In September 2019 the Dust Bunny team run a co-design workshop with several of the households participating in the project. The aim of the workshop was to co-design interventions that householders will take back and implement.
The households were representative of the 4 socio-economic groups found in Ghana.
The one-day workshop included several creative activities and tools which were designed to elicit response and engagement from participants. Some of the tools and activities placed participants in mock-up versions of different types of households and presented in visual ways the bacteria found in households form the microbiological analysis and their potential impact to health.
They then explored the different cleaning hotspots where they believed bacteria are found in their homes and developed cleaning agreements that each household would take back home and test for a month.
Participants were deeply engaged with the data, especially the findings from the microbiological analysis of dust. They wanted to know the number of different bacteria found and from which socioeconomic groups.
The Dust Bunny project has attracted the Interest of journalist Peggy Ama Donkor (Journalist of the Year 2005 award) who created a video documentary on it.
The video was aired on Ghana Today Television (the national public broadcaster of Ghana, run by the Ghana Broadcasting Corporation) on its Breakfast show and Regional Diary on the 28th June 2019, 30th June 2019 and 10th July 2019, seen by several thousands of viewers. It was also posted on Facebook 13 July.
Dust Bunny has investigated the microbiological content of dust by isolating bacteria from dust obtained from a range of homes in Accra in Ghana.
We tested the bacteria for resistance to a number of commonly used antibiotics and found that about 35% of those tested carried resistance to at least one antibiotic and some carried resistance to more than one.
Some of antibiotic resistant bacteria were identified and no were found to be disease-causing but the majority were opportunist pathogens and could cause disease in people who were already suffering from infectious or non-infectious diseases.
The most common bacterium found was a non-pathogenic bacterium found in soil but even so it carried a number of resistance which could pass to antibiotic sensitive pathogens making their treatment more difficult.
Although the sample size was relatively small it showed us that although the dust was a low risk to health with respect to infectious disease, it provides a pool of antibiotic resistance that could compromise future infections.
Developing strategies for promoting health or preventing ‘illbeing’ of the population forms one of the most complex global challenges. As such, global health challenges, such as Antimicrobial Resistance (AMR), are hugely complex problems with diverse influences, driven by human activity as much as by biological mechanisms. Biomedical, clinical and medical expertise alone cannot tackle global health issues alone. Collaborative and innovative interdisciplinary approaches are needed to tackle such challenge.
The Antimicrobial Resistance, Community Engagement, Global Health and the Arts and Humanities, organised in Kathmandu, Nepal between the 26th – 28th of June 2019, focused on this theme. The event, organised by Leeds University, highlighted the value of transdisciplinarity and in particular participatory approaches and community engagement in the context of Global Health and AMR.
During the event, the Dust Bunny presentation demonstrated that from an epidemiology and public health perspective, combining knowledge from multiple sources presents the best opportunity to adequately address public health concerns, such as in the case of AMR. More precisely, it demonstrated that the use of a design research approach to address antimicrobial resistance management at the household level can provide insights into the behavioural challenges, and promote best practices for public health implementation. This is a practice that adds more value to the microbiology and public health aspects of the project, which would typically not engage further with households after sampling has been completed.
We envisage that the experiences and insights outlined in the event and our presentation of the project, will help other researchers to embark on transdisciplinary research that challenges the boundaries of their disciplines in new specialist medical areas.
The unique and truly multidisciplinary research methodology employed by the Dust Bunny research team has been published in the Design Journal. The paper is entitled ‘Combining design research with microbiology to tackle drug-resistant infections in different home environments in Ghana: Challenging the boundaries of design thinking‘ and can be freely accesses from here.
It posits that the approach adopted has the opportunity to provide a platform for understanding complex issues regarding microbiology (microbial resistance) and public health through engaging the community of practice. Doing this from various perspectives (design, social science, epidemiology/public health and microbiological perspectives) presents the best opportunity to adequately address emerging public health concerns, such as antimicrobial resistance in the home setting.
We envisage that the experiences and insights outlined in this paper, will help other researchers to embark on transdisciplinary research that challenges the boundaries of design in new specialist medical areas.
Following the collection of dust data samples from the 12 households participating in the study, the team has been analysing them used different microbiology analyses.
This will help determine if the bacterial strains being identified are of public health importance i.e. known to cause any disease and if these are resistant to one or more antibiotics.
