Congenital and Chronic Non-communicable Diseases Amongst Pediatric Populations in Disaster Settings: A Systematic Review

Background: Congenital disorders and non-communicable diseases(NCDs) constitute leading causes of mortality and disability-affected life years(DALYs) for children globally. Low- and middle-income countries(LMICs) not only experience the largest burden of humanitarian emergencies but additionally experience a greater burden of congenital and noncommunicable diseases, with 95% of deaths due to congenital disorders occurring in LMICs. Despite the growing global burden and challenges inherent in managing chronic diseases amongst pediatric populations during complex emergencies, little is known about the epidemiology or best practices for intervention delivery for children in disaster settings. We conducted a systematic review on the effect of humanitarian disasters on NCDs and congenital disorders for pediatric populations in LMICs, assessing epidemiology, interventions, and treatment.

Methods: A systematic search in MEDLINE(OvidSP), MEDLINE(PubMed), Web of Science, Global Health(EBSCO), Cochrane trials, CINAHL, PsycINFO, and Embase for indexed articles published before October 1, 2020 was conducted in consultation with an experienced librarian, and publications reporting on NCDs and congenital disorders for pediatric populations during humanitarian emergencies in LMICs were included. Pediatric populations were defined as persons under age 21, as defined by the American Academy of Pediatrics. Two separate screeners independently evaluated the titles, abstracts, and full text of the eligible articles, with vetting by a third reviewer. We extracted and synthesized results using a thematic analysis approach. The study is registered at PROSPERO(CRD42020212778).

Results: Of the 214 included publications, most reported on observational studies with the largest number of studies reporting on anemia(32.7%), oncologic disease(15.4%), asthma(10.3%), neurological and neurodevelopmental disorders(7%),cardiovascular disease(6.5%), ophthalmologic disorders(6.1%), chronic kidney disease (2.8%), and diabetes(2.3%). The majority of studies included in our review presented epidemiologic evidence for a high burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited modifiable barriers to healthcare delivery for all major diagnoses studied included: a lack of familiarity with pediatric management of chronic diseases amongst healthcare providers in disaster settings, limited screening for congenital disorders and NCDs prior to crisis onset, advanced presentations of disease, and a lack of pediatric guidelines for chronic disease management amongst humanitarian actors. Disaster exposure was identified as an independent risk factor for diagnosis and delayed treatment of all disease types studied and conferred worse morbidity.

Conclusion: Disaster exposure may be an independent risk factor for diagnosis and delayed treatment of noncommunicable and congenital disorders amongst pediatric populations and was found to confer worse morbidity. While the majority of studies included in our review presented epidemiologic evidence for a high burden of disease, research is needed to address contributing factors, interventions, and means of managing disease in pediatric populations during humanitarian emergencies in LMICs to inform the creation of pediatric-specific guidelines. Nutrition interventions for anemia may provide guidance on pediatric management of diabetes and cardiovascular disease in disasters.