REACTION PAPER

Non-communicable diseases (NCDs) are the primary cause of morbidity and

mortality worldwide with 38 million deaths mainly due to cardiovascular diseases,
diabetes, cancer, and chronic diseases. Almost three-fourths of NCD-related deaths
occur in low and middle-income countries. Humanitarian crises or emergencies stems
from internal or external conflicts, natural disasters, epidemic or pandemic, and complex
emergencies prevents already fragile health care systems in LMICs from timely and
appropriately respond to acute and chronic care needs, increase the risk of acute non-
communicable disease, may compromise prevention and control of these diseases over
a prolonged period, and increase costs of managing complications for humanitarian
agencies. To guide the government and humanitarian organizations, and international
agencies to effectively tackle NCDS during humanitarian crises in LCIMs, research on
examining effectiveness interventions in such settings are highly required.

Blanchet, et al.’s research The Effectiveness of Interventions for Non-

Communicable Diseases in Humanitarian Crises: A Systematic Reviewis the first
systematic review that examines the evidences on effectiveness ofinterventions
targeting NCDsduring humanitarian crises in low-and-middle income countries (LMICs).
The study aimed to describe the study characteristics, examine evidence on
effectiveness of NCDS in humanitarian crises, and assess the quality of the evidence on
NCD interventions in humanitarian crises. Among the 4919 citations yielded from
various bibliography databases such as MEDLIINE, Embase, Global health, etc., only 8
studies met the criteria for the selection of studies to be reviewed. All of them were
published between 1197 and 2014 that were con ducted in 5 different countries –
Afghanistan, Georgia, India, Jordan, and Turkey. Among these selected studies, 7 of
them were observational and 1 study was a non-blinded randominsed controlled trial.
Moreover, 7 of the studies were on populations affected by armed conflict while the
remaining study was on a population affected by earthquake. These studies addressed
a range of NCDs including arthritis, chronic kidney disease, diabetes, heart failure,
hypertension, and thalassemia (cancer and respiratory disease were not included). All
studies examined outcomes at the individual patient level and were primarily focused on
disease management rather than prevention or health promotion. Based on the quality
assessment of these studies, deficiencies common to the observational studies were
predominantly related to comparability and follow-up. None of the studies had a defined
comparison group or unexposed cohort. Study transparency was also noted to be a
weakness common to all observational studies. In addition, results from the quality
assessment of the randomized controlled trial (RCT) study from India using the
Cochrane Risk of Bias Tool shows that there was a high risk of selection,
performance, and detection bias. All members of the research team appeared to
have had knowledge of patients' treatment.
 The research article was hard to understand. When I read the title I was
expecting to learn the most effective interventions for NCDs in humanitarian crises
based on examining the existing studies. What I had in mind was after reading its
abstract, its results, and its conclusions, there will be a comparison and ranking of
the eight selected studies to be reviewed, based on the effectiveness of
interventions and its evidences that were presented in each of the studies. Rather, a
descriptive analysis of the studies was reported in the synthesis of results. This was
because all eight studies reviewed were heterogeneous in setting, intervention and
outcome. For example, two cohort studies were used to test interventions related to
cardiovascular disorders, which were the Georgia study by Hebert et al. on the
treatment program for heart failure and the Khader et al. study on the hypertension
management program in Jordan. Both research centered on the application of
algorithms for disease control in humanitarian crisis settings and aimed to highlight
both the effectiveness and the complexities of such programmes. The only
difference of the two was their context wherein the study in Georgia was examining
the effectiveness of a health programme that then experienced the outbreak of war
during the intervention, while the study in Jordan took place in a long-term refugee
setting that was relatively stable during the study period.
It was only after I read the entire research article that I was able to understand
the significance of the findings. I was able to determine that the research was able to
achieve its specific and learn the various interventions, but the discussion part of the
research article helped me fully understand the quality assessment and its results. It
made me realize that the quality assessment of these studies was not to rank or
screen them out but was actually to assess the strength and weaknesses of each
study. The studies have various strengths but they are outweighed by the
weaknesses identified. One of the weaknesses was none of the interventions in the
studies prioritized preparedness for crisis in relation to NCD management. In
addition, none of the studies examined the effectiveness of NCD prevention
activities despite prevention being central to global efforts to tackle NCDs.Other
common weaknesses between the studies was the high bias risk and lack of
discussion on how missing data were addressed. This proves the insufficiency of
systematic review researches regarding humanitarian crises and how it affects
NCDs in a community.
In conclusion, the research article provides a lot of information but it is very timely
in order to fully comprehend it. Understanding of the methodology is also very
important to appreciate the results and relate them to the concept of the study all
throughout the discussion. It is evident that the insufficiency of researches such as
this research article is due to the difficulty of research during a humanitarian crisis.
Researching NCDs is arguably even harder as their chronic nature tends to demand
more substantial follow-up.
REFERENCE:

Ruby, A., Knight, A., Perel, P., Blanchet, K., & Roberts, B. (2015). The Effectiveness of Interventions for Non-
Communicable Diseases in Humanitarian Crises: A Systematic Review. PLOS ONE, 10(9), e0138303.
https://doi.org/10.1371/journal.pone.0138303