Background Globally, the number of people affected by humanitarian crises, relating to both conflicts and natural disasters, remains at record levels. Many crisis affected populations live in settings where the epidemiological transition is underway. Even now, ischaemic heart disease and stroke combined contribute a similar proportion of deaths as conflict and terrorism in Syria, 33.83% and 36.13% respectively. Following the UN high level meeting on NCDs and the global commitment to Universal Health Coverage (UHC), there is increasing effort being invested in developing guidelines and processes for the management of NCDs, especially hypertension in humanitarian settings.
The objective of this study was to contribute to the discussion by answering the following points:
Prevalence and incidence of hypertension in populations directly affected by conflict or natural disasters.
Proportion diagnosed with hypertension who are aware of the diagnosis, are receiving treatment, and have achieved control.
Proportion with hypertension who sought treatment but did not receive it.
Patient knowledge of and attitude to hypertension.
Methods A literature search was carried out in five databases, looking for peer reviewed publications published since 1999. Grey literature was also searched using Google and non-governmental organisations’ web pages. The population of interest was non-pregnant, non-military adults who were directly exposed to a crisis since 1999. All study types were included. Eligibility assessment, data extraction and quality appraisal were carried out in duplicate.
Results After deduplication, 11703 abstracts were screened resulting in 402 papers for full-text review. Sixty-three studies were included in the narrative synthesis. The studies reported on a wide range of crises including the wars in Syria and Iraq, the Great East Japan Earthquake, Hurricane Katrina and Palestinian refugees in the Middle East. There were few studies from Africa or central Asia. The studies predominantly assessed prevalence of hypertension and this varied with geography and age of the population. Access to care, patient understanding and patient views on hypertension were poorly examined. Most of the studies had a high risk of bias due to methods used in the diagnosis of hypertension and in the selection of representative populations.
Discussion Hypertension is seen in all humanitarian settings and the burden can be considerable. Further studies are needed to accurately estimate prevalence of hypertension in crisis affected populations throughout the world. An appreciation of patient knowledge and understanding of hypertension as well as the cascade of care would be invaluable in informing service provision.
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