{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:39:24Z","timestamp":1790735964160,"version":"4.1.0"},"reference-count":34,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T00:00:00Z","timestamp":1684281600000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000836","name":"University of Liverpool","doi-asserted-by":"publisher","award":["Not Applicable"],"award-info":[{"award-number":["Not Applicable"]}],"id":[{"id":"10.13039\/501100000836","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,5,3]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Complex challenges such as political instability, climate change and population displacement are increasing threats to national disease control, elimination and eradication programmes. The objective of this study was to determine the burden and risk of conflict-related and climate-related internal displacements and the need for strategies for countries endemic with neglected tropical diseases (NTDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and outcome measures<\/jats:title>\n                    <jats:p>A cross-sectional ecological study was conducted including countries that are endemic with at least one of five NTDs requiring preventive chemotherapy in the African region. For each country, the number of NTDs, population size and the number and rate per 100 000 of conflict-related and natural disaster-related internal displacements reported in 2021 were classified into high and low categories and used in unison to stratify and map the burden and risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This analysis identified 45 NTD-endemic countries; 8 countries were co-endemic with 4 or 5 diseases and had populations classified as \u2018high\u2019 totalling &gt;619 million people. We found 32 endemic countries had data on internal displacements related to conflict and disasters (n=16), disasters only (n=15) or conflict only (n=1). Six countries had both high conflict-related and disaster-related internal displacement numbers totalling &gt;10.8 million people, and five countries had combined high conflict-related and disaster-related internal displacement rates, ranging from 770.8 to 7088.1 per 100 000 population. Weather-related hazards were the main cause of natural disaster-related displacements, predominately floods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This paper presents a risk stratified approach to better understand the potential impact of these complex intersecting challenges. We advocate for a \u2018call to action\u2019 to encourage national and international stakeholders to further develop, implement and evaluate strategies to better assess NTD endemicity, and deliver interventions, in areas at risk of, or experiencing, conflict and climate disasters, in order to help meet the national targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-071557","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T11:01:34Z","timestamp":1684321294000},"page":"e071557","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Conflict-climate-displacement: a cross-sectional ecological study determining the burden, risk and need for strategies for neglected tropical disease programmes in Africa"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3330-7629","authenticated-orcid":false,"given":"Louise A","family":"Kelly-Hope","sequence":"first","affiliation":[{"name":"Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1432-8109","authenticated-orcid":false,"given":"Emma Mich\u00e8le","family":"Harding-Esch","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Willems","sequence":"additional","affiliation":[{"name":"CBM Christoffel-Blindenmission Christian Blind Mission e.V, Bensheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Ahmed","sequence":"additional","affiliation":[{"name":"The MENTOR Initiative, Haywards Heath, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7284-0303","authenticated-orcid":false,"given":"Angelia M","family":"Sanders","sequence":"additional","affiliation":[{"name":"Trachoma Control Program, The Carter Center, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,17]]},"reference":[{"key":"2025121601352564000_13.5.e071557.1","unstructured":"World Health Organization . Ending the neglect to attain the sustainable development goals: a road map for neglected tropical diseases 2021\u20132030. Geneva. 