Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches.
BACKGROUND
Community-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children's Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into the study design and methods of a longitudinal epidemiological study in sub-Saharan Africa using this project as an example.


METHODS
The CBPR framework we used involves problem identification, feasibility and planning; implementation; and evaluation and dissemination. This case study will describe how we have engaged the community and adapted CBPR methods to OSCAR's Health and Well-being Project's corresponding to this framework in four phases: 1) community engagement, 2) sampling and recruitment, 3) retention, validation, and follow-up, and 4) analysis, interpretation and dissemination.


RESULTS
To date the study has enrolled 3130 orphaned and separated children, including children living in institutional environments, those living in extended family or other households in the community, and street-involved children and youth. Community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village Chiefs and elders we were able to successfully identify eligible households and randomize the selection of participants. The on-going contribution of the community in the research process has been vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda.


CONCLUSIONS
CBPR methods have the ability to enable and strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent. This project demonstrates that adaptation of these methods is crucial to the successful implementation of a community-based project involving a highly vulnerable population.
Moi Teaching and Referral Hospital, Eldoret, Kenya.
Allan
A
Kamanda
Lonnie
L
Embleton
David
D
Ayuku
Lukoye
L
Atwoli
Peter
P
Gisore
Samuel
S
Ayaya
Rachel
R
Vreeman
Paula
P
Braitstein
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002608:Charities / Q000458:organization & administration; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000600:supply & distribution; D054540:Child, Orphaned; D018672:Community Health Planning / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D055812:Community-Based Participatory Research / Q000379:methods*; D004059:Diffusion of Innovation; D005500:Follow-Up Studies; D006293:Health Promotion / Q000379:methods; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007630:Kenya; D008137:Longitudinal Studies; D019982:Organizational Case Studies; D010358:Patient Participation / Q000379:methods; D018579:Patient Selection; D015980:Public Health Practice; D012107:Research Design; D012111:Residence Characteristics
D044966:Anti-Retroviral Agents