The knowledge hub collates key resources to support the community of humanitarian organizations and academic institutions committed to improving the lives of people living with noncommunicable diseases in humanitarian settings. The hub’s core team are members of the Centre for Global Chronic Conditions at LSHTM. The centre works in partnership with leading international NGOs, key UN agencies, and academic partners to improve NCD care delivery in humanitarian settings.
The hub acts as a repository of resources and tools to support practitioners delivering and evaluating NCD care in fragile and conflict settings. We have included clinical, operational and training guidelines and tools, as well as monitoring, evaluation and research tools.
We have gathered published research, reports, commentaries and opinion pieces related to NCDs in humanitarian settings. All items are open-access publications and the list will be continuously updated with emerging research to keep it relevant to the community.
LSHTM undertakes implementation research and mixed methods evaluations, developing methods around the use of routine clinical data in the context of interrupted health care delivery. Current projects focus on diabetes, hypertension and cardiovascular disease, integrating mental and physical NCD care and the impact of Covid-19 on NCD care delivery. We also feature research projects undertaken by other organisations.
The knowledge hub
The knowledge hub collates key resources to support the community of humanitarian organizations and academic institutions committed to improving the lives of people living with noncommunicable diseases in humanitarian settings. The repository includes materials, tools, publications and other resources to facilitate access, knowledge sharing and mutual learning amongst actors in the field. The knowledge hub is facilitated by the Global Centre for Chronic Conditions at LSHTM, with a cross-disciplinary core team.
The Global Centre for Chronic Conditions collaborates with partners to improve NCD care delivery in humanitarian crises, including fragile health systems, disaster and conflict settings. We aim to:
- Grow the knowledge base via pragmatic evaluations, implementation research, quasi-experimental and innovative approaches to research in fragile humanitarian settings
- Support practitioners designing and delivering NCD care in fragile health systems, disaster and conflict settings
- Work on innovative approaches to chronic care delivery in the setting of healthcare disruption
- Collate evidence, guidelines and tools to manage NCDs in humanitarian settings
- Convene different actors (academia, NGOs, UN agencies, governments)
- Engage in shared learning with partners and building research capacity as relevant
We work with academic partners in Lebanon, Jordan, Iraq, UK and US and with major international humanitarian NGOs and UN agencies. We undertake implementation research, mixed methods evaluations and have developed methodology around the use of routine clinical data in the context of interrupted health care delivery. The focus of our work is on diabetes, hypertension and cardiovascular disease, integrating mental and physical NCD care and the impact of Covid19 on NCD care delivery.
Partners and funders
The NCDs in Humanitarian Setting Special Interest Group of the Global Centre for Chronic Conditions at the London School of Hygiene and Tropical Medicine works with a variety of partners. These include humanitarian implementing organisations, academic institutions, UN bodies and funding bodies, such as the Global Alliance for Chronic Conditions and the private sector.
The knowledge hub is hosted and maintained by the CGCC at LSHTM. Seed funding for site development was provided by Novo Nordisk A/S. The funder has had no role in the design, selection of content or governance of the site.
The knowledge hub has collated the following tools and resources for use by humanitarian actors and researchers. The list will be updated with new resources and tools continuously. Most resources are open access, while some may require consultation with the originator, as indicated.
- Clinical and operational guidelines
- Age and Disability Capacity Programme (ADCAP). HelpAge International. 2015.
- BUILDING BACK BETTER: Sustainable mental health care after emergencies. World Health Organization. 2013.
- IASC Guidance on Operational Considerations for Multisectoral Mental Health and Psychosocial Support Programmes during the COVID-19 Pandemic. Inter-Agency Standing Committee. 2020.
- IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Inter-Agency Standing Committee. 2007.
- Integrating non-communicable disease care in humanitarian settings: an operational guide. United Nations High Commissioner for Refugees. 2020.
- Management of Diabetic Foot. International Committee of the Red Cross. 2020.
- Managing Projects Addressing Non-communicable Diseases: Operational Guidelines for Field Staff. International Committee of the Red Cross. 2018.
- mhGAP Humanitarian Intervention Guide (mhGAP-HIG). World Health Organization, United Nations High Commissioner for Refugees. 2015.
- Non-Communicable Diseases - programmatic and clinical guidelines. Médecins Sans Frontières. 2020.
- Noncommunicable Diseases in Emergencies. World Health Organization, UN Interagency Task Force on NCDs. 2016.
- Operational guidance, mental health & psychosocial support programming for refugee operations. United Nations High Commissioner for Refugees. 2013.
- Package of Essential Non-communicable Diseases Interventions for Humanitarian settings (PEN-H). International Rescue Committee. 2020.
- Problem management plus (PM+): individual psychological help for adults impaired by distress in communities exposed to adversity. World Health Organization. 2016.
- Promoting Treatment Adherence for Refugees and Persons of Concern in Health Care Settings - Tips for health workers. United Nations High Commissioner for Refugees. 2019.
- Rapid assessment of alcohol and other substance use in conflict-affected and displaced populations: a field guide. World Health Organization, United Nations High Commissioner for Refugees. 2008.
- Self‐Help Plus (SH+): a new WHO stress management package. World Health Organization. 2016.
- The Sphere Handbook 2018. Sphere.
- Clinical and operational tools
- Assessing Mental Health and Psychosocial Needs and Resources. World Health Organization, United Nations High Commissioner for Refugees. 2019.
- Checklist for field use of IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Inter-Agency Standing Committee.
- Healthy ageing toolkit. International Federation of the Red Cross. 2016.
- IASC, Who is Where, When, doing What in Mental Health and Psychosocial Support (4W Tool). Inter-Agency Standing Committee. 2014.
- Linking Disaster Risk Reduction (DRR) and Mental Health and Psychosocial Support (MHPSS). Practical Tools, Approaches and Case Studies. Inter-Agency Standing Committee. 2021.
