Introduction to participatory epidemiology

Barbara Wieland (ILRI)

Livestock and Fish participatory epidemiology and gender training workshop, Addis Ababa, 15-19 June 2015

IFAD project (2014-2017), Livestock and Fish gender initiative (2015), Africa RISING

Need to understand disease priorities and how that affects individual members of households

Identify and test appropriate interventions

Scaling out, policy recommendations

Disease priorities and their impactOutline of project activities

• Training in participatory epidemiology and gender

• Field work, collation of research findings and preliminary analysis

• Follow-up training on data analysis and interpretation of results

• Training on sero-surveillance and planning of epidemiological sero-surveys

• Sero-prevalence survey on key livestock diseases

• Identify and plan interventions

Agenda for this weekTraining in PE and gender

Monday Tuesday Wednesday Thursday Frida

PE intro Gender Gender Develop tools fieldwork

Practice fieldwork

PE toolsRankingscoring

PE toolsSSI

PE toolsAnalysisRunning FGD

Practice fieldwork

Logistics

Ball bearing

What is epidemiology?

What is participatory epidemiology?

What is surveillance?

Epidemiology

Epidemiology is the study of diseases in populations and of factors that determine its occurrence.

Pathogen

EnvironmentHost

Questions answered with epidemiology

• How much disease is present in this population?

• What are the factors that make disease more likely to occur in the population?

• What measures could be taken to prevent disease occurring in the population?

• How effective are these measures?

Causality and impact

Participatory epidemiology

Use participatory approaches to improve understanding of pattern of diseases in populations

- Listen, learn, respect researcher = facilitator

- Understanding: people make rational decisions

- Existing knowledge

- Action oriented

Epidemiology – why bother?

• In your current job, were there situations where you wished to know more about epidemiology?– Discuss with your seat neighbor examples from

every day work

Surveillance

Disease data are used to assess a status compared to a predefined threshold and to initiate defined actions

Information for action

Surveillance in Ethiopia

Write down different surveillance activities in livestock in Ethiopia

Surveillance system

= composed of several surveillance system components

Export control

SurveyDiagnostic laboratories

Slaughter-houseClinical signs

Surveillance system component: „A method of surveillance that may include one or more component activities that generates information on the health, disease or zoonosis status of animal populations.“

OIE Terrestrial Animal Health Code 2007

Passive Surveillance

• How do you normally conduct epidemiological studies or surveillance activities?

• What are the limiting factors?

What is participation?

The empowerment of people to find solutions to their own development challenges

Both an attitude and philosophy

• Learning• Discovery• Flexibility

A response to past failures

! Different types of participation…

Moving away from this…

17

Participatory EpidemiologyThe use of participatory rural appraisal

techniques to collect epidemiological knowledge and intelligence

Applications of PENeeds Assessments

• Priorities and entry points

Participatory Epi Research• Basic epi studies• Disease modelling• Risk assessment

Participatory Disease Surveillance• Case finding• Disease freedom• RP, FMD, PPR, CSF and HPAI

Impact AssessmentStrategy and Policy Reform

Example 1: Timeline of outbreaks constructed by PDS teams in Egypt

FarmHouseholdFarmHouseholdFarmHouseholdFarmHouseholdFarmHousehold

FarmHouseholdFarmHouseholdFarmHouseholdFarmHousehold

FarmHouseholdFarmHouseholdFarmHouseholdFarmHouseholdFarmHousehold

J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D

confirmed farm outbreak confirmed household outbreakunreported farm outbreak unreported household outbreak

2006 2007 2008

Outbreaks

PE and PDS in Ethiopia?

For which situations/diseases would PE tools be useful in Ethiopia?

Part 2-4

At the end of the PE tool sessions participants are able to select appropriate PE tools to answer specific research questions

Part 2PE tools ranking/scoring

At the end of this session participants:- Can apply different ranking and scoring tools- Can explain advantages and disadvantages of

each

Participatory tools

- Ranking and scoring- Informal interviewing- Visualisation

Ranking and scoringSimple ranking

The process and explanations and arguments given for ranking are more important than the final agreed ranks

Group work:

- What are the main reasons that make delivery of veterinary services difficult

Ranking and scoringPairwise ranking

Allows for deeper discussions and collection of more details

Takes more time

Group work:

- Poultry disease problems

Ranking and scoringProportional piling

Gives relative scores

Group work

- Reasons why delivery of veterinary service in Ethiopia is difficult

Ranking and scoringMatrix scoring (series of proportional piling)

To better understand• local characterization of livestock disease• meanings of local names

Part 3:PE tools: SSI

At the end of this session participants:• Can explain the concepts of SSI

• Can plan and conduct good interviews

PE tools: Semi-structured interviewsWhat is an interview?

