Publications by Year: 2022

2022
6/15/2022. “Improving water, sanitation, and hygiene (WASH), with a focus on hand hygiene, globally for community mitigation of COVID-19.” PLOS Water. Read PublicationAbstract

Continuity of key water, sanitation, and hygiene (WASH) infrastructure and WASH practices—for example, hand hygiene—are among several critical community preventive and mitigation measures to reduce transmission of infectious diseases, including COVID-19 and other respiratory diseases. WASH guidance for COVID-19 prevention may combine existing WASH standards and new COVID-19 guidance. Many existing WASH tools can also be modified for targeted WASH assessments during the COVID-19 pandemic. We partnered with local organizations to develop and deploy tools to assess WASH conditions and practices and subsequently implement, monitor, and evaluate WASH interventions to mitigate COVID-19 in low- and middle-income countries in Latin America and the Caribbean and Africa, focusing on healthcare, community institution, and household settings and hand hygiene specifically. Employing mixed-methods assessments, we observed gaps in access to hand hygiene materials specifically despite most of those settings having access to improved, often onsite, water supplies. Across countries, adherence to hand hygiene among healthcare providers was about twice as high after patient contact compared to before patient contact. Poor or non-existent management of handwashing stations and alcohol-based hand rub (ABHR) was common, especially in community institutions. Markets and points of entry (internal or external border crossings) represent congregation spaces, critical for COVID-19 mitigation, where globally-recognized WASH standards are needed. Development, evaluation, deployment, and refinement of new and existing standards can help ensure WASH aspects of community mitigation efforts that remain accessible and functional to enable inclusive preventive behaviors.

Sean M Kivlehan, Amy Allen, Olha Viun, Dmitry A Makarov, Daniel Schnorr, Sonny Patel, Sergii A Ryzhenko, Phuong Pham, and Timothy B Erickson. 6/14/2022. “Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study.” BMJ Open. Read PublicationAbstract

Objective: Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course.

Design: Pretest/post-test quasi-experimental study.

Setting: Mechnikov Hospital in Dnipro, Ukraine.

Participants: Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%).

Interventions: The 5-day WHO-ICRC BEC course.

Primary and secondary outcome measures: Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes.

Results: Participant knowledge assessment scores improved from 19 (IQR 15–20) to 22 (IQR 19–23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1–2.8) to 2.9 (IQR 2.5–3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time.

Conclusions: This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.

Valerie A. Dobiesz, Madeline Schwid, Roger D. Dias, Benjamin Aiwonodagbon, Baraa Tayeb, Adrienne Fricke, Phuong Pham, and Timothy B. Erickson. 4/2022. “Maintaining Health Professional Education During War: A Scoping Review.” Medical Education. Read PublicationAbstract

Purpose: War negatively impacts health professional education when healthcare is needed most. The aims of this scoping review are to describe the scope of barriers and targeted interventions to maintaining health professional education during war and summarize the research.

Methods: We conducted a scoping review between June 20, 2018, and August 2, 2018. The search was restricted to English publications including peer reviewed publications without date ranges involving war and health professional education (medical school, residency training, and nursing school), with interventions described to maintain educational activities. Two independent reviewers completed inclusion determinations and data abstraction. Thematic coding was performed using an inductive approach allowing dominant themes to emerge. The frequency of barrier and intervention themes and illustrative quotes were extracted. Articles were divided into modern/postmodern categories to permit temporal and historical analysis of thematic differences.

Results: Screening identified 3,271 articles, with 56 studies meeting inclusion criteria. Publication dates ranged from 1914-2018 with 16 unique wars involving 17 countries. The studies concerned medical students (61.4%), residents (28.6%) and nursing students (10%). Half involved the modern era and half the postmodern era. Thematic coding identified 5 categories of barriers and targeted interventions in maintaining health professions education during war: curriculum, personnel, wellness, resources, and oversight, with most involving curriculum and personnel. The distribution of themes among various health professional trainees was similar. The frequency and specifics changed temporally reflecting innovations in medical education and war, with increased focus on oversight and personnel during the modern era and greater emphasis on wellness, curriculum, and resources during the postmodern era.

Conclusions: There are overarching categories of barriers and targeted interventions in maintaining health professional education during war which evolve over time. These may serve as a useful framework to strategically support future research and policy efforts.