- Living with the Times, A Mental Health and Psychosocial Support Toolkit for Older Adults During the COVID-19 Pandemic. Inter-Agency Standing Committee.
- Psychological first aid. Facilitator’s manual for orienting field workers. World Health Organization. 2013.
- The Noncommunicable Disease (NCD) COVID-19 Toolkit for FETPs. TEPHINET Secretariat.
- Training materials and tools
- Different. Just like you: A psychosocial approach promoting the inclusion of persons with disabilities. IFRC PS Centre.
- eCBHFA Community-based health and first aid programme for volunteers and facilitators. IFRC PS Centre.
- IASC, Mental Health and Psychosocial Support in Emergency Settings for Protection Programme Managers, for Humanitarian Health Actors, for Camp Coordinators and Camp Manager Actors. Inter-Agency Standing Committee.
- ICRC Training Centre [not open-access]. International Federation of Red Cross and Red Crescent Societies.
- MOOC: Non-Communicable Diseases in Humanitarian Settings. University of Copenhagen
- MSF Academy [not open-access]. Médecins Sans Frontières.
- Online course: Non-Communicable Diseases in Humanitarian Settings. Danish Red Cross, The International Federation of Red Cross and Red Crescent Societies.
- PCI Academy [not open-access]. Primary Care International.
- Psychological first aid guide and training. IFRC PS Centre.
- Short course: Non-Communicable Diseases in Humanitarian Settings [not open-access]. Geneva Centre of Humanitarian Studies, London School of Hygiene and Tropical Medicine.
- Monitoring, evaluation and research tools
- Child Friendly Activity Cards – Monitoring & Evaluation Form. IFRC PS Centre, World Vision International. 2020.
- Children’s Resilience Programme – Data Collection Tool. IFRC PS Centre, Save the Children Denmark. 2012.
- IASC Common Monitoring and Evaluation Framework for Mental Health and Psychosocial Support Programmes in Emergency Settings. Inter-Agency Standing Committee. 2017.
- IASC Recommendations for Conducting Ethical Mental Health and Psychosocial Research in Emergency Settings. Inter-Agency Standing Committee. 2014.
- IASC Reference Group Mental Health and Psychosocial Support Assessment Guide. Inter-Agency Standing Committee. 2012. https://interagencystandingcommittee.org
- IFRC Monitoring and evaluation framework for psychosocial support interventions – toolbox, indicator guide, and guidance note. IFRC PS Centre. 2017.
- Monitoring and Evaluation for MHPSS in COVID-19. IFRC PS Centre. 2020.
- The co-production of research between academics, NGOs and communities in humanitarian response: A practice guide. Michelle Lokot, Caitlin Wake. 2021.
This page is regularly updated with new resources. If you are aware of any materials that are missing from this page or would like to contribute your organisation’s tools, please contact Dr Éimhín Ansbro at firstname.lastname@example.org.
This page collates key publications and reports on NCDs in humanitarian settings. We have structured these according to their main themes such as disease burden, access to care, models of care and NCD policy and strategy.
- Perspectives and commentaries
- Addressing chronic diseases in protracted emergencies: Lessons from HIV for a new health imperative. Rabkin M, Fouad FM, El-Sadr WM. Glob Public Health. 2018 Feb;13(2):227-233. doi: 10.1080/17441692.2016.1176226. Epub 2016 May 4. PMID: 27141922.
- At the heart of the conflict. Ansbro É, Perel P. Heart. 2019 Sep;105(18):1382-1383. doi: 10.1136/heartjnl-2019-315010. Epub 2019 Jun 1. PMID: 31154428.
- Care of non-communicable diseases in emergencies. Slama S, Kim HJ, Roglic G, Boulle P, Hering H, Varghese C, Rasheed S, Tonelli M. Lancet. 2017 Jan 21;389(10066):326-330. doi: 10.1016/S0140-6736(16)31404-0. Epub 2016 Sep 13. PMID: 27637675.
- Centers for Disease Control and Prevention public health response to humanitarian emergencies, 2007–2016. Boyd AT, Cookson ST, Anderson M, Bilukha OO, Brennan M, Handzel T, Hardy C, Husain F, Cardozo BL, Colorado CN, Shahpar C. Emerging infectious diseases. 2017 Dec;23(Suppl 1):S196.
- Challenges associated with providing diabetes care in humanitarian settings. Boulle P, Kehlenbrink S, Smith J, Beran D, Jobanputra K. Lancet Diabetes Endocrinol. 2019 Aug;7(8):648-656. doi: 10.1016/S2213-8587(19)30083-X. Epub 2019 Mar 14. PMID: 30878269.
- Diabetes in humanitarian crises: the Boston Declaration. Kehlenbrink S, Jaacks LM; Boston Declaration signatories. Lancet Diabetes Endocrinol. 2019 Aug;7(8):590-592. doi: 10.1016/S2213-8587(19)30197-4. Epub 2019 Jun 6. Erratum in: Lancet Diabetes Endocrinol. 2019 Aug;7(8):e20. PMID: 31178312.
- ICRC’s Non-communicable diseases management: the experience of a humanitarian organization. Aebischer Peron S, Martinez E. Politorbis Nr. 67 – 1 / 2019
- Looking beyond the issue of access to insulin: what is needed for proper diabetes care in resource poor settings. Beran D, Yudkin JS. Diabetes Res Clin Pract. 2010 Jun;88(3):217-21. doi: 10.1016/j.diabres.2010.03.029. Epub 2010 May 5. PMID: 20447710.
- Modifying the Interagency Emergency Health Kit to include treatment for non-communicable diseases in natural disasters and complex emergencies. Tonelli M, Wiebe N, Nadler B, Darzi A, Rasheed S. BMJ Glob Health. 2016 Oct 20;1(3):e000128. doi: 10.1136/bmjgh-2016-000128. PMID: 28588970; PMCID: PMC5321368.
