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Molenaar J, Beňová L, Christou A, Lange IL, van Olmen J. Travelling numbers and broken loops: A qualitative systematic review on collecting and reporting maternal and neonatal health data in low-and lower-middle income countries. SSM Popul Health 2024; 26:101668. [PMID: 38645668 PMCID: PMC11031824 DOI: 10.1016/j.ssmph.2024.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Data and indicator estimates are considered vital to document persisting challenges in maternal and newborn health and track progress towards global goals. However, prioritization of standardised, comparable quantitative data can preclude the collection of locally relevant information and pose overwhelming burdens in low-resource settings, with negative effects on the provision of quality of care. A growing body of qualitative studies aims to provide a place-based understanding of the complex processes and human experiences behind the generation and use of maternal and neonatal health data. We conducted a qualitative systematic review exploring how national or international requirements to collect and report data on maternal and neonatal health indicators are perceived and experienced at the sub-national and country level in low-income and lower-middle income countries. We systematically searched six electronic databases for qualitative and mixed-methods studies published between January 2000 and March 2023. Following screening of 4084 records by four reviewers, 47 publications were included in the review. Data were analysed thematically and synthesised from a Complex Adaptive Systems (CAS) theoretical perspective. Our findings show maternal and neonatal health data and indicators are not fixed, neutral entities, but rather outcomes of complex processes. Their collection and uptake is influenced by a multitude of system hardware elements (human resources, relevancy and adequacy of tools, infrastructure, and interoperability) and software elements (incentive systems, supervision and feedback, power and social relations, and accountability). When these components are aligned and sufficiently supportive, data and indicators can be used for positive system adaptivity through performance evaluation, prioritization, learning, and advocacy. Yet shortcomings and broken loops between system components can lead to unforeseen emergent behaviors such as blame, fear, and data manipulation. This review highlights the importance of measurement approaches that prioritize local relevance and feasibility, necessitating participatory approaches to define context-specific measurement objectives and strategies.
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Affiliation(s)
- Jil Molenaar
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
- University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
| | - Lenka Beňová
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Aliki Christou
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Isabelle L. Lange
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- Center for Global Health, Technical University of Munich (TUM), Munich, Germany
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2
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Nzinga J, Oliwa J, Oluoch D, Jepkosgei J, Mbuthia D, Boga M, Musitia P, Ogola M, Muinga N, Muraya K, Hinga A, Kamuya D, Kelley M, Molyneux S. The hidden emotional labour behind ensuring the social value of research: Experiences of frontline health policy and systems researchers based in Kenya during COVID-19. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002116. [PMID: 37643165 PMCID: PMC10464993 DOI: 10.1371/journal.pgph.0002116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/23/2023] [Indexed: 08/31/2023]
Abstract
Health policy and systems research (HPSR) is a multi-disciplinary, largely applied field of research aimed at understanding and strengthening the performance of health systems, often with an emphasis on power, policy and equity. The value of embedded and participatory HPSR specifically in facilitating the collection of rich data that is relevant to addressing real-world challenges is increasingly recognised. However, the potential contributions and challenges of HPSR in the context of shocks and crises are not well documented, with a particular gap in the literature being the experiences and coping strategies of the HPSR researchers who are embedded in health systems in resource constrained settings. In this paper, we draw on two sets of group discussions held among a group of approximately 15 HPSR researchers based in Nairobi, Kenya, who were conducting a range of embedded HPSR studies throughout the COVID-19 pandemic. The researchers, including many of the authors, were employed by the KEMRI-Wellcome Trust Research Programme (KWTRP), which is a long-standing multi-disciplinary partnership between the Kenya Medical Research Institute and the Wellcome Trust with a central goal of contributing to national and international health policy and practice. We share our findings in relation to three inter-related themes: 1) Ensuring the continued social value of our HPSR work in the face of changing priorities; 2) Responding to shifting ethical procedures and processes at institutional and national levels; and 3) Protecting our own and front-line colleagues' well-being, including clinical colleagues. Our experiences highlight that in navigating research work and responsibilities to colleagues, patients and participants through the pandemic, many embedded HPSR staff faced difficult emotional and ethical challenges, including heightened forms of moral distress, which may have been better prevented and supported. We draw on our findings and the wider literature to discuss considerations for funders and research leads with an eye to strengthening support for embedded HPSR staff, not only in crises such as the on-going COVID-19 pandemic, but also more generally.