Then the team will assess the implications in the household (i.e. babies and toddlers, food safety, treatment/control options, etc…) and whether, in terms of cleaning, there are any particular cleaning processes (i.e. detergents) that can kill these?
The Dust Bunny project was presented at the 13th International Conference of the European Academy of Design (EAD), in Dundee, UK. The conference, was found to promote the publication and dissemination of research in design through by different educational institutions in Europe and the publication of proceedings, newsletters and a journal.
The paper and discussions that followed after its presentation raised awareness on the project. It presented its unique research approach of combining design-led research with microbiology profiling methods. It highlighted some of the lessons learned in applying design research within this context and the benefits of such a transdispilinary research for both microbiology and design.
It is envisaged that the paper presented, which is also published and can be accessed at the Design Journal, will encourage further transdiciplinary research collaborations for tackling global health challenges, such as antimicrobial resistance.
Lancaster University in collaboration with Lancaster University Ghana and with funding from the UKRI and the Global Challenges Research Fund, has organised the International Forum on Health and Wellbeing, with the main objective of creating impact on existing research among academics in the areas of social health, medicine, environment, sustainability, water and food availability. The Forum took place in the Lancaster University Ghana between the 21-22 March 2019.
Following the Forum the Dust Bunny team explored how to achieve maximum impact and genuine, embedded change for the better across Ghana and wider Africa.
The project team along with several experts from Ghana and Africa discussed how the outputs of the project research can be applied, disseminated, adapted and further developed in order to achieve maximum benefit in African countries. The team also discussed some of barriers to change in this area as well as some of the opportunities that might arise from combining the results of multiple, related work to tackle key issues.
Lastly everyone engaged in a discussion on local, national and continental issues in the area of health and wellbeing more broadly and how research can be applied in the right way to meet these challenges in the most effective way.
Apart from achieving wider dissemination of the Dust Bunny through the Forum, This also led to new collaborations and the development of a revised Impact strategy and pathway for the Dust Bunny project.
The design ethnography was intended to give researchers a closer understanding of the cleaning practices and the perceptions of cleanliness and hygiene, in relation to dust, of householders and the people who regularly clean homes as part of, and for, households in the Greater Accra Region of Ghana. In addition, it sought to gain insights into the physical actions undertaken and the range of cleaning agents and cleaning tools used as part of those actions. During the review of the data fifteen recurrent themes emerged.
1. Religion, superstition and traditional practice
2. Individual creed over religious practice
3. Social judgement
4. Taught knowledge and situated practice
5. Negotiated practice
6. Cleaning styles are often tacit practices
8. Different brooms for different rooms
9. Walking dirt in and sweeping dirt out
10. New and old or new for old
11. Chemical storage and safety practices, strong smells and mitigations
12. Dusting, sweeping, scrubbing and mopping
14. Waste disposal
15. Seasonal Variation
Additional work is currently undertaken to develop these initial findings along with the microbiology sampling analysis and the development and testing of interventions.
In a co-design workshop run in February in Accra, representatives of the communities participating in the Dust Bunny project and experts (public health, epidemiology, behavioural psychology, etc) came together to co-develop an interdisciplinary research project addressing infectious disease in the home environment in Ghana.
Through a series of creative and interactive activities, workshop co-designers identified the key health challenges faced by communities as well as the barriers to conducting research with communities in Ghana. These included the role of cleaning and hygiene practices in the transmission of infectious disease in the home and the impact of cultural and religious beliefs on them. Furthermore, attention was paid to antimicrobial resistance (AMR) in Ghana in light of the national action plan on AMR.
In terms of the challenges of conducting research with local communities, these included access to communities and establishing trust, use of technology for recording data (i.e. cameras, audio recorders) and sampling of microbiological material, such as dust. Again the role of culture and religion featured on these discussions.
Workshop participants, led by community members provided ways of mitigating these challenges and set aims and objective fo a new and impactful project that would tackle these. Examples included working with schools (primary and junior), religious groups (churches, mosques) and other social groups. This led to discussion and a set of research methods that would work well with the identified communities, including citizen science and research endorsed, carried and promoted by different communities.
Following this and working in groups, workshop participants were invited to think and discuss about what they would hope to learn knowledge from project such as this, what is important about that knowledge, how might it impact Ghana and the world. This led to the identification of several research outcomes as well as pathway to impact for the project.
What became clear from this co-design workshop was the value of engaging the community along with experts in the research planning process and in defining the wider contexts of infectious diseases , as well as the research methods, outcomes, stakeholders and pathways to impact.