UNASSIGNED: Oral diseases affect nearly half of the global population, presenting significant challenges in fragile and conflict-affected states. Despite comprising a population of over one billion people, oral health data and comprehensive evidence on oral health system strengthening on these countries are limited. This study, therefore, aims to explore oral health system strengthening in fragile and conflict-affected states by synthesising evidence from relevant global literature.
UNASSIGNED: We conducted a systematic review of literature across Ovid MEDLINE, EMBASE, Global Health, Scopus, Web of Science, and grey literature databases. The methodological quality of published literature was assessed using the relevant Joanna Briggs Institute critical appraisal tools. The findings were narratively synthesised and presented using the Lancet\'s high-quality health system framework.
UNASSIGNED: The review included 23 papers from 12 countries. The evidence documented impacts of armed conflicts, political crisis, pandemics, and natural disasters on oral health systems, and initiatives to strengthen them focusing on the \'foundations\' domain. The initiatives included: workforce development and career opportunities; health service platforms such as mobile dental services and teledentistry; integration of oral health into national health systems and emergency responses; contingency planning and adaptability; and effective governance such as financing systems and infrastructures. Collaborative action, both local and international, including monitoring and evaluation were emphasised as key strategies for health system strengthening to ensure an equitable distribution of responsibilities and resources.
UNASSIGNED: Whilst evidence on oral health system strengthening in fragile and conflict-affected states is limited, our findings suggest the need for integrated action, such as mobilising local resources and engaging stakeholders equitably. Further research, with particular focus in the area of processes of care and quality impacts, is necessary to explore comprehensive strategies for strengthening the oral health system.

BACKGROUND: Globally, there is growing attention towards health system strengthening, and the importance of quality in health systems. However, fragile and conflict-affected states present particular challenges. The aim of this study was to explore health system strengthening in fragile and conflict-affected states by synthesising the evidence from published literature.
METHODS: We conducted a review of systematic reviews (Prospero Registration Number: CRD42022371955) by searching Ovid (Medline, Embase, and Global Health), Scopus, Web of Science, and the Cochrane Library databases. Only English-language publications were considered. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was employed to assess methodological quality of the included studies. The findings were narratively synthesised and presented in line with the Lancet\'s \'high-quality health system framework\'.
RESULTS: Twenty-seven systematic reviews, out of 2,704 identified records, considered key dimensions of health systems in fragile and conflict-affected states, with the \'foundations\' domain having most evidence. Significant challenges to health system strengthening, including the flight of human capital due to safety concerns and difficult working conditions, as well as limited training capacities and resources, were identified. Facilitators included community involvement, support systems and innovative financing mechanisms. The importance of coordinated and integrated responses tailored to the context and stage of the crisis situation was emphasised in order to strengthen fragile health systems. Overall, health system strengthening initiatives included policies encouraging the return and integration of displaced healthcare workers, building local healthcare workers capacity, strengthening education and training, integrating healthcare services, trust-building, supportive supervision, and e-Health utilisation.
CONCLUSIONS: The emerging body of evidence on health system strengthening in fragile and conflict-affected states highlights its complexity. The findings underscore the significance of adopting a comprehensive approach and engaging various stakeholders in a coordinated manner considering the stage and context of the situation.

The year 2022 witnessed an alarming surge in state-based armed conflicts globally, reaching a staggering 56, with major hostilities in Ukraine, Myanmar, and Nigeria resulting in over 10,000 estimated conflict-related deaths. This trend continued with the onset of a significant conflict between Israel and Hamas in October 2023. The escalating frequency of armed conflicts, reaching the highest number since 1946, poses a critical threat to global health. This paper explores the multifaceted health impacts of armed conflicts, encompassing physical injuries, infectious diseases, malnutrition, and profound mental health consequences. Healthcare systems in conflict zones face severe strain, and achieving Sustainable Development Goals by 2030 becomes increasingly challenging. The surge in armed conflicts globally is characterized as a \"pandemic,\" justifying urgent attention. The paper identifies and discusses strategies to safeguard public health in conflict zones, emphasizing humanitarian response, protecting healthcare workers and infrastructure, building preparedness and resilience, and promoting mental health support. In navigating this \"pandemic\" of armed conflicts, comprehensive strategies are imperative to address the intricate challenges and secure a healthier global future.

Conflict adversely affects respiratory health in both direct and indirect ways among populations whose health is already compromised through the compounding effects of conflict. Our aim is to review academic and grey literature relevant to respiratory health in the Syrian conflict (now more than a decade in duration) to explore its impacts on populations across Syria. We performed a scoping literature review of academic and grey literature on respiratory health in Syria between March 2011 (taken as the start of the conflict for practicality) and December 2023. Of 11,472 papers screened, 34 met the inclusion criteria, of which 29 were peer reviewed. Key themes identified included the impact of conflict on asthma diagnosis and management; the burden of respiratory tract infections (RTIs) and COVID-19; the impact of chemical weapon use and the impact of destruction and interruptions to the health system(s) across Syria on respiratory health. This review highlights the need for more in-depth exploration of the impact of conflict on respiratory health in Syria with focus on social determinants, for example, shelter, public health interventions, smoking cessation, and supporting early diagnosis and treatment of respiratory conditions to counter the effects that conflict has had on respiratory health.

