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Ali SH, Conteh A, Macarthy JM, Sesay A, Blango VN, Hrdličková Z. Ebola, informal settlements, and the role of place in infectious disease vulnerability: evidence from the 2014-16 outbreak in urban Sierra Leone. Disasters 2023; 47:389-411. [PMID: 35762519 DOI: 10.1111/disa.12553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Studies of vulnerability often focus on the differential susceptibility of marginalised groups to the effects of disaster. This paper considers how vulnerability is also associated with the characteristics of place, especially the social setting of the informal settlement. In this light, it assesses specifically how cultural, historical, and political economic forces resulted in increased vulnerability to Ebola virus disease (EVD) within informal settlements in Sierra Leone during the epidemic of 2014-16. Key informant and community member interviews and focus-group discussions in two communities revealed that increased vulnerability to EVD could, at least in part, be attributed to a set of place-based social factors pertaining to 'community beliefs and practices' (importance of family ties, funeral rites, traditional healing) and 'structural poverty and low socioeconomic status' (poor healthcare provision, mobility patterns, overcrowding). Together, these different factors demonstrate how multiple and intersecting vulnerabilities contribute to the spatial production of disease risk.
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Affiliation(s)
| | - Abu Conteh
- Senior Researcher at the Sierra Leone Urban Research Centre, Sierra Leone
| | - Joseph Mustapha Macarthy
- Lecturer at Njala University and Executive Director at the Sierra Leone Urban Research Centre, Sierra Leone
| | | | | | - Zuzana Hrdličková
- Senior Researcher at the Sierra Leone Urban Research Centre, Sierra Leone
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Aktar B, Alam W, Ali S, Awal A, Bayoh M, Chumo I, Contay Y, Conteh A, Dean L, Dobson S, Edstrom J, Elsey H, Farnaz N, Garimella S, Gray L, Gupte J, Hawkins K, Hollihead B, Josyula KL, Kabaria C, Karuga R, Kimani J, Leyland AH, Te Lintelo D, Mansaray B, MacCarthy J, MacGregor H, Mberu B, Muturi N, Okoth L, Otiso L, Ozano K, Parray A, Phillips-Howard P, Rao V, Rashid S, Raven J, Refell F, Saidu S, Sobhan S, Saligram PS, Sesay S, Theobald S, Tolhurst R, Tubb P, Waldman L, Wariutu J, Whittaker L, Wurie H. How to prevent and address safeguarding concerns in global health research programmes: practice, process and positionality in marginalised spaces. BMJ Glob Health 2021; 5:bmjgh-2019-002253. [PMID: 32409330 PMCID: PMC7228499 DOI: 10.1136/bmjgh-2019-002253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/12/2022] Open
Abstract
Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working in informal urban spaces in low-income and middle-income countries (Bangladesh, India, Kenya and Sierra Leone). Our manuscript is divided into three key sections. We start by discussing the importance of safeguarding in global health research and consider how thinking about vulnerability as a relational concept (shaped by unequal power relations and structural violence) can help locate fluid and context specific safeguarding risks within broader social systems. We then discuss the different steps undertaken in ARISE to develop a shared approach to safeguarding: sharing institutional guidelines and practice; facilitating a participatory process to agree a working definition of safeguarding and joint understandings of vulnerabilities, risks and mitigation strategies and share experiences; developing action plans for safeguarding. This is followed by reflection on our key learnings including how safeguarding, ethics and health and safety concerns overlap; the challenges of referral and support for safeguarding concerns within frequently underserved informal urban spaces; and the importance of reflective practice and critical thinking about power, judgement and positionality and the ownership of the global narrative surrounding safeguarding. We finish by situating our learning within debates on decolonising science and argue for the importance of an iterative, ongoing learning journey that is critical, reflective and inclusive of vulnerable people.
