• The burden of diabetes and use of diabetes care in humanitarian crises in low-income and middle-income countries

      Kehlenbrink, S; Smith, J; Ansbro, E; Fuhr, D; Cheung, A; Ratnayake, R; Boulle, P; Jobanputra, K; Perel, P; Roberts, B (Elsevier, 2019-03-13)
      Human suffering as a result of natural disasters or conflict includes death and disability from non-communicable diseases, including diabetes, which have largely been neglected in humanitarian crises. The objectives of this Series paper were to examine the evidence on the burden of diabetes, use of health services, and access to care for people with diabetes among populations affected by humanitarian crises in low-income and middle-income countries, and to identify research gaps for future studies. We reviewed the scientific literature on this topic published between 1992 and 2018. The results emphasise that the burden of diabetes in humanitarian settings is not being captured, clinical guidance is insufficient, and diabetes is not being adequately addressed. Crisis-affected populations with diabetes face enormous constraints accessing care, mainly because of high medical costs. Further research is needed to characterise the epidemiology of diabetes in humanitarian settings and to develop simplified, cost-effective models of care to improve the delivery of diabetes care during humanitarian crises.
    • Cardiovascular Disease Risk and Prevention Amongst Syrian Refugees: Mixed Methods Study of Médecins Sans Frontières Programme in Jordan

      Collins, D; Jobanputra, K; Frost, T; Muhammed, S; Ward, A; Shafei, A; Fardous, T; Gabashneh, S; Heneghan, C (BioMed Central, 2017-07-17)
      The growing burden of non-communicable diseases (NCDs) presented new challenges for medical humanitarian aid and little was known about primary health care approaches for these diseases in humanitarian response. We aimed to evaluate Médecins Sans Frontières (MSF's) use of total CVD risk based prevention strategies amongst Syrian refugees in northern Jordan to identify opportunities to improve total CVD risk based guidance for humanitarian settings.
    • Challenges associated with providing diabetes care in humanitarian settings

      Boulle, P; Kehlenbrink, S; Smith, J; Beran, D; Jobanputra, K (Elsevier, 2019-03-13)
      The humanitarian health landscape is gradually changing, partly as a result of the shift in global epidemiological trends and the rise of non-communicable diseases, including diabetes. Humanitarian actors are progressively incorporating care for diabetes into emergency medical response, but challenges abound. This Series paper discusses contemporary practical challenges associated with diabetes care in humanitarian contexts in low-income and middle-income countries, using the six building blocks of health systems described by WHO (information and research, service delivery, health workforce, medical products and technologies, governance, and financing) as a framework. Challenges include the scarcity of evidence on the management of diabetes and clinical guidelines adapted to humanitarian contexts; unavailability of core indicators for surveillance and monitoring systems; and restricted access to the medicines and diagnostics necessary for adequate clinical care. Policy and system frameworks do not routinely include diabetes and little funding is allocated for diabetes care in humanitarian crises. Humanitarian organisations are increasingly gaining experience delivering diabetes care, and interagency collaboration to coordinate, improve data collection, and analyse available programmes is in progress. However, the needs around all six WHO health system building blocks are immense, and much work needs to be done to improve diabetes care for crisis-affected populations.
    • Diabetes Care in a Complex Humanitarian Emergency Setting: A Qualitative Evaluation

      Murphy, A; Biringanine, M; Roberts, B; Stringer, B; Perel, P; Jobanputra, K (BioMed Central, 2017-06-23)
      Evidence is urgently needed from complex emergency settings to support efforts to respond to the increasing burden of diabetes mellitus (DM). We conducted a qualitative study of a new model of DM health care (Integrated Diabetic Clinic within an Outpatient Department [IDC-OPD]) implemented by Médecins Sans Frontières (MSF) in Mweso Hospital in eastern Democratic Republic of Congo (DRC). We aimed to explore patient and provider perspectives on the model in order to identify factors that may support or impede it.
    • Diabetes in humanitarian crises: the Boston Declaration.

      Kehlenbrink, S; Jaacks, M; Aebischer Perone, S; Ansbro, E; Ashbourne, E; Atkinson, C; Atkinson, M; Atun, R; Besancon, S; Boulle, P; et al. (Elsevier, 2019-08)
    • Three Steps to Improve Management of Noncommunicable Diseases in Humanitarian Crises

      Jobanputra, K; Boulle, P; Roberts, B; Perel, P (Public Library of Science, 2016-11-08)
      Kiran Jobanputra and colleagues argue that better evidence, guidance, and tools are needed to improve the effectiveness and feasibility of noncommunicable disease care in humanitarian settings.