Conversation between two or more people.2 types: • Structured • Semi-structured

• Checklist vs. questionnaire• Open ended questions • Non-leading questions

PE toolsSemi-structured interviews

• Interviewing is a specialized skill

• Bad interviewing technique yields poor information and may create feelings of suspicion, fear or even hostility

• What types of questions are you familiar with?

• Advantages and disadvantages?

Questions

What is an open-ended question?

• questions starting with why, when, how, what, where, who?

What are closed-ended questions?

• a question where the answer is either yes or no

What is a leading question?

• a question that includes part of the answer within the question people want to give the right answer

Questions: closed or open ended? Neutral or leading? Appropriate questions?

Instead of… …better to askDo you have goats? What animals species do you

keep?

When did you last vaccinate against FMD?

What do you do against FMD?

Do you keep ducks or not? What types of poultry do you keep?

Do you eat dead animals? What do you do with animals that die due to disease?

Differences between questionnaires and checklists

Questionnaire ChecklistUsing a list of questions to be followed when collecting data

Uses bullet points of topics to guide the facilitator in capturing the main points during the interview

Fixed questions - not changeable

Questions are not fixed, can vary depending on the situation

Not flexible in different situations

Flexible and suitable for all environments

Enumerators collect information

Facilitators collect information

Example of a checklist /interview guideObjective: identification & prioritization of animal health issues• Introductions• Purpose of the visit – general! • Livestock species kept• Husbandry systems• Grazing locations• Problems facing livestock keeping

• If diseases mentioned – explore further (frequency, seasonality, morbidity mortality, what do you do?….)

• Questions from participants?• Give advice• Thanks

What to consider before going to the field?

Content

• Objective of conducting interview

• Secondary information about area

• Talk to key informant

Context:

• Time and place of interview

• Duration interview

• Understand community culture and background

While in the field

• Group organization (interviewer, translator, recorder, assistants)

• Do not disclose the disease your searching.• Apply open ended questions (where, who,

what, how, when)• Ordering questions from general to specifics• Probe further the area of interest

While interviewing

• Use simple language

• Mind the body language

• Observe for non verbal communication

• Keep eye contacts where possible

• Include everybody

• Use appropriate PE tools to bring out information

Pretty, N.J., Guijt, I., Thompson, J. and Scoones, I. (1995) A Trainer’s Guide for Participatory Learning and Action, IIED.

Group work – semi-structured interview

Divide into 3 groups:

come up with an objective for a semi-structured interview and a checklist to answer this objective

AFTER THAT: role play!

Select one interviewer and one notetaker – the rest are observers (to give feedback), interview a person from another group

2 rounds

Part 4: PE toolsVisualisation

At the end of this session participants

- Can explain the use of different visualization tools

- Can apply seasonal calendar and mapping in PE studies

Part 4: PE toolsVisualisation

Participatory mapping

Useful at the beginning of an inquiry to define the spatial boundary of the system under investigation. It also acts as a good ice-breaker as many people can be involved

If we are interested to map livestock resources what kinds of things could we map?

Map examplesCan be at different scale

PE tools: visualizationSeasonal calendar

• Local perception of seasonality of disease, farming practice, risk factors, etc.

• Seasonality of rainfall and festivals

PE tools: visualisation

Group work 1, aim: identify possible groups for field work

• draw map of Ethiopia

• mark the project locations

• show ways how one can move from one location to another

• estimate of time needed to move from one location to another

• Maps should have a title, scale and key.

Group work 2: use calendar to relate seasons, key events and disease incidence

• Select an area of your choice

• Map the seasons

• Estimate occurrence of major diseases (proportional piling)

Group work 3: disease transmission

- Draw transmission pathways for a disease of your choice

- For each pathway, indicate how much men, women and youth are involved (proportional piling)

Part 5:Planning FGD and data analysis

• Define objectives of FGD

• Target audience

• Identify PE tools, ensure gender aspects are covered appropriately

Data recording

• Needs to be carefully planned in advance!

• Prepare templates

• Poor recording leads to loss of information

• At least one person recording

• Consider using voice recorder

Example: recording of pairwise ranking

Factors compared

Winning factor Reason

4x7 4 The capacity also includes the data recording system

4x8 4 If capacity is built they can work even in areas where

there is no private veterinary services

4x9 4 The first thing is improving capacity, then incentives

come later

4x10 4 If vets capacity is built, then they can create farmers

awareness as much as possible

4x11 11 The poor integration with other sectors has led to

capacity limitation

5x6 6 Work burden is not such much problem here

Data analysis

Only possible if data was recorded consistently

When do we carry out analysis?

