Date Published: April 15, 2008
Publisher: Public Library of Science
Author(s): Vincent Brown, Philippe J Guerin, Dominique Legros, Christophe Paquet, Bernard Pécoul, Alain Moren
Abstract: Vincent Brown and colleagues review Epicentre’s 20 years of experience conducting research during complex humanitarian emergencies.
Partial Text: This is the first in a series of articles on conducting research during complex humanitarian emergencies.
Rapid assessments in CHEs, often based on population surveys, help guide emergency response by measuring mortality rates, prevalence of malnutrition, and coverage of basic needs (food, water, shelter).
In a CHE, overcrowding, inadequate shelter, poor water and sanitation, collapse of health services, and the breakdown of existing infectious disease control programs can markedly increase the burden of communicable diseases and the risk of epidemics. In such a context, early detection and prompt, well-conducted outbreak investigations are essential to guide adapted responses.
Diagnostic tools adapted to field conditions can serve two purposes—diagnosis of individuals and confirmation of an outbreak. Few rapid diagnostic tests (RDTs) are designed for use in CHEs, and little is known about their performance in such a context. However, the use of RDTs can potentially improve the capacity of case detection and the efficacy of treatments. Epicentre has tested the performance of several RDT kits, which are now used in the field.
Finding pragmatic and efficacious answers to public health questions generated by the field has led Epicentre research activities over the last 20 years. Such an intimate and continuous link between field operations and applied research is unusual in the world of humanitarian response to CHEs. The nonstop interaction between field actors and researchers has been key in developing an original research agenda and conducting successful projects, which help improve the quality and effectiveness of the operational response. This, in turn, enhances the capacity of the scientific community and of aid agencies to cope with increasingly complex humanitarian crises.
Looking towards the future, Epicentre continues to address unanswered questions in the field epidemiology of CHEs. Among these, the aim is to continue to improve the control of infectious diseases and patient management, including easy-to-use and cheap alternative therapeutic regimens and preventive strategies. Conducting high-quality research in CHEs means testing new techniques in remote areas, while taking into consideration all usual aspects of logistics and ethics. Improved survey methods and surveillance systems are continuing challenges for the future. Some under-researched areas should be further explored. The ultimate goal remains to address questions aimed at significantly improving the health status of affected populations.