Understanding the home as a source of infection of AMR bacteria carried by dust by exploring hygiene practices in different home environments in Ghana

Lead Research Organisation: Lancaster University
Department Name: Lancaster Inst for the Contemporary Arts

Abstract

The Dust Bunny project will apply design 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.

Bacteria found in the natural and built environment (e.g. homes, schools, hospitals, etc.) are building up a resistance to drugs -changing to protect themselves against antibiotics. What this means is that in the not-too-distant future, something as simple as a minor cut infection could become life-threatening. This is such a concern that antimicrobial resistance (AMR) is now considered a global health crisis, far surpassing outbreaks of diseases such as Ebola and as real as climate change. This is even more evident and critical in developing countries in Africa, such as in Ghana, where there are a great number of deaths from infectious diseases.

Bacteria are made up of pathogens (bad germs) and non-pathogens (good germs) and are generally scattered across the home. Most surfaces in the home are covered to a certain degree with bacteria, but unlike fixed surfaces such as kitchen work surfaces and furniture, dust can move more easily around different parts of the home and therefore presents a major route for human exposure to bacterial infections.
Despite being clear evidence for microbial exposure and infection transmission within the home, there has been less research effort invested in understanding the home environment, due to difficulty of conducting detailed studies. Although the transmission routes by dust in the home environment are well known, what has not been studied is how to prevent bacterial infection at home and thereby reduce resistance.

Particularly in developing countries, such as Ghana, social inequalities mean a range of different quality and types of homes; this combined with often poor levels of domestic hygiene that is influenced by a number of economic, educational and religion factors, contributes to the spread of infectious diseases.

Although there are hygiene guidelines available for preventing infection in the home environment, these are targeted at hygiene professionals and do not reach the everyday household in Ghana. There is therefore a much-required and unmet need to identify, understand and develop domestic hygiene practices that are relevant to different home environments, educational and cultural backgrounds in developing countries, such as in Ghana, in order to reduce exposure to bacteria pathogens and thereby exposure to resistance forms.

Within this context, the Dust Bunny project aims at developing an understanding of the home as a source of infection of bacteria, resistant to antibiotics, found and carried by dust. This will be done by exploring hygiene practices across different home environments in Ghana, with the ultimate aim to reduce bacterial infection in the home environment thereby reducing AMR.

Understanding the hygiene practices in the household and interactions with airborne AMR bacteria will serve as a first step to designing appropriate education/information dissemination materials for various sections of the Ghanaian population as well as other low- and middle-income countries in Africa.

Dust Bunny, uniquely combines design research and microbiology to provide an informed assessment of societal practices in domestic cleanliness and novel solution to reduce infections in the home. The project team includes Imagination@Lancaster -an internationally leading research institution in design research- and the Noguchi Memorial Institute for Medical Research -a research centre of excellence and the prime biomedical research institution in Ghana, involved with the Ghana Health Service and Ministry of Health in providing the evidence to effect policy changes.

Planned Impact

Building on the 4 identified impacts in our Pathways to Impact document, here we expand on who we envisage benefiting from this research and develop further how they would benefit:

[IO1] Disseminating the findings: to academic and non-academic audiences in the UK and Ghana. Mechanisms, such as the project website, social media, regular dissemination trough the AHRC, ESRC AMR Champions and NERC AMR Programme Leader, academic (conference & journal papers) and non-academic publications (press releases/media briefings & newsletters via our partners, the Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council) will help in achieving this.

[IO2] Raising the profile: to engage appropriate stakeholders thereby bringing the research to the attention of a wider audience and solicit feedback as research insights emerge. Through our collaborators we will engage government and health policy makers who are actively involved in healthcare and AMR reduction such as the Ghanaian government, World health Organisation and United Nations Development programme. By engaging our governmental and non-governmental partners, the outcomes of this study will help to further inform Ghana's national antimicrobial resistance policy; and will further help inform future policy interventions to change the daily routine of hygiene practice to reduce bacterial pathogens and thereby exposure to antibiotic resistant forms which complicate and prevent effective treatment of diseases. Mechanisms for this include our advisory panel and project partners, co-design workshops with communities and expects in Ghana; a thought leaders workshop and development of personas of hygiene practices across different user groups.

