Conference Material > Slide Presentation
Lavilla KM, Teal J, Schausberger B, Sankoh M, Conteh AB, et al.
MSF Scientific Days International 2022. 2022 May 11; DOI:10.57740/pyhg-f359
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 > LetterFull Text
Emerg Infect Dis. 2015 September 9; Volume 21 (Issue 11); DOI:10.3201/eid2111.151119
Achar J, Berry C, Herboczek K, Parpieva N, Tillashaykhov M, et al.
Emerg Infect Dis. 2015 September 9; Volume 21 (Issue 11); DOI:10.3201/eid2111.151119
Conference Material > Poster
Malden D, Datta P, Pharand S, Gharami D, Akter R, et al.
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/3dDCo6vP
Conference Material > Poster
Teklehaimanot BF, Filina Y, Keating P, Morales AM, Sahelie B, et al.
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Conference Material > Slide Presentation
Sadique S, Beversluis D, Caleo GNC, Carter W, Chowdhury SM, et al.
MSF Scientific Day 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 Day 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 > Abstract
Lavilla KM, Teal J, Schausberger B, Sankoh M, Conteh AB, et al.
MSF Scientific Days International 2022. 2022 May 11; DOI:10.57740/8sd6-2h56
INTRODUCTION
MSF and the MoHS implemented a partnership model of free and accessible maternal and child healthcare at primary and hospital-level health facilities in Tonkolili District, Sierra Leone, in order to reduce barriers to care and improve health outcomes. We conducted a health-seeking behaviour (HSB) study in 2021 to evaluate impact and change since a previous HSB study conducted in 2016/17. We also compared MSF-supported primary health unit (PHU) catchment areas with MSF-unsupported PHU’s. In addition, we explored adolescent reproductive health, family planning, and female genital mutilation (FGM).
METHODS
Study design was mixed-methods, similar to that used in 2016/17, including a quantitative household survey, structured interviews with key informants, and qualitative in-depth interviews (IDI’s). We randomly selected 60 clusters; 30 in MSF-supported areas, and 30 in unsupported areas. IDI’s explored topics identified through the survey, and were conducted with purposively-sampled participants, and analyzed thematically.
ETHICS
This study was approved by the Sierra Leone Ethical and Scientific Review Committee and by the MSF Ethics Review Board
RESULTS
Between February and August 2021, 1,164 women and 1,177 carers (of 1,559 children aged under 5) participated in the survey; 59 structured interviews and 42 IDI’s were conducted. Compared to the 2016/17 study, access to healthcare improved, with the proportion of women delivering in a health facility increasing from 52.0% (95% confidence intervals (CI) 42-64) to 90.9% (95% CI 89.2-92.5), and the proportion of mothers reporting at least one barrier to accessing care decreasing from 90.0% (95% CI 80-95) to 45.9% (95% CI 43.0-48.8). Outcomes of care also improved over this period, with under-5 mortality decreasing from 1.55 per 10,0000/day (95% CI 1.30-1.86) to 0.25 per 10,000/day (95% CI 0.17-0.36).When comparing unsupported PHU’s versus supported areas in 2021, complications during labour or delivery were higher in unsupported areas (10.9%; 95% CI 8.6-13.6) vs 7.2% (95% CI 5.3-9.7), as was stillbirth (4.5%; 95% CI 3.1-6.5) vs 1.4% (95% CI 0.6-2.8). Under-5 mortality was 0.44 per 10,000/day (95% CI 2.4-7.2) in unsupported areas and 0.17 per 10,000/day (95% CI 0.8-2.9) in supported areas. 42.9% (95% CI 34.7-51.4) of adolescents in unsupported areas and 39.7% (95% CI 31.3- 48.7) in supported areas reported unmet need for contraception. More than 90% (96.6%, 95% CI 95.3-97.5) of women reported FGM. Qualitative data suggests that communities recognized the importance of delivering in a health facility with trained assistance. Nevertheless, health staff and community members felt the current fine system for home births was applied inflexibly in circumstances when distance, transport, or cost restricted or delayed access.
CONCLUSION
Since 2016/17, access to healthcare and outcomes have improved in all areas, but improvement has been greatest in areas where, in addition to hospital care, MSF supported MoHS PHU’s. This provides evidence for ongoing implementation and scale-up of comprehensive models of care. Progress made must not overshadow areas requiring further attention, such as care for adolescents, access to contraception, and the need to reduce stillbirths.
CONFLICTS OF INTEREST
None declared.
MSF and the MoHS implemented a partnership model of free and accessible maternal and child healthcare at primary and hospital-level health facilities in Tonkolili District, Sierra Leone, in order to reduce barriers to care and improve health outcomes. We conducted a health-seeking behaviour (HSB) study in 2021 to evaluate impact and change since a previous HSB study conducted in 2016/17. We also compared MSF-supported primary health unit (PHU) catchment areas with MSF-unsupported PHU’s. In addition, we explored adolescent reproductive health, family planning, and female genital mutilation (FGM).
METHODS
Study design was mixed-methods, similar to that used in 2016/17, including a quantitative household survey, structured interviews with key informants, and qualitative in-depth interviews (IDI’s). We randomly selected 60 clusters; 30 in MSF-supported areas, and 30 in unsupported areas. IDI’s explored topics identified through the survey, and were conducted with purposively-sampled participants, and analyzed thematically.
ETHICS
This study was approved by the Sierra Leone Ethical and Scientific Review Committee and by the MSF Ethics Review Board
RESULTS
Between February and August 2021, 1,164 women and 1,177 carers (of 1,559 children aged under 5) participated in the survey; 59 structured interviews and 42 IDI’s were conducted. Compared to the 2016/17 study, access to healthcare improved, with the proportion of women delivering in a health facility increasing from 52.0% (95% confidence intervals (CI) 42-64) to 90.9% (95% CI 89.2-92.5), and the proportion of mothers reporting at least one barrier to accessing care decreasing from 90.0% (95% CI 80-95) to 45.9% (95% CI 43.0-48.8). Outcomes of care also improved over this period, with under-5 mortality decreasing from 1.55 per 10,0000/day (95% CI 1.30-1.86) to 0.25 per 10,000/day (95% CI 0.17-0.36).When comparing unsupported PHU’s versus supported areas in 2021, complications during labour or delivery were higher in unsupported areas (10.9%; 95% CI 8.6-13.6) vs 7.2% (95% CI 5.3-9.7), as was stillbirth (4.5%; 95% CI 3.1-6.5) vs 1.4% (95% CI 0.6-2.8). Under-5 mortality was 0.44 per 10,000/day (95% CI 2.4-7.2) in unsupported areas and 0.17 per 10,000/day (95% CI 0.8-2.9) in supported areas. 42.9% (95% CI 34.7-51.4) of adolescents in unsupported areas and 39.7% (95% CI 31.3- 48.7) in supported areas reported unmet need for contraception. More than 90% (96.6%, 95% CI 95.3-97.5) of women reported FGM. Qualitative data suggests that communities recognized the importance of delivering in a health facility with trained assistance. Nevertheless, health staff and community members felt the current fine system for home births was applied inflexibly in circumstances when distance, transport, or cost restricted or delayed access.
CONCLUSION
Since 2016/17, access to healthcare and outcomes have improved in all areas, but improvement has been greatest in areas where, in addition to hospital care, MSF supported MoHS PHU’s. This provides evidence for ongoing implementation and scale-up of comprehensive models of care. Progress made must not overshadow areas requiring further attention, such as care for adolescents, access to contraception, and the need to reduce stillbirths.
CONFLICTS OF INTEREST
None declared.