Close
Explore more Centres, Projects and Groups
Welcome
Welcome Banner
A nurse checks intravenous medications in a general hospital in Ratchaburi, Thailand. Antibiotics have become a quick fix for hygiene but with resistance to antibiotics, infection rates are rising (AMIS project). Photo by Bundit Chotsuwan, August 2018

Anthropological Approaches to Global Health 

Our team apply innovative anthropological approaches to topical issues in global health, particularly in low- and middle-income countries.

Bottom Content
About

The Anthropological Approaches to Global Health group (AAGH) brings together a team of medical anthropologists conducting innovative research into a variety of topical challenges in global health. We work in settings across the world, with a particular commitment to addressing health challenges that disproportionately affect people living in low and middle-income countries.

About
About AAGH 2 columns
About AAGH 2 columns left paragraph
Paragraph

The Anthropological Approaches to Global Health group (AAGH) brings together a team of medical anthropologists conducting innovative research into a variety of topical challenges in global health. We work in settings across the world, with a particular commitment to addressing health challenges that disproportionately affect people living in low and middle-income countries. The topics we address include:

  • Antimicrobial resistance
  • Epidemic preparedness and response
  • Gender-based violence
  • Humanitarian crises
  • Medical research and bioethics
  • Universal health coverage
  • Pharmaceutical supply chains
  • Roles of the private and informal retail sectors

We draw on theories from medical anthropology, critical global health, science and technology studies, history and other disciplines to offer fresh insights. In designing our studies, we work closely with partners and stakeholders to identity pressing research needs and to ensure responsive and impactful anthropological research. We analyse how health issues are framed and prioritised in the global policy arena, and how setting shapes implementation and vice versa. Many of our projects are grounded in ethnographic method and involve immersive, longitudinal fieldwork in particular settings to understand local realities and concerns. To design and deploy innovative mixed methods approaches, our interdisciplinary collaborations involve clinicians, epidemiologists, economists, lab scientists, pharmacists and veterinarians. 

World-leading scholars present and discuss their research in our regular monthly medical anthropology seminar series.

The AAGH team is connected to a number of other groups, hubs and centres, including:

Team
Team Block

Sarah Bernays

Senior Lecturer in Global Health

Virginia
Bond

Associate Professor

Alex Bowmer

Research Fellow in Medical Anthropology

Dan
Brunsdon

Research Fellow

Tracey
Chantler

Assistant Professor

Laurie Denyer-Willis

Research Fellow in Anthropology
Justin Dixon

Justin
Dixon

Research Fellow

Diane
Duclos

Assistant Professor

Eleanor
Hutchinson

Assistant Professor

Coll Hutchison

Research Fellow in the Anthropology of Microbes

Isabelle
Lange

Assistant Professor

Shelley
Lees

Associate Professor

Frederick Martineau

Research Fellow

Melissa Parker

Professor of Medical Anthropology

Hana
Rohan

Assistant Professor

Janet
Seeley

Professor

Ruth
Willis

Research Fellow
Projects
Projects AAGH 2 columns
Projects AAGH 2 columns left paragraph
Paragraph
Anthropology of Microbial Resistance

Title

Anthropology of Antimicrobial Resistance

Summary

The Anthropology of Antimicrobial Resistance (AMR) Research Group applies ethnographic approaches and social theories such as pharmaceuticalisation, care, global health assemblages and multi-species perspectives to the study of AMR. We currently have seven ongoing projects with collaborators in a number of low and middle-income countries, including Uganda, Zimbabwe, Malawi, Thailand and Myanmar. Our work addresses numerous topics, including pharmaceutical supply chains, prescribing practice in clinics and hospitals, clinical guidelines and algorithms, antibiotic use in residential and farm settings, and the roles of the private and informal providers.

Approach

Our approach is grounded in a commitment to slow thinking and exploring alternative ways of thinking about the 'problem' of AMR to those offered in prevailing discourses. In particular we seek to move beyond approaches which centre the individual and their behaviour and to instead foreground the complex interactions between epidemiology, economics, infrastructure, politics and culture that lead people use and depend on antimicrobials. To this, we use both discourse analysis to examine the framing of AMR in the global policy arena, as well as in-depth ethnographic research to examine antimicrobial use in context and the effects of AMR interventions in local worlds.

Studies

Antimicrobials in Society (AMIS) Hub – involves research in Uganda and Thailand, and a platform to stimulate fresh perspectives in social research on AMR.

Febrile Illness Evaluation in a Broad Range of Endemicities (FIEBRE) – a fever aetiology study with social science work on antimicrobial use in Zimbabwe, Malawi and Myanmar.

