Feasibility, acceptability, and effectiveness of non-pharmaceutical interventions against infectious diseases among crisis-affected populations: a scoping review

Background:Non-pharmaceutical interventions(NPIs)are a crucial suite of measures to prevent and control infectious disease outbreaks.Despite being particularly important for crisis-affected populations and those living in informal settlements,who typically reside in overcrowded and resource limited settings with inadequate access to healthcare,guidance on NPI implementation rarely takes the specific needs of such populations into account.We therefore conducted a systematic scoping review of the published evidence to describe the landscape of research and identify evidence gaps concerning the acceptability,feasibility,and effectiveness of NPIs among crisis-affected populations and informal settlements.Methods:We systematically reviewed peer-reviewed articles published between 1970 and 2020 to collate available evidence on the feasibility,acceptability,and effectiveness of NPIs in crisis-affected populations and informal settlements.We performed quality assessments of each study using a standardised questionnaire.We analysed the data to produce descriptive summaries according to a number of categories:date of publication;geographical region of intervention;typology of crisis,shelter,modes of transmission,NPI,research design;study design;and study quality.Results:Our review included 158 studies published in 85 peer-reviewed articles.Most research used low quality study designs.The acceptability,feasibility,and effectiveness of NPIs was highly context dependent.In general,simple and cost-effective interventions such as community-level environmental cleaning and provision of water,sanitation and hygiene services,and distribution of items for personal protection such as insecticide-treated nets,were both highly feasible and acceptable.Logistical,financial,and human resource constraints affected both the implementation and sustainability of measures.Community engagement emerged as a strong factor contributing to the effectiveness of NPIs.Conversely,measures that involve potential restriction on personal liberty such as case isolation and patient care and burial restrictions were found to be less acceptable,despite apparent effectiveness.Conclusions:Overall,the evidence base was variable,with substantial knowledge gaps which varied between settings and pathogens.Based on the current landscape,robust evidence-based guidance is not possible,and a research agenda is urgently required that focusses on these specific vulnerable populations.Although implementation of NPIs presents unique practical challenges in these settings,it is critical that such an agenda is put in place,and that the lessons learned from historical and present experiences are documented to build a firm evidence base.

Operational adaptations of the trachoma pre-validation surveillance strategy employed in Ghana:a qualitative assessment of successes and challenges

Background:In 2009 Ghana began to design a trachoma pre-validation surveillance plan,based on then-current WHO recommendations.The plan aimed to identify active trachoma resurgence and identify and manage trichiasis cases,through both active and passive surveillance approaches.This paper outlines and reviews the adaptations made by Ghana between 2011 and 2016.The assessment will provide a learning opportunity for a number of countries as they progress towards elimination status.Methods:A mixed methods approach was taken,comprising in-depth interviews and documents review.Between January and April 2016,20 in-depth interviews were conducted with persons involved in the operationalisation of the trachoma surveillance system from across all levels of the health system.A three-tier thematic coding framework was developed using a primarily inductive approach but also allowed for a more iterative approach,which drew on aspects of grounded theory.Results:During the operationalisation of the Ghana surveillance plan there were a number of adaptations(as compared to the WHO recommendations),these included:(i)Inclusion of surveillance of active trachoma in the passive surveillance approach,as compared to trichiasis alone.Issues with case identification,challenges in implementation coverage and a non-specific reporting structure hampered effectiveness;(ii)Random selection and increase in number of sites selected for the active surveillance component.This likely lacked the spatiotemporal power to be able to identify recrudescence in a timely manner;(iii)Targeted trichiasis door-to-door case searches,led by ophthalmic nurses.An effective methodology to identify trichiasis cases but resource intensive;(iv)A buddy system between ophthalmic nurses to support technical skills in an elimination setting where it is difficult to attain diagnostic and surgical skills,due to a lack of cases.The strategy did not take into account the loss of proficiency within experienced personnel.Conclusions:Ghana developed a comprehensive surveillance system that exceeded the WHO recommendations but issues with sensitivity and specificity likely led to an inefficient use of resources.Improved targeted surveillance strategies for identification of recrudescence and trichiasis case searches,need to be evaluated.Strategies must address the contextual changes that arise because of transmission decline,such as loss of surgical skills.