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Overcoming the challenges of Rural Surveys in Developing Countries

Field researchers, Dr Giacomo Zanello, Dr Marco Haenssgen, Ms Nutcha Charoenboon and Mr Jeffrey Lienert explain the importance of continuing to improve survey research techniques when working in rural areas of developing countries.

News about big data and artificial intelligence can leave the impression that a data revolution has made conventional research methods obsolete. Yet, many questions remain unanswerable without working directly with (and understanding) the people whose lives we are interested in. In development studies research, survey research methods therefore remain a staple of data generation, and survey data generation itself remains an active field of debate. In today’s blog, four researchers showcase recent methodological advances in rural health survey research and the advantages they bring to conventional research approaches.

Reaching People at the Margins, 25% off! (Dr Marco J Haenssgen, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine)

Generating representative data from rural areas of developing countries is a real challenge because often we lack detailed and dependable information on the local population, which makes drawing a sample very difficult. However, recent technological revolutions that we are rather familiar with – the Internet, mobile phone technology, satellite navigation – can also facilitate our work in survey research. Satellite maps in particular help us to:

(1) Select villages more rigorously: We can use satellite maps to generate or verify geo-coded village registers (e.g. censuses or the US National Geospatial-Intelligence Agency) to draw geographically stratified samples. Geo-stratification ensures that we do not accidentally select only “easy” villages that represent less constrained lifestyles in the rural population.
(2) Identify and select houses within the villages more inclusively: Conventional methods to draw a sample of households require either a very laborious enumeration process by going from house to house to establish a sampling frame, and/or are likely to exclude households and settlements at the fringes of a village (e.g. a “random walk”). By using satellite images to enumerate all houses in a village, not only do we save a lot of time and money, but we can also ensure that all parts of a village are represented fairly.
(3) Reach survey sites more efficiently: The logistical benefits cut as much as 25% off the conventional survey costs and time, which can save up to £5,000 for a PhD-level survey (400 respondents in 16 villages) and £40,000 for a medium-sized two-country survey (6,000 respondents in 139 villages).

We need to appreciate that satellite-aided sampling approaches are only an addition to our survey toolkit. They do not work well in urban areas, with mobile populations, or in regions that we are not familiar with. But where they work, they are a real alternative to conventional survey approaches and can make projects feasible that would otherwise be prohibitively expensive, without compromising quality.

Taking Energy Measurement From the Lab to the Field (Dr Giacomo Zanello, School of Agriculture, Policy and Development, University of Reading)

How much energy do you burn during the day (at your job, doing household chores, or at the gym) and is this “energy expenditure” in balance with the calories you take in with your food and drinks? Historically, to answer this question, participants had to spend time in a sealed chamber in a lab which measures the change in oxygen levels while performing activities. While this provides an accurate estimate of energy use, this method is quite impractical to understand real-life settings, particularly for remote areas in a developing country context. It is in these contexts where calorie deficits are most pressing, and yet we do not know much about farmers’ energy use, differences across gender and age groups, or variations of energy use across the seasons and during health or climate-borne adversities.

Recent technological advances allow the measurement of energy expenditures of free living populations to a scale and within a budget inconceivable few years ago. Using Fitbit-like accelerometers we can capture people’s movements and use this information to estimate calorie expenditure. By wearing these devices we follow people’s activities throughout the day, weeks, and seasons and use this information to estimate their energy use. This new glimpse into how people spend their energy can improve health research in multiple domains, for example:

• Having a more accurate assessments of the incidence, depth and severity of undernutrition and poverty,
• Estimating energy requirements for specific livelihood activities, or
• Studying the effect of health conditions and illnesses on livelihood activities.

These are just some possibilities, and the data collected through this innovative methodology extends beyond health-focused research. It also enables us to learn more about how labour is distributed within rural households in developing countries, or measure production in the household and the “informal economy” to produce better estimates of the size of rural economies.

Taking energy measurement from the lab to real-life settings is not without complications. We have to make careful decisions about the devices we use (e.g. easy to wear, not requiring user interaction, not attracting too much attention), build a trusting relationship with our research participants, and acknowledge that even accelerometer-generated data only offers a partial view into energy expenditure and daily activities. Yet even this partial view can afford a completely new understanding of people’s rural livelihood.

