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Responding to the Need for Non-communicable Disease Care for Refugees

In the second installment of a blog to mark World Refugee Day, we asked grantees conducting studies on interventions for non-communicable diseases (NCDs) to tell us about their work.

At Elrha, we fund research studies and innovation projects that address priority gaps in humanitarian response, and while many of our grantees work in refugee contexts, this World Refugee Day we wanted to spotlight some of those tackling health issues that require more attention in research and innovation.

Globally, a series of trends including population ageing, increased life expectancy, and exposure to lifestyle factors have led to an increase in prevalence of non-communicable diseases (NCDs), including cancers, cardiovascular disease, diabetes and chronic lung illnesses. However, as our updated health evidence review shows, there is still very limited evidence on the effectiveness of health interventions in NCDs.

In this blog post, we are turning our attention to some of our R2HC- funded grantees working in NCDs, to learn from why this is a critical thematic area in humanitarian health.

For this blog, we asked grantees working across different contexts to tell us:

- Why more focus is needed on NCDs in refugee settings
- How their research will affect health outcomes for refugees
- How improving health outcomes in NCDs will have wider implications on the lives of refugees

Discover the three NCD studies and what our grantees had to say…

Integrating an evidence-based mental health intervention into non-communicable disease care

Partners: International Rescue Committee (IRC), Johns Hopkins University, Khon Kaen University

A study team led by the IRC is conducting research to integrate the Common Elements Treatment Approach (CETA) — an evidence-based intervention used to treat mental disorders — into interventions for people living with hypertension, diabetes and epilepsy.

There are around 9 people sitting around a U-shaped table in a room, with one person standing up, facing and speaking to the people sitting around the table. The walls of the room are covered in posters, it looks like a classroom setting.
Introducing the project and pamphlet in a Camp Health Committee Meeting, 18 February 2022.

Recognising that there are links between mental disorders and NCDs, members of the study team Dr. Ye Htut Oo, Dr. Kaung Nyein Aye and Ashley Leichner explain how “over a quarter of adults over 40 years old are diagnosed with one or more NCDs” in Mae La refugee camp, where the research is taking place, and cite risk factors of “unhealthy diet, lack of physical activity, and substance use”.

“As refugees, they face the compounding issue of stress which increases barriers to achieving improvements in NCD management.”

“By focusing on both medication adherence and lifestyle modifications, we hope study participants will see improved health outcomes, and that providers within the health system will demonstrate stronger collaboration to deliver mental health care through NCD service delivery.”

The findings of this study, the team explains, could be applied in other refugee settings:

“We hope this integrated approach to mental health interventions through NCD care is a blueprint for future interventions in various refugee settings.”

If effective, the research will contribute to the evidence base for strengthening NCD care service models, programmatic standards and policies.

Interested in this topic? Explore the study profile: Integrating an evidence-based mental health intervention into non-communicable disease care

Optimising a community-based model for case identification, monitoring, and prevention of hypertension and diabetes among Syrian refugees in Jordan

Partners: International Rescue Committee, University of Southern California, Jordanian University of Science and Technology, Brigham and Women’s Hospital

Another study team led by IRC set out to implement and evaluate a comprehensive Community Health Volunteer (CHV) led strategy for managing NCDs among Syrian refugees in Jordan. Having to pivot their study due to COVID-19, the team ended up implementing a simpler, remote intervention, and recent publications share the key findings and recommendations from this study, including recommendations for the use of CHVs in primary healthcare, and for delivery of remote NCD care.

Principal investigators Parveen Parmar and Ruwan Ratnayake explained why the CHV programme was important in supporting Syrian refugees with diabetes and hypertension during the pandemic: “Though delivered remotely to counteract COVID-related interruptions in care, this programme was able to ensure ongoing access to medication, and patients maintained stable blood pressure and blood glucose throughout the period of the study.”

The study team wants to see more attention on NCDs among refugees and in humanitarian settings:

“Many humanitarian crises occur in settings where the population already has a pre-existing high burden of NCDs.

“With displacement into both camps and non-camp urban settings now becoming the norm, it is critical that the management of NCDs are a core part of any humanitarian health response.”

They hope that their work will show “a means to provide a minimum level of access to NCD care when care is disrupted due to acute conflict, and other interruptions in care due to a variety of circumstances.” They also add that their research “highlights the ability of CHV programs to meet a variety of complex needs in displacement settings.”

Want to know more? Discover the research study: Optimising a community-based model for case identification, monitoring, and prevention of hypertension and diabetes among Syrian refugees in Jordan

Non-communicable disease guidelines and mHealth records for refugees in Lebanon

Partners: Johns Hopkins Bloomberg School of Public Health, International Organisation for Migration; Massachusetts Institute of Technology

Other R2HC-funded research on NCDs has sought to test the use of mobile application technology in health systems. To improve treatment of hypertension and type 2 diabetes, a mHealth (mobile health) app was developed in Lebanon between 2014 to 2016 by researchers from Johns Hopkins. The mHealth tool comprised of both an electronic medical record function and software providing decision making support to healthcare professionals.

Reflecting on the results of this study, Principal Investigator Shannon Doocy said that:

“We saw significant improvements in patient-provider interactions, which previous research has shown substantially improves health outcomes. Specifically, we found increases in providers asking about medical history, medication complications, and other questions related to patients’ hypertension and/or diabetes, as well as counseling on lifestyle risk factors such as diet and smoking.”

How will improving care for refugees suffering from NCDs impact refugees’ lives?

“Chronic NCDs have an immense impact on the quality of life and well-being of refugees. Improvements in our study in the quality of care refugees receive, have far-reaching impacts on their day-to-day lives, and also likely lessen the socioeconomic burden associated with complications of these conditions when left uncontrolled.”
— Shannon Doocy, Principal Investigator

Since completing their R2HC funded study in 2016, the team received further funding from Humanitarian Grand Challenge to do a pilot project in Hagadera Refugee Camp in Kenya with IRC. We are looking forward to seeing the results.

Would you like further details? Visit the study team’s profile: Non-Communicable Disease Guidelines and mHealth Records for Refugees in Lebanon

If you’d like to hear from grantees working on other health concerns for refugees, check out Part 1 of our blog, where we speak to research and innovation teams working on the often-stigmatised areas of incontinence, menstrual health and abortion in refugee settings.

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