• during the interview by probing (example!)• summarizing the interview• summary report for the village or area• at central level

Triangulation is carried out:

• between questions and tools used with the same informants

• between questions and tools repeated with multiple informants

• between information collected from interviews and tools with laboratory diagnostics

• between PE findings and secondary information

Field recording forms

Interview records

PE field study report

Analysis of simple ranking dataGroup 1 result: 1. cow2. goat3. sheep4. donkey5. chickens

Group 2 result:6. cow7. goat8. sheep9. chickens10.donkeys

Group 4 result:1. cow2. goat3. chickens4. sheep5. donkeys

Group 5 result:6. cow7. goat8. sheep9. donkey10.chickens

Group 3 result:1. goat2. cow3. sheep4. donkeys5. chickens

Summary of interview results

  Interview    

Species 1 2 3 4 5 Total Rank

Cow 1 1 2 1 1 6 1

Goat 2 2 1 2 2 9 2

Sheep 3 3 3 4 3 16 3

Donkey 4 5 4 5 4 22 4

Chickens 5 4 5 3 5 22 4

However if there were a sixth group …

Group 6 result:

1.cow,

2.goat,

3.sheep,

4.chickens,

5.ducks

  Interview    

Species 1 2 3 4 5 6 Total Rank?

Cow 1 1 2 1 1 1 7 2?

Goat 2 2 1 2 2 2 11 3?

Sheep 3 3 3 4 3 3 19 4?

Donkey 4 5 4 5 4 - 22 5?

Chickens 5 4 5 3 5 4 26 6?

Ducks           5 5 1?

This is not correct!

In this case the original ranks should be converted to scores.

For each interview the species ranked 1 is given a score of 6, species ranked 2 is given a score of 5, 3 = 4, 4=3, 5 = 2, and 6 =1.

Summary of interview results  Interview    

Species 1 2 3 4 5 6 Total Rank

Cow 6 6 5 6 6 6 35 1

Goat 5 5 6 5 5 5 31 2

Sheep 4 4 4 3 4 4 23 3

Donkey 3 2 3 2 3 - 13 5

Chickens 2 3 2 4 2 3 16 4

Ducks - - - - - 2 2 6

Analysis of proportional piling dataInterviews

Species 1 2 3 4 Median Range

Cow 50 40 45 40

Goat 20 25 20 15

Sheep 15 20 20 15

Donkey 10 10 5 10

Chickens 5 5 10 15

Ducks 0 0 0 5

100 100 100 100

Median

• A measure of the center of the data

• The median is the middle value of a set that has been put into rank order

The median, like the mode, is not generally affected by one or two extreme values (outliers) which may greatly affect the mean (average).

Example: Cattle: 52 – 42 – 45 – 40 – 48

Put in rank order: 40 – 42 – 45 – 48 – 52

Median: 45

Range

A measure of the dispersion of the data

Reports from the smallest value (minimum) to the largest (the maximum)

Example:

Cattle: 52 – 42 – 45 – 40 – 48

Range: 40 – 52

Analysis of proportional piling dataInterviews

Species 1 2 3 4 Median Range

Cow 50 40 45 40 42.5 40 - 50

Goat 20 25 20 15 20 15 - 25

Sheep 15 20 20 15 17.5 15 – 20

Donkey 10 10 5 10 10 5 – 10

Chickens 5 5 10 15 7.5 5 – 15

Ducks 0 0 0 5 0 0 - 5

100 100 100 100

E.g. Use of income resulting from livestock sales (results from men; n=14)

Discussion

Compare qualitative and quantitative epidemiology

- Advantages

- Disadvantages

Quantitative versus QualitativeEpidemiology

Quantitative• Objective• Numerical estimates• Data intensive• Expensive• Logistically complex• Long-time frames• Difficult to sustain• Information gaps

Qualitative• Subjective• Flexible• Rapid• Discovery• Simple• Sensitive• Skilled field personnel• Analytical challenges

Qualitative data checking Probing

• Internal consistency

Triangulation• Multiple methods and sources• Patterns and coherence• Understanding bias

Understanding conflict of interest

On the spot analysis• Evolving hypotheses and data collection• Weighing of evidence

Bias

What do you understand under bias?

Systematic deviation from reality, aligning to a certain belief, ranking people in a population, being selective, unjust, favouring one side over another

Q. What might be sources of bias in field work?

Some possible biases in PE studies…

• Spatial bias

• Project bias

• Personal bias

• Seasonal bias

• Diplomatic bias

• Professional bias

Important to understand our own biases!

How can you minimize bias?

Questions?

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Special thanks to Saskia Hendrickx (ILRI) and PENAPH.net for slides