Drivers of Resistance in Uganda and Malawi (DRUM) – research in Malawi and Uganda into how antimicrobial use in humans, animals and wider environment contribute to AMR.

Capacity Sharing for AntiMicrobial Stewardship (CaSAMS) – a collaboration between UK and Ugandan institutions to establish an antimicrobial stewardship committee at a referral hospital in Uganda.

People

  • Clare Chandler
  • Laurie Denyer-Willis
  • Coll Hutchison
  • Justin Dixon
  • Eleanor MacPherson  
  • Nicolas Fortane
  • Chris Pinto
  • Jenny Westad

Resources and Publications

Quick fix for care, productivity, hygiene and inequality: reframing the entrenched problem of antibiotic overuse
Laurie Denyer-Willis and Clare Chandler
2019
BMJ Global Health

Knowing antmicrobial resistance in practice: a multi-country qualitative study with human and animal healthcare professionals
Maddy Pearson & Clare Chandler
2019
Global Health Action

The ‘Drug Bag’ method: lessons from anthropological studies of antibiotic use in Africa and South-East Asia
Justin Dixon, Eleanor MacPherson, Salome Manyau, Susan Nayiga, Yuzana Khine Zaw, Miriam Kayendeke, Christine Nabirye, Laurie Denyer Willis, Coll de Lima Hutchison and Clare I. R. Chandler
2019
Global Health Action

Antibiotic prescribing and resistance: Views from low- and middle-income prescribing and dispensing professionals
Doble A, Glogowski R, Ibezim S, Lazenby T, Heilie Redai A, Shaikh N, Treharne A, Yardakul S, Yemanaberhan R, Reynolds L, Chandler C
2018

Anthropology’s contribution to AMR control
Laurie Denyer-Willis and Clare Chandler
2018

The modern era must end: antibiotic resistance helps us rethink medicine and farming
Coll de Lima Hutchison, Gwen Knight, Richard Stabler, Clare Chandler
2018
BMJ

Addressing Antimicrobial Resistance Through Social Theory: An Anthropologically Oriented Report
Clare Chandler, Eleanor Hutchinson, Coll Hutchison, C 2016
Technical Report. London School of Hygiene & Tropical Medicine

The Constructing of Antimicrobial Resistance: A Workshop. 3rd August 2016, Latimer Place, Chesham, UK

Antimicrobial Resistance and Anthropology: Research Brief
Chandler, C.I.R., and Hutchinson, C.
2016
ESRC AMR Research Champion/University of Bristol

Consolidating practice in social science research for Ebola, DRC

Title

Consolidating practice in social science research for Ebola, DRC

Summary

This project a collaboration between the University of Oxford in collaboration with UNICEF and LSHTM. The project aims to support the response to the Ebola epidemic in North Kivu and Ituri provinces, Democratic Republic of Congo which has been described as one of the most complex that national and international communities have had to face. Given the complexity of this protracted epidemic, social science research has become a critically important part of the response in order to help contextualise strategies, investigate social determinants of infection, and inform understanding and reception of interventions employed for outbreak control. To routinely generate this intelligence, an innovative solution has emerged in the form of the Cellule d’Analyse en Sciences Sociales. UNICEF-funded, this group is made up predominantly of local and national social scientists. Other ad hoc social science research is also being conducted in the field.

Approach

Through this project we aim to consolidate learning and articulate what is needed to replicate similar initiatives in future outbreaks. We will provide remote technical support, conduct structured critical appraisal of the field experience, capture lessons learned, and develop guidance and tools for the current and for future outbreaks. Our vision is to contribute to better outbreak prevention and response through excellence in social and behavioural science research, integrated into current and future responses to infectious disease.

People

  • Nina Gobat (University of Oxford) 
  • Carlos Navarro (UNICEF)
  • Simone Carter (UNICEF)
  • Julienne Annoko (WHO)
  • Mathias Mossoko(DRC MOH)
  • Shelley Lees (CI)
  • Gillian Mckay (CI)
  • Kevin Bardosh 
Preparedness for future epidemic outbreaks

Title

Preparedness for future epidemic outbreaks

As part of a wider consortium called EBOVAC 3 the work package we lead on aims to explore how Sierra Leone, Guinea and DRC are prepared for future disease outbreaks.