- Noncommunicable diseases and post-conflict countries. Roberts B, Patel P, McKee M. Bulletin of the World Health Organization. 2012;90:2-A.
- Non-communicable diseases in emergencies: a call to action. Demaio A, Jamieson J, Horn R, de Courten M, Tellier S. PLoS Curr. 2013 Sep 6;5.doi: 10.1371/currents.dis.53e08b951d59ff913ab8b9bb51c4d0de. PMID: 24056956; PMCID: PMC3775888.
- Non-communicable diseases in humanitarian settings: ten essential questions. Aebischer Perone S, Martinez E, du Mortier S, Rossi R, Pahud M, Urbaniak V, Chappuis F, Hagon O, Jacquérioz Bausch F, Beran D. Confl Health. 2017 Sep 17;11:17. doi: 10.1186/s13031-017-0119-8. PMID: 28932259; PMCID: PMC5602789.
- Operational considerations for the management of non-communicable diseases in humanitarian emergencies. Bausch, F.J., Beran, D., Hering, H. et al. Confl Health 15, 9 (2021). https://doi.org/10.1186/s13031-021-00345-w
- Simple ideas to mitigate the impacts of the COVID-19 epidemic on refugees with chronic diseases. Fawad M, Rawashdeh F, Parmar PK, Ratnayake R. Conflict and health. 2020 Dec;14(1):1-2.
- The development of the noncommunicable diseases emergency health kit. Slama S, Lee J, Aragno M, Laroche S, Hogerzeil H. East Mediterr Health J. 2018 Apr 5;24(1):92-98. PMID: 29658625.
- Three Steps to Improve Management of Noncommunicable Diseases in Humanitarian Crises. Jobanputra K, Boulle P, Roberts B, Perel P. PLoS Med. 2016 Nov 8;13(11):e1002180. doi: 10.1371/journal.pmed.1002180. PMID: 27824879; PMCID: PMC5100924.
- Addressing noncommunicable diseases among urban refugees in the Middle East and North Africa - a scoping review. McNatt, Z. Confl Health 14, 9 (2020). https://doi.org/10.1186/s13031-020-0255-4
- A systematic review of the burden of hypertension, access to services and patient views of hypertension in humanitarian crisis settings. Keasley J, Oyebode O, Shantikumar S, Proto W, McGranahan M, Sabouni A, Kidy F. BMJ Glob Health. 2020 Nov;5(11):e002440. doi: 10.1136/bmjgh-2020-002440. PMID: 33168520; PMCID: PMC7654140.
- Burden of cardiovascular morbidity and mortality following humanitarian emergencies: a systematic literature review. Hayman KG, Sharma D, Wardlow RD, Singh S. Prehospital and disaster medicine. 2015 Feb;30(1):80-8.
- Factors influencing the effective management of diabetes during humanitarian crises in low-and middle-income countries: a systematic review. [not open-access] Song K, Lee A. Public Health. 2021 Oct 1;199:110-7.
- Host country responses to non-communicable diseases amongst Syrian refugees: a review. Akik C, Ghattas H, Mesmar S, Rabkin M, El-Sadr WM, Fouad FM. Confl Health. 2019 Mar 22;13:8. doi: 10.1186/s13031-019-0192-2. PMID: 30949232; PMCID: PMC6431037.
- Identifying and describing the impact of cyclone, storm and flood related disasters on treatment management, care and exacerbations of non-communicable diseases and the implications for public health. Ryan B, Franklin RC, Burkle Jr FM, Aitken P, Smith E, Watt K, Leggat P. PLoS currents. 2015 Sep 28;7.
- Impact of armed conflict on cardiovascular disease risk: a systematic review. Jawad M, Vamos EP, Najim M, Roberts B, Millett C. Heart. 2019 Sep 1;105(18):1388-94.
- Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review. Jaung MS, Willis R, Sharma P, Aebischer Perone S, Frederiksen S, Truppa C, Roberts B, Perel P, Blanchet K, Ansbro É. Health Policy Plan. 2021 May 17;36(4):509-532. doi: 10.1093/heapol/czab007. PMID: 33693657; PMCID: PMC8128021.
- Issue brief: Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review. Partnering for Change. 2021 Sep.
- No calm after the storm: a systematic review of human health following flood and storm disasters. Prehospital and disaster medicine. Saulnier DD, Ribacke KB, von Schreeb J. 2017 Oct;32(5):568-79.
- Psychological therapies for the treatment of mental disorders in low‐and middle‐income countries affected by humanitarian crises. Purgato M, Gastaldon C, Papola D, Van Ommeren M, Barbui C, Tol WA. Cochrane Database of Systematic Reviews. 2018(7).
- The burden of diabetes and use of diabetes care in humanitarian crises in low-income and middle-income countries.Kehlenbrink S, Smith J, Ansbro É, Fuhr DC, Cheung A, Ratnayake R, Boulle P, Jobanputra K, Perel P, Roberts B. Lancet Diabetes Endocrinol. 2019 Aug;7(8):638-647. doi: 10.1016/S2213-8587(19)30082-8.Epub 2019 Mar 14. PMID: 30878268.
- The culture, mental health and psychosocial wellbeing of Rohingya refugees: a systematic review. Tay AK, Riley A, Islam R, Welton-Mitchell C, Duchesne B, Waters V, Varner A, Moussa B, Alam AM, Elshazly MA, Silove D. Epidemiology and psychiatric sciences. 2019 Oct;28(5):489-94.
- The Effectiveness of Interventions for Non-Communicable Diseases in Humanitarian Crises: A Systematic Review. Ruby A, Knight A, Perel P, Blanchet K, Roberts B. PLoS One. 2015 Sep 25;10(9):e0138303. doi: 10.1371/journal.pone.0138303. PMID: 26406317; PMCID: PMC4583445.