Statistical data indicate a link between war and the spread of sexually transmitted infections (STIs), then it is necessary to carefully analyze the factors that directly affect the identified pattern in order to overcome this problem. Therefore, the purpose of the study was to systematically analyze the factors that influence the spread of STIs during war.
The study included all original research articles and meta-analyses on the impact of war on the spread of sexually transmitted infections that met the following eligibility criteria: (1) articles published exclusively in English; (2) articles published in the period 2013-2023; (3) studies with quantitative, qualitative or mixed design. The search for relevant literature was conducted using four databases: PubMed, Embase, Web of Science, and Ebsco.
The articles selected for our systematic review had different research designs and were mainly published as original studies (n = 8) and literature reviews (n = 6). As a result of the evaluation of the selected articles for the systematic review, the authors identified migration, a decrease in access to health care, difficult access to contraception, sexual violence as the most frequent factors directly affecting the spread of STIs during the war.
This systematic review systematizes data on the impact of hostilities on the spread of STIs and outlines the main factors that contribute to the dissemination of pathogens far beyond the territory at the epicenter of the conflict.Systematic review registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023479808, CRD42023479808.

OBJECTIVE: To identify chronic pain management strategies aimed to reduce pain intensity and enhance functional outcomes in veterans of wars and armed conflict.
METHODS: Systematic review without meta-analysis.
METHODS: Key words \"chronic pain,\" \"veterans,\" and \"injuries\" were used to search for articles in the MEDLINE, CINAHL, APA PsycInfo, and Embase databases. Articles published in English between 2000 and 2023 were included.
METHODS: A systematic literature search was conducted in June 2020, updated in April 2023, and managed using Covidence review software. Inclusion criteria focused on combat-injured veterans with chronic pain, excluding nonveterans and civilians treated for acute or chronic pain. Data from included studies were extracted, summarized, and critically appraised using the 2018 Mixed Methods Appraisal Tool. This review is registered with PROSPERO (CRD42020207435).
RESULTS: Fourteen studies met the inclusion criteria, with 10 of them supporting nonpharmacological approaches for managing chronic pain among veterans of armed conflicts and wars. Interventions included psychological/behavioral therapies, peer support, biofeedback training via telephone-based therapy, manual therapy, yoga, cognitive processing therapy, cognitive-behavioral therapy, and social and community integration to reduce pain intensity and enhance functional outcomes.
CONCLUSIONS: Nonpharmacological treatments for chronic pain have increased in recent years, a shift from earlier reliance on pharmacological treatments. More evidence from randomized controlled trials on the benefits of combined pain interventions could improve pain management of veterans with complex care needs.

BACKGROUND: Scant data are available on the link between armed conflicts and the development and spread of antimicrobial resistance.
OBJECTIVE: We performed a systematic review with the aim to summarize the available data on the prevalence and features of antibiotic resistance and the causes of antibiotic resistance development during armed conflicts in the 21st century.
METHODS: Data sources: PubMed and SCOPUS databases were searched from 1 January 2000 to 30 November 2023.
METHODS: Original articles reporting data on armed conflicts and antimicrobial resistance were included in this systematic review. No attempt was made to obtain information from unpublished studies. No language restriction was applied. Methods of data synthesis: Both quantitative and qualitative information were summarized by means of textual descriptions.
METHODS: Patients or soldiers deployed in armed conflict zones.
METHODS: culture-dependent antibiotic sensitivity testing or molecular detection of the genetic determinants of antibiotic resistance after a confirmed diagnosis of bacterial infection. Assessment of risk of bias: To evaluate the quality of the included studies, we adapted the tool recommended by the Joanna Briggs Institute.
RESULTS: Thirty-four studies were identified, published between November 2004 and November 2023. The quality of included studies was high and medium in 47% and 53% of the studies, respectively. The included studies reported high infection and colonization rates of multidrug-resistant bacteria. Studies performed during the Eastern Ukraine conflict reported high rates of New Delhi metallo-β-lactamase producers.
CONCLUSIONS: Our findings confirm that wars lead to a large pool of multidrug-resistant infections that could potentially spread. Infection control in healthcare facilities in conflict zones and proper antimicrobial stewardship are crucial.

