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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 

Applying innovative anthropological approaches to topical issues in global health, with a focus on low- and middle-income countries.

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About

Conducting meticulous ethnographic research in a diversity of settings and drawing on cutting-edge social theory, we challenge established ways of thinking about global health issues and open up new avenues for responding to them. 

Projects

We work on diverse themes, from global pandemics to violence against women and children, and from antimicrobial resistance to the ethics of clinical trials in low-resource settings. 

Team

Our team is comprised of over 50 medical anthropologists with a range of research interests and regional expertise.

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

  • Antimicrobial resistance
  • COVID-19
  • Epidemic preparedness and response
  • Gender-based violence
  • Humanitarian crises
  • Medical research and bioethics
  • Pharmaceutical supply chains
  • Roles of the private and informal retail sectors
  • Universal health coverage

We critically analyse these health challenges at multiple levels, from the ways in which they are framed on the global stage, through to their enactment in particular settings through policy, research and interventions. Always looking to push intellectual boundaries, we draw on theories from medical anthropology, critical global health, science and technology studies, history and numerous other fields to offer fresh insights. Many of our studies are grounded in ethnographic method and involve immersive, longitudinal fieldwork to understand local realities and concerns, which we use to challenge assumptions and established ways of thinking. Our studies are designed in close collaboration with local partners and stakeholders to identify pressing research needs and to ensure responsive and impactful anthropological research. We also increasingly work as part of interdisciplinary collaborations that include clinicians, epidemiologists, economists, lab scientists, pharmacists and veterinarians to develop innovative mixed-methods approaches.   

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

Gemma
Aellah

Distance Learning Tutor

Femke
Bannink

Assistant Professor
Image

Sarah Bernays

Associate Professor

Rose
Burns

Research Fellow

Dan
Brunsdon

Research Fellow

Manuel
Campinas

Research Degree Student

Tracey
Chantler

Assistant Professor
Justin Dixon

Justin
Dixon

Assistant Professor

Giulia
D'Odorico

Research Fellow

Diane
Duclos

Assistant Professor

Emily
Eldred

Project Coordinator

Luisa
Enria

Assistant Professor

Rachel
Ford

Administrative Assistant

Mitzy
Gafos

Associate Professor

Andrew
Gomez

Administrator

Coll
de Lima Hutchison

Research Fellow

Maddy
Gupta-Wright

Research Degree Student

Sarai
Keestra

Research Assistant

Yuzana
Khine Zaw

Research Degree Student

Isabelle
Lange

Assistant Professor

Shelley
Lees

Associate Professor

Paula
Palanco Lopez

Research Assistant

Salome
Manyau

Research Degree Student

Sophie
Mylan

Research Degree Student

Susan
Nayiga

Research Degree Student

Jennifer
Palmer

Assistant Professor

ANNA
PERRIS

Research Assistant

Chris
Pinto

Research Fellow

Denis
Regnier

Research Degree Student

Hana
Rohan

Assistant Professor

Esther
Rottenburg

Research Degree Student

Janet
Seeley

Professor

Maureen
Seguin

Research Fellow

Esther
Sharma

Research Degree Student

Alice
Tompson

Research Degree Student

Jenny
Westad

Project Coordinator

Ruth
Willis

Research Fellow
Projects
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Anthropology of Antimicrobial Resistance

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.

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

Adolescent social science research in Zimbabwe

In partnership with the Biomedical Research Training Institute in Zimbabwe, we are conducting social science research focused on adolescent health in Zimbabwe.

Constance Mackworth-Young is the lead social scientist for this work, supported by Sarah Bernays, as the senior social science advisor (both members of the Department of Global Health and Development). The social science research is embedded within projects and trials on Adolescent Health led by Rashida Ferrand, Director of the Zimbabwe-LSHTM Research Group.

Studies

Process evaluation of the CHIEDZA trial: a community-based sexual and reproductive health intervention for adolescents

CHIEDZA, which stands for Community based interventions to improve HIV outcomes in adolescents: a cluster randomised trial in Zimbabwe, is a two-year study to develop and evaluate the impact of a community-based, youth-friendly reproductive and sexual health service on improving HIV outcomes in people aged 16-24. STI screening within CHIEDZA (STICH) is a sub-study which aims to evaluate the effectiveness of community-based screening for STIs among youth in Zimbabwe.

We are conducting a process evaluation of both CHIEDZA and STICH, which aims to understand the intervention's implementation, mechanisms of action, and the role of local context to inform and understand the intervention. The MRC Process Evaluation Framework informs this study. Specific service focuses include on HIV, STI screening and family planning. Methods include non-participant observation of intervention sites, interviews with clients and providers, and participant observation of team meetings.

People

Y-CHECK: Co-designing routine health check-ups during adolescence

The Y-CHECK study seeks to co-design and evaluate an intervention programme to screen, treat and refer adolescents for a range of common health conditions using routine health check-ups undertaken at two time points during adolescence (the first between 10 to 14 years, and the second between 15 to 19 years).