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Affiliation(s)
- Bachera Aktar
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Wafa Alam
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Samiha Ali
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Abdul Awal
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Margaret Bayoh
- Federation of Urban and Rural Poor, Freetown, Sierra Leone
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Yirah Contay
- Federation of Urban and Rural Poor, Freetown, Sierra Leone
| | - Abu Conteh
- Sierra Leone Urban Research Centre, Njala University, Freetown, Sierra Leone
| | - Laura Dean
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Skye Dobson
- Slum Dwellers International, Cape Town, South Africa
| | - Jerker Edstrom
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Helen Elsey
- Health Sciences, University of York, York, UK
| | - Nadia Farnaz
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | | | - Jaideep Gupte
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Kate Hawkins
- Pamoja Communications, Brighton and Hove, United Kingdom
| | - Beth Hollihead
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | | | | | | | - Joseph Kimani
- Slum and Shack Dwellers International Kenya, Nairobi, Kenya
| | | | - Dolf Te Lintelo
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Bintu Mansaray
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Joseph MacCarthy
- Sierra Leone Urban Research Centre, Njala University, Freetown, Sierra Leone
| | - Hayley MacGregor
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Kim Ozano
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Ateeb Parray
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | | | - Sabina Rashid
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | | | - Samuel Saidu
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Shafinaz Sobhan
- BRAC University James P Grant School of Public Health, Dhaka, Dhaka District, Bangladesh
| | | | - Samira Sesay
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Phil Tubb
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Linda Waldman
- Institute of Development Studies, Brighton, Brighton and Hove, UK
| | - Jane Wariutu
- Slum and Shack Dwellers International Kenya, Nairobi, Kenya
| | - Lana Whittaker
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Western Area, Sierra Leone
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O'Connor EC, Hutain J, Christensen M, Kamara MS, Conteh A, Sarriot E, Samba TT, Perry HB. Piloting a participatory, community-based health information system for strengthening community-based health services: findings of a cluster-randomized controlled trial in the slums of Freetown, Sierra Leone. J Glob Health 2019; 9:010418. [PMID: 30842881 PMCID: PMC6394878 DOI: 10.7189/jogh.09.010418] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although community engagement has been promoted as a strategy for health systems strengthening, there is need for more evidence for effectiveness of this approach. We describe an operations research (OR) Study and assessment of one form of community engagement, the development and implementation of a participatory community-based health information system (PCBHIS), in slum communities in Freetown, Sierra Leone. METHODS A child survival project was implemented in 10 slum communities, which were then randomly allocated to intervention (PCBHIS) and comparison areas. In the 5 PCBHIS communities, the findings from monthly reports submitted by community health workers (CHWs) and verbal autopsy findings for deaths of children who died before reaching 5 years of age, were processed and shared at bimonthly meetings in each community. These meetings, called Community Health Data Review (CHDR) meetings, were attended by community leaders, including members of the Ward Development Committee (WDC) and Health Management Committee (HMC), by the CHW Peer Supervisors, and by representatives of the Peripheral Health Unit. Following a review of the information, attendees proposed actions to strengthen community-based health services in their community. These meetings were held over a period of 20 months from July 2015 to March 2017. At baseline and endline, knowledge, practice and coverage (KPC) surveys measured household health-related behaviors and care-seeking behaviors. The capacity of HMCs and WDCs to engage with the local health system was also measured at baseline and endline. Reports of CHW household contact and assessments of CHW quality were obtained in the endline KPC household survey, and household contacts measured in monthly submitted reports were also tabulated. RESULTS The self-assessment scores of WDCs' capacity to fulfil their roles improved more in the intervention than in the comparison area for all six components, but for only 1 of the 6 was the improvement statistically significant (monthly and quarterly meetings in which Peer Supervisor and/or CHW supervision was an agenda item). The scores for the HMCs improved less in the intervention area than in the comparison area for all six components, but none of these differences were statistically significant. Topics of discussion in CHDRs focused primarily on CHW functionality. All three indicators of CHW functioning (as measured by reports submitted from CHWs) improved more in the intervention area relative to the comparison area, with 2 out of 3 measures of improvement reaching statistical significance. Five of 7 household behaviors judged to be amenable to promotion by CHWs improved more in the intervention area than in the comparison area, and 2 out of the 5 were statistically significant (feeding colostrum and appropriate infant and young child feeding). Four of the 6 care-seeking behaviors judged to be amenable to promotion by CHWs improved more in the intervention area than in the comparison area, and 1 was statistically significant (treatment of diarrhea with ORS and zinc). None of the findings that favored the comparison area were statistically significant. CONCLUSIONS This study was implemented in challenging circumstances. The OR Study intervention was delayed because of interruptions in finalizing the national CHW policy, two separate cholera epidemics, and the Ebola epidemic lasting more than 2 years. Weaknesses in the CHW intervention severely limited the extent to which the PCBHIS could be used to observe trends in mortality and morbidity. Nonetheless, the positive results achieved in the area of functionality of the CHW intervention and community structure capacity are encouraging. Results suggest there is value in further methodologically rigorous investigations into improving community-based health system functioning through a similar approach to community engagement.
