As part of the Dust Bunny project commitments, series of community dissemination meeting were organized to share some key findings with the people and district health and education authorities. From April to May 2021 over 150 participants were engaged in four meetings organised across the different regions in Accra where our communities reside.
Participants included representatives from the district health directorate and the health facilities in each of the study communities, representatives from the Ghana education service, the chiefs and opinion leaders, Assembly members, selected study participants and few community members.
Four short presentations were made to guide discussions. The first presentation focused on the global burden of AMR and why it is very important to tackle it from all possible angles including the home. The second was on selected key findings from the study and the cleaning intervention implemented, the fourth presentation was testimonies given by participants who took part in the cleaning intervention, and the fourth was on the cleaning education and information material.
Each presentation was followed by a discussion session, where questions were asked, and answers provided. There were also general discussions with people making suggestions on the usefulness of the project, especially the interventions implemented. Generally, participants in all the communities were happy about the study and have requested for its expansion for the benefit of all residents. The following key discussion points and issues were raised:
The cleaning education and information material was very well received, and the people wanted more to be distributed in the communities. All the district directors of health service have requested for the soft copies of the material for their own printing and distributions. It was the toast of all participants!
Chiefs in all the communities have requested that, if covid-19 pandemic is over, they will be ready to organise community durbars for us to share the findings, especially the cleaning education and information materials and the finding that bacteria were found in the homes, including bedrooms.
The chiefs and Assembly members pledged their supports for any research project that will be brought into their communities because, they found the Dust bunny project to be very useful on that could promote the health of community members.
The people want to know how to curb dust from entering their rooms, since they have no control over it. In Abokobi where road construction was ongoing, the dust situation was very unbearable.
Participants in Adenta requested that the cleaning intervention is implemented in more homes, if not all the homes in the municipality.
Participants in Madina said it will be good to test the dust from the market to know the infection there too. They concluded that, they believe that the situation will be worst in the market compared to the home.
Some people wanted to know how participants were selected for the cleaning intervention because they would have loved to participate in it.
It came to light that the cleaning intervention should also be implemented in schools to teach the children how to clean properly.
As a result of the project the team has developed a range of design research tools which can be used to support projects using creative methods for:
a) collecting data on home cleaning and hygiene related to WASH (Water Sanitation and Hygiene) and/or Antimicrobial Resistance (AMR);
b) for co-designing cleaning interventions with professionals and communities to reduce the spread of infections in the home and other built environments. These can be freely downloaded (they are in PDF format) and be modified by researchers to suit their research needs.
These tools are an outcome of interdisciplinary research that combines design research with microbiology analysis. Therefore these tools reflect this in their design by integrating microbiological elements in the data visualisation and data gathering process.
Following the popularity of the first video of the project on Ghana TV in June/July 2019, a new video documentary has been created about the Dust Bunny project by the journalist Peggy Ama Donkor (Journalist of the Year 2005 award).
The new video documentary features the co-design workshop held by the Dust Bunny researchers in Accra, on September 2019. It also includes interviews from the research team and workshop participants.
The video was aired on Ghana Today Television (the national public broadcaster of Ghana, run by the Ghana Broadcasting Corporation) in in October and November 2019 for more than 15 times and was seen by several thousands of viewers. It is also available to view on Facebook , where it was posted on the 31st of January 2020.
Following the co-design workshops, the participating households have been implementing the co-designed cleaning interventions.
Our team is currently evaluating these by visiting the households. The evaluation include post-intervention interviews with members of the households and a second collection of dust samples. These will enable us to assess any changes in the household attitudes to cleaning but also to compare the diversity of bacteria following the first dust sample.
In September 2019 the Dust Bunny team run a co-design workshop with several of the households participating in the project. The aim of the workshop was to co-design interventions that householders will take back and implement.
The households were representative of the 4 socio-economic groups found in Ghana.
The one-day workshop included several creative activities and tools which were designed to elicit response and engagement from participants. Some of the tools and activities placed participants in mock-up versions of different types of households and presented in visual ways the bacteria found in households form the microbiological analysis and their potential impact to health.
They then explored the different cleaning hotspots where they believed bacteria are found in their homes and developed cleaning agreements that each household would take back home and test for a month.
Participants were deeply engaged with the data, especially the findings from the microbiological analysis of dust. They wanted to know the number of different bacteria found and from which socioeconomic groups.
The Dust Bunny project has attracted the Interest of journalist Peggy Ama Donkor (Journalist of the Year 2005 award) who created a video documentary on it.
The video was aired on Ghana Today Television (the national public broadcaster of Ghana, run by the Ghana Broadcasting Corporation) on its Breakfast show and Regional Diary on the 28th June 2019, 30th June 2019 and 10th July 2019, seen by several thousands of viewers. It was also posted on Facebook 13 July.
Dust Bunny has investigated the microbiological content of dust by isolating bacteria from dust obtained from a range of homes in Accra in Ghana.
We tested the bacteria for resistance to a number of commonly used antibiotics and found that about 35% of those tested carried resistance to at least one antibiotic and some carried resistance to more than one.
Some of antibiotic resistant bacteria were identified and no were found to be disease-causing but the majority were opportunist pathogens and could cause disease in people who were already suffering from infectious or non-infectious diseases.
The most common bacterium found was a non-pathogenic bacterium found in soil but even so it carried a number of resistance which could pass to antibiotic sensitive pathogens making their treatment more difficult.
Although the sample size was relatively small it showed us that although the dust was a low risk to health with respect to infectious disease, it provides a pool of antibiotic resistance that could compromise future infections.
Developing strategies for promoting health or preventing ‘illbeing’ of the population forms one of the most complex global challenges. As such, global health challenges, such as Antimicrobial Resistance (AMR), are hugely complex problems with diverse influences, driven by human activity as much as by biological mechanisms. Biomedical, clinical and medical expertise alone cannot tackle global health issues alone. Collaborative and innovative interdisciplinary approaches are needed to tackle such challenge.
The Antimicrobial Resistance, Community Engagement, Global Health and the Arts and Humanities, organised in Kathmandu, Nepal between the 26th – 28th of June 2019, focused on this theme. The event, organised by Leeds University, highlighted the value of transdisciplinarity and in particular participatory approaches and community engagement in the context of Global Health and AMR.
During the event, the Dust Bunny presentation demonstrated that from an epidemiology and public health perspective, combining knowledge from multiple sources presents the best opportunity to adequately address public health concerns, such as in the case of AMR. More precisely, it demonstrated that the use of a design research approach to address antimicrobial resistance management at the household level can provide insights into the behavioural challenges, and promote best practices for public health implementation. This is a practice that adds more value to the microbiology and public health aspects of the project, which would typically not engage further with households after sampling has been completed.
We envisage that the experiences and insights outlined in the event and our presentation of the project, will help other researchers to embark on transdisciplinary research that challenges the boundaries of their disciplines in new specialist medical areas.
The unique and truly multidisciplinary research methodology employed by the Dust Bunny research team has been published in the Design Journal. The paper is entitled ‘Combining design research with microbiology to tackle drug-resistant infections in different home environments in Ghana: Challenging the boundaries of design thinking‘ and can be freely accesses from here.
It posits that the approach adopted has the opportunity to provide a platform for understanding complex issues regarding microbiology (microbial resistance) and public health through engaging the community of practice. Doing this from various perspectives (design, social science, epidemiology/public health and microbiological perspectives) presents the best opportunity to adequately address emerging public health concerns, such as antimicrobial resistance in the home setting.
We envisage that the experiences and insights outlined in this paper, will help other researchers to embark on transdisciplinary research that challenges the boundaries of design in new specialist medical areas.