We are pleased to send you this December 2021 bulletin from Evidence Aid, containing four recent evidence summaries. Please forward this to anyone who might be interested. If they would like to receive these bulletins directly, they should contact Claire Allen (firstname.lastname@example.org) and anyone with questions about our work should also contact Claire. We will send our regular Evidence Aid newsletter at the end of the month. If you would like to stop receiving our bulletins or newsletters, please contact Claire.
Emergency care by lay responders in low- and middle-income countries and for underserved populations (https://evidenceaid.org/resource/emergency-care-by-lay-responders-in-low...)
from our Resilient Health Systems Collection
Orkin AM, Venugopal J, Curran JD, et al. Emergency care with lay responders in underserved populations: a systematic review.
Bulletin of the World Health Organization. 2021;99(7):514-528H
Training lay providers to respond to health emergencies is a key factor for a resilient health system. In this systematic review, the authors searched for studies that evaluated task shifting of emergency care to lay providers in low-resource settings and underserved populations. They did not restrict their searches by language of publication and did the search on 16 December 2019. They included 34 studies, which were from low- and middle-income countries (21 studies) and underserved populations in high-income countries (13 studies).
What was found: First aid education and task shifting to laypeople for emergency care may decrease patient morbidity and mortality and build community capacity to manage health emergencies in underserved and low-resource settings. First aid interventions and lay emergency care might contribute to addressing priority global health challenges such as opioid poisoning, trauma and malaria. First aid education for laypeople may have its most meaningful impact when approached as a series of targeted interventions that equip the public to respond to the health emergencies that they are likely to encounter in their everyday lives and communities.
Implications: The authors of the review stated that more work is needed to orient first aid education to deliver the greatest effects on patient and community health and to identify the modalities that are best suited to specific contexts, populations, clinical conditions and public health priorities.
Healthcare service delivery interventions in low- and middle-income countries: cost effectiveness
(https://evidenceaid.org/resource/healthcare-service-delivery-interventio...) from our Resilient Health Systems Collection
Watson SI, Sahota H, Taylor CA, et al. Cost-effectiveness of health care service delivery interventions in low and middle income countries: A systematic review.
(https://ghrp.biomedcentral.com/track/pdf/10.1186/s41256-018-0073-z.pdf) Global Health Research and Policy. 2018;3:17.
Low- and middle-income countries (LMICs) have limited resources and face a high disease burden. Cost-effective interventions may lead to a better provision of services for various conditions and a more resilient health system. In this systematic review, the authors searched for studies of economic evaluations of healthcare service delivery interventions in LMICs. They did not restrict their searches by language of publication and searched for articles published between January 2000 and October 2016. They included 36 studies, which were from Bangladesh (1), Brazil (1), China (1), Côte d’Ivoire (1), Ethiopia (1), Ghana (1), India (4), Kenya (4), Nicaragua (2), Pakistan (2), Sierra Leone (1), South Africa (7), Thailand (1), Uganda (6) and Zambia (2). There was also a review that included studies from 70 countries.
What was found: Shifting tasks from doctors to nurses or community health workers, or from facilities into the community, was cost effective. HIV management and counselling at home was more effective than the same service provision in facilities but was more costly. Involving and training community members in emergency care, cardiovascular disease management, and mental health were cost effective. Quality improvement efforts in the community that involved training staff, equipment upgrades and better surveillance were cost effective.
Implications: The authors of the review stated that decision makers will have difficulty choosing between alternative organizational arrangements if knowledge on their relative cost effectiveness is limited. They also stated that standardization of research methods and reporting of economic evaluations in this context is essential for future research and guidelines.
Interventions to address mental health issues in healthcare workers during infectious disease outbreaks (https://evidenceaid.org/resource/interventions-to-address-mental-health-...)
Zaçe D, Hoxhaj I, Orfino A, et al. Interventions to address mental health issues in healthcare workers during infectious disease outbreaks: a systematic review.
(https://www.sciencedirect.com/science/article/pii/S0022395621000868) Journal of Psychiatric Research. 2021;136:319-33
Some healthcare workers are affected by mental health issues during pandemics and epidemics. In this systematic review, the authors searched for qualitative and quantitative research into interventions intended to address mental health issues of healthcare workers during infectious disease outbreaks. They restricted their searches to articles published in English and conducted the search up to 2 October 2020. They included 24 studies, which had used a variety of study designs.
What was found: Organizational-level interventions (e.g., promoting leadership and teamwork, manpower allocation and adjusting work hours) helped promote mental health wellbeing among healthcare workers. Providing healthcare workers with sufficient personal protective equipment reduced anxiety and depression levels, improved sleep quality and decreased worries about their own and their families' health. Clear communication of directives and precautionary measures reduced mental health issues among healthcare workers. During pandemics and epidemics, psycho-emotional interventions (e.g., psychological education/training, therapy, counselling and cognitive behaviour training) helped build resilience among healthcare workers and reduced stress.
Implications: The authors of the review concluded that the mental health impact on healthcare workers, during epidemics/pandemics and after, is complex and should be addressed in a sustained way by governments and healthcare systems, which should design and implement multi-factorial intervention strategies to mitigate its impact in a collaborative and interdisciplinary manner. They stated that there is a need for further research on the effectiveness of these interventions.
Mental health and psychosocial support strategies in highly contagious emerging disease outbreaks (https://evidenceaid.org/resource/mental-health-and-psychosocial-support-...)
Kunzler AM, Stoffers-Winterling J, Stoll M, et al. Mental health and psychosocial support strategies in highly contagious emerging disease outbreaks of substantial public concern: A systematic scoping review. (https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244748) PLoS ONE. 2021;16(2):e0244748
Disease outbreaks can impact on the mental health of healthcare workers and the general population. In this systematic review, the authors searched for studies of psychological interventions before, during and after emerging infectious disease outbreaks (SARS, MERS, Ebola and COVID-19) for healthcare workers, community members and individuals at risk. They did not restrict their searches by date, language or status of publication and did the search on 7 May 2020. They included 19 studies (including two randomised trials), which were from Canada (2 studies), China (1), Hong Kong (2), Liberia (2), Sierra Leone (4), Sierra Leona and Liberia (2), South Korea (1), Taiwan (1), USA (3) and West Africa (1). They also identified an additional 7 unpublished studies.
What was found: Providing individuals with information related to infectious disease outbreaks and teaching them psychological coping strategies improved psychological outcomes. The use of a train the trainer models and provision of interventions by trained peers can be beneficial. Healthcare workers, patients and the general population experienced higher psychological stress caused by the COVID-19 pandemic, resulting from factors such as quarantine measures.
Implications: The authors of the review stated that psychological interventions must adapt to the cultural context of the respective group or community. They stated that further research is needed to inform policy and practice on mental health and psychological support before, during and after infectious disease outbreaks.
Claire Allen, Operations Manager
Evidence Aid: Championing evidence-based humanitarian action.
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HIFA profile: Claire Allen is Operations Manager at Evidence Aid, UK. Professional interests: Evidence Aid (www.evidenceaid.org) provides evidence for people in disaster preparedness and response to make better decisions. Areas of interest = humanitarian crises, natural disasters and major healthcare emergencies (disaster = when a country is unable to cope with the disaster/crisis or emergency). She is a member of the HIFA Working Group on Access to Health Research. http://www.hifa.org/working-groups/access-health-research Email: callen AT evidenceaid.org