Frederick M. Burkle, Krzysztof Goniewicz, and Amir Khorram-Manesh. 3/2022. “Bastardizing Peacekeeping and the Birth of Hybrid Warfare.” Prehospital and Disaster Medicine. Read Publication
Vincenzo Bollettino and Lea Ivy Manzanero. 3/2022. “Climate Change and Civil-Military Coordination in the Philippines: How climate change disasters will impact aid delivery in areas affected by conflict.” Climate, Disaster and Development Journal. Read PublicationAbstract

The Philippines is one of the most disaster-prone countries in the world and frequently ranks among the top three countries most impacted by disasters. Ongoing conflict with non-state armed actors results in scenarios where civilians are impacted by both conflict and natural hazards. The result is a situation where civilian relief agencies operate in proximity to the military. We argue that there is an important need for principled civil-military coordination in these contexts to ensure the integrity of security operations to support peace and stability while preserving the independence of humanitarian actors serving crisis-affected populations.


The research reveals significant challenges in protecting the integrity of independence of both military and humanitarian actors in areas impacted by both conflict and disaster and underscores the need for principled humanitarian civil-military coordination to avert threats to both humanitarian aid workers and disaster affected populations. The findings are particularly relevant to South East Asia where the use of military in disaster response is common. The findings also underscore the need for research on the role of militaries in responding to disasters in light of anticipated impacts of climate change. 

Sonny S. Patel and Timothy B. Erickson. 3/2022. “The new humanitarian crisis in Ukraine: Coping with the public health impact of hybrid warfare, mass migration, and mental health trauma.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

One of the largest mass movements of displaced people from their homelands in recent history must be recognized and assisted by the Free World. The unprovoked Russian attacks on Ukraine during February-March 2022 will leave long-lasting devastating effects on millions of innocent victims. Nations worldwide, especially NATO member countries, will need to intervene to ameliorate the situation. This letter describes major public health issues apart from the COVID-19 pandemic that are emerging concerns, such as shortages of healthcare professionals, chronic care treatments and health prevention services, disinformation communication campaigns affecting the healthcare infrastructure, and the generational impact of the conflict on people’s mental health. A global response and public health support need immediate action including humanitarian assistance, food security, clean water supplies, adequate shelter, and safe transportation out of the active military zones.

3/2022. Health Technologies and Innovations to Effectively Respond to the COVID-19 Pandemic. Lausanne: Frontiers Media SA.Abstract

The COVID-19 pandemic marks one of the greatest global challenges experienced this century. It has led to more than 20 million reported infections and caused more than 800 000 deaths world-wide. Despite attempts at lifting restrictions for lock-downs and seeking ways “back” to a “new normal”, we are far from a stable transition to a new normal life.

Digital Health solutions have already been used in many ways from tracking and tracing apps to deep learning for analysis of computerized tomography images or audio-based diagnosis and early symptom recognition. However, there are many technologies and innovations that remain unexploited with vast potential in improving the reliability, trustability, usability, and explainability of healthcare services: including the speed and quality of diagnosis, healthcare process and results. In addition, novel technology solutions and innovations to adapt processes and technologies are desperately needed. Further, there is a need for new regulatory pathways and processes for rapid testing, approval and integration of these new technologies into practice.

Many opportunities for the development and application of health technologies and digital health exist in the global fight against Coronavirus that concerns all of us.

In this light, this Research Topic aims to explore new approaches and scientific developments that enable and accelerate the adoption and diffusion of health technology innovations in health systems to improve the fight against the COVID-19 pandemic. The collection will bring together novel technologies, innovations and approaches, including studies and cases from a highly interdisciplinary point of view to harness strengths and perspectives of diverse experts.

Topic of interest include but are not limited to:

  1. Digital data
  2. E-health/M-health
  3. New production methods for rapid and flexible manufacturing at scale for:
  4. Digital health care
health_technologies_and_innovations_to_effectively_respond_to_the_covid_19_pandemic_e-book.pdf
HHI Resilient Communities. 3/2022. Symposium Report: The Impacts of the COVID-19 Pandemic on Vulnerable Communities in the Philippines.Abstract

The COVID-19 pandemic has caused the loss of millions of lives, disrupted the global economy, and created secondary impacts on livelihoods, education, and mental health across the globe. No country or economic group has been immune to the direct impacts of the pandemic, but marginalized communities are particularly vulnerable to the secondary impacts including some public health measures like extended lockdowns. Marginalized populations are those excluded from mainstream social, economic, educational, political, and/or cultural life. They can be excluded or discriminated due to multiple factors such as their race, ethnicity, age, gender identity, sexual orientation, disability, religion, language, and/or displacement, among others. The Harvard Humanitarian Initiative's (HHI) Resilient Communities Program sought to understand how vulnerable or marginalized communities in the Philippines experienced COVID-19, and how communities coped and adapted in response to direct and indirect effects of COVID-19, including public health measures. To do this, HHI invited Filipino authors exploring this central question to submit papers for consideration to be selected to present and share in a symposium. In addition to its research objectives, the symposium sought to connect researchers and practitioners to create a network of professionals dedicated to serving the needs of marginalized communities in the country.