Project summary

In Sierra Leone the LSHTM team are leading on innovative research exploring and disrupting notions household structure and care-giving during peace-time to inform preparedness for epidemic outbreaks. Our work is also looking at Ebola clinical trial legacies. In Guinea, Frederic Le Marcis, professor of social anthropology at the Département des Sciences Sociales, Ecole normale supérieure de Lyon is conducting a study on Thinking Preparedness in the light of history. Unmasking virological longue durée in Guinea and Rubis Le Coq is conducting doctoral research on Seeking care in times of fear

Research approach

Anthropological and survey methods

People involved

Anthropological exploration of facilitators and barriers to vaccine deployment and administration during disease outbreaks (AViD)

Title

Anthropological exploration of facilitators and barriers to vaccine deployment and administration during disease outbreaks (AViD)

Summary

Recent outbreaks have made clear that inadequate consideration of social, cultural, political, and religious factors in humanitarian responses has consequences for the effectiveness and community acceptability of response activities. A growing number of studies have focused on the historical, social, cultural and political determinants of vaccine acceptance, and have highlighted the specificities of these dynamics during emergencies. While these theories are useful to help understand potential issues for vaccine deployment and administration during an outbreak, there are gaps in the evidence, particularly relating to acquiring evidence in real-time.

Given the wider range of disease and contexts, there is a need to understand different of perspectives about vaccines and outbreaks, including the political and economic factors that determine whether vaccines can be deployed effectively in an emergency situation, health system perspectives, which are closely tied to cultural, policy, and historical developments in how provision is organised as well as local systems of to identify community perceptions surrounding vaccine use. Finally, given that many diseases are zoonotic, understandings of community experiences of vaccination in both human and animal health are needed.

This study sets out to address these gaps through qualitative, comparative research across four different countries to explore the facilitators and barriers to vaccine deployment during outbreaks. Rather than focusing on one disease/vaccine or one context, this study will explore an “ecosystem” of vaccine deployment, drawing on different perspectives in low-income contexts and for the poorest in middle-income contexts.

Approach

Using a multiple-case study approach and a mix of qualitative and ethnographic methods including key stakeholder interviews, document analysis and participant observation, the project will ensure insights into the complex web of factors that determine countries’ ability to deploy vaccines during an outbreak. Each case study aims to shed light on different factors that determine preparedness for emergency vaccine deployment.

People

Shelley Lees PI
Luisa Enria
Alex Bowmer
Samantha Vanderslott
Clarissa Simas
Lys Alcanya Stevens
Mark Marchant
Hana Rohan
Juliet Bedford
Theresa Jones
Jimmy Whitworth CI
Karl Blanchet CI
Heidi Larson CI

ALERRT

Title

ALERRT

Summary

The African coaLition for Epidemic Research, Response and Training (ALERRT) aims reduce the public health and socio-economic impact of REPID in SSA. This will be achieved by building a sustainable clinical and laboratory research preparedness and response network, with the operational readiness to rapidly implement clinical and laboratory research in support of REPID control efforts at local, regional and international level. Our role is the lead Work Package 5, which aims to understand effective community engagement through anthropological research.

Approach

Using systematic reviews, workshops and drawing anthropological research and political theory we aim to interrogate community engagement in response and research for emergent diseases

People

  • Jimmy Whitworth (overall PI)
  • Shelley Lees (work package lead)
  • Mark Marchant
The effects of cash transfers on intrahousehold dynamics and intimate partner violence in Mali: proposal for additional mixed method work (IFPRI)

Title

The effects of cash transfers on intrahousehold dynamics and intimate partner violence in Mali: proposal for additional mixed method work (IFPRI)

Summary

In 2014 the Government of Mali began implementing the “Filets Sociaux (Jigisémèjiri)” program that aims at reducing inter-generational poverty and improving human capital accumulation through targeted cash transfers to predominantly male heads of household, accompanying measures (trainings), and preventive nutrition packages. Research has revealed significant impacts of the program on experiences of physical violence amongst women in polygamous relationships.

This study aimed to provide an in-depth qualitative exploration of the effects of the program on intimate partner relationships in Mali. Findings of the study revealed that positive aspects around intimate partner relationships were communication and shared values; however, much of the discussion around decision-making narrated male authority and limited power for women to influence decisions. The cash transfer reduced household poverty and improved personal wellbeing, especially for men. Whilst there were few discussions around the effects of the program on intimate partner violence, there were clear narratives on the reduction of tensions and disputes that lead to physical violence. This may have been greater in polygamous households, where there were more tensions and disputes over responsibilities across a husband and his wives and across co-wives.