- Burden of disease
- Cardiovascular Disease among Syrian refugees: a descriptive study of patients in two Médecins Sans Frontières clinics in northern Lebanon. Boulle P, Sibourd-Baudry A, Ansbro É, Prieto Merino D, Saleh N, Zeidan RK, Perel P. Confl Health. 2019 Aug 9;13:37. doi: 10.1186/s13031-019-0217-x. PMID: 31413727; PMCID: PMC6688221.
- Chronic disease and disability among Iraqi populations displaced in Jordan and Syria. Doocy S, Sirois A, Tileva M, Storey JD, Burnham G. Int J Health Plann Manage. 2013 Jan-Mar;28(1):e1-e12. doi: 10.1002/hpm.2119. Epub 2012 Jun 8. PMID: 22685057.
- Factors affecting the prevalence of chronic diseases in Palestinian people: an analysis of data from the Palestinian Central Bureau of Statistics. Abukhdeir HF, Caplan LS, Reese L, Alema-Mensah E. East Mediterr Health J. 2013 Apr;19(4):307-13. PMID: 23882954; PMCID: PMC4143143.
- Health status and health needs of older refugees from Syria in Lebanon. Strong J, Varady C, Chahda N, Doocy S, Burnham G. Confl Health. 2015 Apr 9;9:12. doi: 10.1186/s13031-014-0029-y. PMID: 26056531; PMCID: PMC4459463.
- Medical conditions among Iraqi refugees in Jordan: data from the United Nations Refugee Assistance Information System. Mateen FJ, Carone M, Al-Saedy H, Nyce S, Ghosn J, Mutuerandu T, Black RE. Bull World Health Organ. 2012 Jun 1;90(6):444-51. doi: 10.2471/BLT.11.097048. Epub 2012 Apr 11. PMID: 22690034; PMCID: PMC3370367.
- Prevalence of patients with end-stage renal disease on dialysis in the West Bank, Palestine. Khader MI, Snouber S, Alkhatib A, Nazzal Z, Dudin A. Saudi J Kidney Dis Transpl. 2013 Jul;24(4):832-7. doi: 10.4103/1319-2442.113913. PMID: 23816745.
- The Effect of War on Syrian Refugees With End-Stage Renal Disease. Isreb MA, Kaysi S, Rifai AO, Al Kukhun H, Al-Adwan SAS, Kass-Hout TA, Sekkarie MA. Kidney Int Rep. 2017 May 26;2(5):960-963. doi: 10.1016/j.ekir.2017.05.009. PMID: 29270503; PMCID: PMC5733747.
- The effect of war on the control of diabetes in patients with type 2 diabetes mellitus in Yemen: a cross-sectional study. Al-Sharafi BA, Al-Tahami BA. Endocrinol Metab Syndr. 2017;6(270):2161-1017.
- "To die is better for me", social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study. Maconick L, Ansbro É, Ellithy S, Jobanputra K, Tarawneh M, Roberts B. Confl Health. 2020 Sep 1;14:63. doi: 10.1186/s13031-020-00309-6. PMID: 32905304; PMCID: PMC7465779.
- Access to care
- Access to care and prevalence of hypertension and diabetes among Syrian refugees in northern Jordan. Ratnayake R, Rawashdeh F, AbuAlRub R, Al-Ali N, Fawad M, Hani MB, Goyal R, Greenough PG, Al-Amire K, AlMaaitah R, Parmar P. JAMA network open. 2020 Oct 1;3(10):e2021678-.
- Access to care for non-communicable diseases in Mosul, Iraq between 2014 and 2017: a rapid qualitative study. Baxter LM, Eldin MS, Al Mohammed A, Saim M, Checchi F. Conflict and health. 2018 Dec;12(1):1-4.
- Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan. Doocy S, Lyles E, Akhu-Zaheya L, Oweis A, Al Ward N, Burton A. PLoS One. 2016 Apr 13;11(4):e0150088. doi: 10.1371/journal.pone.0150088. PMID: 27073930; PMCID: PMC4830531.
- “I try the one that they say is good.” - factors influencing choice of health care provider and pathways to diabetes care for Syrian refugees in Lebanon. Haderer, F., Venables, E., van Olmen, J. et al. Confl Health 15, 45 (2021). https://doi.org/10.1186/s13031-021-00375-4
- Prevalence and care-seeking for chronic diseases among Syrian refugees in Jordan. Doocy S, Lyles E, Roberton T, Akhu-Zaheya L, Oweis A, Burnham G. BMC Public Health. 2015 Oct 31;15:1097. doi: 10.1186/s12889-015-2429-3. PMID: 26521231; PMCID: PMC4628338.
- Noncommunicable disease burden among conflict-affected adults in Ukraine: A cross-sectional study of prevalence, risk factors, and effect of conflict on severity of disease and access to care. Greene-Cramer B, Summers A, Lopes-Cardozo B, Husain F, Couture A, Bilukha O. PLoS One. 2020 Apr 21;15(4):e0231899. doi: 10.1371/journal.pone.0231899. PMID: 32315357; PMCID: PMC7173772.
- Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon. Doocy S, Lyles E, Hanquart B; LHAS Study Team, Woodman M. Confl Health. 2016 Oct 19;10:21. doi: 10.1186/s13031-016-0088-3. PMID: 27777613; PMCID: PMC5070168.
- Prevalence, management and control of diabetes mellitus among Syrian refugees in Duhok governorate, Kurdistan Region of Iraq–a cross sectional study in the camp of Domiz 1. Shamsi HG. LSMU research information system
- Prevalence of non-communicable diseases and access to care among non-camp Syrian refugees in northern Jordan. Rehr M, Shoaib M, Ellithy S, Okour S, Ariti C, Ait-Bouziad I, van den Bosch P, Deprade A, Altarawneh M, Shafei A, Gabashneh S, Lenglet A. Confl Health. 2018 Jul 11;12:33. doi: 10.1186/s13031-018-0168-7. PMID: 30008800; PMCID: PMC6040066.
