Conference Material > Abstract
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/b641-d608
INTRODUCTION
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Between 2020 and 2021, MSF’s social sciences team designed and supported implementation of qualitative assessments to better understand community-level outbreak responses and well-being in the context of Covid-19. Assessments were conducted in seven sites, specifically Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland. Although a single protocol was designed and followed, each site was unique in terms of its setting (e.g. camp, conflict, urban, or rural), who implemented assessments (e.g. field epidemiologists, health promotion staff), timing of implementation (early phase of the pandemic versus late phase), and community involvement. Here we present a synthesis of the assessments to inform future public health responses.
METHODS
Synthesis involved secondary analysis of qualitative reports over five iterative phases. Phase 1 involved in-depth reading of each report, during which analytic annotation and note-taking took place. In Phase 2, each report was coded inductively. In Phase 3, codes were reviewed, defined, and clustered into initial categories and themes. Phase 4 involved reviewing and refining codes, categories, and themes, and establishing connections. In Phase 5, synthesis findings were organised and written up. The process was managed using the software ATLAS.ti.
ETHICS
This synthesis is an a posteriori analysis of secondary data. Ethics approval for primary data was granted by officials in Nigeria, Sierra Leone, Chad, Iraq, Tajikistan, Syria, and Somaliland and the MSF Ethics Review Board.
RESULTS
Overall 138, people participated in the assessments, of which 21 (15%) were women. Participants included health workers, community members, traditional healers, chiefs, young people, women’s leaders and local staff. Four themes were identified: 1) exacerbation of pre-existing vulnerabilities and inequalities; 2) disruption of coping mechanisms; 3) awareness of the risks of Covid-19; 4) community as a public health enabler. The pandemic was seen to magnify existing social inequalities and overall health burden. Public health measures to control the spread of Covid-19 often disrupted community coping mechanisms by causing fear of separation and practical challenges around compliance. Awareness of the risks of Covid-19 and understanding of prevention measures were high, with socio-economic costs of compliance relying on external funding and relief. A community led intervention for effective public health controls varied between sites, depending on previous outbreak experiences (e.g. Ebola and tuberculosis), and/or settings experiencing protracted conflict (e.g. Syria, and Iraq).
CONCLUSION
Our synthesis illustrates syndemic effects of the pandemic. From an operational perspective, there is a need to diversify humanitarian, social, and health interventions, and strengthen approaches to working with communities to identify how best to take forward public health measures in humanitarian settings.
CONFLICTS OF INTEREST
None declared.
Journal Article > ResearchFull Text
PLOS One. 16 April 2014; Volume 9 (Issue 4); DOI:10.1371/journal.pone.0093716
Greig J, Thurtle N, Cooney L, Ariti C, Ahmed AO, et al.
PLOS One. 16 April 2014; Volume 9 (Issue 4); DOI:10.1371/journal.pone.0093716
In 2010, Médecins Sans Frontières (MSF) investigated reports of high mortality in young children in Zamfara State, Nigeria, leading to confirmation of villages with widespread acute severe lead poisoning. In a retrospective analysis, we aimed to determine venous blood lead level (VBLL) thresholds and risk factors for encephalopathy using MSF programmatic data from the first year of the outbreak response.
Protocol > Research Protocol
Stellmach DUS
1 July 2014
Overall Aim: To describe and understand the human and technological factors that contribute to the constitution of emergency as a named and actionable entity in the context of medical humanitarianism.
Primary Objective: To describe how individual and institutional attitudes, tools, discretion and practices influence
identification and response to emergency.
Secondary Objective: To document ambiguities, uncertainties or structural barriers that impede the identification of and response to emergency.
Primary Objective: To describe how individual and institutional attitudes, tools, discretion and practices influence
identification and response to emergency.
Secondary Objective: To document ambiguities, uncertainties or structural barriers that impede the identification of and response to emergency.
Journal Article > ResearchFull Text
Int J Health Policy Manag. 9 November 2020; DOI:10.34172/ijhpm.2020.203
Thow AM, Apprey C, Winters J, Stellmach DUS, Alders R, et al.
Int J Health Policy Manag. 9 November 2020; DOI:10.34172/ijhpm.2020.203
Background
The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry – a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF).
Methods
This study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present).
Results
Despite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of ‘failure’ of food policy intervention and an entrenched narrowly economic conception of food security.
Conclusion
This study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition.
The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry – a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF).
Methods
This study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present).
Results
Despite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of ‘failure’ of food policy intervention and an entrenched narrowly economic conception of food security.