A Qualitative Research Update for Social Network Surveys (Ms Nutcha Charoenboon, Mahidol-Oxford Tropical Medicine Research Unit)

Health and treatment hardly take place in isolation – people around us influence our behaviour, give us advice, or lend us a ride to the hospital. Public health information campaigns, too, are subject to people’s relationships because they might be communicated further or even be instrumentalised for political purposes. Perhaps it is no surprise then that there are calls for more social network research on health in developing countries, but such research faces difficult questions, like how do we ask elicit the names of people in these networks, and how we can match these names in place where one person might be addressed in several different ways (e.g. “Old Father,” “Leader,” Yod Phet, and Ja Bor).

How can we overcome such difficulties? One possibility is cognitive interviewing, consisting of a set of interview techniques to test and interpret survey questions. Among others, interviewees are given survey questions and asked to “think out loud” on how they understand and answer the question, to paraphrase the question in their own words, or to explain village life and the local context. Such information gives researchers a better grasp of local social networks, living arrangements, and people’s understanding of social network questions. In our study in rural Thailand and Lao PDR, it enabled us to drop irrelevant questions, add questions to map health social networks more comprehensively, and to identify mechanisms to locate named contacts within the village more effectively.

But beware of surprises when you carry these methods over to developing country contexts because they tend to assume Western communication norms. Our research participants felt uncomfortable when asked to articulate their thought processes or to answer “why” questions. To cope with such complications, the methods themselves need to be adapted to context, for example by being more closed-ended and by adopting more conventional semi-structured interview techniques.

Shining New Light on Health Behaviours (Mr Jeffrey Lienert, Saïd Business School and National Institutes of Health)

When people get sick, they do not just make a one-off treatment decision like “I’ll go to a clinic / a private doctor / a pharmacist” and stick to it for the remainder of their illness until they are cured. Rather, they go through several phases. For example, a person might first wait and see if it the illness would not go away by itself, then later decide to buy some painkillers to cope with it, visit a private doctor when things do not get better, then lose hope in modern medicines and visit a traditional healer. We gain a lot of information about people’s behaviour if we collect such data on treatment “sequences.”

Not only is it rare for studies to record treatment sequences at all, but there are also no agreed tools for their analysis. First ground has been broken with sequence-sensitive analyses to produce more accurate typologies of behaviour, but we can go further and apply network analysis techniques to make maximal use of sequential data. More detailed analyses can differentiate between the individual steps, explore whether sequences of behaviour resemble each other across people, and which kind of social network is most decisive for such a resemblance. The downside of these arguably more complex analyses is the technical skill required to perform them, but once these methods become more established, they will be able to us to give more detailed (and realistic!) behavioural profiles of different settings and social groups with revolutionarily new insights for health policy.

Methodological innovation enables easier, more precise, and new ways of understanding human behaviour. That does not necessarily mean “big data” and algorithms. Innovation also arises from new combinations of conventional methods with other established techniques and new technologies. Combining rural health surveys with satellite imagery and accelerometers, social network surveys with cognitive interviewing, and healthcare access data with social network analysis does not just keep the methodological debates in survey research alive. It also enables new research, new questions, and a new view on human behaviour.

This blog entry derives from the authors’ contributions to the ESRC NRCM Research Methods Festival 2018 Conference in Bath, drawing on research from the projects Antibiotics and Activity Spaces (ESRC grant ref. ES/P00511X/1), Mobile Phones and Rural Healthcare Access in India and China (John Fell OUP Research Fund ref. 122/670 and ESRC studentship ref. SSD/2/2/16), and IMMANA Grants funded with UK aid from the UK government (ref. #2.03).

Agreeing to disagree about medical treatment for children

Professor Dominic Wilkinson, Professor of Medical Ethics at the University of Oxford and a Consultant in newborn intensive care at the John Radcliffe Hospital, Oxford, discusses the ethical issues around providing medical treatment for children when parents and doctors disagree.

The fraught life and death cases of Charlie Gard and Alfie Evans, reached global attention in 2017 and early 2018. They led to widespread debate about conflicts between doctors and parents, and about the place of the law in such disputes. Changes to the law in response to these high-profile cases are currently being debated in the House of Lords.