Approach

Qualitative interviews with women and men in Malian households

People

  • Shelley Lees
  • Nambusi Kyeombe

Paper

Lees, S, Kyegombe, N, Diatta, A. D, Zongrone, A, Roy, S, Hidrobo, M (In Press) Intimate partner relationships and gender norms in Mali: The scope of cash transfers targeted to men to reduce intimate partner violence. Violence Against Women 

Contested legitimacy for anthropologists involved in medical humanitarian action: Experiences from the 2014-2016 West Africa Ebola epidemic

Title

Contested legitimacy for anthropologists involved in medical humanitarian action: Experiences from the 2014-2016 West Africa Ebola epidemic

Summary

The study involved exploring lessons learnt of anthropologists and other social scientists, and key informants from humanitarian organisations involved in infectious disease responses, collating and assessing rapid ethnographic assessment tools and methodologies for use by social scientists in infectious disease outbreaks.

Approach

In-depth interviews with anthropologists and humanitarian workers. Round table discussion at a Wellcome Trust event led by Shelley Lees, Karl Blancher, Jennifer Palmer and Fanny Procureur

People

  • Shelley Lees co PI
  • Karl Blanchet co PI
  • Jennifer Palmer
  • Fanny Procureur

Paper

Lees S, Palmer J, Procureur F and Blanchet K (In Press) Contested legitimacy for anthropologists involved in medical humanitarian action: Experiences from the 2014-2016 West Africa Ebola epidemic. Anthropology and Medicine

Anthropological study to explore the sociocultural context of sexual violence against children in Zanzibar

Title

Anthropological study to explore the sociocultural context of sexual violence against children in Zanzibar

Summary

Anthropological study to understand the sociocultural context of sexual violence against children in Zanzibar.

Approach

Anthropological research including ethnography and in dept interviews with key informants, parents and adolescents in Zanzibar

People

  • Shelley Lees
  • Karen Devries

Paper

Lees, S and Devries, K (2018). Local narratives of sexual and other violence against children and young people in Zanzibar. Culture, Health and Sexuality. 20(1):99-112

Social science research of the EBOVAC1 and PREVAC vaccine trials in Sierra Leone

Title

Social science research of the EBOVAC1 and PREVAC vaccine trials in Sierra Leone

Summary

These multifaceted studies are exploring understand vaccine and trial acceptability by conducting in depth social science research (anthropology). This research has examined understandings and experiences of Ebola and vaccines, perspectives of the vaccine and the trial as well as rumours, and concerns.

Approach

Traditional social science methods, including in-depth interviews, focus groups discussions and ethnography, will employed to ensure an in-depth exploration is conducted and wider lessons can be learned for the current Ebola outbreak and any future outbreaks of this and other new infectious diseases. Further to this, rapid approaches will be employed to ensure that findings are quickly fed back to the trial investigators and trial processes and communication around the trial can be adapted to ensure that participants and communities accept the trial and that adherence and acceptability are high.

People

Papers

Enria L & Lees S (2018) Citizens, Dependents, Sons of the Soil:  Defining Political Subjectivities through Encounters with Biomedicine during the Ebola epidemic in Sierra Leone Medical Anthropology Theory

Tengbeh A, Enria L, Smout E, Mooney T, Callaghan M, Ishola D, Leigh B, Watson-Jones D, Greenwood B, Larson H, Lees S (2018) “We are the heroes because we are ready to die for this country”: Participants’ Decision-making and “Grounded Ethics” in an Ebola vaccine clinical trial. Social Science & Medicine. 203: 35-42.

Enria, L., Lees, S., Smout, E., Mooney, T., Tengbeh, A. F., Leigh, B., ... & Larson, H. (2016). Power, fairness and trust: understanding and engaging with vaccine trial participants and communities in the setting up the EBOVAC-Salone vaccine trial in Sierra Leone. BMC Public Health, 16(1), 1140.

Social Science research within the MAISHA study, Tanzania

Title

Social Science research within the MAISHA study, Tanzania

Summary

The MAISHA Study is a cluster randomised trial to assess the impact of a combined micro-finance and gender training intervention for women, and the impact of a participatory gender training programme for women and their partners. The social science research focuses on women’s experiences of intimate partner violence and of the intervention. Understanding that  violence against women is situated within structures that are instigated by political economics that create marginalisation and vulnerability to violence, including distribution and use of resources in the home, the community, and at the political level. In order to understand violence, a political economy approach is thus required and should incorporate broader links between poverty, identity, and power as well as reveal historical contingencies

Approach

Longitudinal qualitative study with trial participants

People

  • Shelley Lees
  • Sheila Harvey
  • Saidi Kapiga
  • Charlotte Watts