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Community Engagement and Building Trust to Resolve Yimer et al. Conflict and Health (2020) 14:68 https://doi.org/10.1186/s13031-020-00313-w RESEARCH IN PRACTICE Open Access Community engagement and building trust to resolve ethical challenges during humanitarian crises: experience from the CAGED study Getnet Yimer1* , Wondwossen Gebreyes1, Arie Havelaar2, Jemal Yousuf3, Sarah McKune4, Abdulmuen Mohammed3 and Dónal O’Mathúna5 Abstract Background: According to the Internal Displacement Monitoring Centre report on global human displacement, Ethiopia has the highest number of newly displaced people forced to flee their homes. Displaced people have arrived in other regions, sometimes leading to conflict. Several regions in Ethiopia experience on-going ethnic tensions and violence between tribes, which leaves smallholder farmers suspicious of any outside activities in their locale, assuming other ethnic groups may harm them. Changes in the central Ethiopian government have also led to suspicion of non-local agencies. The Campylobacter Genomics and Enteric Dysfunction (CAGED) research project’s objective is to improve the incomes, livelihoods and nutrition of smallholder farmers and was conducted during this period of increasing violence. The project aims to assess the impact of reducing exposure to chicken excreta on young children’s gut health and growth. This paper does not report empirical findings from CAGED, but is part of a series that aims to identify challenges in humanitarian research and reports on mitigation strategies during this research. Discussion: This research is important to determine whether Campylobacter infection in chicken’s contributes to illness and stunting in children. However, violence against other researchers in different parts of Ethiopia led to mistrust and lack of engagement by the community with the researchers. Some reactions were so hostile that the team was fearful about returning to some households. As a result, the team designed strategies to respond, including establishing two types of community advisory boards. One used pre-existing village elder structures and another was composed of village youth. Data collection team members received training in principles of ethics, consent, and crisis management, and were provided on-going support from local and international principal investigators and the study’s ethics advisor. Conclusion: The hostility and mistrust led to fear among the data collectors. These and the resulting strategies to address them resulted in delays for the research. However, the interventions taken resulted in successful completion of the field activities. Moreover, the lessons learned from this project are already being implemented with other projects being conducted in various parts of Ethiopia. Keywords: Ethiopia, Community advisory board, Humanitarian research, Ethics, Trust, Conflict * Correspondence: [email protected] 1Global One Health initiative, The Ohio State University, Columbus, OH, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Yimer et al. Conflict and Health (2020) 14:68 Page 2 of 6 Background Plan (LMP), which aims to increase poultry production Humanitarian context significantly by transitioning from traditional (scavenging) The Campylobacter Genomics and Enteric Dysfunction family poultry to improved (semi-scavenging) family (CAGED) formative research project was conducted in poultry systems [3]. However, animal excreta, and particu- Haramaya Woreda (or district) in Eastern Ethiopia while larly chicken manure, is considered one of the key factors conflict occurred in various parts of Ethiopia. According driving exposure to and (asymptomatic) infection by en- to data from the Internal Displacement Monitoring Centre teric pathogenic bacteria, and causing EED. (IDMC) for the first half of 2019, Ethiopia had the highest Studies estimate that EED may cause up to 40% of number of people newly displaced within their own coun- stunting in the developing world [4]. The Etiology, Risk try due to violence [1]. Conflict has uprooted some 1.4 Factors, and Interactions of Enteric Infections and million Ethiopians from the total population of 107 million. Malnutrition and the Consequences for Child Health In 2018, the central government changed after being ruled (MAL-ED) study identified a high Campylobacter preva- by another party for decades. While the new government lence in primarily asymptomatic children in eight low- is working to bring about peace and security, internal con- resource settings, not including Ethiopia. Cumulative flict continues partly due to intertribal strife, which makes Campylobacter burden was associated with lower length- both routine and humanitarian research very difficult. for-age Z-scores (LAZ), increased intestinal permeability, Although Haramaya was not directly affected by human and intestinal and systemic inflammation at 24 months of displacements, the participants’ attitudes and trust levels age [5]. The CAGED hypothesis is that Campylobacter bac- were impacted by displaced people arriving in nearby teria are a primary factor in inducing EED through expos- regions. ure to livestock (predominantly chickens), which are a This paper does not report empirical findings from major reservoir of Campylobacter. It is further hypothesized CAGED, but is part of a series that aims to identify chal- that adequate management of livestock feces will improve lenges in humanitarian research and reports on mitigation childhood nutrition in Ethiopia, particularly within the strategies during this research. These strategies are context of increasing poultry production. supported by a growing body of literature, some of which The CAGED project has several phases, some of which will be cited. However, an extensive literature review is are completed and others on-going. Results are currently not within the scope of this paper as it is an individual being written up for dissemination. An ethnographic study case study following a specific “Research in Practice” was conducted to understand relevant local community format for this series. contexts, beliefs and practices, and explore the opportun- ities and challenges with the subsequent research phases. Research study Formative research was conducted around three themes: The demand for animal source foods (ASF) in Africa is microbiology, EED and stunting, and agriculture and envir- growing rapidly. According to the United Nations, the onment. The formative research aimed to guide decisions demand for meat, milk and eggs in Africa will quadruple about later phases of CAGED by collecting data on by 2050, mostly due to population growth and rising living colonization of young children and animals with Campylo- standards [2]. This creates opportunities for improved bacter. Excreta from chickens and children were collected nutrition and income generation, particularly among and tested in Ethiopia and the US for the presence of mi- Africa’s poorest who produce much of the continent’sASF. crobes. Data were collected on nutrition, health, sanitation At the same time, animals also contribute to human and social environment of children, as well as animal illness. One long-term goal of CAGED is to improve the husbandry practices. The results are informing a longitu- understanding of the causes and mitigation of environ- dinal study to further evaluate risk factors for childhood mental enteric dysfunction (EED). EED causes stunting in colonization with Campylobacter bacteria, and identify the children by severely curtailing the absorption of nutrients reservoirs and contamination networks of these bacteria in children who ingest fecal droppings from poultry and and their impact on young children’sguthealthand other livestock in smallholder farms. The CAGED project growth. is led by the University of Florida in collaboration with In the ethnographic phase of CAGED (March to May Haramaya University in East Hararghe zone, Oromia 2018) teams from Haramaya University and the University Region, Ethiopia, the Global One Health initiative (GOHi), of Florida developed working relationships at the commu- an affiliate of The Ohio State University with collaborators nity, regional, and national levels. Data collectors were re- in Ethiopia, and Washington University in St. Louis. Data cruitedwhowerebornandraisedintheregion,knewthe collection is led by Haramaya University, with assistance local language and culture, and had prior experience work- and training provided by the US universities. ing
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