In 2016, Professor Savulescu of the Oxford Uehiro Centre for Practical Ethics wrote an editorial for the Lancet medical journal strongly criticizing the court’s decision, and arguing that Charlie Gard should be allowed to travel to America for experimental treatment. He argued that Donald Trump and the Pope were right to support Charlie’s family. In the same issue of the Lancet, I took the opposing view, supporting Charlie’s doctors, and arguing that Charlie should be allowed to die. Professor Savulescu and I are colleagues and long-time collaborators.

Over the ensuing months, while the appeals for Charlie Gard were heard in the courts, Savulescu and I conducted a vigorous debate in academic journals and in the media about the rights and wrongs of the Gard case. Over time, we found areas of agreement, as well as areas of reasonable disagreement.

In a newly published book, Professor Julian Savulescu and I examine the ethics of medical treatment disputes for children, as well as outlining our own professional disagreement on the Gard case. At one level, this is a rigorous analysis of the rights of parents, the harms of treatment, and the vital issue of limited resources. From opposite sides of the debate about treatment for Charlie Gard, we provocatively outline the strongest arguments in favour of and against treatment. We also outline a series of lessons from the Gard case and propose a radical new ‘dissensus’ framework for future cases of disagreement.

This case also illustrates some of the distinctive and challenging features of ethical debate in the 21st century. We have shown that it is possible for those who find themselves at opposite ends of an issue to find common ground. Indeed, disagreement about controversial ethical questions is both inevitable and desirable.

There is a need for sensitive, rational debate within our community about how to fairly address disagreements about treatment between health professionals and families. That debate cannot, now, help Charlie Gard or Alfie Evans. It can, though, help current and future children with serious illnesses.

It can support their families to access desired treatment, within limits. It can help health professionals to be able to advocate for the best interests of their patients. It can help doctors to maintain relationships with families (even if not always seeing eye to eye). It can help society to understand what is at stake, why these disagreements are so difficult, so vexed, and so inevitable.

In difficult ethical debates, there is sometimes a desire to reach consensus or agreement on the right thing to do. But that can be a mistake. On questions of deep ethical values, there will always be disagreement. We need to embrace dissensus, not consensus. We should be prepared to disagree

‘Ethics, conflict and medical treatment for children: from disagreement to dissensus,’ is published by Elsevier.

Professor Julian Savulescu is Professor of Practical Ethics in the Oxford Uehiro Centre for Practical Ethics at the University of Oxford. Professor Dominic Wilkinson is Professor of Medical Ethics at the University of Oxford and a Consultant in newborn intensive care at the John Radcliffe Hospital, Oxford. Wilkinson and Savulescu are medical doctors as well as experts in medical ethics.

Coral reef

New research published in Nature Ecology & Evolution from the Department of Zoology at Oxford University aims to show how big data can be used as an essential tool in the quest to monitor the planet’s biodiversity.

A research team from 30 institutions across the world, involving Oxford University’s Associate Professor in Ecology, Rob Salguero-Gómez, has developed a framework with practical guidelines for building global, integrated and reusable Essential Biodiversity Variables (EBV) data products.

They identified a ‘void of knowledge due to a historical lack of open-access data and a conceptual framework for their integration and utilisation'. In response the team of ecologists came together with the common goal of examining whether it is possible to quantify, compile, and provide data on temporal changes in species traits to inform national and international policy goals.

These goals, such as the Sustainable Developmental Goals (SDG) of the United Nations, have become fundamental in shaping global economic investments and human actions to preserve and protect nature and its ecoservices.

Essential Biodiversity Variables (EBVs) have been proposed as ideal measurable traits for detecting changes in biodiversity. Yet, the researchers say, little progress has been made to empirically estimate how EBVs in fact change through time at the regional and global scales.

To overcome this, Rob Salguero-Gómez and his international collaborators have developed a framework with practical guidelines for building global, integrated and reusable EBV data products of species traits. This framework will greatly aid in the monitoring of species trait changes in response to global change and human pressures, with the aim to use species trait information in national and international policy assessments.

Salguero-Gómez says: 'We have for the first time synthesised how species trait information can be collected (specimen collections, in-situ monitoring, and remote sensing), standardised (data and metadata standards), and integrated (machine-readable trait data, reproducible workflows, semantic tools and open access licenses).'