- Prevalence of non-communicable diseases and access to health care and medications among Yazidis and other minority groups displaced by ISIS into the Kurdistan Region of Iraq. Cetorelli V, Burnham G, Shabila N. Confl Health. 2017 Apr 6;11:4. doi: 10.1186/s13031-017-0106-0. PMID: 28396693; PMCID: PMC5382370.
- "What's happening in Syria even affects the rocks": a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan. McNatt ZZ, Freels PE, Chandler H, Fawad M, Qarmout S, Al-Oraibi AS, Boothby N. Confl Health. 2019 Jun 13;13:26. doi: 10.1186/s13031-019-0209-x. PMID: 31210780; PMCID: PMC6567402.
- Models of care
- Adaptation of a community health volunteer strategy for the management of hypertension and diabetes and detection of COVID-19 disease: a progamme for Syrian refugees in northern Jordan. Ratnayake R, Rawashdeh F, Hani MB, Zoubi S, Fawad M, AbuAlRub R, Al-Ali N, Goyal R, Al-Amire K, AlMaaitah R, Parmar P. The Lancet Global Health. 2021 Mar 1;9:S14.
- A social-network behavioral health program on sustained long-term body weight and glycemic outcomes: 2-year follow-up of a 4-month Microclinic Health Program in Jordan. Zoughbie DE, Rushakoff JA, Watson KT, Bui N, Ireifij A, Farraj RS, Ding EL. Prev Med Rep. 2018 Dec 13;13:160-165. doi: 10.1016/j.pmedr.2018.12.002. PMID: 30596007; PMCID: PMC6307340.
- Barriers to cardiovascular disease secondary prevention care in the West Bank, Palestine – a health professional perspective. Collier, J., Kienzler, H. Confl Health 12, 27 (2018). https://doi.org/10.1186/s13031-018-0165-x
- Cardiovascular disease risk and prevention amongst Syrian refugees: mixed methods study of Médecins Sans Frontières programme in Jordan. Collins DRJ, Jobanputra K, Frost T, Muhammed S, Ward A, Shafei AA, Fardous T, Gabashneh S, Heneghan C. . Confl Health. 2017 Jul 17;11:14. doi: 10.1186/s13031-017-0115-z. PMID: 28725259; PMCID: PMC5512828.
- Clinical audit on the provision of diabetes care in the primary care setting by United nations relief and works agency for Palestine refugees in the near East (UNRWA). Shahin Y, Kapur A, Khader A, Zeidan W, Harries AD, Nerup J, Seita A. Journal of Diabetes Mellitus. 2014 Dec 31;5(01):12.
- Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan. Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, Kochi A, Harries AD, Zachariah R, Kapur A, Venter W, Seita A. Trop Med Int Health. 2012 Dec;17(12):1569-76. doi: 10.1111/j.1365-3156.2012.03097.x. Epub 2012 Oct 11. PMID: 23051859.
- Cohort monitoring of persons with hypertension: an illustrated example from a primary healthcare clinic for Palestine refugees in Jordan. Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, Kochi A, Harries AD, Zachariah R, Kapur A, Venter W, Seita A. Trop Med Int Health. 2012 Sep;17(9):1163-70. doi: 10.1111/j.1365-3156.2012.03048.x. Epub 2012 Jul 29. PMID: 22845700.
- Community-based noncommunicable disease care for Syrian refugees in Lebanon. Sethi S, Jonsson R, Skaff R, Tyler F. Global Health: Science and Practice. 2017 Sep 27;5(3):495-506.
- Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study. Ansbro É, Garry S, Karir V, Reddy A, Jobanputra K, Fardous T, Sadique Z. Health Policy Plan. 2020 Oct 1;35(8):931-940. doi: 10.1093/heapol/czaa050. PMID:32621490; PMCID: PMC8312704.
- Diabetes care in a complex humanitarian emergency setting: a qualitative evaluation. Murphy A, Biringanine M, Roberts B, Stringer B, Perel P, Jobanputra K. BMC Health Serv Res. 2017 Jun 23;17(1):431. doi: 10.1186/s12913-017-2362-5. PMID: 28645279; PMCID: PMC5481869.
- Diabetes in an emergency context: the Malian case study. Besançon S, Fall IS, Doré M, Sidibé A, Hagon O, Chappuis F, Beran D. Confl Health. 2015 May 1;9:15. doi: 10.1186/s13031-015-0042-9. PMID: 25937831; PMCID: PMC4416388.
- Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan. Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, Zeidan W, Abu-Zayed I, Kochi A, Harries AD, Zachariah R, Kapur A. Public Health Action. 2013 Dec 21;3(4):259-64.
- Early Experiences in the Integration of Non-communicable Diseases into Emergency Primary Health Care, Beni Region, Democratic Republic of the Congo. Ratnayake R, Wittcoff A, Majaribu J, Nzweve JP, Katembo L, Kasonia K, Nzanzu AK, Kiapi L, Ngoy P. Ann Glob Health. 2021 Mar 19;87(1):27. doi: 10.5334/aogh.3019. PMID: 33777712; PMCID: PMC7977479.
- Evaluation of NCD service integrated into a general OPD and HIV service in Matsapha, Eswatini, 2017. Ansbro, É., Meyer, I., Okello, V., Verdecchia, M., Keus, K., Piening, T., Sadique, Z., Roberts, B., Perel, P. and Jobanputra, K., 2018. https://fieldresearch.msf.org
- Guidelines and mHealth to Improve Quality of Hypertension and Type 2 Diabetes Care for Vulnerable Populations in Lebanon: Longitudinal Cohort Study. Doocy S, Paik KE, Lyles E, Hei Tam H, Fahed Z, Winkler E, Kontunen K, Mkanna A, Burnham G. JMIR Mhealth Uhealth. 2017 Oct 18;5(10):e158. doi: 10.2196/mhealth.7745. PMID: 29046266; PMCID: PMC5695979.
