Community Engagement and Building Trust to Resolve Ethical Challenges during Humanitarian Crises: Experience from the CAGED Study in Ethiopia

Background According to data from the Internal Displacement Monitoring Centre’s Global Report on Internal Displacement 2019, Ethiopia had the highest number of people newly displaced within their own country due to violence. Several regions in the country experience on-going ethnic tensions and violent tribal conflict, which leaves smallholder farmers suspicious and distrustful of any outside activities in their locale, fearing harm from other ethnic groups. Changes in the central Ethiopian government have also led to suspicion of non-local agencies. The Campylobacter Genomics and Enteric Dysfunction (CAGED) research project’s objective is to improve the incomes, livelihoods and nutrition of smallholder farmers and was conducted during this period of increased tension and violence. The project aims to assess the impact of reducing exposure to chicken excreta on young children’s gut health and growth. To inform the study design, formative baseline field data was collected between March 2018 and February 2019 by a team of trained and experienced human and animal health professionals from the same region, who speak the local language. Discussion This research is important to determine whether Campylobacter infection in chickens contributes to illness and stunting in children. Stunting is widespread in humanitarian settings, with major implications for children’s well-being and social inequalities. During this research, violence against other researchers elsewhere in Ethiopia led to mistrust and lack of engagement by the community. Hostile reactions developed until the team was fearful about returning to certain households. The team designed mitigation strategies in response, including establishing two types of community advisory boards. One used pre-existing village elder structures and another included village youth. Data collection team members received training in principles of ethics, consent, and crisis management, and were provided on-going support from local and international principal investigators and the study’s ethics advisor. Conclusion Tension and conflict led to mistrust of outsiders which generated fear among the CAGED data collectors The resulting challenges were addressed by innovative strategies which also delayed the research process. The interventions resulted in successful completion of the field activities. The lessons learned are being implemented with other projects being conducted in various parts of Ethiopia.