This latest review provides a perspective on how species traits can contribute to assessing progress towards biodiversity conservation and sustainable development goals. The researchers believe that big data is one of the keys to address the global and societal problems from security food, to preventing ecoservice loss, or effects of climate change. 

They say that the operationalization of this idea will require substantial financial and in-kind investments from universities, research infrastructures, governments, space agencies and other funding bodies. ‘Without the support of the Max Planck Institute for Demographic Research, NERC, Oxford, and the open-access mentality of hundreds of population ecologists, our work with COMPADRE & COMADRE would not have been possible,’ says Salguero-Gómez.

The integration of trait data to address global questions in ecology, evolution, and conservation biology is one of the main themes in Salguero-Gómez’ research group, the SalGo Lab.

This work was funded primarily by the Horizon 2020 project GLOBIS-B of the European Commission.

 Read the full paper in Nature Ecology & Evolution.

Artists reconstruction of fossil

Stephen Pates, a researcher from Oxford University’s Department of Zoology, has uncovered secrets from the ancient oceans.

With Dr Rudy Lerosey-Aubril from New England University (Australia), he meticulously re-examined fossil material collected over 25 years ago from the mountains of Utah, USA. The research, published in a new study in Nature Communications, reveals further evidence of the great complexity of the oldest animal ecosystems.

Twenty hours of work with a needle on the specimen while submerged underwater exposed numerous, delicate microscopic hair-like structures known as setae. This revelation of a frontal appendage with fine filtering setae has allowed researchers to confidently identify it as a radiodont – an extinct group of stem arthropods and distant relatives of modern crabs, insects and spiders.

Before and after view of Pahvantia Before and after view of Pahvantia

‘Our new study describes Pahvantia hastasta, a long-extinct relative of modern arthropods, which fed on microscopic organisms near the ocean’s surface’ says Stephen Pates. ’We discovered that it used a fine mesh to capture much smaller plankton than any other known swimming animal of comparable size from the Cambrian period. This shows that large free-swimming animals helped to kick-start the diversification of life on the sea floor over half a billion years ago.’

Causes of the Cambrian Explosion - the rapid appearance in the fossil record of a diverse animal fauna around 540-500 million years ago - remain hotly debated. Although it probably included a combination of environmental and ecological factors, the establishment of a system to transfer energy from the area of primary production (the surface ocean) to that of highest diversity (the sea floor) played a crucial role.

Even though relatively small for a radiodont (FIG), Pahvantia was 10-1000 times larger than any mesoplanktonic primary consumers, and so would have made the transfer of energy from the surface oceans to the deep sea much more efficient. Primary producers such as unicellular algae are so small that once dead they are recycled locally and do not reach the deep ocean. In contrast large animals such as Pahvantia, which fed on them, produce large faecal pellets and carcasses, which sink rapidly and reached the seafloor, where they become food for bottom-dwelling animals.

Amateur enthusiasts provide research gold-dust

The presence of Pahvantia in the Cambrian of Utah has been known for decades thanks to the efforts of local amateur collectors Bob Harris and the legendary Gunther family.

‘This work also provides an opportunity to celebrate the exceptional contribution of local and amateur collectors to modern palaeontology’ explains Stephen. ‘Without their tireless efforts, knowledge, and generosity, thousands of specimens representing hundreds of new species, would not be known to science.’ 

Bob Harris is rumoured to have turned down a job offer from the CIA, instead opening up a fossil shop and a number of quarries in the spectacular House Range, Utah. He discovered the first specimens of Pahvantia in the 1970s, and donated them to Richard Robison, a leading expert on Cambrian life from the University of Kansas. The Gunther family are famous for their extensive fossil collecting in Utah and Nevada. Over a dozen species have been named in honour of their contributions to palaeontology, as they have shared thousands of specimens with museums and schools over the years. Among these were specimens of Pahvantia which they uncovered between 1987 and 1997. Donated to the Kansas University Museum of Invertebrate Paleontology (KUMIP), these specimens are described for the first time in our study.

