Conference Material > Abstract
Sadique S, Lin YD, Walker SA, Rao B, du Cros PAK, et al.
MSF Scientific Days International 2022. 2022 May 9; DOI:10.57740/s2se-8951
INTRODUCTION
The crowded conditions within camps for refugees and internally displaced people create risk environments for unmitigated transmission of SARS-CoV-2. Within one such setting, Cox’s Bazar, Bangladesh, MSF distributed face masks in July-August 2020 for use by people living in eight camps to reduce transmission risks. However, uptake of face masks within camp populations and the factors influencing use are not well understood.
METHODS
We conducted a multi-level triangulation mixed-methods study in March 2021 in Cox’s Bazar. Field observations were undertaken in public spaces in four camps, noting individuals’ facemask use (appropriate versus not), use of other types of face covering (e.g., headscarf), and gender. We also analysed photographs posted on Twitter during March 2021 that were geotagged in the Cox’s Bazar area, posted with a specific keyword, or posted by connected accounts and tweets. Photographs were also categorised by facemask/headscarf use and gender. Finally, we conducted 32 in-depth interviews to understand perceptions and barriers around mask use. Qualitative data were analysed thematically using NVivo.
ETHICS
This study was approved by the Office of the Civil Surgeon, Cox’s Bazar, Bangladesh and by the MSF Ethics Review Board.
RESULTS
We made 3,152 public observations. Only 190/3,152 (6%) were using a mask appropriately. Men were more likely to be seen using any visible standard facemask appropriately than women (odds ratio, OR, 1.5, 95% confidence interval 1.1-2.2, p-value 0.037). Most women were observed wearing headscarves that precluded observing if masks were worn underneath. The content of 20 tweets were analysed. One photograph showed one person wearing a mask correctly; in 17 photographs individuals wore no face covering and in 2 wore scarves. Qualitative data suggested participants were aware of the importance of mask use but highlighted several reasons for not wearing them, including the fear of being insulted for wearing a mask due to the association between mask use and having Covid-19; a view that they were unnecessary because there was little Covid-19 in the camps; experiences of physical difficulties or discomfort whilst wearing masks; and a belief that wearing facemasks was unnecessary because “life or death is up to Allah”. Participants highlighted the current shortage of masks in the camps as well as adverse consequences of insufficient masks, and requested further distribution.
CONCLUSION
These findings suggest low adherence to recommendations around mask use in this camp setting. Multiple strategies need to be considered, including better distribution strategies and improved messaging and engagement with religious and community leaders to increase facemask use in settings such as Cox’s Bazar.
CONFLICTS OF INTEREST
None declared.
The crowded conditions within camps for refugees and internally displaced people create risk environments for unmitigated transmission of SARS-CoV-2. Within one such setting, Cox’s Bazar, Bangladesh, MSF distributed face masks in July-August 2020 for use by people living in eight camps to reduce transmission risks. However, uptake of face masks within camp populations and the factors influencing use are not well understood.
METHODS
We conducted a multi-level triangulation mixed-methods study in March 2021 in Cox’s Bazar. Field observations were undertaken in public spaces in four camps, noting individuals’ facemask use (appropriate versus not), use of other types of face covering (e.g., headscarf), and gender. We also analysed photographs posted on Twitter during March 2021 that were geotagged in the Cox’s Bazar area, posted with a specific keyword, or posted by connected accounts and tweets. Photographs were also categorised by facemask/headscarf use and gender. Finally, we conducted 32 in-depth interviews to understand perceptions and barriers around mask use. Qualitative data were analysed thematically using NVivo.
ETHICS
This study was approved by the Office of the Civil Surgeon, Cox’s Bazar, Bangladesh and by the MSF Ethics Review Board.
RESULTS
We made 3,152 public observations. Only 190/3,152 (6%) were using a mask appropriately. Men were more likely to be seen using any visible standard facemask appropriately than women (odds ratio, OR, 1.5, 95% confidence interval 1.1-2.2, p-value 0.037). Most women were observed wearing headscarves that precluded observing if masks were worn underneath. The content of 20 tweets were analysed. One photograph showed one person wearing a mask correctly; in 17 photographs individuals wore no face covering and in 2 wore scarves. Qualitative data suggested participants were aware of the importance of mask use but highlighted several reasons for not wearing them, including the fear of being insulted for wearing a mask due to the association between mask use and having Covid-19; a view that they were unnecessary because there was little Covid-19 in the camps; experiences of physical difficulties or discomfort whilst wearing masks; and a belief that wearing facemasks was unnecessary because “life or death is up to Allah”. Participants highlighted the current shortage of masks in the camps as well as adverse consequences of insufficient masks, and requested further distribution.