2020. Available: https:\/\/apps.who.int\/iris\/handle\/10665\/338565"},{"key":"2025121601352564000_13.5.e071557.2","doi-asserted-by":"crossref","DOI":"10.1186\/s40249-017-0288-0","article-title":"The cross-cutting contribution of the end of neglected tropical diseases to the sustainable development goals","volume":"6","author":"Bangert","year":"2017","journal-title":"Infect Dis Poverty"},{"key":"2025121601352564000_13.5.e071557.3","unstructured":"United Nations.Department of Economic and Social Affairs. Sustainable Development Goals . Sustainable development. n.d. Available: https:\/\/sdgs.un.org\/goals"},{"key":"2025121601352564000_13.5.e071557.4","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1093\/trstmh\/traa192","article-title":"The impact of climate change on neglected tropical diseases: A systematic review","volume":"115","author":"Tidman","year":"2021","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2025121601352564000_13.5.e071557.5","doi-asserted-by":"crossref","first-page":"1443","DOI":"10.4269\/ajtmh.19-0380","article-title":"Neglected tropical diseases in the context of climate change in East Africa: A systematic Scoping review","volume":"102","author":"Bryson","year":"2020","journal-title":"Am J Trop Med Hyg"},{"key":"2025121601352564000_13.5.e071557.6","doi-asserted-by":"publisher","DOI":"10.1016\/bs.apar.2018.02.001"},{"key":"2025121601352564000_13.5.e071557.7","unstructured":"Eckstein D , K\u00fcnzel V , Sch\u00e4fer L . Global climate risk index 2021 who suffers most extreme weather events? Weather-related loss events in 2019 and 2000-2019. 2021."},{"key":"2025121601352564000_13.5.e071557.8","unstructured":"State of Climate Africa 2021 . World meteorological organization. 2022. Available: https:\/\/library.wmo.int\/index.php?lvl=notice_display&id=22125#.Y5l2B-zP2lM"},{"key":"2025121601352564000_13.5.e071557.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2022-010965","article-title":"Cop27 climate change conference: Urgent action needed for Africa and the world","volume":"7","author":"Zielinski","year":"2022","journal-title":"BMJ Glob Health"},{"key":"2025121601352564000_13.5.e071557.10","unstructured":"Palik J , Rustad SA , Methi F . n.d. Conflict trends in Africa 1989\u20132019."},{"key":"2025121601352564000_13.5.e071557.11","doi-asserted-by":"publisher","DOI":"10.1177\/0022343310378914"},{"key":"2025121601352564000_13.5.e071557.12","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1093\/trstmh\/trac061","article-title":"Lessons learned in the implementation of programmes to eliminate Trachoma within conflict zones","volume":"116","author":"Yaya","year":"2022","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2025121601352564000_13.5.e071557.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006136","article-title":"Could violent conflict derail the London declaration on Ntds","volume":"12","author":"Du","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"2025121601352564000_13.5.e071557.14","unstructured":"McPherson S . Working outside our comfort zone: Fighting Ntds in conflict areas. working outside our comfort zone: Fighting Ntds in conflict areas. n.d. Available: https:\/\/iamtropmed.org\/blog\/2019\/11\/21\/working-outside-our-comfort-zone-fighting-ntds-in-conflict-areas"},{"key":"2025121601352564000_13.5.e071557.15","doi-asserted-by":"crossref","first-page":"ii33","DOI":"10.1093\/inthealth\/ihac010","article-title":"How can the neglected tropical disease community be inclusive and equitable in programme delivery? reaching refugees and internally displaced persons through integrating a 'leave no one behind' approach","volume":"14","author":"Harvey","year":"2022","journal-title":"Int Health"},{"key":"2025121601352564000_13.5.e071557.16","unstructured":"Neglected Tropical Disease NGO Network (NNN) . Conflict and humanitarian emergencies. n.d. Available: https:\/\/www.ntd-ngonetwork.org\/cross-cutting-groups\/conflict-and-humanitarian-emergencies"},{"key":"2025121601352564000_13.5.e071557.17","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-021-00356-7","article-title":"Complex emergencies and the control and elimination of neglected tropical diseases in Africa: Developing a practical approach for implementing safe and effective mapping and intervention strategies","volume":"15","author":"Kelly-Hope","year":"2021","journal-title":"Confl Health"},{"key":"2025121601352564000_13.5.e071557.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-049732","article-title":"Quantifying conflict zones as a challenge to certification of Guinea worm eradication in Africa: A new Analytical approach","volume":"11","author":"Kelly-Hope","year":"2021","journal-title":"BMJ Open"},{"key":"2025121601352564000_13.5.e071557.19","doi-asserted-by":"crossref","DOI":"10.1016\/j.jmh.2021.100071","article-title":"Understanding the health needs of internally displaced persons: a Scoping review","volume":"4","author":"Cantor","year":"2021","journal-title":"J Migr Health"},{"key":"2025121601352564000_13.5.e071557.