Implications of the social determinants of health and identifying effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: a systematic review

Abstract

Abstract Background The impact of rapid urbanization taking place across the world is posing variegated challenge. Especially in terms of communicable disease, the risk is more concentrated in urban poor areas where basic amenities are inadequate. In this context, the aim of this study was to carry out an evidence synthesis on the state-of the art effective community-based interventions in tackling infectious diseases among the urban poor in the LMICs across the globe. Methods This review has been registered in PROPSPERO (CRD42021278689). A total of 18,260 published articles were primarily selected; after applying the inclusion and exclusion criteria 115 studies were considered for full-text screening. Among them, 17 articles were included. Afterwards, reference check was done and finally total of 21 articles were considered for the systematic review. Narrative synthesis was done. Results The pathway to identifying and addressing the SDOH through community-based intervention in the urban poor setting was complex. For effectiveness of a community-based intervention, the socio-cultural context is found extremely important. From this review, the effective community-based interventions were- community-based screening and socio-economic support, community-based vector control, behaviour change communication, capacity building of the Community Health Workers, health education and e-health interventions. Interventions need to be delivered considering the day-to-day realities of the urban poor. While some studies considered the outcome of specific diseases through vertical intervention approach, scarcity of evidence was found in terms of taking an intersectional approach. Discussion The effectiveness of an intervention are inextricable linked with social context, stakeholder dimensions and macro level social issues. The review results thus suggestive of an intervention package that considers a systems approach. Conclusion Considering this complex reality of an intervention to be effective, this evidence-synthesis therefore advocates for designing the intervention package with multiple components related to prevention and control of communicable diseases in poor urban areas. PROSPERO registration number: This review has been registered in PROPSPERO (CRD42021278689).