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.
The Dust Bunny team run engagement workshops in the second week of February in Accra, Ghana. The workshops engaged with members of the community who are participating in the project as well as Ghanian external to the project public health experts and researchers.
It presented the preliminary findings (from the design ethnography and first round of microbiology analysis) and provided a space for feedback and debate. It also presented some of the challenges faced by the research team in conducting design-led research in Ghana and invited workshop participate in brainstorming sessions aimed at generating solutions .
Themes that emerged from the workshop related to the influence of cultural, religious practices and beliefs of different communities in the cleaning and hygiene practices employed across a range of households. Furthermore, there was discussion around the importance of establishing trust and rapport with household research participant prior to the fieldwork, especially given the morally bound nature of the research. In addition to this, the tables were turned with workshop participants asking questions to the research team and making suggestions for maximising the dissemination of findings.
Lastly, community members and experts alike were provided with dissemination material to take back to their respective communities.
Dust Bunny is a 2-year UK funded research project that applies innovative design research methods coupled with microbiological analyses to address issues of home-based infections in Ghana, particularly those carrying antimicrobial resistance, resulting in a reduction of infection and in positive increase of health outcomes.
In the first part of the workshop the Ghanaian (Noguchi Memorial Institute for Medical Research, University of Ghana) and UK (University of Lancaster) project team will be presenting the project, its initial findings as well as challenges and opportunities in this area.
In the second part of the workshop it will be inviting participants, through a number of creative and interactive activities, in sharing their feedback on the work thus far and help define future steps.
The workshop is scheduled for Wednesday 13th February 2019 at 09:30am – 14:30pm
Venue: Noguchi Memorial Institute for Medical Research, University of Ghana.
For more information on the event and to register contact Dr Dziedzom de Souza at firstname.lastname@example.org .
This project has a microbiological component which seeks to assess the extent of antimicrobial resistance (AMR) in bacteria attached to dust in Ghanaian homes. This is a problem as resistance, if found in infectious bacteria, may hinder treatment of infectious disease. However it may be lurking in non-infectious bacteria as well. No problem? Well there is… this resistance might be mobile and transfer from non-infectious to infections bacteria. So we are going to assess the extent of AMR in all the bacteria we can. No matter which environment we look at there are common microbiological problems: We can culture bacteria directly from dust and we can test them for their resistance or sensitivity to a range of antibiotics commonly used in the treatment of infectious disease.
The sting is the tail is we can only culture usually less than 1% of all the bacteria present. The remaining >99% cannot be cultured but are still active, they may contain infectious bacteria that are resistant to antibiotics. So how do were find these unculturable microbes?
Two strategies can be adopted in addition to culture: one for identifying bacteria and the other for identifying AMR. Both involve taking a dust sample and extracting all DNA from all the attached bacteria. For bacteria we will use next generation sequencing which generates signatures of bacterial species from which we can identify and quantify (within limits) species and this will tell us about bacterial diversity in a number of homes. For AMR, we will detect the signatures of different genes that will tell us which antibiotic resistances are present.
By combining the sequencing and culturing we will obtain a picture of AMR is different households.
*Photo Credit: Dr. Graham Beards, CC BY-SA
The team at Noguchi have been running for the past month a survey on the hygiene and cleaning practices across different domestic environments (i.e. urban vs rural, private vs communal dwellings) and a range of social scales (i.e. low, low-middle, middle, upper) within Accra, Ghana.
Recruited household complete with the help of researchers a survey of over 50 questions. These include questions on the household demographics, the household configuration, dwelling information, the cleaning methods, cleaning items, cleaning frequency, cleaning responsibilities within the household, cleanliness and hygiene perceptions and practices. So far over 200 surveys have been completed.
The team aims at collecting 250 surveys. From the 250 surveys 12 households (across urban and rural domestic environments, private and communal house environments, low, low-middle, middle and upper social scales) are currently being recruited to participate in the rapid ethnography phase of the project in order to collect more in-depth information on the cleaning and hygiene practices. Dust samples from each study household will also be collected to assess bacterial diversity, including the presence of infectious bacteria and to assess the degree of AMR in those bacteria.
The co-design workshop run in Ghana in early February 2017 helped in establishing the research context, local challenge, research methodology and dissemination strategy for the Dust Bunny project. The key outcomes outlined below demonstrate several of the research activities and aspects this project now explores. For more details see the Dust Bunnies Workshop Report.
The key outcomes from the workshop suggested that dust is a health and infection issue, as it is a carrier for bacteria but also it can be used as a medium to monitor bacteria.
Given the scope of the indented research project and the resources available it was suggested to use vacuum cleaners as a medium of sampling dust in household which had one; and use other manual dust collection techniques in households with no access to a vacuum cleaner. A range of different cultural and common household hygiene practices exist. These are often affected and determined by the different houseful environments (urban versus rural) domestic dwellings (private versus communal) and different socio-economic scales (low, low-middle, middle, upper).
A range of benefits was identified for households participating in the study, including adoption of better hygiene practices, hygiene and health education, better health and health economic gains. A number of pathways to impact and dissemination effective and relevant to Ghana have been also identified.
The co-design workshop run in Ghana in February 2017 helped in establishing the research context, local challenge, research methodology and dissemination strategy for a research bid targeting a relevant AHRC Call on AMR in Real World. This led to the successful development and funding of the Dust Bunny research project. The workshop also created a network of Ghanaian scientists and researchers interested in purposing further research in the AMR and health area.
The workshop was run by Lancaster University and held in Accra, Ghana at the Noguchi Memorial Institute for Medical Research premises. It included several participants from across different areas of antimicrobial resistance, public health, environmental studies and sanitation.
Several of the areas explored during the workshop included:
DustBunny has officially started with a project meeting held in early November. The research team is now in the processing of developing and pilot testing a survey on the hygiene practices in the home, which will be distributed to several households in Accra, Ghana.