Challenges in public health and epidemiology research in humanitarian settings: experiences from the field

Abstract

Background Humanitarian settings often present unique scientific challenges and conditions that distinguish them from standard research settings. While a number of these challenges are faced in both standard settings and humanitarian settings, factors unique to humanitarian settings such as inaccessibility and time sensitivities further exacerbate the effects of these challenges. This analysis focuses on experiences in post-disaster contexts such as Indonesia and India following the 2004 Indian Ocean Tsunami, the Philippines following Typhoon Haiyan in 2013, and Nepal following the 2015 earthquake. Discussion Particular issues that we faced in undertaking research in post-disaster settings include challenges with uncharted ethical and cultural considerations, non-standardised administrative methods for record keeping, data sharing and dissemination. While these issues are not unique to post-disaster humanitarian settings, the time-sensitive nature of our work exacerbated the effects of these concerns. Relying on local partners and making quick decisions to tackle issues is imperative for navigating both foreseen and unforeseen challenges. While pre-emptive action to address these concerns is the most efficient means to expedite research protocols, adaptability and contingency planning are key components of practical research implementation in dynamic situations. Conclusions Research is not always a priority in humanitarian settings, so innovative methods are necessary to conduct meaningful and situationally appropriate research in these venues. By understanding available resources, local culture, and political considerations and working efficiently and decisively, we can begin to jump hurdles associated with epidemiologic research in humanitarian settings.

Operational challenges and considerations for COVID-19 research in humanitarian settings: A qualitative study of a project in Eastern Democratic Republic of the Congo and South Sudan

“…A high proportion of cases referred to our study either refused to enroll (6.5%) or were unreachable (51.1%), which is consistent with the challenges in recruitment and retention of participants reported from humanitarian research elsewhere [ 6 ]. Among the 2,446 eligible cases reported in the study area, more than half (51.1%) were unreachable after three attempts.…”

“…Stigmatization of COVID-19 individuals also negatively affected our study; KIs identified negative perceptions of the virus as the primary influencer of demand for testing, careseeking, and willingness to engage with the public health system including researchers. Stigma against infected individuals has similarly influenced research on Ebola, HIV, SARS, Zika, and other infectious diseases [ 6 , 16 , 17 ]. The intense global attention on COVID-19 may have had an adverse effect on the general public’s willingness to test and seek care, which is consistent with the findings of reduced COVID-19 careseeking behaviors reported in other research [ 18 – 20 ].…”

Exploring the Feasibility of Establishing a Core Set of Sexual, Reproductive, Maternal, Newborn, Child, and Adolescent Health Indicators in Humanitarian Settings: Results From a Multi-methods Assessment in Jordan

“…Study participants repeatedly emphasized their preference for a core set of facility-based indicators, as they perceived them to be more programmatically relevant and actionable. Guha-Sapir and Scales (2020) found that the use of facility-based data, preferably in the form of patient records, improved data analysis and quality, and strengthens the estimation of mortality and morbidity in emergency settings (41). The study ndings also suggest that facility-based indicators could be used as proxies to re ect recognized services delivery standards of SRMNCAH care in humanitarian settings, as most are pertinent to the Minimum Initial Services Package (MISP).…”

Disaster nursing research: A scoping review of the nature, content, and trends of studies published during 2011–2020

“…One specific challenge that might reduce the possibility of conducting research in the very early stages of a disaster is related to the formal procedures for obtaining ethical approval [22] . Infrastructural damage, severe impacts on essential societal functions, or the loss of professionals may reduce the practical possibilities of processing such applications.…”

“…In any case, researchers should prepare their studies and ethical protocols so that these can easily be adapted to different emergencies as needed [23] . If the research is being conducted in other countries or contexts where the researcher is less familiar, it is recommended to work closely with local partners from the start in order to ensure contextual awareness, such as local ethical, cultural, and practical circumstances [22] . The ongoing Covid-19 pandemic, on the other hand, is a long-lasting, worldwide situation that offers different and, to some extent, new possibilities to gain scientific knowledge on nursing in pandemics.…”