OBJECTIVE: This systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes.
METHODS: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
METHODS: PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, ScienceDirect, Embase and medRxiv.
METHODS: Three reviewers independently screened, selected eligible studies and extracted data. A narrative review was undertaken to summarise the findings qualitatively.
RESULTS: Eleven studies were included in this review, reporting on tuberculosis incidence rates, prevalence and treatment outcomes, including mortality. Overall, the impact of armed conflicts on case notifications was variable. Six studies reported overall increases in tuberculosis case notifications following the onset of conflicts, while three studies reported overall decreases in tuberculosis case notifications. Factors, including limited access to healthcare services, challenges in surveillance and laboratory confirmation, the destruction of health systems and incapacitating the healthcare workforce, contributed to a decrease in the number of notified cases. The higher tuberculosis notification in some of the studies could be attributed to the disruption of tuberculosis prevention and control programmes as well as increased socioeconomic deprivation, including malnutrition, mass migration, poor living conditions and overcrowding that are worsened during conflicts. Armed conflicts without effective interventions were associated with worse tuberculosis treatment outcomes, including lower proportions of people with treatment success and higher proportions of people with loss to follow-up, mortality and treatment failure. However, implementing various interventions in conflict settings (such as establishing a National Tuberculosis Control Programme) led to higher tuberculosis notification rates and treatment success.
CONCLUSIONS: The impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources.

BACKGROUND: Women exposed to armed conflicts and forced migration face significant health-related risks and consequences. Consequently, there is a need to identify and develop effective interventions that provide tailored support for them. The aim of this scoping review was to examine research evaluating support interventions promoting the health and well-being among women with traumatic experiences linked to armed conflict and/or forced migration.
METHODS: A scoping review of empirical studies evaluating non-pharmacologic/non-surgical interventions promoting health and well-being among adult women with traumatic experiences linked to armed, torture, and/or forced migration, identified through systematic searches in February 2022 within five databases (AMED, CINAHL, Cochrane Library, PsycINFO, and PubMed). Methodological characteristics and results were extracted and analyzed with narrative analysis using tabulations, descriptive statistics, text-based summaries, and thematization.
RESULTS: Assessment of 16 748 records resulted in 13 included reports. The methodological approaches were quantitative (n = 9), qualitative (n = 2), and mixed methods (n = 2), with most reports being feasibility/pilot studies (n = 5) and/or randomized controlled trials (n = 4). The most common recruitment strategy was non-probability sampling (n = 8). Most interventions were conducted in North America (n = 4), Asia (n = 3) or Middle East (n = 3). Thirteen intra-intervention techniques and five categories of components utilized within the interventions were identified, the most common being skill building (n = 12). Ten developed the interventions through theoretical frameworks or manuals/therapy, while five developed interventions through public or stakeholder involvement. Eleven studies evaluated outcomes related to psychological health, disorders, or distress. A large proportion of the investigated outcomes showed post-exposure improvements and improvements when compared with controls. Qualitative findings highlighted improved mental and physical health, empowerment and stigma reduction, and enhanced knowledge.
CONCLUSIONS: Few studies have developed and evaluated tailored support interventions for this population, containing a range of components and intra-intervention techniques. No clear focus was identified regarding outcome measures, and most studies used non-probability sampling. Few developed interventions through public contribution in collaboration with women. While limited studies show promising effects on women\'s mental health, more empirical intervention research that closely corresponds to women\'s needs are needed.

Malaria is a major public health problem in developing countries. The burden of malaria in fragile and conflict-affected states (FCAS) is increasing year by year. Moreover, the population living in FCAS is often the most vulnerable and at high risk of malaria due to factors, such as deteriorating healthcare system, mass relocations, and reduced resilience to shocks. Therefore, this scoping review aims to map the interventions that are conducted at the FCAS on malaria prevention among the general population. In addition, this review can help policy-makers and international health bodies, providing a comprehensive overview that can lead to more targeted, effective, and context-specific interventions. Databases, such as PubMed, EBSCO-CINAHL, Web of Science, ProQuest, and Cochrane Central Register of Controlled Trials, were searched using specified search terms. A total of 3601 studies were retrieved from the search. After screening, 62 studies were included in the synthesis that met the eligibility criteria. Narrative analysis of the findings was done. The results revealed that in fragile countries, interventions for children below 5 years of age included IPTi, TDA, and ACT. In conflicted countries, interventions for children below 5 years of age included TDA, LLINs, SMC, drug trials, and vaccination. Similar interventions were reported for other age groups and populations. Despite ongoing conflicts, malaria interventions have been maintained in these countries, but a persistent high burden of malaria remains. To achieve the goals of malaria elimination, the results of the review highlight the need for continued research and evaluation of malaria control interventions to assess their effectiveness and impact. Strengthening health systems, building partnerships, utilizing digital health technologies, and conducting context-specific research are recommended to improve healthcare access and reduce the burden of malaria in FCAS.