1
|
Delgado IS, Outterson A, Ramesh V, Amador Sanchez AG, Boza AC, Lopez-Pilarte D, Amador Velázquez JJ, Friedman DJ, Brooks DR, Scammell MK, Wang C. Ethical considerations for genetic research in low-income countries: perceptions of informed consent, data sharing, and expectations in Nicaragua. Eur J Hum Genet 2023:10.1038/s41431-023-01505-7. [PMID: 38052907 DOI: 10.1038/s41431-023-01505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/18/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023] Open
Abstract
Genetic research presents numerous ethical, legal, and social implications (ELSI), particularly when the research involves collaborations between investigators in high and low-income countries. Some ELSI issues are universal, and others are specific to context and culture. This study investigates perceptions of genetic research in Nicaragua, Central America, where local and U.S. based researchers have collaborated for over a decade. A total of 43 residents from northwestern Nicaragua, a region with high mortality rates attributed to chronic kidney disease of non-traditional causes (CKDnt), were interviewed, including research participants in ongoing studies (n = 36), health professionals (n = 3), labor leaders (n = 2), and family members of research participants (n = 2). Questions focused on informed consent, data-sharing, and post-study expectations. Audio recordings of interviews conducted in Spanish were transcribed and translated into English. English transcripts were coded and analyzed using NVivo 12 software. The lack of familiarity with terms in the consent form presented a barrier to participant comprehension of key elements of the genetic research study, raising concerns about the validity of informed consent. Research participants often viewed their participation as access to health care. Health professionals emphasized the importance of long-term partnerships between foreign-based researchers and local health institutions. Leaders and family members recommended that they be informed of research studies and allowed the opportunity to consent, as they felt the benefits and risks of research also apply to them. Our findings identified genetic research practices to be improved upon in order to be more responsive to the contextual realities of collaborators living in low-resource settings.
Collapse
Affiliation(s)
- Iris S Delgado
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA.
| | - Abigail Outterson
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vaishnavi Ramesh
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Alfonso César Boza
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Damaris Lopez-Pilarte
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Juan José Amador Velázquez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - David J Friedman
- Renal Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel R Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Madeleine K Scammell
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Catharine Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Braithwaite T, Verlander NQ, Peto T, Bartholomew D, Deomansingh F, Bridgemohan P, Saei A, Sharma S, Singh D, Ramsewak SS, Bourne RRA. National Eye Survey of Trinidad and Tobago (NESTT): prevalence, causes and risk factors for presenting vision impairment in adults over 40 years. Br J Ophthalmol 2019; 104:74-80. [PMID: 30914421 DOI: 10.1136/bjophthalmol-2018-313428] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/26/2022]
Abstract
AIM To estimate the prevalence, causes and risk factors for presenting distance and near vision impairment (VI) in Trinidad and Tobago. METHODS This is a national, population-based survey using multistage, cluster random sampling in 120 clusters with probability-proportionate-to-size methods. Stage 1 included standardised, community-based measurement of visual acuity. Stage 2 invited all 4263 people aged ≥40 years for comprehensive clinic-based assessment. The Moorfields Eye Hospital Reading Centre graded fundus photographs and optical coherence tomography images independently. RESULTS The response rates were 84.2% (n=3589) (stage 1) and 65.4% (n=2790) (stage 2), including 97.1% with VI. The mean age was 57.2 (SD 11.9) years, 54.5% were female, 42.6% were of African descent and 39.0% were of South Asian descent. 11.88% (95% CI 10.88 to 12.97, n=468) had distance VI (logarithm of the minimum angle of resolution [logMAR] >0.30), including blindness (logMAR >1.30) in 0.73% (95% CI 0.48 to 0.97, n=31), after adjustment for study design, non-response, age, sex and municipality. The leading causes of blindness included glaucoma (31.7%, 95% CI 18.7 to 44.8), cataract (28.8%, 95% CI 12.6 to 45.1) and diabetic retinopathy (19.1%, 95% CI 4.2 to 34.0). The leading cause of distance VI was uncorrected refractive error (47.4%, 95% CI 43.4 to 51.3). Potentially avoidable VI accounted for 86.1% (95% CI 82.88 to 88.81), an estimated 176 323 cases in the national population aged ≥40 years. 22.3% (95% CI 20.7 to 23.8, n=695) had uncorrected near VI (logMAR >0.30 at 40 cm with distance acuity <0.30). Significant independent associations with distance VI included increasing age, diagnosed diabetes and unemployment. Significant independent associations with near VI included male sex, no health insurance and unemployment. CONCLUSIONS Trinidad and Tobago's burden of avoidable VI exceeds that of other high-income countries. Population and health system priorities are identified to help close the gap.
