal of General Practice. 2004;54(507):794–795.
    1. Huerga H, Vasset B, Prados E. Adult and paediatric mortality patterns in a referral hospital in Liberia 1 year after the end of the war. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009;103(5):476–484. doi: 10.1016/j.trstmh.2008.12.004.
    1. Tanaka H, Oda J, Iwai A, Kuwagata Y, Matsuoka T, Takaoka M, Kishi M, Morimoto F, Ishikawa K, Mizushima Y, Nakata Y, Yamamura H, Hiraide A, Shimazu T, Yoshioka T. Morbidity and mortality of hospitalized patients after the 1995 Hanshin-Awaji earthquake. The American Journal of Emergency Medicine. 1999;17(2):186–191. doi: 10.1016/S0735-6757(99)90059-1.
    1. Chen KT, Chen WJ, Malilay J, Twu SJ. The public health response to the Chi-Chi earthquake in Taiwan, 1999. Public Health Rep. 2003;118(6):493–499.
    1. Jonaidi Jafari N, Radfar MH, Ghofrani H. Incidence of infectious diseases one month after the bam eartquake (2004) Journal of Medical Sciences. 2007;7(4):597–602. doi: 10.3923/jms.2007.597.602.
    1. Krieg CM, Gardemann J. A record of morbidity and medical request profiles in international humanitarian aid, taking the earthquake in Bam in Iran in 2003 as an example. Journal of Public Health. 2009;17(2):97–106. doi: 10.1007/s10389-008-0230-9.
    1. Bai XD, Liu XH. Retrospective analysis: The earthquake-injured patients in Barakott of Pakistan. Chinese Journal of Traumatology (English Edition) 2009;12(2):122–124.
    1. World Health Organization. South Asia earthquake Weekly Mortality and Morbidity Reports archive 2006. Geneva: World Health Organization; 2005. Accessed 8 November 2009.
    1. Siddique AK, Baqui AH, Eusof A, Zaman K. 1988 floods in Bangladesh: pattern of illness and causes of death. J Diarrhoeal Dis Res. 1991;9(4):310–314.
    1. Kondo H, Seo N, Yasuda T, Hasizume M, Koido Y, Ninomiya N, Yamamoto Y. Post-flood--infectious diseases in Mozambique. Prehosp Disaster Med. 2002;17(3):126–133.
    1. Cariappa MP, Khanduri P. Health emergencies in large populations: The Orissa experience. Medical Journal of the Armed Forces of India. 2003;59(4):286–289.
    1. Fan SW. Clinical cases seen in tsunami hit Banda Aceh: from a primary health care perspective. Ann Acad Med Singapore. 2006;35(1):54–59.
    1. Malilay J, Real MG, Ramirez Vanegas A, Noji E, Sinks T. Public health surveillance after a volcanic eruption: lessons from Cerro Negro, Nicaragua, 1992. Bull Pan Am Health Organ. 1996;30(3):218–226.
    1. United States Census Bureau. International database. 2009. accessed 8 November 2009.
    1. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997;349(9061):1269–1276. doi: 10.1016/S0140-6736(96)07493-4.
    1. Naheed A, Saha SK, Breiman RF, Khatun F, Brooks WA, El Arifeen S, Sack D, Luby SP. Multihospital Surveillance of Pneumonia Burden among Children Aged <5 Years Hospitalized for Pneumonia in Bangladesh. Clinical Infectious Diseases. 2009;48(s2):S82–S89. doi: 10.1086/596485.
    1. Magree HC, Russell FM, Sa'aga R, Greenwood P, Tikoduadua L, Pryor J, Waqatakirewa L, Carapetis JR, Mulholland EK. Chest X-ray-confirmed pneumonia in children in Fiji. Bull World Health Organ. 2005;83(6):427–433.
    1. Nantanda R, Hildenwall H, Peterson S, Kaddu-Mulindwa D, Kalyesubula I, Tumwine JK. Bacterial aetiology and outcome in children with severe pneumonia in Uganda. Ann Trop Paediatr. 2008;28(4):253–260. doi: 10.1179/146532808X375404.
    1. United Nations Children's Fund, World Health Organization. Pneumonia: the forgotten killer of children. New York: Unicef; 2006.
    1. Salama P, Spiegel P, Talley L, Waldman R. Lessons learned from complex emergencies over past decade. Lancet. 2004;364(9447):1801–1813. doi: 10.1016/S0140-6736(04)17405-9.
    1. Kallander K, Nsungwa-Sabiiti J, Peterson S. Symptom overlap for malaria and pneumonia--policy implications for home management strategies. Acta Trop. 2004;90(2):211–214. doi: 10.1016/j.actatropica.2003.11.013.
    1. Kallander K, Hildenwall H, Waiswa P, Galiwango E, Peterson S, Pariyo G. Delayed care seeking for fatal pneumonia in children aged under five years in Uganda: a case-series study. Bull World Health Organ. 2008;86(5):332–338. doi: 10.2471/BLT.07.049353.
    1. Watson JT, Gayer M, Connolly MA. Epidemics after natural disasters. Emerg Infect Dis. 2007;13(1):1–5. doi: 10.3201/eid1301.060779.
    1. Greenwood BM, Weber MW, Mulholland K. Childhood pneumonia--preventing the worlds biggest killer of children. Bull World Health Organ. 2007;85(7):502–503. doi: 10.2471/BLT.07.044032.
    1. Ministry of Health Pakistan, WHO. Weekly Morbidity and Mortality Report 1 May 2006 edition. 2006.

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