Zimbabwe is one of the three sites where the study is being conducted, alongside Ghana, and Tanzania. It is coordinated by the World Health Organization, in collaboration with London School of Hygiene and Tropical Medicine, Biomedical Research & Training Institute in Zimbabwe, University of Ghana School of Public Health and Mwanza Intervention Trials Unit.

Through a process of co-design with adolescents, parents, healthcare professionals, teachers and key stakeholders a routine health check-up design was created. This entailed a review of existing programmes and data, key informant interviews and workshops using participatory approaches with all stakeholders. The co-designed intervention will be piloted and its effectiveness and cost-effectiveness will be evaluated, pending funding.

People

Consolidating practice in social science research for Ebola, DRC

A collaboration between the University of Oxford, UNICEF and LSHTM, this project supports the response to the Ebola epidemic in North Kivu and Ituri provinces, Democratic Republic of Congo, one of the most complex epidemics that national and international communities have faced. 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.

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

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

In Sierra Leone, the LSHTM team lead innovative research exploring and disrupting notions of household structure and care-giving during peace-time to inform preparedness for epidemic outbreaks. We also study the legacies of Ebola clinical trials. 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, Rubis Le Coq is conducting doctoral research on seeking care in times of fear.

People involved

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

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.

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

ALERRT

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.

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

The effects of cash transfers on intrahousehold dynamics and intimate partner violence in Mali

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 used qualitative interviews with women and men in households to provide an in-depth 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.

People

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

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.

The approach included in-depth interviews with anthropologists and humanitarian workers, and a 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

To understand the sociocultural context of sexual violence against children in Zanzibar, anthropological research including ethnography and in-depth interviews with key informants, parents and adolescents.

People

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

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.

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

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. This longitudinal qualitative study with trial participants shows that violence against women is situated within structures 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.

People

 

Pandemic Preparedness: Local and Global Concepts and Practices in Tackling Disease Threats in Africa

The research examines ‘preparedness from below’ – the understandings and practices of communities through which they anticipate and manage disease threats such as COVID-19 on a daily basis. We aim to identify entry points and pathways for connecting global, intermediate and local ‘assemblages’ in ways that build on, enhance and support the legitimacy and agency of communities’ ‘preparedness from below’. Ethnographic fieldwork is being conducted in Sierra Leone and Uganda.

People:

  • Melissa Parker
  • Fred Martineau

Partner organisations include:

Publications

Parker, M., MacGregor, H and Akello, G 2020. COVID-19, public authority and enforcement. Medical Anthropologyhttps://doi.org/10.1080/01459740.2020.1822833

Baluku, M., Akello, G., Parker, M and Grant, C 2020. How the ‘disease of the radio’ is affecting people on the Uganda-DRC border. https://www.ids.ac.uk/opinions/covid-19-how-the-disease-of-the-radio-is-affecting-people-on-the-uganda-drc-border/

MacGregor, H., Leach, M., Wilkinson, A and Parker, M. 2020. Covid-19 – a social phenomenon requiring diverse expertise. https://www.ids.ac.uk/opinions/covid-19-a-social-phenomenon-requiring-diverse-expertise/

Public Authority and International Development

The ESRC-funded Centre for Public Authority and International Development is based at the LSE and explores how governance works in marginalised and conflict-affected regions. It investigates the complexity of public authority and the risks and opportunities this creates for international development and inclusive growth (add link)

Melissa Parker’s contributions to this multi-disciplinary and collaborative project includes on-going research about: (i) Ebola and public authority (ii) COVID-19, public authority and enforcement and (iii) the various ways in which day to day experiences of child soldiers returning from the Lord’s Resistance Army in northern Uganda are shaped by formal, hybrid and informal public authorities.

Resources and publications

Parker, M., MacGregor, H and Akello, G 2020. COVID-19, public authority and enforcement. Medical Anthropology. https://doi.org/10.1080/01459740.2020.1822833

Allen, T., Atingo, J., Atim, D., Ocitti, J., Brown, C., Torre,C., Fergus, C. and Parker, M. 2020. What happened to children who returned from the Lord’s Resistance Army in Uganda. Journal of Refugee Studies

Torre, C., Mylan, S., Parker, M and Allen, T 2020. Is promoting war trauma a good idea?Anthropology Today 35 (6): 3-6.

Parker, M., Hanson, T., Vandi, A., Babawo, L and Allen, T 2019. Ebola and public authority: saving loved ones in Sierra Leone. Medical Anthropology 38 (5): 440-454.

Parker, M., Hanson, T.M., Vandi, A., Babawo, L.S. and Allen, T. 2019. Ebola, community engagement, and saving loved ones. The Lancet, published online on June 10th at: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2931364-9

McKay, G and Parker M, (2018). ‘Epidemics’ In:  Humanitarianism: A Dictionary of Concepts, pp: 81-95. Edited by T. Allen, Macdonald, A and Radice H. London/New York: Routledge