Assessing the response to the COVID-19 pandemic in Internally Displaced Persons Camp in Northern Nigeria

Project Title: Assessing the response to the COVID-19 pandemic in Internally Displaced Persons Camp in Northern Nigeria Background Over 2 million people are displaced in Nigeria as a result of Boko Haram Terrorist that have been engaged in an armed conflict with the Federal Republic of Nigeria for close to two decades. Consequently, many migrants live below the poverty line and are at risk of facing dire health consequences due to the fact that many of them are disadvantaged and marginalized. While some studies on the response to the novel coronavirus pandemic among people living with disabilities, individuals in urban settings and among the elderly population, there have been no studies on barriers and drivers to uptake and adherence to preventive public health measures in humanitarian settings such as Internally Displaced Persons (IDP) camps. After searching eight (8) databases (Google Scholar, PubMed, SCOPUS, HINARI, CINAHL, JURN, DOAJ, and Web of Science), I have found no single original study on this area. Knowing about the response to the COVID-19 pandemic in these fragile regions will help in informing public health interventions and policies and will assist these vulnerable communities during the current SARS-CoV-2 pandemic and also for future pandemic and public health emergency response in this region. The priority of this study is supported by a commentary by Dahab and colleagues1 where they identified the following reasons for an urgent response to the pandemic in humanitarian settings such as internally displaced persons (IDP) camps. 1. Increase likelihood of coronavirus transmission due to larger family size, overcrowded IDP camps, poor water and hygienic practices and increased social gatherings 2. Greater chance for the progression of the covid-19 infection to progress to severe condition in these region due to an higer prevalence of noncommunnicable comorbidities eg HIV, TB, malnutrition, etc 3. Greater probability for these vulnerable people to die if they need specialized healthcare services which is not readily available due to lack of intensive care services in these region which are often located outside the major citities.[1] Our focus is to identify both the barriers and drivers to uptake and adherence to prevention public measures such as social distancing, hand washing, etc among the internally displaced persons during the present coronavirus pandemic. The findings of this project will be greatly influential in providing the evidence base needed in national, regional, and continental health policies in the African continent especially during the COVID-19 pandemic and beyond. Also, the project is important in providing great insight into the health burden of vulnerable population in two African countries (Ethiopia and Nigeria) which will provide the necessary evidence for the international non-governmental organization, foreign agencies, multinational companies, philanthropic bodies, and external government agencies to provide funding, support, and partnership to African communities, regions, and countries to help promote health and wellbeing within the great African continent. Research Question What are the barriers and drivers to uptake and adherence to public health prevention measures among internally displaced persons in conflicting regions in Northern Nigeria during the COVID-19 pandemic? Objectives 1. To determine the barriers to uptake of public health prevention measures 2. To investigate the barriers to adherence to public health prevention measures 3. To assess the drivers to the uptake of public health prevention measures 4. To determine the drivers to the uptake of public health prevention measures 5. To assess the effectiveness of developed tools and evidence-based strategies and tools that can enable uptake and adherence to prevention measures in humanitarian settings STUDY DESIGN and Approach Used to Maximise Research Output A mixed-method cross-sectional study will be utilized in order to ensure the collection of both comprehensive quantitative and qualitative data on the topic of interest. Participants would be chosen across internally displaced persons' camps in northern Nigeria using a multistage sampling technique. The list of the IDP camps to be used for the study in the chosen regions would be chosen randomly using a combination of systematic random sampling and simple random sampling (fish bowl technique). While participants for the quantitative part of the study would be selected via consecutive random sampling, participants for the qualitative part would be recruited from the quantitative one that was earlier done to further explore the situation, as those interested would be encouraged to indicate interest. A minimum of 700 participants would be recruited for the qualitative component and 50 for the qualitative component. The qualitative component will involve 7 focus group discussions (involving a maximum of 6 people) and 15 Key in-depth/informant interviews. Qualitative data would be collected (with the help of 4 trained research assistants) through the use of questionnaires adapted from similar gold standard questionnaires with very good psychometric properties, on the uptake, and adherence to preventive measures for infectious diseases. Also, the focus guide along with the guide for the KII would also be prepared from similar ones in high-impact journals. Additionally, tools would be created in consultation with stakeholders and key organizations working with migrants and refugees. Face validity, content validity, inter-rater and intra-rater validity of the developed tools would also be assessed by the research teams. The key variables would include sociodemographic characteristics (age, sex, religion, location of the camp, occupation, marital status, financial status, etc). The questionnaires plus focus and key informant interview guide would also assess for factors responsible for uptake and adherence to preventive measures along with the barriers. Analysis Plan The qualitative data from the Focused group discussion and Indepth interviews would be analyzed thematically using Nvivo software. Quantitative data would be analyzed using both descriptive (mean, mode, standard deviation, charts, maps) and inferential (confidence interval, chi-square, independent T-test, Kruskawalis (ANOVA)) statistical tools using Microsoft Excel, Epi Info (for data entry majorly), and SPSS software. Expected Outcome 1. Identification of barriers and drivers to both uptake and adherence to public health preventive measures by internally displaced persons 2. Development of support for the public health response to individuals living in humanitarian support during the current COVID-19 pandemic an also for future epidemics, pandemics, and other public health emergencies 3. Development of a sound and solid research paper to be published in a very high impact journal such as JAMA, The Lancet, BMC journals that will be easily accessible to governmental agencies, NGOs, donors, etc to facilitate appropriate and evidence-based response to individuals in humanitarian settings Further outcomes 1. These findings of this study would be published as an original research in a high impact journal such as The Lancet. Hence, it can be used in systematic reviews and meta-analysis that inform decisions. Also, being in a high impact journal, it will be easily accessible to policymakers and stakeholders working in the humanitarian field can make use of it for various advocacy, research, and innovation projects. 2. Also, our research and study will greatly contribute to policy development at the community, state, national and continental levels. 3. Also, it will help the government, international NGOs, foreign agencies, philanthropic bodies and corporations know how best to support and aid vulnerable communities to prevent the community spread of the COVID-19 virus and also for future pandemics. MY ROLE IN THE STUDY I will be the Principal Investigator (who will work and report regularly to my supervisor) where I will be recruiting, training, and supervising research assistants and other research team members on this project. I will also be involved in writing for ethical approval from the Ethics Review Committee in Nigeria, and I will also be directly be involved in the data collection (qualitative and quantitative) data collection, data analysis and report writing about the research project. Furthermore, I will be involved in the publication and dissemination of research findings to the State and Federal Ministry of Health in Nigeria, NGOs, humanitarian agencies, foreign bodies, and philanthropic organizations who work in humanitarian settings in Nigeria. I will be majorly involved in writing the manuscripts for publication in a high-impact journal such as The Lancet, BMC, JAMA, among others. Reference: 1. Dahab M, Zandvoort K, Flasche S, Warsame A, Spiegel PB, Waldman RJ, and Checchi F. COVID-19 control in low-income settings and displaced populations: what can realistically be done? http: https://www.lshtm.ac.uk/newsevents/news/2020/covid-19-control-low-income-settings-and-displaced-populations-what-can