- Hypertension and treatment outcomes in Palestine refugees in United Nations Relief and Works Agency primary health care clinics in Jordan. Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, Zachariah R, Kochi A, Kapur A, Harries AD, Shaikh I, Seita A. Trop Med Int Health. 2014 Oct;19(10):1276-83. doi: 10.1111/tmi.12356. Epub 2014 Jul 12. PMID: 25039838.
- Implementing Fixed Dose Combination Medications for the Prevention and Control of Cardiovascular Diseases. Webster R, Murphy A, Bygrave H, Ansbro É, Grobbee DE, Perel P. Glob Heart. 2020 Aug 19;15(1):57. doi: 10.5334/gh.860. PMID: 32923350; PMCID: PMC7442173.
- Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis. Parmar PK, Rawashdah F, Al-Ali N, Abu Al Rub R, Fawad M, Al Amire K, Al-Maaitah R, Ratnayake R. BMJ Open. 2021 Apr 20;11(4):e045455. doi: 10.1136/bmjopen-2020-045455. PMID: 33879489; PMCID: PMC8061821.
- Management of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort study. Ansbro ÉM, Biringanine M, Caleo G, Prieto-Merino D, Sadique Z, Perel P, Jobanputra K, Roberts B. BMJ Open. 2019 Nov 24;9(11):e030176. doi: 10.1136/bmjopen-2019-030176. PMID: 31767582; PMCID: PMC6887084.
- Model to improve cardiometabolic risk factors in Palestine refugees with diabetes mellitus attending UNRWA health centers. Abu Kishk N, Shahin Y, Mitri J, Turki Y, Zeidan W, Seita A. BMJ Open Diabetes Res Care. 2019 Aug 18;7(1):e000624. doi: 10.1136/bmjdrc-2018-000624. PMID: 31497303; PMCID: PMC6708257.
- MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework. Ansbro É, Homan T, Qasem J, Bil K, Rasoul Tarawneh M, Roberts B, Perel P, Jobanputra K. BMC Health Serv Res. 2021 Apr 26;21(1):381. doi: 10.1186/s12913-021-06333-3. PMID: 33896418; PMCID: PMC8074194.
- Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone. Witter, S., Zou, G., Diaconu, K. et al. Confl Health 14, 3 (2020). https://doi.org/10.1186/s13031-019-0248-3
- Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland. Rabkin M, Melaku Z, Bruce K, Reja A, Koler A, Tadesse Y, Kamiru HN, Sibanyoni LT, El-Sadr W. J Trop Med. 2012;2012:137460. doi: 10.1155/2012/137460. Epub 2012 Sep 27. PMID: 23056058; PMCID: PMC3465908.
- Syrian refugees with diabetes and hypertension in Shatila refugee camp, Lebanon: Médecins Sans Frontières model of care and treatment outcomes. Kayali M, Moussally K, Lakis C, Abrash MA, Sawan C, Reid A, Edwards J. Treating. Confl Health. 2019 Apr 2;13:12. doi: 10.1186/s13031-019-0191-3. PMID: 30976298; PMCID: PMC6444539.
- Treating Syrian refugees with diabetes and hypertension in Shatila refugee camp, Lebanon: Médecins Sans Frontières model of care and treatment outcomes. Kayali, M., Moussally, K., Lakis, C. et al. Confl Health 13, 12 (2019). https://doi.org/10.1186/s13031-019-0191-3
- Treatment outcomes in a cohort of Palestine refugees with diabetes mellitus followed through use of E-Health over 3 years in Jordan. Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, Zeidan W, Abu-Zayed I, Kochi A, Harries AD, Zachariah R, Kapur A, Shaikh I, Seita A. Trop Med Int Health. 2014 Feb;19(2):219-23. doi: 10.1111/tmi.12241. Epub 2013 Dec 17. PMID: 24341942.
- What influenced provision of non-communicable disease healthcare in the Syrian conflict, from policy to implementation? A qualitative study. Garry S, Checchi F, Cislaghi B. Conflict and health. 2018 Dec;12(1):1-0.
LSHTM research projects
- NCD Care in Humanitarian Settings during Covid19 Disruption
This study aimed to support the continuation of primary health care delivery for people with hypertension and/or diabetes in humanitarian crises settings, in the context of Covid-19 and inform future similar healthcare delivery disruptions. With an advisory committee of humanitarian implementing organisations, we have identified priority service delivery approaches for maintaining access to care for people with hypertension and/or diabetes in low- and middle-income countries and humanitarian contexts. We have reviewed the evidence on factors affecting implementation processes and the effectiveness of these approaches. Via an online survey and follow-up interviews, we are collating experiences at the project level of adapting NCD service delivery to Covid-19 related disruption.
- CHANGE: Alcohol misuse and associated adversities among conflict-affected populations
CHANGE is a five-year multi-stakeholder research project which started in July 2020. It aims to address alcohol misuse and associated adversities among conflict-affected populations in Uganda and Ukraine. We seek to further develop Problem Management Plus (PM+). an evidence-based psychological intervention. We will complement PM+ by adding an additional psychological component addressing alcohol misuse. These country settings represent very different socio-economic, cultural and humanitarian characteristics and populations which supports understanding of the contextual influences on adapting and implementing PM+A. The comparison of outcomes and processes between the two sites will also help inform the future development and application of PM+A with other conflict-affected populations.
