From left: Professor Sabiha Essack, Professor Percy Mashige, and Dr Annick Lenglet.

Epidemiology in Humanitarian Settings

Honorary Associate Professor in UKZN’s Antimicrobial Research Unit, Dr Annick Lenglet’s public lecture focused on her experience of working as an epidemiologist with the international medical humanitarian organisation, Medecins Sans Frontieres /Doctors Without Borders (MSF).

Titled, Applied Epidemiology in Humanitarian Settings: The Lived Experience, the infectious disease field epidemiologist began her presentation by defining what a humanitarian context is considered to be.

She listed the 12 priorities that most humanitarian organisations use to intervene in unfolding emergency settings, including initial assessment, measles vaccination, water/sanitation, and shelter/access to non-food items, etc.

Lenglet also discussed some of the routine activities that an epidemiologist would engage in when responding to an acute humanitarian crisis including establishing a population denominator and how this is done in practice; designing a surveillance system to monitor health trends, evaluate interventions and detect outbreaks; and designing a system to track mortality rates in the affected population.

She highlighted operational research as an area of work where an epidemiologist might be involved and illustrated this using two examples, namely, understanding risk factors for disease and establishing prevalence in Noma, northwest Nigeria; and testing whether mental health counselling interventions work to reduce anxiety and depression in clients in Grozny, Chechnya.

Lastly, Lenglet discussed how these surveillance and research skills and methods came together in an obstetric emergency hospital in Port Au Prince, Haiti. Using an established but simple surveillance system in the neonatal care unit, epidemiologists were able to determine risk factors for infection and death from suspected bloodstream infections caused by extended spectrum beta-lactamase (ESBL) positive bacteria.

‘They then conducted research using a point prevalence survey amongst women and babies to illustrate that the bacteria implicated in the outbreak was one that was hospital acquired. Using simple mathematic model algorithms generated from historical data, they were able to design an alert system for any new suspected neonatal outbreak which would reduce reliance on microbiological diagnostics,’ explained Lenglet.

Lenglet has more than 15 years’ experience in countries in Latin America, Central Asia, Southeast Asia, Africa and Europe. She has worked on the design, implementation and evaluation of surveillance systems, led and collaborated large-scale outbreak response efforts, and led and participated in research on hepatitis A and E, cholera, antimicrobial resistance, mental health, and non-communicable diseases.

She is currently the Science Team Lead at the International Centre for Antimicrobial Resistance Solutions (ICARS) in Denmark.

‘There are several scientists who will leave a footprint in one’s mind, but once in a lifetime one has the rare privilege of meeting a scientist who leaves a footprint on one’s heart because of her selflessness and humanitarian service to the most vulnerable. Annick has left an indelible footprint on my heart and mind,’ said UKZN’s Professor Sabiha Essack, South African Research Chair in Antibiotic Resistance and One Health.

Words and photograph: Nombuso Dlamini