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Affiliation(s)
- Jacinta Nzinga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacquie Oliwa
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorothy Oluoch
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Joyline Jepkosgei
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Daniel Mbuthia
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mwanamvua Boga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peris Musitia
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Muthoni Ogola
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Naomi Muinga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - Alex Hinga
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorcas Kamuya
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- Nuffield Department of Population Health, Wellcome Centre for Ethics & Humanities, University of Oxford, Oxford, United Kingdom
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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3
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Varley E. Hospital Paperworlds: Medical (Mis)Reporting and Maternal Health in Northern Pakistan. Med Anthropol Q 2023; 37:23-41. [PMID: 36469657 DOI: 10.1111/maq.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Global health metrics come into being in complex circumstances. Through ethnography that focuses closely on the forces driving uneven obstetric case reporting in a government hospital in northern Pakistan, this article challenges the integrity of the health care system documentation on which the state and non-state interventions and evaluations rely. Incomplete and skipped case records not only resulted from the time constraints posed by work on a busy maternity ward. They also helped vulnerable frontline providers disguise and avoid accountability for the aftermaths of the medical mismanagement and maltreatment made more likely by infrastructural scarcity and disarray. Yet the provider-side protections these tactics afforded came at patients' expense because they rendered error, wrongdoing, and iatrogenesis as invisible and unactionable. The sum of these reporting practices was "hospital paperworlds": defensively authored and aspirational datasets that conveyed desired rather than achieved outcomes, decontextualized risks and harms, and were too-rarely triangulated for their correlational significances or deficiencies. [hospital ethnography, obstetrics, case reporting, metrics, Pakistan].
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Affiliation(s)
- Emma Varley
- Department of Anthropology, Brandon University
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Lee SJ, Vernooij E, Enria L, Kelly AH, Rogers J, Ansumana R, Bangura MH, Lees S, Street A. Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone. Glob Public Health 2022; 17:4129-4145. [PMID: 36168658 DOI: 10.1080/17441692.2022.2110917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper examines health worker experiences in two areas of post-epidemic preparedness in Sierra Leone - vaccine trials and laboratory strengthening - to reflect on the place of people in current models of epidemic response. Drawing on ethnographic research and interviews with health workers in the aftermath of Ebola, it explores the hopes and expectations that interventions foster for frontline workers in under-resourced health systems, and describes the unseen work involved in sustaining robust response infrastructures. Our analysis focuses on what it means for the people who sustain health systems in an emergency to be 'prepared' for an epidemic. Human preparedness entails more than the presence of a labour force; it involves building and maintaining 'relational infrastructures', often fragile social and moral relationships between health workers, publics, governments, and international organisations. The COVID-19 pandemic has underscored the value of rethinking human resources from an anthropological perspective, and investing in the safety and support of people at the forefront of response. In describing the labour, personal losses, and social risks undertaken by frontline workers for protocols and practicality to meet in an emergency context, we describe the social process of preparedness; that is, the contextual engineering and investment that make response systems work.
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Affiliation(s)
- Shona J Lee
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Eva Vernooij
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK.,Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Luisa Enria
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ann H Kelly
- Department of Global Health and Social Medicine, Kings College London, London, UK
| | - James Rogers
- Laboratory Technical Working Group, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Rashid Ansumana
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Mahmood H Bangura
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Shelley Lees
- London School of Hygiene and Tropical Medicine, London, UK
| | - Alice Street
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
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5
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Campbell JI, Musiimenta A, Natukunda S, Eyal N, Haberer JE. "The research assistants kept coming to follow me up; I counted myself as a lucky person": Social support arising from a longitudinal HIV cohort study in Uganda. PLoS One 2022; 17:e0262989. [PMID: 35077497 PMCID: PMC8789171 DOI: 10.1371/journal.pone.0262989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/10/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Participation in longitudinal research studies in resource-limited settings often involves frequent interactions with study staff and other participants, as well as receipt of incentives and transportation reimbursements. Social support-receipt of material and emotional resources from one's social network-has been linked to antiretroviral adherence in sub-Saharan Africa. The extent to which social support arises from study participation, its range and depth, and its implications for observational study conduct, have not been extensively described. METHODS We conducted individual open-ended and semi-structured interviews with participants in a longitudinal, observational antiretroviral therapy adherence monitoring study in Mbarara, Uganda. Participants were asked about their experiences in the longitudinal study and their interactions with research staff. We also interviewed study research assistants (RAs). Deductive and inductive coding were used to identify content related to the experience of study participation. Codes were organized into themes, and relationships between themes were used to develop overarching categories. RESULTS Sixty longitudinal study participants and 6 RAs were interviewed. Instrumental and emotional social support emerged as pervasive and valued aspects of longitudinal study participation. Instrumental support that participants received consisted of enhanced linkage to medical care, health education, and direct and indirect material benefits. Emotional support consisted of perceptions of feeling "cared for" and social interactions that permitted escape from HIV-related stigma. Both instrumental and emotional support often arose through the close relationships participants formed with research staff and with each other. Study-derived social support motivated some participants to adhere to antiretroviral therapy-an unanticipated effect potentially influencing the longitudinal study's primary observational outcome. CONCLUSIONS Longitudinal study participation resulted in instrumental and emotional social support for participants. The depth of support participants experienced has implications for observational study design in resource-limited settings, including need to assess potential effects on study outcomes; consideration of social support during risk/benefit assessment in study ethics review and consent; and vigilance for consequences of social support loss when studies end.
