Researching the delivery of health and nutrition interventions for women and children in the context of armed conflict: lessons on research challenges and strategies from BRANCH Consortium case studies of Somalia, Mali, Pakistan and Afghanistan

Abstract

Background The BRANCH Consortium recently conducted 10 mixed-methods case studies to investigate the provision of health and nutrition interventions for women and children in conflict-affected countries, aiming to better understand the dominant influences on humanitarian health actors’ programmatic decision-making and how such actors surmount intervention delivery barriers. In this paper, the research challenges encountered and the mitigating strategies employed by the case study investigators in four of the BRANCH case study contexts are discussed: Somalia, Mali, Pakistan and Afghanistan. Discussion Many of the encountered research challenges were anticipated, with investigators adopting mitigation strategies in advance or early on, but others were unexpected, with implications for how studies were ultimately conducted and how well the original study aims were met. Insecurity was a fundamental challenge in all study contexts, with restricted geographical access and concerns for personal safety affecting sampling and data collection plans, and requiring reliance on digital communications, remote study management, and off-site team meetings wherever possible. The need to navigate complex local sociopolitical contexts required maximum reliance on local partners’ knowledge, expertise and networks, and this was facilitated by early engagement with a wide range of local study stakeholders. Severe lack of reliable quantitative data on intervention coverage affected the extent to which information from different sources could be triangulated or integrated to inform an understanding of the influences on humanitarian actors’ decision-making. Conclusion Strong local partners are essential to the success of any project, contributing not only technical and methodological capacity but also the insight needed to truly understand and interpret local dynamics for the wider study team and to navigate those dynamics to ensure study rigour and relevance. Maintaining realistic expectations of data that are typically available in conflict settings is also essential, while pushing for more resources and further methodological innovation to improve data collection in such settings. Finally, successful health research in the complex, dynamic and unpredictable contexts of conflict settings requires flexibility and adaptability of researchers, as well as sponsors and donors.

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

“…This case study was developed to reflect on the complex operational environment in which a COVID-19 prospective cohort study was conducted within two humanitarian settings in Sub-Saharan Africa. The operational challenges and good practices identified–primarily in relation to participant recruitment and study management–were in general not specific to COVID-19, and have been identified in previous research carried out in the midst of epidemics [ 5 – 8 ]. However, the global impact of COVID-19, its high public profile, and specific pandemic policies appear to have exacerbated these problems and contributed to a final sample that underrepresented lower income individuals and nationals, and resulted in lower rates of enrollment than planned.…”

“…Most African research on COVID-19 has been clustered in South Africa, Egypt, and Nigeria, translating to a paucity of evidence from humanitarian settings where populations often present with different risk profiles and health characteristics and where health services are more limited [ 4 ]. This may be partly attributable to specific challenges of pandemic research, as well as difficulties that have been previously identified in designing and managing robust studies in emergency settings [ 5 – 8 ]. However, little documentation exists describing the realities of COVID-19 research in these types of environments.…”

The impact of armed conflicts on the nutritional status of children: Evidence from Northern Nigeria

“…29 These conflicts range from agitation for resource control in the oil-rich Niger Delta region, to farmers-herders clashes in the Middle Belt region, to communal clashes and religious fundamentalism in the North. 2,29,30 However, since 2009, the Islamic fundamentalist terror group, Boko Haram (BH), has added a new dimension to the conflicts and has engaged the Nigerian state in the northern part of the country in the most violent armed conflict since the country's civil war. [30][31][32] The insurgency started in Maiduguri, Borno State, in 2009 and spread to other parts of Northern Nigeria.…”

“…Selection bias across time and regions could arise if the composition of the sample in the conflict and non-conflict areas changes, for instance, due to population movement to and from the conflict area, in the period before and during the insurgency. 2 In our model, of particular concern is the fact that information about previous locations and reasons for migration of respondents is not available in the demographic health survey (DHS) and therefore, difficult to ascertain whether or not migration is due to the conflict. Also, the descriptive statistics in Figure 1 suggest some baseline differences (e.g., household wealth, household size etc.…”

“…The effect of armed conflict on the health and wellbeing of the affected population is multidimensional. 1,2 Forced displacement may result in families living in environments with poor and unsanitary conditions and overstretched and sometimes non-functional healthcare systems. 3 Worse still, social and agricultural infrastructure, including supply-chain networks, may be destroyed, causing disruption in food production.…”