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Affiliation(s)
| | | | | | | | - Abu Conteh
- Formerly Concern Worldwide/Sierra Leone, Freetown, Sierra Leone
| | | | - Thomas T Samba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Cao M, Breidt FJ, Solomon JN, Conteh A, Gavin MC. Understanding the drivers of sensitive behavior using Poisson regression from quantitative randomized response technique data. PLoS One 2018; 13:e0204433. [PMID: 30265700 PMCID: PMC6161884 DOI: 10.1371/journal.pone.0204433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/09/2018] [Indexed: 11/18/2022] Open
Abstract
Understanding sensitive behaviors-those that are socially unacceptable or non-compliant with rules or regulations-is essential for creating effective interventions. Sensitive behaviors are challenging to study, because participants are unlikely to disclose sensitive behaviors for fear of retribution or due to social undesirability. Methods for studying sensitive behavior include randomized response techniques, which provide anonymity to interviewees who answer sensitive questions. A variation on this approach, the quantitative randomized response technique (QRRT), allows researchers to estimate the frequency or quantity of sensitive behaviors. However, to date no studies have used QRRT to identify potential drivers of non-compliant behavior because regression methodology has not been developed for the nonnegative count data produced by QRRT. We develop a Poisson regression methodology for QRRT data, based on maximum likelihood estimation computed via the expectation-maximization (EM) algorithm. The methodology can be implemented with relatively minor modification of existing software for generalized linear models. We derive the Fisher information matrix in this setting and use it to obtain the asymptotic variance-covariance matrix of the regression parameter estimates. Simulation results demonstrate the quality of the asymptotic approximations. The method is illustrated with a case study examining potential drivers of non-compliance with hunting regulations in Sierra Leone. The new methodology allows assessment of the importance of potential drivers of different quantities of non-compliant behavior, using a likelihood-based, information-theoretic approach. Free, open-source software is provided to support QRRT regression.
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Affiliation(s)
- Meng Cao
- Department of Statistics, Colorado State University, Fort Collins, Colorado, United States of America
| | - F. Jay Breidt
- Department of Statistics, Colorado State University, Fort Collins, Colorado, United States of America
| | - Jennifer N. Solomon
- Department of Human Dimensions of Natural Resources, Colorado State University, Fort Collins, Colorado, United States of America
| | - Abu Conteh
- School of Geography, Environment and Earth Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Michael C. Gavin
- Department of Human Dimensions of Natural Resources, Colorado State University, Fort Collins, Colorado, United States of America
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de Souza DK, Ansumana R, Sessay S, Conteh A, Koudou B, Rebollo MP, Koroma J, Boakye DA, Bockarie MJ. The impact of residual infections on Anopheles-transmitted Wuchereria bancrofti after multiple rounds of mass drug administration. Parasit Vectors 2015; 8:488. [PMID: 26399968 PMCID: PMC4581406 DOI: 10.1186/s13071-015-1091-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many countries have made significant progress in the implementation of World Health Organization recommended preventive chemotherapy strategy, to eliminate lymphatic filariasis (LF). However, pertinent challenges such as the existence of areas of residual infections in disease endemic districts pose potential threats to the achievements made. Thus, this study was undertaken to assess the importance of these areas in implementation units (districts) where microfilaria (MF) positive individuals could not be found during the mid-term assessment after three rounds of mass drug administration. METHODS This study was undertaken in Bo and Pujehun, two LF endemic districts of Sierra Leone, with baseline MF prevalence of 2 % and 0 % respectively in sentinel sites for monitoring impact of the national programme. Study communities in the districts were purposefully selected and an assessment of LF infection prevalence was conducted together with entomological investigations undertaken to determine the existence of areas with residual MF that could enable transmission by local vectors. The transmission Assessment Survey (TAS) protocol described by WHO was applied in the two districts to determine infection of LF in 6-7 year old children who were born before MDA against LF started. RESULTS The results indicated the presence of MF infected children in Pujehun district. An. gambiae collected in the district were also positive for W. bancrofti, even though the prevalence of infection was below the threshold associated with active transmission. CONCLUSIONS Residual infection was detected after three rounds of MDA in Pujehun--a district of 0 % Mf prevalence at the sentinel site. Nevertheless, our results showed that the transmission was contained in a small area. With the scale up of vector control in Anopheles transmission zones, some areas of residual infection may not pose a serious threat for the resurgence of LF if the prevalence of infections observed during TAS are below the threshold required for active transmission of the parasite. However, robust surveillance strategies capable of detecting residual infections must be implemented, together with entomological assessments to determine if ongoing vector control activities, biting rates and infection rates of the vectors can support the transmission of the disease. Furthermore, in areas where mid-term assessments reveal MF prevalence below 1 % or 2 % antigen level, in Anopheles transmission areas with active and effective malaria vector control efforts, the minimum 5 rounds of MDA may not be required before implementing TAS. Thus, we propose a modification of the WHO recommendation for the timing of sentinel and spot-check site assessments in national programs.
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Affiliation(s)
- Dziedzom K de Souza
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | - Rashid Ansumana
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK. .,Mercy Hospital Research Laboratory, Bo, Sierra Leone.
| | | | - Abu Conteh
- Ministry of Health and Sanitation, Freetown, Sierra Leone.
| | - Benjamin Koudou
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | - Joseph Koroma
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Daniel A Boakye
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | - Moses J Bockarie
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK.
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