Watch the full symposium: https://www.youtube.com/watch?v=4zC1FzWRUuo

hhi_symposium_report_march_2022.pdf
Phuong Pham, Manasi Sharma, Kennedy Kihangi Bindu, Pacifique Zikomangane, Rachel C. Nethery, Eric Nilles, and Patrick Vinck. 2/16/2022. “Protective Behaviors Associated With Gender During the 2018-2020 Ebola Outbreak in Eastern Democratic Republic of the Congo.” JAMA Network Open. Read PublicationAbstract

Importance: In 2018 to 2020, the Democratic Republic of the Congo experienced the world’s second largest Ebola virus disease (EVD) outbreak, killing 2290 individuals; women were disproportionately infected (57% of all cases) despite no evidence of differential biological EVD risk. Understanding how gender norms may influence exposure to EVD, intensity, and prognosis as well as personal protective behaviors against the virus is important to disease risk reduction and control interventions.

Objective: To assess whether men and women differ in personal protective behaviors (vaccine acceptance, health-seeking behaviors, physical distancing) and the mediating role of EVD information and knowledge, perceived disease risk, and social relations.

Design, Setting, and Participants: This cross-sectional, multistage cluster survey study of 1395 randomly selected adults was conducted in the Ebola-affected regions of North Kivu from April 20, 2019, to May 10, 2019. Path analyses were conducted using structural equation modeling to examine associations among study variables. Statistical analysis was conducted from August 2019 to May 2020.

Main Outcomes and Measures: The main behavioral outcomes of interest were (1) vaccine acceptance, (2) formal health care seeking, and (3) self-protective behaviors. The primary factor of interest was self-reported gender identity. We also assessed sociodemographic factors.

Results: Among the study’s 1395 participants, 1286 (93%) had Nande ethnicity and 698 (50%) were women; the mean (SD) age was 34.5 (13.1) years. Compared with female participants, male participants reported significantly higher levels of education, wealth, and mobile phone access. There were associations found between gender and all EVD preventive behavioral outcomes, with evidence for mediation through EVD knowledge and belief in rumors. Men reported greater EVD knowledge accuracy compared with women (mean [SE] score for men: 12.06 [0.13] vs women: 11.08 [0.16]; P < .001), and greater knowledge accuracy was associated with increases in vaccine acceptance (β = 0.37; P < .001), formal care seeking (β = 0.39; P < .001), and self-protective behaviors (β = 0.35; P < .001). Lower belief in rumors was associated with greater vaccine acceptance (β = −0.30; P < .001), and greater EVD information awareness was associated with increased adoption of self-protective behaviors (β = 0.23; P < .001).

Conclusions and Relevance: This survey study found gender differences in adopting preventive protective behaviors against EVD. These findings suggest that it is critical to design gender-sensitive communication and vaccination strategies, while engaging women and their community as a whole in any response to infectious disease outbreaks. Research on the potential link between gender and sociodemographics factors associated with disease risk and outcomes is needed.

Markus Enenkel and Andrew Kruczkiewicz. 2/2022. “The humanitarian sector needs clear job profiles for climate science translators – more than ever during a pandemic.” Bulletin of the American Meteorological Society. Read PublicationAbstract
A new generation of “climate science translators” (CSTs) is currently evolving, both as independent professionals and affiliated with humanitarian agencies. While people in this role represent an opportunity to foster communication and collaboration between climate science, humanitarian decision-support, policy and decision making, there are neither clear job profiles, nor established criteria for success. Based on an analysis of job opportunities published on one of the largest humanitarian and development aid job portals we show that the demand for CSTs has been increasing since 2011. Subsequently, we present a characterization of core skills for the next generation of CSTs aiming to establish a space for not only current CSTs to thrive, but also a path for future translators to follow, with milestones and opportunities for recognition.