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      Ethics of conducting research in conflict settings

      review-article
      Author(s): 1 , 2 , , 3 , 4 , 5
      Publication date (Electronic):
      Journal: Conflict and Health
      Publisher: BioMed Central

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          Abstract

          Humanitarian agencies are increasingly engaged in research in conflict and post-conflict settings. This is justified by the need to improve the quality of assistance provided in these settings and to collect evidence of the highest standard to inform advocacy and policy change. The instability of conflict-affected areas, and the heightened vulnerability of populations caught in conflict, calls for careful consideration of the research methods employed, the levels of evidence sought, and ethical requirements. Special attention needs to be placed on the feasibility and necessity of doing research in conflict-settings, and the harm-benefit ratio for potential research participants.

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          Declaration of Helsinki. Ethical principles for medical research involving human subjects.

          (2009)
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            Management of severe acute malnutrition in children.

            Steve Collins, Nicky Dent, Paul Binns … (2006)
            Severe acute malnutrition (SAM) is defined as a weight-for-height measurement of 70% or less below the median, or three SD or more below the mean National Centre for Health Statistics reference values, the presence of bilateral pitting oedema of nutritional origin, or a mid-upper-arm circumference of less than 110 mm in children age 1-5 years. 13 million children under age 5 years have SAM, and the disorder is associated with 1 million to 2 million preventable child deaths each year. Despite this global importance, child-survival programmes have ignored SAM, and WHO does not recognise the term "acute malnutrition". Inpatient treatment is resource intensive and requires many skilled and motivated staff. Where SAM is common, the number of cases exceeds available inpatient capacity, which limits the effect of treatment; case-fatality rates are 20-30% and coverage is commonly under 10%. Programmes of community-based therapeutic care substantially reduce case-fatality rates and increase coverage rates. These programmes use new, ready-to-use, therapeutic foods and are designed to increase access to services, reduce opportunity costs, encourage early presentation and compliance, and thereby increase coverage and recovery rates. In community-based therapeutic care, all patients with SAM without complications are treated as outpatients. This approach promises to be a successful and cost-effective treatment strategy.
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              Measuring trauma and health status in refugees: a critical review.

              Michael Hollifield, Teddy D. Warner, Nityamo Lian … (2002)
              Refugees experience multiple traumatic events and have significant associated health problems, but data about refugee trauma and health status are often conflicting and difficult to interpret. To assess the characteristics of the literature on refugee trauma and health, to identify and evaluate instruments used to measure refugee trauma and health status, and to recommend improvements. MEDLINE, PsychInfo, Health and PsychoSocial Instruments, CINAHL, and Cochrane Systematic Reviews (searched through OVID from the inception of each database to October 2001), and the New Mexico Refugee Project database. Key terms and combination operators were applied to identify English-language publications evaluating measurement of refugee trauma and/or health status. Information extracted for each article included author; year of publication; primary focus; type (empirical, review, or descriptive); and type/name and properties of instrument(s) included. Articles were excluded from further analyses if they were review or descriptive, were not primarily about refugee health status or trauma, or were only about infectious diseases. Instruments were then evaluated according to 5 criteria (purpose, construct definition, design, developmental process, reliability and validity) as described in the published literature. Of 394 publications identified, 183 were included for further analyses of their characteristics; 91 (49.7%) included quantitative data but did not evaluate measurement properties of instruments used in refugee research, 78 (42.6%) reported on statistical relationships between measures (presuming validity), and 14 (7.7%) were only about statistical properties of instruments. In these 183 publications, 125 different instruments were used; of these, 12 were developed in refugee research. None of these instruments fully met all 5 evaluation criteria, 3 met 4 criteria, and 5 met only 1 of the criteria. Another 8 standard instruments were designed and developed in nonrefugee populations but adapted for use in refugee research; of these, 2 met all 5 criteria and 6 met 4 criteria. The majority of articles about refugee trauma or health are either descriptive or include quantitative data from instruments that have limited or untested validity and reliability in refugees. Primary limitations to accurate measurement in refugee research are the lack of theoretical bases to instruments and inattention to using and reporting sound measurement principles.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Confl Health
                Title: Conflict and Health
                Publisher: BioMed Central
                ISSN (Electronic): 1752-1505
                Publication date Collection: 2009
                Publication date (Electronic): 10 July 2009
                Volume: 3
                Page: 7
                Affiliations
                [1 ]Médecins Sans Frontières, Johannesburg, South Africa
                [2 ]Simon Fraser University, Vancouver, Canada
                [3 ]British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Canada
                [4 ]Médecins Sans Frontières, Brussels, Belgium
                [5 ]Joint Centre for Bioethics, University of Toronto, Canada
                Article
                Publisher ID: 1752-1505-3-7
                DOI: 10.1186/1752-1505-3-7
                PMC ID: 2717053
                PubMed ID: 19591691
                SO-VID: 4b94cf89-359a-4a3f-ba16-be4d63cbfde7
                Copyright © Copyright © 2009 Ford et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 30 June 2009
                Date accepted : 10 July 2009
                Categories
                Subject: Review

                ScienceOpen disciplines: Health & Social care
                Data availability:
                ScienceOpen disciplines: Health & Social care

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