- The GOAL partnership: Supporting government and partners in health system strengthening for better mental health of Syrian refugees and host communities in Lebanon
GOAL is a three-year multi-stakeholder research project which began in February 2020. The aim of GOAL is to support government and partners in strengthening the ability of health systems to meet the mental health needs of refugee and host communities affected by protracted displacement, focusing on Lebanon. GOAL consists of five Work Packages focusing on governance (transparency, accountability, and integrity), governance (participation), financing, and capacity strengthening. Co-production is also central to the GOAL approach, particularly involving the National Mental Health Program of Lebanon and mental health service users in the co-design and co-implementation of the project activities and outputs. We will also examine the benefits and challenges of co-production for the research in GOAL.
- El Chammay R, Roberts B (2020) Using COVID-19 responses to help strengthen the mental health system in Lebanon in Psychological trauma : theory, research, practice and policy.
- Lokot M, Wake C (2021) The co-production of research between academics, NGOs and communities in humanitarian response: a practice guide
- Rass E, et al. (2020) Participation by conflict-affected and forcibly displaced communities in humanitarian healthcare responses: A systematic review in Journal of Migration and Health
- MSF Cardiovascular Polypill Implementation Study
The primary objective of this research project was to evaluate the implementation of treatment with a fixed-dose combination strategy for patients with ASCVD in a humanitarian refugee setting. It specifically assesses the impact on adherence and the acceptability, fidelity and sustainability, including costs, of this strategy. The research project utilises a mixed-method design with a prospective before and after study as well qualitative and descriptive costing components. The study sites were two MSF-run clinics in North Lebanon. The analysis is currently underway and will result in three papers submitted for peer-reviewed publication.
- Boulle P., et al. "Cardiovascular Disease among Syrian refugees: a descriptive study of patients in two Medecins Sans Frontieres clinics in northern Lebanon." Conflict and health 13.1 (2019): 1-11.
- Partnership for Change (ICRC/DRC/Novo Nordisk) Models of care for NCDs in humanitarian settings
The research component of the partnership aims to review diabetes and hypertension services and gaps in humanitarian settings in LMICs and design an enhanced service delivery approach to support access to context-appropriate management and prevention activities for diabetes and hypertension. It consists of multiple streams, including a global assessment of existing evidence on models of care for hypertension and diabetes in humanitarian settings, a global review of expert opinions, and two case study assessments (in Lebanon and Iraq). The findings of these activities will inform the development of new approaches to diabetes and hypertension models of care and their evaluation in these settings.
- Jaung M. S., et al. "Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review." Health policy and planning 36.4 (2021): 509-532.
- STRENGTHS project: Scaling up psychological interventions with Syrian Refugees
The STRENGTHS project will train Syrian refugees to provide a mental health intervention called Problem Management+ (PM+) to fellow Syrian refugees. PM+ is developed by the WHO. It is a short programme that does not target a single disorder but the symptoms of common mental disorders. The STRENGTHS project will translate, adapt, test and implement the PM+ programmes Individual, Group, Early Adolescent Skills for Emotions (EASE) and an internet-delivered version. STRENGTHS will - in eight different countries in Europe and the MENA region - evaluate whether the intervention works, explore how it can be implemented in the specific context and whether it is cost-effective.
- Kiselev N, et al. "Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist’s view." BMC psychiatry 20.1 (2020)
- Kiselev N, et al. "Structural and socio-cultural barriers to accessing mental healthcare among Syrian refugees and asylum seekers in Switzerland." European journal of psychotraumatology 11.1 (2020)
- Sijbrandij M, et al. "Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries." European Journal of Psychotraumatology 8.sup2 (2017)
- Burchert S, et al. "User-centered app adaptation of a low-intensity e-mental health intervention for Syrian refugees." Frontiers in psychiatry 9 (2019)
- Fuhr, Daniela C., et al. "Pathways towards scaling up problem management plus in Turkey: a theory of change workshop." Conflict and health 14.1 (2020)
- de Graaff, Anne M., et al. "Peer-provided Problem Management Plus (PM+) for adult Syrian refugees: a pilot randomised controlled trial on effectiveness and cost-effectiveness." Epidemiology and Psychiatric Sciences 29 (2020)
- Brown, Felicity L., et al. "The cultural and contextual adaptation process of an intervention to reduce psychological distress in young adolescents living in Lebanon." Frontiers in psychiatry 11 (2020)
- Mixed Methods Evaluation of MSF NCD Multidisciplinary Primary Care Service in Irbid, Jordan
This research project aimed to evaluate a primary care-based model of NCD care implemented by Medecins sans Frontieres in Irbid, Jordan in order to refine the model and to generate evidence on its feasibility, acceptability and effectiveness with a view to translating a similar model to comparable humanitarian settings. The study utilised a mixed-methods design based upon the RE-AIM framework. The data collection included a pre-existing cross-sectional health service access survey, routine cohort data, key stakeholder interviews and a medication adherence survey. The data were analysed using descriptive statistics, multivariate regression analysis, costing analysis and qualitative thematic analysis. The key findings included: the MSF programme is highly acceptable to patients, staff and stakeholders and is achieving good clinical outcomes. However, the costs are high, and it seems plausible to simplify the model of care for patients and staff. We proposed potential opportunities around referral pathways, task shifting, or the simplification of treatment.
- Ansbro É, et al. "Mixed methods evaluation of MSF primary care based NCD service in Irbid, Jordon: February 2017-February 2018." (2018).
- Ansbro É, et al. "MSF experiences of providing multidisciplinary primary level NCD care for Syrian refugees and the host population in Jordan: an implementation study guided by the RE-AIM framework." BMC health services research 21.1 (2021): 1-19.
- Ansbro É, et al. "Clinical outcomes in a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: A cohort analysis using routine data." PLoS medicine 18.1 (2021): e1003279.
- Maconick L., et al. "“To die is better for me”, social suffering among Syrian refugees at a noncommunicable disease clinic in Jordan: a qualitative study." Conflict and health 14.1 (2020): 1-13.