Conclusion
This study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition.
Journal Article > CommentaryFull Text
Med Anthropol Theory. 15 December 2017; Volume 4 (Issue 5); DOI:10.17157/mat.4.5.477
Beshar I, Stellmach DUS
Med Anthropol Theory. 15 December 2017; Volume 4 (Issue 5); DOI:10.17157/mat.4.5.477
Journal Article > Short ReportFull Text
BMJ Glob Health. 25 March 2018; Volume 3 (Issue 2); DOI:10.1136/bmjgh-2017-000534
Stellmach DUS, Beshar I, Bedford J, du Cros PAK, Stringer B
BMJ Glob Health. 25 March 2018; Volume 3 (Issue 2); DOI:10.1136/bmjgh-2017-000534
Recent outbreaks of Ebola virus disease (2013-2016) and Zika virus (2015-2016) bring renewed recognition of the need to understand social pathways of disease transmission and barriers to care. Social scientists, anthropologists in particular, have been recognised as important players in disease outbreak response because of their ability to assess social, economic and political factors in local contexts. However, in emergency public health response, as with any interdisciplinary setting, different professions may disagree over methods, ethics and the nature of evidence itself. A disease outbreak is no place to begin to negotiate disciplinary differences. Given increasing demand for anthropologists to work alongside epidemiologists, clinicians and public health professionals in health crises, this paper gives a basic introduction to anthropological methods and seeks to bridge the gap in disciplinary expectations within emergencies. It asks: 'What can anthropologists do in a public health crisis and how do they do it?' It argues for an interdisciplinary conception of emergency and the recognition that social, psychological and institutional factors influence all aspects of care.
Conference Material > Slide Presentation
Croft LA, Puig-García M, Silver C, Pearlman J, Stellmach DUS, et al.
MSF Scientific Days International 2022. 9 May 2022; DOI:10.57740/pe41-5813
Protocol > Research Protocol
Stringer B, Alcayna T, Caleo GNC, Carrion-Martin I, Froud A, et al.
1 June 2020
What are the perceptions of community groups toward preserving their health and wellbeing during a COVID-19 outbreak?
Both rural, urban, camp, open and conflict settings will be included. Recognising that different locations may have been exposed to COVID-19 in its early phase, it will continue to explore within each setting throughout the outbreak period. So far, the following sites are to be included:
• Nigeria: Anka and Benue IDP camps (Pilot)
• Jordan: Syrian refugee Zaatari camp
• Iraq: Syrian and Iraqi refugee camp(s)
• Sierra Leone: Tonkolili project (Pilot)
• Malaysia: Penang Rohingya refugees : Myanmar Pauktaw camp, Rakhine state
• Bangladesh:Cox Bazaar camps and Kamrangirchar peri-urban slum
• Ethiopia Gambella camp
• Democratic Republic of Congo: South Kivu (Fizi and Kimbi-Lulenge health zones)
Further sites may be submitted to ERB during the outbreak.
Both rural, urban, camp, open and conflict settings will be included. Recognising that different locations may have been exposed to COVID-19 in its early phase, it will continue to explore within each setting throughout the outbreak period. So far, the following sites are to be included:
• Nigeria: Anka and Benue IDP camps (Pilot)
• Jordan: Syrian refugee Zaatari camp
• Iraq: Syrian and Iraqi refugee camp(s)
• Sierra Leone: Tonkolili project (Pilot)
• Malaysia: Penang Rohingya refugees : Myanmar Pauktaw camp, Rakhine state
• Bangladesh:Cox Bazaar camps and Kamrangirchar peri-urban slum
• Ethiopia Gambella camp
• Democratic Republic of Congo: South Kivu (Fizi and Kimbi-Lulenge health zones)
Further sites may be submitted to ERB during the outbreak.
Journal Blog > Perspective
Ethnography. 7 January 2020; DOI:10.1177/1466138119898744
Stellmach DUS
Ethnography. 7 January 2020; DOI:10.1177/1466138119898744
This short reflection considers how humanitarian workers conceptualize and practice “the field” as a site of action. Through the use of narrative ethnography, and drawing on comparisons with the practice of academic anthropology, it attempts to draw out disciplinary assumptions that govern how and where humanitarian action is undertaken. It demonstrates how the field is a central imaginary that underpins the principles and performance of both anthropology and humanitarian action. It highlights how the conceptualization of “the field” is itself a methodological tool in the practice of humanitarian intervention.