Responses to Lassa fever disease in Nigeria: a multilevel ethnography of a health system.

拉沙热是一种致命的病毒性出血热，流行于西非。尼日利亚经历了日益严重的疫情，尽管国家和国际行为者开展了越来越多的预防和应对努力。卫生系统和科学活动的增加与日益加重的疾病负担之间的脱节，需要仔细审查如何设计和执行战略和方案行动，如何处理实地现实，如何利用流行病学知识为战略提供信息，以及政策制定者如何在国家和全球议程优先事项之间导航。除了人类学方法外，这项研究还将利用卫生系统研究和流行病学研究，以检查卫生系统行为者如何在尼日利亚组织低频应对战略。我将在以往LF疫情热点地区的卫生系统不同“级别”(决策“级别”和医疗保健提供“级别”)的界面上进行多层次的人种学研究。通过对参与低频反应的行为者的利益相关者分析、深入访谈以及在政策制定和医疗保健提供领域的参与者观察，这项研究将有助于更好地了解尼日利亚的低频反应，并将有助于确定从设计到实施的障碍。这些发现将适用于其他新出现的传染病，并将有助于更好地了解卫生系统如何应对暴发(如SARS-CoV-2)。此外，这项研究将为流行病学知识的产生和卫生系统的组织如何相互影响提供见解。从方法论的角度来看，这项创新研究将促进在卫生系统研究中使用跨学科方法。

Lassa fever (LF) is a deadly viral haemorrhagic fever endemic to West Africa. Nigeria has experienced outbreaks of increasing severity, despite growing prevention and response efforts deployed by national and international actors.This disconnect between increased health systems and scientific activity alongside an increasing disease burden requires a close examination of how strategies and programmatic actions are designed and implemented, how on-the-ground realities are addressed, how strategies are informed by epidemiological knowledge, and how policymakers navigate between national and global agenda priorities. This study will draw on health systems research and epidemiological research in addition to anthropological approaches, to examine how health system actors organise LF response strategies in Nigeria. I will conduct a multilevel ethnography at the interfaces of different 'levels' of the health system (the policymaking 'level' and the healthcare delivery 'level') in hotspots of previous LF outbreaks. Through a stakeholder analysis of the actors involved in LF response, in-depth interviews, and participant observation in the policymaking and healthcare delivery spheres, this study will contribute to improved understanding of LF responses in Nigeria and will help identify obstacles from design to implementation.Findings will be applicable to other emerging infectious diseases and will contribute to improved understanding of how health systems respond to outbreaks (such as SARS-Cov-2). Moreover, this study will provide insights into how the production of epidemiological knowledge and the organisation of a health system influence one another. From a methodological perspective, this innovative study will promote the use of interdisciplinary approaches in health systems research.