CONCLUSION
These findings suggest low adherence to recommendations around mask use in this camp setting. Multiple strategies need to be considered, including better distribution strategies and improved messaging and engagement with religious and community leaders to increase facemask use in settings such as Cox’s Bazar.
CONFLICTS OF INTEREST
None declared.
Conference Material > Poster
Sadique S, Beversluis D, Caleo GNC, Gray NSB, Hossain MS, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Journal Article > ResearchFull Text
BMJ Glob Health. 2022 March 16; Volume 7 (Issue 3); e007707.; DOI:10.1136/bmjgh-2021-007707
Sheather J, Apunyo R, DuBois M, Khondaker R, Noman A, et al.
BMJ Glob Health. 2022 March 16; Volume 7 (Issue 3); e007707.; DOI:10.1136/bmjgh-2021-007707
This paper explores the quality and usefulness of ethical guidance for humanitarian aid workers and their agencies. We focus specifically on public health emergencies, such as COVID-19. The authors undertook a literature review and gathered empirical data through semi-structured focus group discussions amongst front-line workers from health clinics in Cox’s Bazar, Bangladesh and in the Abyei Special Administrative Area, South Sudan. The purpose of the project was to identify how front-line workers respond to ethical challenges, including any informal or local decision-making processes, support networks, or habits of response.
The research findings highlighted a dissonance between ethical guidance and the experiences of front-line humanitarian health workers. They suggest the possibility: (1) that few problems confronting front-line workers are conceived, described, or resolved as ethical problems; and (2) of significant dissonance between available, allegedly practically oriented guidance (often produced by academics in North America and Europe), and the immediate issues confronting front-line workers. The literature review and focus group data suggest a real possibility that there is, at best, a significant epistemic gulf between those who produce ethical guidelines and those engaged in real-time problem solving at the point of contact with people. At worst they suggest a form of epistemic control—an imposition of cognitive shapes that shoehorn the round peg of theoretical preoccupations and the disciplinary boundaries of western academies into the square hole of front-line humanitarian practice.
The research findings highlighted a dissonance between ethical guidance and the experiences of front-line humanitarian health workers. They suggest the possibility: (1) that few problems confronting front-line workers are conceived, described, or resolved as ethical problems; and (2) of significant dissonance between available, allegedly practically oriented guidance (often produced by academics in North America and Europe), and the immediate issues confronting front-line workers. The literature review and focus group data suggest a real possibility that there is, at best, a significant epistemic gulf between those who produce ethical guidelines and those engaged in real-time problem solving at the point of contact with people. At worst they suggest a form of epistemic control—an imposition of cognitive shapes that shoehorn the round peg of theoretical preoccupations and the disciplinary boundaries of western academies into the square hole of front-line humanitarian practice.
Conference Material > Video (talk)
Sadique S
MSF Scientific Days International 2022. 2022 June 7; DOI:10.57740/58t4-k468
Conference Material > Slide Presentation
Sadique S, Beversluis D, Caleo GNC, Carter W, Chowdhury SM, et al.
MSF Scientific Days International 2023. 2023 June 7; DOI:10.57740/5qd0-yj04
Conference Material > Abstract
Sadique S, Beversluis D, Caleo GNC, Carter W, Chowdhury SM, et al.
MSF Scientific Days International 2023. 2023 June 7; DOI:10.57740/bzht-7p36
INTRODUCTION
Addressing occupational injury and disease has been declared a national priority in Bangladesh. However critical gaps remain in improving work safety in small-scale peri-urban factories. We aimed to assess the feasibility of collaborating with owners and workers to design and implement interventions to improve work safety in two metal factories in Kamrangirchar, Dhaka.
METHODS
We implemented a participatory mixed methods before-and-after study with four phases. Phase 1 explored the dynamics of injuries, hazards, and risks using hazard assessments, surveillance, in-depth interviews, and focus group discussions. Triangulation of phase 1 findings informed design and implementation of intervention packages implemented in phase 2. In phases 3 and 4, we repeated hazard assessments and used qualitative methods to document changes in hazards and perspectives at 6- and 12-months post-intervention. Observations captured by field notes complemented data generated throughout the study.