‘I visited the KUMIP in the first year of my PhD,’ says Stephen. ‘It was awesome, exploring such a fantastic collection of fossils from the Cambrian of Utah and Nevada.’

The study has produced the most up-to-date analysis of evolutionary relationships between radiodonts. It shows that filter feeding evolved twice, possibly three times in this group, which otherwise essentially comprised fearsome predators such as Anomalocaris canadensis from the Burgess Shale in Canada.

Pahvantia adds to an ever-growing body of evidence that radiodonts were vital in the structure of Cambrian ecosystems, in this case linking the primary producers of the surface waters to the highly diverse fauna on the sea floor. It also shows the importance of museum collections like the KUMIP, and local collectors, such as Bob Harris and the Gunther family, in uncovering new and exciting findings about early animal life.

The article is available from Nature Communications via this link.

Coding

Amy Kao, PhD student at the Department of Psychiatry, Oxford University, reveals how she represented the UK at the international ActinSpace hackathon as part of an Oxford team which combined talents to take on a social problem.

Hackathons have a reputation as a software-heavy coding event welcoming only those with specific skill sets and domain knowledge in computer science. However, as diversity continues to emerge as a pivotal aspect of success for any project, the ActinSpace (AIS) hackathon invited anyone from any background to come and work up realistic ideas using space technology in innovative ways.

The experience was truly memorable. In the beginning stages at Harwell, Oxfordshire, within 24 hours my team and I proposed a satellite-based artificial intelligence application to address street harassment. We worked through the night, inspired by the knowledge that we could be building a technology that could truly make the world a better place.

Our proposed platform was a navigation app to guide you the safest way home. In order to find the safest route, the app estimates the danger on each road segment. Crime record databases in the UK and US are public and annotate with exact geo-location. These can be used to count the number of incidents on each road segment. Using convolutions neural networks and satellite data, the app could accurately estimate the number of pedestrians going along each road. This forms the technical basis of our platform. Additional features are AI-driven velocity tracking that can be used to identify whether the user suddenly stops moving, starts running or even deviating from the intended route, all of which are unexpected behaviours on a normal walk home. Using vibration or non-visual cues avoids the need to be constantly looking down at a phone making you appear less lost, and a much less of a viable target.

We pitched our product in seven minutes the following day, and won the hearts of the UK judges. This gave us the unique opportunity to represent the UK at the international semi- finals in Toulouse.

This was an enormous event gathering teams from over 30 countries, all with exciting and novel technologies.

The finals competition in Toulouse brought together people from across the world sharing a passion for technology and innovation. However, it also sadly highlighted the lack of diversity and representation that remains.

Amy Kao and Anna Jungbluth, DPhil students at Oxford Amy Kao and Anna Jungbluth, DPhil students at Oxford

The AIS 2018 had 23% female participation, but only one team among the six finalists had a female team member. There has been considerable movement in increasing this number; however, we see it as our social obligation to do our part and encourage our female peers to take part and pursue activities that they didn’t think they could achieve.

The best part of the team was our diversity, where we were five students from five different countries, coming to Oxford to study five extremely different disciplines (computer science, economics, medicine, physics, psychiatry) ranging from fresh undergraduates to seasoned DPhils. The hackathon really was a problem-solving event, not a software-heavy event at all. It provided the opportunity of working with other astute individuals to propose a holistic solution using space technology and creative business models. 

The burst of productivity over one 24-hour period can be extremely refreshing. I would really encourage others to take part, particularly if you’re not in any mainstream programming fields, and even more so if you’re part of an underrepresented demographic (e.g. women in STEM). My bachelor’s was in cell and molecular biology, and my postgraduate research degrees were in pharmaceutical science and neuroscience; perhaps as far removed from space technology as you can get, let alone participating in a hackathon! The mentality of industries are shifting from the limiting idea of entering a career based entirely on what you studied in school to a dynamic stage that embraces diversity and different approaches to solving a problem. Domain knowledge can be quickly accumulated, but the courage to pursue something outside your normal comfort zone and the confidence that you have meaningful contributions requires deliberate time and context to be developed. Just give it a try! 

MPLS runs an Enterprising Women lunch and learn in week 4 of each term, welcoming all researchers interested in developing of a supportive network of STEM women. Details are always advertised via eship.ox.ac.uk