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Affiliation(s)
| | - Angella Musiimenta
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Nir Eyal
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, United States of America
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Jessica E. Haberer
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
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6
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Bain LE, Tchuisseu-Kwangoua LA, Adeagbo O, Nkfusai NC, Amu H, Saah FI, Kombe F. Fostering research integrity in sub-Saharan Africa: challenges, opportunities, and recommendations. Pan Afr Med J 2022; 43:182. [PMID: 36923394 PMCID: PMC10008683 DOI: 10.11604/pamj.2022.43.182.37804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Integrity and adherence to appropriate ethical standards are important elements of research. These standards are key to protecting research participants´ rights as well as ensuring the reliability and quality of research outputs. Although empirical evidence is scanty, several authors have alluded to the fact that violation of research integrity standards could be common in low- and middle-income countries including sub-Saharan Africa (SSA). Understanding the issues, challenges, and opportunities of research integrity and ethics in SSA is key to promoting the responsible conduct of research and the protection of research participants. This paper presents the authors´ critical views and recommendations on the current state of research integrity in SSA. We argue that understanding the current research integrity architecture in SSA has the potential to identify opportunities to promote responsible conduct of research in SSA. Such opportunities include, but are not limited to transparency, accountability, and reproducibility of research, which collectively lead to enhanced public trust in the research enterprise. We highlight the need to embrace equity, fairness, diversity, and inclusivity in the research cycle from conception (priority setting), funding, implementation, dissemination of findings, and scale up. We move on to provide a rationale for understanding the differences and similarities between research ethics and research integrity. Governments, research, and academic institutions must develop multifaceted approaches to promote compliance with principles of research integrity by developing and implementing clear research integrity policies and guidelines that foster responsible conduct of research and prioritize capacity building and empowerment of early career researchers, students, and other targeted key stakeholders.
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Affiliation(s)
- Luchuo Engelbert Bain
- Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa.,International Development Research Centre (IDRC), Ottawa, Canada
| | - Larissa Ange Tchuisseu-Kwangoua
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Research Department, Medical Mind Association, Yaoundé, Cameroon
| | - Oluwafemi Adeagbo
- Department of Community and Behavioral Health, College of Public Health, University of lowa, lowa, United States.,Department of Sociology, University of Johannesburg, Auckland Park, Johannesburg, South Africa
| | | | - Hubert Amu
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Farrukh Ishaque Saah
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Francis Kombe
- African Research Integrity Network, Durban, South Africa.,EthiXPERT, Pretoria, South Africa.,University of KwaZulu Natal, KwaZulu Natal, South Africa
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7
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Morton B, Vercueil A, Masekela R, Heinz E, Reimer L, Saleh S, Kalinga C, Seekles M, Biccard B, Chakaya J, Abimbola S, Obasi A, Oriyo N. Consensus statement on measures to promote equitable authorship in the publication of research from international partnerships. Anaesthesia 2021; 77:264-276. [PMID: 34647323 PMCID: PMC9293237 DOI: 10.1111/anae.15597] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
Despite the acknowledged injustice and widespread existence of parachute research studies conducted in low‐ or middle‐income countries by researchers from institutions in high‐income countries, there is currently no pragmatic guidance for how academic journals should evaluate manuscript submissions and challenge this practice. We assembled a multidisciplinary group of editors and researchers with expertise in international health research to develop this consensus statement. We reviewed relevant existing literature and held three workshops to present research data and holistically discuss the concept of equitable authorship and the role of academic journals in the context of international health research partnerships. We subsequently developed statements to guide prospective authors and journal editors as to how they should address this issue. We recommend that for manuscripts that report research conducted in low‐ or middle‐income countries by collaborations including partners from one or more high‐income countries, authors should submit accompanying structured reflexivity statements. We provide specific questions that these statements should address and suggest that journals should transparently publish reflexivity statements with accepted manuscripts. We also provide guidance to journal editors about how they should assess the structured statements when making decisions on whether to accept or reject submitted manuscripts. We urge journals across disciplines to adopt these recommendations to accelerate the changes needed to halt the practice of parachute research.
