The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review

doi:10.1186/s13031-021-00357-6

. 2021 Apr 6;15(1):21.

doi: 10.1186/s13031-021-00357-6.

The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review

Elsa Kobeissi¹, Marilyne Menassa¹, Krystel Moussally², Ernestina Repetto³, Ismail Soboh⁴, Marwan Hajjar⁴, Shadi Saleh⁵, Ghassan Abu-Sittah^{6

7}

Affiliations

¹ Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon.
² Lebanon Branch Office, Médecins Sans Frontières, Beirut, Lebanon.
³ Medical Department, Operational Center Brussels, Médecins Sans Frontières, Brussels, Belgium.
⁴ Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
⁵ Global Health Institute, American University of Beirut, Beirut, Lebanon.
⁶ Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon. ga60@aub.edu.lb.
⁷ Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon. ga60@aub.edu.lb.

PMID: 33823882
PMCID: PMC8025481
DOI: 10.1186/s13031-021-00357-6

Free PMC article

The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review

Elsa Kobeissi et al. Confl Health. 2021.

Free PMC article

. 2021 Apr 6;15(1):21.

doi: 10.1186/s13031-021-00357-6.

Authors

Elsa Kobeissi¹, Marilyne Menassa¹, Krystel Moussally², Ernestina Repetto³, Ismail Soboh⁴, Marwan Hajjar⁴, Shadi Saleh⁵, Ghassan Abu-Sittah^{6

7}

Affiliations

¹ Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon.
² Lebanon Branch Office, Médecins Sans Frontières, Beirut, Lebanon.
³ Medical Department, Operational Center Brussels, Médecins Sans Frontières, Brussels, Belgium.
⁴ Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
⁵ Global Health Institute, American University of Beirut, Beirut, Lebanon.
⁶ Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon. ga60@aub.edu.lb.
⁷ Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon. ga60@aub.edu.lb.

PMID: 33823882
PMCID: PMC8025481
DOI: 10.1186/s13031-021-00357-6

Abstract

Background: Antibiotic resistance (ABR) is a major global threat. Armed and protracted conflicts act as multipliers of infection and ABR, thus leading to increased healthcare and societal costs. We aimed to understand and describe the socioeconomic burden of ABR in conflict-affected settings and refugee hosting countries by conducting a systematic scoping review.

Methods: A systematic search of PubMed, Medline (Ovid), Embase, Web of Science, SCOPUS and Open Grey databases was conducted to identify all relevant human studies published between January 1990 and August 2019. An updated search was also conducted in April 2020 using Medline/Ovid. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. The Newcastle-Ottawa Scale was used to assess study quality. Data extraction and analysis were based on the PICOS framework and following the PRISMA-ScR guideline.

Results: The search yielded 8 studies (7 publications), most of which were single-country, mono-center and retrospective studies. The studies were conducted in Lebanon (n = 3), Iraq (n = 2), Jordan (n = 1), Palestine (n = 1) and Yemen (n = 1). Most of the studies did not have a primary aim to assess the socioeconomic impact of ABR and were small studies with limited statistical power that could not demonstrate significant associations. The included studies lacked sufficient information for the accurate evaluation of the cost incurred by antibiotic resistant infections in conflict-affected countries.

Conclusion: This review highlights the scarcity of research on the socioeconomic burden of ABR on general populations in conflict-affected settings and on refugees and migrants in host countries, and lists recommendations for consideration in future studies. Further studies are needed to understand the cost of ABR in these settings to develop and implement adaptable policies.

Keywords: Antibiotic resistance; Conflict-affected; Cost of illness; Multi-drug resistance; Refugee; Socioeconomic.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Study flow diagram in accordance with PRISMA statement with modifications

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[1] World Health Organization. Antimicrobial resistance 2018 [cited 2019 2019/05/30]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resist....

[2] World Health Organization. Antimicrobial resistance 2018 [cited 2019 2019/05/30]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/antimicrobial-resist....

[3] Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. 2013 [cited 2020 22 April, 2020]. Available from: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf.

[4] Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. 2013 [cited 2020 22 April, 2020]. Available from: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf.

[5] European Centers for Disease Control and Prevention. Antimicrobial resistance: trackling the burden in the European Union. 2019. [cited 2020 22 April, 2020]. Available from: https://www.oecd.org/health/health-systems/AMR-Tackling-the-Burden-in-th....

[6] European Centers for Disease Control and Prevention. Antimicrobial resistance: trackling the burden in the European Union. 2019. [cited 2020 22 April, 2020]. Available from: https://www.oecd.org/health/health-systems/AMR-Tackling-the-Burden-in-th....

[7] World Health Organization. Health financing policy and implementation in fragile and conflict-affected settings: Synthesis of evidence and policy recommendations. 2019 Contract No.: WHO/HIS/HGF/HFGuidance/19.7.

[8] World Health Organization. Health financing policy and implementation in fragile and conflict-affected settings: Synthesis of evidence and policy recommendations. 2019 Contract No.: WHO/HIS/HGF/HFGuidance/19.7.

[9] Lafta R, Al-Shatari S, Cherewick M, Galway L, Mock C, Hagopian A, et al. Injuries, death, and disability associated with 11 years of conflict in Baghdad, Iraq: a randomized household cluster survey. PLoS One. 2015;10(8):e0131834. doi: 10.1371/journal.pone.0131834. - DOI - PMC - PubMed

[10] Lafta R, Al-Shatari S, Cherewick M, Galway L, Mock C, Hagopian A, et al. Injuries, death, and disability associated with 11 years of conflict in Baghdad, Iraq: a randomized household cluster survey. PLoS One. 2015;10(8):e0131834. doi: 10.1371/journal.pone.0131834. - DOI - PMC - PubMed

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The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review

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The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review

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