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Title
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Improving the evidence base of health interventions in humanitarian crises
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Author
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Abstract
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| Humanitarian crises are unforeseen events causing damage, destruction and human suffering, which overwhelm local capacity. With increasing health crises and interventions growing in magnitude and complexity, strong scientific evidence to guide interventions is crucial. However, the quality of the evidence in humanitarian interventions is often weak. This thesis aims to demonstrate how knowledge can be generated efficiently and applied in different types of humanitarian crises such as measles epidemics, and during a natural disaster in the Philippines. We demonstrated the added value of household coverage surveys after a measles mass vaccination campaign in Democratic Republic of Congo, compared to administrative coverage surveys. Certain groups of children were never reached by campaigns, while others were repeatedly vaccinated. Improving community engagement by investing sufficient time in less accessible areas and assessing reasons for non-vaccination through qualitative studies is key. Following a measles mass vaccination campaign in Guinea, we explored the reasons behind the decision to vaccinate or not, by interviewing caregivers and health staff organising the campaign. Caregivers suggested that community engagement can improve vaccination campaigns, specifically through the pivotal role of community health workers, local recruitment of staff, development of their communication skills, attitudes, and knowledge to provide adequate information about vaccination. Studies conducted after typhoon Haiyan in the Philippines allowed us to determine the disaster impact on hospitalisations and health care workers. We documented a drop in hospital admissions, while gastroenteritis and respiratory admissions increased after Haiyan. Mobile clinics most frequently diagnosed acute respiratory infections, hence their appropriate management should be ensured in future typhoons. Health staff were forced to prioritise between their personal and professional life. Health staff’ performance was affected by accessibility to the hospital, personal and family safety and faith. Improving communication, accessibility through housing health staff and relatives close to the hospital and considering faith and religious practices could improve health staff protection and performance in similar responses. Three cross-cutting concepts were distilled in this thesis: improving estimates during crises and response can be achieved by integrating pre-existing and crisis-induced data, including pre/post analyses and combining facility-level and community-level data. Second, investigating the experiences of care-givers and health workers through qualitative studies is important for an in-depth understanding of crises and responses. Third, community engagement can improve the knowledge by informing communities, consulting them and involving them. Additional efforts to bridge the gap between generating and using the knowledge during humanitarian crises are needed. |
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Language
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English
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Publication
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Antwerp
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University of Antwerp, Faculty of Medicine and Health Sciences
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2020
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Volume/pages
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259 p.
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Note
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Colebunders, Robert [Supervisor]
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Vogt, Florian [Supervisor]
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Van den Bergh, Rafael [Supervisor]
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Full text (publisher's version - intranet only)
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