[IO3] Engaging and co-developing: with the aim of ensuring shared ownership of the action plan, the research insights will be co-developed through engagement with key stakeholders and beneficiaries including discussions with key influencers at regional and national levels. We will engage wider society/community, usually via a relatively small group of change makers within communities, to inform and be informed by research, and so to co-design and implement the 'smart solutions' that are appropriate to the domestic environment on a range of social scales. To this end, the project will feed information and possible changes to Ghana's government-driven goal of reducing antimicrobial resistance, which uses the React toolbox incorporating into React Ghana's (one of our project partners) national AMR policy through its national AMR policy. Mechanisms for achieving this includes community engagement in Ghana through seminars, workshops, flyers in schools, churches, mosques and other relevant community access points; development of storyboards & other dis/nation material of co-designed hygiene practices; follow-on GCRF bid scoping workshop in Ghana.

[IO4] Capacity building and Knowledge Exchange: on hygiene practices, design-based and AMR based research in low and middle income countries in the African continent, such as in Ghana (for UK and Ghanaian researchers). Building capacity to deliver strategic development goals (3: Good health and well-being; 11: Sustainable cities and communities) from research in science & technology, which here encompasses microbiology and design, requires more than just research and training in those disciplines. It also demands research and training in the social and management sciences that maximises the capacity for translation to life influencing design in wider communities to shape the design, development and exploitation of this project. Our strategy is to build capacity and capability is fundamentally interdisciplinary. Mechanisms for this include our project partners (Design Council, EPN/ReAct Africa, Zoomlion, Global Hygiene Council), research exchange and training of the UK & Ghanaian researchers of the project and capacity building and knowledge exchange workshops to be held in the UK & Ghana.

Publications

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Description As the project is still ongoing we currently have preliminary findings from the design ethnography.

The Dust Bunny project seeks to develop an understanding of the home as a source of infection of AMR bacteria carried by dust, by exploring hygiene practices across different home environments in Ghana, with the ultimate aim to reduce bacterial infection in the home environment thereby reducing AMR. 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
7. Repetition
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
13. Tools
14. Waste disposal
15. Seasonal Variation

Additional work is still to be done to develop these initial findings along with the microbiology sampling analysis and the development and testing of interventions.
Exploitation Route These are already been taken forward in a conference paper at the European academy of design conference to be presented in April 2019 and a Book Chapter. A number of stakeholder workshop events will also take place in Ghana towards the end of the project to disseminate the findings. Also community workshops are planned to take place in May to co-design cleaning interventions that communities can take forward. these will be tested and then further disseminated and validated. A video documentary may also be produced by Ghana Broadcasting to disseminate the project and its findings more widely.
Sectors Agriculture, Food and Drink,Communities and Social Services/Policy,Environment,Healthcare

URL https://dustbunny.global/
 
Description GCRF GIAA Growth Fund
Amount £10,000 (GBP)
Organisation Lancaster University 
Sector Academic/University
Country United Kingdom
Start 01/2019 
End 03/2019
 
Description Community and experts pave the way for new Global Health project 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Study participants or study members
Results and Impact 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.
Year(s) Of Engagement Activity 2019
URL https://dustbunny.global/2019/02/26/community-and-experts-pave-the-way-for-new-global-health-project...
 
Description Engagements with Ghana Broadcasting TV for developing a video documentary about the project 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Media (as a channel to the public)
Results and Impact Initial interaction and interview of team members by Ghan Broadcasting (TV) with the aim of producing a documentary about the project and research conducted by the team in Ghana.
Year(s) Of Engagement Activity 2019
 
Description Engaging with community and experts in Accra 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and 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.
Year(s) Of Engagement Activity 2019
URL https://dustbunny.global/2019/02/19/engaging-with-community-and-experts-in-accra/