- Mixed Methods Evaluation of MSF integration of NCD care into general OPD and HIV/TB services at primary care level in Eswatini
MSF provided primary care services, HIV and TB programmes at a comprehensive clinic from 2011 to 2018 in Eswatini. With MOH collaboration, MSF integrated NCD care into general outpatient HIV and TB services in April 2016. The aim of the research project was to examine the processes, effectiveness and costs in order to strengthen the service, facilitate handover to another NGO and inform MSF and MOH policy and scale-up. We undertook a retrospective evaluation of routine facility-level data. This comprised: care model description; routine cohort data; and incremental costing analysis. The main research conclusion was that NCD care could be integrated into an HIV department and OPD setting and could achieve acceptable intermediate clinical outcomes and retention rates at a cost that was similar to HIV programmes. We proposed ways for improving the model of care around the themes of supply chains, counselling, advocacy and collaboration.
- Ansbro É, et al. "Evaluation of NCD service integrated into a general OPD and HIV service in Matsapha, Eswatini, 2017." (2018).
- Support and Evaluation of MSF Diabetes Outpatient Services in Mweso Hospital, DRC
MSF implemented an Integrated Diabetic Clinic within the Outpatient Department in North Kivu, Democratic Republic of Congo. We examined the effectiveness of this diabetes programme, the challenges and facilitators, and the lessons learnt from implementation that could be generalised to comparable settings. A retrospective cohort study of routine data from patients enrolled in the programme from January 2014 to February 2017 was undertaken and complemented by a descriptive costing analysis as well as focus group discussions and semi-structured qualitative interviews. The implications of the study findings were the observed deterioration in clinical target attainment during periods of service disruption due to insecurity highlighted the need for diabetes programmes in insecure settings to engage in emergency preparedness, including prioritising a sustained medication supply. The qualitative findings emphasized the importance of community awareness of diabetes and the value of treatment support. The costing results indicated that increased efficiencies in terms of supply use and patient throughput can reduce unit costs.
- Caleo G, et al. "Evaluating the effectiveness and burden of diabetes care in a complex humanitarian emergency setting in Mweso, North Kivu, Democratic Republic of the Congo (DRC), 2015." (2018).
- Jobanputra, Kiran, and Éimhín Ansbro. "Diabetes service evaluation (2014-2017)–main findings from Mweso, North Kivu, the Democratic Republic of Congo." (2018).
- Ansbro É, et al. "Management of diabetes and associated costs in a complex humanitarian setting in the Democratic Republic of Congo: a retrospective cohort study." BMJ open 9.11 (2019): e030176.
- Murphy A, et al. "Diabetes care in a complex humanitarian emergency setting: a qualitative evaluation." BMC health services research 17.1 (2017): 1-10.
Partner research projects
Rights Based Self Learning to Promote Mental Health after Disasters
This study will test a hypothesis that these e-tools on psychosocial support as well as rights of persons with mental or psychosocial disabilities can increase knowledge on mental health and disability, as well as resilience to disaster.
Refugee Emergency: (RE-DEFINE)
Refugee Emergency: Aim is to adapt, test and implement the Self Help Plus (SH+), a novel trans-diagnostic self-help preventive psycho social intervention developed by WHO to prevent the onset of mental disorders in refugees and asylum seekers resettled in middle-income and high-income countries.
These are the core people working on NCDs in humanitarian settings across the different departments and faculties at LSHTM.
MSF Scientific days. Médecins Sans Frontières. Conference, 2021.
MSF Scientific Days bring together researchers, practitioners, academics and patient representatives to catalyse improvements in the quality of care provided to patients and communities at risk. The presentations include a wide range of subjects, including non-communicable disease care.
Caring for people with NCDs in humanitarian settings during the COVID-19 pandemic. Ready Initiative. Webinar, 2020.
In this webinar, experts from humanitarian organizations and the World Health Organization shared their experiences with challenges, current responses, lessons learned, and the pending agenda for non-communicable diseases in COVID-19.
2nd Annual Symposium on Diabetes in Humanitarian Crisis. Harvard Humanitarian Initiative, London School of Hygiene & Tropical Medicine, International Alliance for Diabetes Action, Brigham and Women’s Hospital. Symposium, 2020.
This 2nd Annual Symposium on Diabetes in Humanitarian Crises followed up on the progress that has been made over the past year since the Boston Declaration. Discussions covered major global events of the past year that changed the humanitarian health agenda, and a way forward.
1st Annual Symposium on Diabetes in Humanitarian Crisis. Harvard Humanitarian Initiative, London School of Hygiene & Tropical Medicine, International Alliance for Diabetes Action, Brigham and Women’s Hospital. Symposium, 2020.
In April 2019, Harvard University convened a meeting in Boston with humanitarian and other organizations in global health to discuss the immediate needs and barriers to tackling diabetes in humanitarian crises and push a unified agenda. The meeting resulted in the Boston Declaration which was signed by 64 signatories from over 40 international organizations.
Chronic care in humanitarian crises. International Committee of the Red Cross (ICRC), the Danish Red Cross, Novo Nordisk, London School of Hygiene & Tropical Medicine. World Health Assembly 19 side-event, 2019.
As a WHA72 side-event, the impact partnership between the ICRC, DRC and Novo Nordisk brought key stakeholders together in a panel discussion to explore the current state of NCD care in humanitarian settings. Moderator: Pablo Perel.
Fixed Dose Combination Pills for NCDs Symposium. George Institute for Global Health, London School of Hygiene & Tropical Medicine, Médecins sans Frontières. Symposium, 2018.
This international symposium brought together experts working on fixed-dose combinations for CVD and hypertension together with experts working in the fields of HIV and TB, as well as representatives from governmental, non-governmental organizations, civil society, industry and funders. The aim was to provoke a lively discussion around the barriers, next steps, and an agenda for further research, advocacy and policy change.