ETHICS
The study was approved by the MSF Ethical Review Board (ERB) and by the ERB of the Centre for Injury Prevention and Research, Bangladesh.
RESULTS
Overall 136 workers in two factories (A and B) participated in the study (with a turnover of 41.5%). Surveillance captured 129 injuries during phase 1 (from 10th March 2019 in factory A and 30th April 2019 in factory B, to 31st July 2019), and all workers aged under 18 years experienced incidents. Hazard assessments documented hazard risk scores (HRS) of 54% in factory A and 36% in factory B. Qualitative data indicated workers perceived their work as risky, but explained it was prioritised over their health due to financial necessity. Phase 2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Factory owners and workers actively participated in design and implementation. Phase 3 showed a two-fold reduction in HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase 4 hazard assessment revealed that improvement was sustained in one factory; the final HRS was 27% in factory A, but returned to the pre-intervention score of 36% in factory B. Workers explained they observed improvements in workplace safety but noted challenges in sustainability due to owner commitment and worker turnover. Observation and qualitative data revealed complex power dynamics in the factories, as well as power imbalances and risks faced by female and young workers.
CONCLUSION
It was feasible to collaborate with workers and owners to implement interventions aimed at improving work safety. However, sustainability was mixed, and long-standing structural inequities that contribute to poor safety remain. Findings indicate urgent action is needed to improve safety and build an inclusive model of occupational health, including social and protection components, with particular attention for female workers and workers aged under 18.
CONFLICTS OF INTEREST
None declared
Addressing occupational injury and disease has been declared a national priority in Bangladesh. However critical gaps remain in improving work safety in small-scale peri-urban factories. We aimed to assess the feasibility of collaborating with owners and workers to design and implement interventions to improve work safety in two metal factories in Kamrangirchar, Dhaka.
METHODS
We implemented a participatory mixed methods before-and-after study with four phases. Phase 1 explored the dynamics of injuries, hazards, and risks using hazard assessments, surveillance, in-depth interviews, and focus group discussions. Triangulation of phase 1 findings informed design and implementation of intervention packages implemented in phase 2. In phases 3 and 4, we repeated hazard assessments and used qualitative methods to document changes in hazards and perspectives at 6- and 12-months post-intervention. Observations captured by field notes complemented data generated throughout the study.
ETHICS
The study was approved by the MSF Ethical Review Board (ERB) and by the ERB of the Centre for Injury Prevention and Research, Bangladesh.
RESULTS
Overall 136 workers in two factories (A and B) participated in the study (with a turnover of 41.5%). Surveillance captured 129 injuries during phase 1 (from 10th March 2019 in factory A and 30th April 2019 in factory B, to 31st July 2019), and all workers aged under 18 years experienced incidents. Hazard assessments documented hazard risk scores (HRS) of 54% in factory A and 36% in factory B. Qualitative data indicated workers perceived their work as risky, but explained it was prioritised over their health due to financial necessity. Phase 2 intervention packages included engineering controls, personal protective equipment, infrastructure safety and training. Factory owners and workers actively participated in design and implementation. Phase 3 showed a two-fold reduction in HRS in factory A (24%) and a 1.5-fold reduction (21%) in factory B. Phase 4 hazard assessment revealed that improvement was sustained in one factory; the final HRS was 27% in factory A, but returned to the pre-intervention score of 36% in factory B. Workers explained they observed improvements in workplace safety but noted challenges in sustainability due to owner commitment and worker turnover. Observation and qualitative data revealed complex power dynamics in the factories, as well as power imbalances and risks faced by female and young workers.
CONCLUSION
It was feasible to collaborate with workers and owners to implement interventions aimed at improving work safety. However, sustainability was mixed, and long-standing structural inequities that contribute to poor safety remain. Findings indicate urgent action is needed to improve safety and build an inclusive model of occupational health, including social and protection components, with particular attention for female workers and workers aged under 18.
CONFLICTS OF INTEREST
None declared
Conference Material > Video (talk)
Sadique S
MSF Scientific Days International 2023. 2023 June 7; DOI:10.57740/g4wt-k448
Conference Material > Video (panel)
Ellman T, Ali Z, Raghaven V, Sadique S, Singh JA, et al.
MSF Scientific Days International 2021: Research. 2021 May 18
Conference Material > Slide Presentation
Sadique S, Lin YD, Walker SA, Rao B, du Cros PAK, et al.
MSF Scientific Days International 2022. 2022 May 10; DOI:10.57740/54qw-5453