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Conflict and Health

, 4:3

First Online: 11 February 2010Received: 14 December 2009Accepted: 11 February 2010DOI: 10.1186-1752-1505-4-3

Cite this article as: Bellos, A., Mulholland, K., O-Brien, K.L. et al. Confl Health 2010 4: 3. doi:10.1186-1752-1505-4-3


Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections ARIs have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality 20-35% proportional mortality and case-fatality up to 30-35% due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1505-4-3 contains supplementary material, which is available to authorized users.

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Autor: Anna Bellos - Kim Mulholland - Katherine L O-Brien - Shamim A Qazi - Michelle Gayer - Francesco Checchi


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