3 research outputs found
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Things that take from peopleâs bodies: rumours about minimally invasive tissue sampling and evil spirits in ethiopia
In this paper we describe how the innovative technique of minimally invasive tissue sampling (MITS) and the researchers associated with it came to represent the fears, anger, and suspicions of a community in Eastern Ethiopia. MITS was developed to lessen the uncertainty over causes of death in low- and middle-income countries (Bassat et al. 2016). It is a medical procedure where a core biopsy instrument is used to extract numerous small tissue samples from a pre-defined set of organs (brain, lung, heart, liver, bone marrow) in deceased children under 5 and stillbirths. Additionally, MITS practitioners collect blood, urine, stool, and cerebral spinal fluid, take nasopharyngeal and oropharyngeal swabs, and include measurements and several pictures of the body to identify any abnormalities. In the study site, MITS has become more than just an act of extracting samples. Instead, it is a social process that begins when the research team learns about the death of a child and ends when the child is buried. Furthermore, the act of sample taking has come to represent the underlying fears, anger, and suspicions in the com-munity about organ and blood theft, and those researchers associated with it â whether social scientists or histopathologists â have become the embodiment of an evil spirit called tuqatta, who survives on blood and organs, and conducts ritual sacrifice by offering the blood of its victims to spiritual ancestors. We suggest that the tuqatta embodies the strongly felt suspicion that the MITS intervention is not there for peopleâs benefit, but rather that it is taking something from them. The emergence of the tuqatta in the research site highlights the vulnerability that people feel in relation to this global health medical intervention. We conclude by arguing that local frames of understanding should not be dismissed as ârumoursâ or simply as something to overcome in health research; rather, they require serious attention and indicate the need for open dialogue between researchers and the public
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Setting up child health and mortality prevention surveillance in Ethiopia
Background: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a âgreenfieldâ site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment.
Methods: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health.
Results: Despite considerable challenge, with financial support, personal commitment and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children.
Conclusions: The most valuable data for global health policy are from high mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong local research capacity and to broaden the scientific remit. To support this, we have set up a new collaboration, the âHararghe Health Research Partnershipâ
Setting up child health and mortality prevention surveillance in Ethiopia.
BACKGROUND: Mortality rates for children under five years of age, and stillbirth risks, remain high in parts of sub-Saharan Africa and South Asia. The Child Health and Mortality Prevention Surveillance (CHAMPS) network aims to ascertain causes of child death in high child mortality settings (>50 deaths/1000 live-births). We aimed to develop a âgreenfieldâ site for CHAMPS, based in Harar and Kersa, in Eastern Ethiopia. This very high mortality setting (>100 deaths/1000 live-births in Kersa) had limited previous surveillance capacity, weak infrastructure and political instability. Here we describe site development, from conception in 2015 to the end of the first year of recruitment. METHODS: We formed a collaboration between Haramaya University and the London School of Hygiene & Tropical Medicine and engaged community, national and international partners to support a new CHAMPS programme. We developed laboratory infrastructure and recruited and trained staff. We established project specific procedures to implement CHAMPS network protocols including; death notifications, clinical and demographic data collection, post-mortem minimally invasive tissue sampling, microbiology and pathology testing, and verbal autopsy. We convened an expert local panel to determine cause-of-death. In partnership with the Ethiopian Public Health Institute we developed strategies to improve child and maternal health. RESULTS: Despite considerable challenge, with financial support, personal commitment and effective partnership, we successfully initiated CHAMPS. One year into recruitment (February 2020), we had received 1173 unique death notifications, investigated 59/99 MITS-eligible cases within the demographic surveillance site, and assigned an underlying and immediate cause of death to 53 children. CONCLUSIONS: The most valuable data for global health policy are from high mortality settings, but initiating CHAMPS has required considerable resource. To further leverage this investment, we need strong local research capacity and to broaden the scientific remit. To support this, we have set up a new collaboration, the âHararghe Health Research Partnershipâ