Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working in informal urban spaces in low-income and middle-income countries (Bangladesh, India, Kenya and Sierra Leone). Our manuscript is divided into three key sections. We start by discussing the importance of safeguarding in global health research and consider how thinking about vulnerability as a relational concept (shaped by unequal power relations and structural violence) can help locate fluid and context specific safeguarding risks within broader social systems. We then discuss the different steps undertaken in ARISE to develop a shared approach to safeguarding: sharing institutional guidelines and practice; facilitating a participatory process to agree a working definition of safeguarding and joint understandings of vulnerabilities, risks and mitigation strategies and share experiences; developing action plans for safeguarding. This is followed by reflection on our key learnings including how safeguarding, ethics and health and safety concerns overlap; the challenges of referral and support for safeguarding concerns within frequently underserved informal urban spaces; and the importance of reflective practice and critical thinking about power, judgement and positionality and the ownership of the global narrative surrounding safeguarding. We finish by situating our learning within debates on decolonising science and argue for the importance of an iterative, ongoing learning journey that is critical, reflective and inclusive of vulnerable people.

For the large population living in Nairobi’s informal settlements, the long-term effects of Covid-19 pose a threat to livelihoods, health, and wellbeing. For those working in the informal sector, who are the lifeblood of the city, livelihoods have been severely supressed by Covid-19 restrictions such as curfews, pushing many into further poverty. This article draws on community data, meetings, and authors’ observations as community organisers, to explore the challenges posed by existing government responses from a community development perspective. We found that poor accountability structures and targeted income support only for the ‘most vulnerable’ exacerbates tensions, mistrust, and insecurity among already vulnerable communities. We draw on a rapid desk review of existing literature to argue that community-led enumeration to validate entitlement claims, improved accountability for distribution, and widening income support is required to build solidarity and improve the future resilience of these communities.

IntroductionThere is increasing urgency to document changing antimicrobial resistance (AMR) patterns of N. gonorrhoea (GC) in different parts of the world. High-level resistance to previously recommended quinolones is widespread and decreased susceptibility to the extended-spectrum (third-generation) cephalosporin. The surveillance for AMR in Kenya and the region was undertaken to determine the frequency and diversity of antimicrobial resistance of gonococcal isolates from Sex Workers Outreach Program (SWOP) Clinic.MethodsThe survey tested 238 isolates over a period of 4 years from participants presenting with cervical/vaginal discharge. Samples collected were inoculated directly on modified Thayer martin media (MTM), transported to GASP Laboratories at KAVI-Institute of Clinical Research and identified by standard bacteriological procedures. Antibiotic susceptibility testing of GC isolates was performed using diffusion gradient method. The MICs of penicillin, tetracycline, ciprofloxacin, spectinomycin, erythromycin, Azithromycin, cefixime and ceftriaxone were determined by the E-test method. The strains were defined as susceptible, intermediate and resistant using the WHO guidelines, all the findings were validates at WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital in Sweden.Results41 isolates in 2012,119 isolates in 2013, 24 isolates in 2014 and 54 isolates in 2015 showed 100% susceptaility for cefixime, ceftriaxone and spectinomycin, with a mean susceptibility of 82%, 37.7%, 19.5%, 1.6% and 0% for azithromycin, erythromycin, ciprofloxacin, penicillin and tetracycline respectively. Resistance for ciprofloxacin had rise from 56% in 2012, 58.8% in 2013, 66.7% in 2014 to 68.5% in 2015. ConclusionSpectinomycin, cefixime, ceftriaxone, azithromycin are useful. Ciprofloxacin the most prescribed antibiotic is no longer reliable for treatment of GC. Continuous surveillance is essetial to mordify treatmet guidelies. Worsening GC drug resistance will compromise effective treatment and decrease disease control efforts.

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