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-022-02365-6","article-title":"Leaving no one behind: Targeting mobile and migrant populations with health interventions for disease elimination\u2014a descriptive systematic review","volume":"20","author":"Adams","year":"2022","journal-title":"BMC Med"},{"key":"2025121601352564000_13.5.e071557.21","unstructured":"World Health Organization . Summary of global update on implementation of preventive chemotherapy against Ntds in 2020. 2021."},{"key":"2025121601352564000_13.5.e071557.22","doi-asserted-by":"crossref","DOI":"10.1098\/rstb.2012.0144","article-title":"Preventive chemotherapy as a strategy for elimination of neglected tropical parasitic diseases: Endgame challenges","volume":"368","author":"Bockarie","year":"2013","journal-title":"Philos Trans R Soc Lond B Biol Sci"},{"key":"2025121601352564000_13.5.e071557.23","unstructured":"Internal Displacement Monitoring Centre (IDMC) . Global internal displacement database data. 2022. Available: https:\/\/www.internal-displacement.org\/database\/displacement-data"},{"key":"2025121601352564000_13.5.e071557.24","unstructured":"World Health Organization . Expandedspecial project for elimination of neglected tropical diseases (ESPEN). 2022 Available: https:\/\/espen.afro.who.int\/"},{"key":"2025121601352564000_13.5.e071557.25","unstructured":"Carlin A . Why we should reconsider population data for disease control and public health programmes. BMC BugBitten 2021. Available: https:\/\/blogs.biomedcentral.com\/bugbitten\/2021\/11\/26\/population-data-disease-control-public-health\/"},{"key":"2025121601352564000_13.5.e071557.26","doi-asserted-by":"crossref","DOI":"10.1016\/j.jmh.2022.100120","article-title":"What we do know (and could know) about estimating population sizes of internally displaced people","volume":"6","author":"Ratnayake","year":"2022","journal-title":"J Migr Health"},{"key":"2025121601352564000_13.5.e071557.27","unstructured":"United Nations Develop Programme (UNDP) . Human development report 2021-22: Uncertain times, unsettled lives: Shaping our future in a transforming world. New York. 2022. Available: https:\/\/hdr.undp.org\/data-center\/human-development-index#\/indicies\/HDI"},{"key":"2025121601352564000_13.5.e071557.28","unstructured":"United Nations Environment Programme (UNEP) . Climate change and security risks. Disasters and conflicts. 2022. Available: https:\/\/www.unep.org\/explore-topics\/disasters-conflicts\/what-we-do\/disaster-risk-reduction\/climate-change-and-security"},{"key":"2025121601352564000_13.5.e071557.29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2346.2007.00678.x"},{"key":"2025121601352564000_13.5.e071557.30","doi-asserted-by":"publisher","DOI":"10.1177\/17579139211058299"},{"key":"2025121601352564000_13.5.e071557.31","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-019-1300-6"},{"key":"2025121601352564000_13.5.e071557.32","unstructured":"United Nations Office for the Coordination of Humanitarian Affairs (OCHA) . Humanitarian system\/clusters\/what is the cluster approach? n.d. Available: https:\/\/www.humanitarianresponse.info\/en\/coordination\/clusters\/what-cluster-approach"},{"key":"2025121601352564000_13.5.e071557.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007491","article-title":"Prevalence of Trachoma within refugee camps serving South Sudanese refugees in white Nile state, Sudan: Results from population-based surveys","volume":"13","author":"Sanders","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2025121601352564000_13.5.e071557.34","unstructured":"The International, Coalition for Trachoma Control, (ICTC) . THE END IN SIGHT: From collaboration to elimination, strategic plan 2022\u20132030. 2022. Available: https:\/\/www.trachomacoalition.org\/sites\/default\/files\/content\/resources\/files\/ICTC%20Strategic%20Plan.pdf"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-071557","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:35:36Z","timestamp":1765877736000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-071557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,17]]},"published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1136\/bmjopen-2023-071557"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-071557","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5]]}}}