Collapse
Affiliation(s)
- Tasanee Braithwaite
- Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK .,Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | | | - Tunde Peto
- Centre for Public Health, Blackwell's Queen's University Belfast, Belfast, UK
| | - Debra Bartholomew
- Ophthalmology, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
| | - Frank Deomansingh
- Optometry, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Petra Bridgemohan
- Ophthalmology, Sangre Grande Hospital, Sangre Grande, Trinidad and Tobago
| | - Ayoub Saei
- Biostatistics, Public Health England London Region, London, UK
| | - Subash Sharma
- Optometry, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Deo Singh
- Caribbean Eye Institute, Valsayn, Trinidad and Tobago
| | - Samuel S Ramsewak
- Medicine, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Rupert R A Bourne
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.,Ophthalmology, Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
3
|
Braithwaite T, Winford B, Bailey H, Bridgemohan P, Bartholomew D, Singh D, Sharma S, Sharma R, Silva JC, Gray A, Ramsewak SS, Bourne RRA. Health system dynamics analysis of eyecare services in Trinidad and Tobago and progress towards Vision 2020 Goals. Health Policy Plan 2018; 33:70-84. [PMID: 29092057 DOI: 10.1093/heapol/czx143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 12/24/2022] Open
Abstract
Avoidable blindness is an important global public health concern. This study aimed to assess Trinidad and Tobago's progress towards achieving the Pan American Health Organization, 'Strategic Framework for Vision 2020: The Right to Sight-Caribbean Region,' indicators through comprehensive review of the eyecare system, in order to facilitate health system priority setting. We administered structured surveys to six stakeholder groups, including eyecare providers, patients and older adult participants in the National Eye Survey of Trinidad and Tobago. We reviewed reports, registers and policy documents, and used a health system dynamics framework to synthesize data. In 2014, the population of 1.3 million were served by a pluralistic eyecare system, which had achieved 14 out of 27 Strategic Framework indicators. The Government provided free primary, secondary and emergency eyecare services, through 108 health centres and 5 hospitals (0.26 ophthalmologists and 1.32 ophthalmologists-in-training per 50 000 population). Private sector optometrists (4.37 per 50 000 population), and ophthalmologists (0.93 per 50 000 population) provided 80% of all eyecare. Only 19.3% of the adult population had private health insurance, revealing significant out-of-pocket expenditure. We identified potential weaknesses in the eyecare system where investment might reduce avoidable blindness. These included a need for more ophthalmic equipment and maintenance in the public sector, national screening programmes for diabetic retinopathy, retinopathy of prematurity and neonatal eye defects, and pathways to ensure timely and equitable access to subspecialized surgery. Eyecare for older adults was responsible for an estimated 9.5% (US$22.6 million) of annual health expenditure. This study used the health system dynamics framework and new data to identify priorities for eyecare system strengthening. We recommend this approach for exploring potential health system barriers to addressing avoidable blindness, and other important public health problems.
Collapse
Affiliation(s)
- Tasanee Braithwaite
- Vision and Eye Research Unit, Anglia Ruskin University, East Road, Cambridge CB1?1PT, UK
| | - Blaine Winford
- Department of Ophthalmology, Eric Williams Medical Centre, Mt Hope Hospital, St Augustine, Trinidad
| | - Henry Bailey
- Arthur Lok Jack Graduate School of Business, and HEU, Centre for Health Economics, The University of the West Indies, St Augustine, Trinidad
| | | | | | - Deo Singh
- Caribbean Eye Institute, Valsayn, Trinidad
| | - Subash Sharma
- Faculty of Medical Science, University of the West Indies, St Augustine, Trinidad
| | - Rishi Sharma
- Scarborough General Hospital, Scarborough, Tobago
| | | | - Alastair Gray
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Samuel S Ramsewak
- Faculty of Medical Science, University of the West Indies, St Augustine, Trinidad
| | - Rupert R A Bourne
- Vision and Eye Research Unit, Anglia Ruskin University, East Road, Cambridge CB1?1PT, UK
| |
Collapse
|
4
|
Braithwaite T, Verlander NQ, Bartholomew D, Bridgemohan P, McNally K, Roach A, Sharma S, Singh D, Pesudovs K, Teelucksingh S, Carrington C, Ramsewak S, Bourne R. The National Eye Survey of Trinidad and Tobago (NESTT): Rationale, Objectives and Methodology. Ophthalmic Epidemiol 2017; 24:116-129. [PMID: 28107088 DOI: 10.1080/09286586.2016.1259639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. METHODS A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. RESULTS The fieldwork was conducted over 13 months in 2013-2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. CONCLUSION The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Deo Singh
- g Caribbean Eye Institute , Trinidad
| | | | | | | | | | - Rupert Bourne
- a Vision and Eye Research Unit , Anglia Ruskin University , UK
| | | |
Collapse
|