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.

SCHISTOX: An individual based model for the epidemiology and control of schistosomiasis

A stochastic individual based model,SCHISTOX,has been developed for the study of schistosome transmission dynamics and the impact of control by mass drug administration.More novel aspects that can be investigated include individual level adherence and access to treatment,multiple communities,human sex population dynamics,and implementation of a potential vaccine.Many of the model parameters have been estimated within previous studies and have been shown to vary between communities,such as the age-specific contact rates governing the age profiles of infection.However,uncertainty remains as there are wide ranges for certain parameter values and a few remain relatively unknown.We analyse the model dynamics by parameterizing it with published parameter values.We also discuss the development of SCHISTOX in the form of a publicly available open-source GitHub repository.The next key development stage involves validating the model by calibrating to epidemiological data.