Abstract
BackgroundEpidemics 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.MethodsReported 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 2010–2019.ResultsA 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.ConclusionThe 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.
Highlights
Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations
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
Our search focused on epidemic-prone pathogens commonly occurring in low resource or humanitarian settings and which presented an immediate threat to life
Summary
Epidemics of infectious disease occur frequently in low-income and humanitarian settings and pose a serious threat to populations. 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]. Responses to large-scale epidemics or epidemics of newly emergent pathogens tend to generate global attention and corresponding responses incur scrutiny [7–9]. 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]
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