Farnham Andrea, Cossa Hermínio, Dietler Dominik, Engebretsen Rebecca, Leuenberger Andrea, Lyatuu Isaac, Nimako Belinda, Zabre Hyacinthe R, Brugger Fritz, Winkler Mirko S
Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
JMIR Res Protoc. 2020 Apr 8;9(4):e17138. doi: 10.2196/17138.
Natural resource extraction projects offer both opportunities and risks for sustainable development and health in host communities. Often, however, the health of the community suffers. Health impact assessment (HIA) can mitigate the risks and promote the benefits of development but is not routinely done in the developing regions that could benefit the most.
Our study aims to investigate health and health determinants in regions affected by extractive industries in Burkina Faso, Ghana, Mozambique, and Tanzania. The evidence generated in our study will inform a policy dialogue on how HIA can be promoted as a regulatory approach as part of the larger research initiative called the HIA4SD (Health impact assessment for sustainable development) project.
The study is a concurrent triangulation, mixed methods, multi-stage, multi-focus project that specifically addresses the topics of governance and policy, social determinants of health, health economics, health systems, maternal and child health, morbidity and mortality, and environmental determinants, as well as the associated health outcomes in natural resource extraction project settings across four countries. To investigate each of these health topics, the project will (1) use existing population-level databases to quantify incidence of disease and other health outcomes and determinants over time using time series analysis; (2) conduct two quantitative surveys on mortality and cost of disease in producer regions; and (3) collect primary qualitative data using focus groups and key informant interviews describing community perceptions of the impacts of extraction projects on health and partnership arrangements between the projects and local and national governance. Differences in health outcomes and health determinants between districts with and without an extraction project will be analyzed using matched geographical analyses in quasi-Poisson regression models and binomial regression models. Costs to the health system and to the households from diseases found to be associated with projects in each country will be estimated retrospectively.
Fieldwork for the study began in February 2019 and concluded in February 2020. At the time of submission, qualitative data collection had been completed in all four study countries. In Burkina Faso, 36 focus group discussions and 74 key informant interviews were conducted in three sites. In Ghana, 34 focus group discussions and 64 key informant interviews were conducted in three sites. In Mozambique, 75 focus group discussions and 103 key informant interviews were conducted in four sites. In Tanzania, 36 focus group discussions and 84 key informant interviews were conducted in three sites. Quantitative data extraction and collection is ongoing in all four study countries. Ethical approval for the study was received in all four study countries prior to beginning the fieldwork. Data analyses are underway and results are expected to be published in 2020 and 2021.
Disentangling the complex interactions of resource extraction projects with their host communities requires an integrative approach drawing on many methodologies under the HIA umbrella. By using complementary data sources to address the question of population health in project areas from several angles, bias and missing data will be reduced, generating high-quality evidence to aid countries in moving toward sustainable development.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17138.
自然资源开采项目给所在社区的可持续发展和健康带来了机遇与风险。然而，社区健康往往会受到损害。健康影响评估（HIA）能够降低风险并促进发展带来的益处，但在最能从中受益的发展中地区却未得到常规开展。
我们的研究旨在调查布基纳法索、加纳、莫桑比克和坦桑尼亚受采掘业影响地区的健康状况及健康决定因素。我们研究中产生的证据将为关于如何将HIA作为一种监管方法加以推广的政策对话提供信息，这是名为HIA4SD（可持续发展健康影响评估）项目的更大规模研究计划的一部分。
该研究是一个同步三角测量、混合方法、多阶段、多重点的项目，专门涉及治理与政策、健康的社会决定因素、健康经济学、卫生系统、母婴健康、发病率和死亡率、环境决定因素以及四个国家自然资源开采项目背景下的相关健康结果等主题。为调查这些健康主题中的每一个，该项目将：（1）使用现有的人口层面数据库，通过时间序列分析来量化疾病及其他健康结果和决定因素随时间的发生率；（2）对生产地区的死亡率和疾病成本进行两项定量调查；（3）通过焦点小组和关键信息人访谈收集主要定性数据，描述社区对开采项目对健康影响的看法以及项目与地方和国家治理之间的伙伴关系安排。将使用准泊松回归模型和二项回归模型中的匹配地理分析方法，分析有开采项目地区和无开采项目地区之间健康结果和健康决定因素的差异。将对每个国家中发现与项目相关疾病给卫生系统和家庭带来的成本进行回顾性估计。
该研究的实地调查于2019年2月开始，并于2020年2月结束。在提交本文时，所有四个研究国家的定性数据收集工作均已完成。在布基纳法索，在三个地点进行了36次焦点小组讨论和74次关键信息人访谈。在加纳，在三个地点进行了34次焦点小组讨论和64次关键信息人访谈。在莫桑比克，在四个地点进行了75次焦点小组讨论和103次关键信息人访谈。在坦桑尼亚，在三个地点进行了36次焦点小组讨论和84次关键信息人访谈。所有四个研究国家的定量数据提取和收集工作正在进行中。在开始实地调查之前，所有四个研究国家均已获得该研究的伦理批准。数据分析正在进行中，预计结果将于2020年和2021年发表。
理清资源开采项目与其所在社区之间复杂的相互作用需要一种综合方法，借鉴HIA框架下的多种方法。通过使用互补数据源从多个角度解决项目地区的人群健康问题，将减少偏差和缺失数据，从而生成高质量证据，帮助各国朝着可持续发展迈进。
国际注册报告识别码（IRRID）：DERR1-10.2196/17138