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Affiliation(s)
- B Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A Vercueil
- King's College Hospital NHS Foundation Trust, London, UK
| | - R Masekela
- Head of Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - E Heinz
- Departments of Clinical Sciences and of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - L Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Saleh
- Wellcome Trust Clinical, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - C Kalinga
- Department of Social Anthropology, University of Edinburgh, Edinburgh, UK
| | - M Seekles
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - B Biccard
- Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - J Chakaya
- Global Respiratory Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Medicine, Dermatology and Therapeutics, School of Medicine, Kenyatta University, Nairobi, Kenya
| | - S Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
| | - A Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,AXESS Clinic, Royal Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N Oriyo
- National Institute of Medical Research, Dar es Salaam, Tanzania
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8
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Agathokleous E. Mastering the scientific peer review process: tips for young authors from a young senior editor. JOURNAL OF FORESTRY RESEARCH 2021; 33:1-20. [PMID: 34545272 PMCID: PMC8443951 DOI: 10.1007/s11676-021-01388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
Are you a student at a higher institution or an early-career researcher who is striving to understand and master the peer review process so to increase the odds of getting a paper published in the Journal of Forestry Research or another reputable, peer-reviewed, scientific journal? In this paper, a young, senior editor provides a handbook of the peer review process based on his decadal experience in scientific publishing. He covers major information you need to know during the entire process, from selecting journals to completing the proofing of your accepted paper. He introduces key points for consideration, such as avoidance of predatory journals, dubious research practices and ethics, interaction with peers, reviewers, and editors, and the pursuit of aretê. Finally, he points out some common statistical errors and misconceptions, such as P hacking and incorrect effect size inference. He hopes that this paper will enhance your understanding and knowledge of the peer-review process.
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Affiliation(s)
- Evgenios Agathokleous
- Department of Ecology, School of Applied Meteorology, Nanjing University of Information Science and Technology (NUIST), Nanjing, 210044 People’s Republic of China
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9
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Closser S, Mendenhall E, Brown P, Neill R, Justice J. The anthropology of health systems: A history and review. Soc Sci Med 2021; 300:114314. [PMID: 34400012 DOI: 10.1016/j.socscimed.2021.114314] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/04/2021] [Accepted: 08/11/2021] [Indexed: 12/17/2022]
Abstract
Ethnographies of health systems are a theoretically rich and rapidly growing area within medical anthropology. Critical ethnographic work dating back to the 1950s has taken policymakers and health staff as points of entry into the power structures that run through the global health enterprise. In the last decade, there has been a surge of ethnographic work on health systems. We conceptualize the anthropology of health systems as a field; review the history of this body of knowledge; and outline emergent literatures on policymaking, HIV, hospitals, Community Health Workers, health markets, pharmaceuticals, and metrics. High-quality ethnographic work is an excellent way to understand the complex systems that shape health outcomes, and provides a critical vantage point for thinking about global health policy and systems. As theory in this space develops and deepens, we argue that anthropologists should look beyond the discipline to think through what their work does and why it matters.
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Affiliation(s)
- Svea Closser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Rm E5545, Baltimore, MD, 21205, USA.
| | - Emily Mendenhall
- Science, Technology and International Affairs Program, Edmund A. Walsh School of Foreign Service, Georgetown University, USA
| | - Peter Brown
- Department of Anthropology, Emory University, USA
| | - Rachel Neill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Judith Justice
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, USA
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10
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Steinert JI, Atika Nyarige D, Jacobi M, Kuhnt J, Kaplan L. A systematic review on ethical challenges of 'field' research in low-income and middle-income countries: respect, justice and beneficence for research staff? BMJ Glob Health 2021; 6:bmjgh-2021-005380. [PMID: 34285041 PMCID: PMC8292801 DOI: 10.1136/bmjgh-2021-005380] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/24/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Primary data collection in low-income and middle-income countries (LMICs) is associated with a range of ethical complexities. Considerations on how to adequately ensure the well-being of research staff are largely neglected in contemporary ethics discourse. This systematic review aims to identify the ethical challenges that research staff across different hierarchical levels and scientific disciplines face when conducting research in LMICs. Methods We searched 13 electronic databases and handsearched publications in six selected journals as well as the reference lists of all included studies. No restrictions were applied with respect to the publication date, research design, and target population. Results 23 151 studies were retrieved, 183 of which met our inclusion criteria. We identified nine different types of ethical challenges that research staff may be exposed to during field research, including (1) role conflicts that can emerge from participants’ help requests and the high level of deprivation found in certain study settings, (2) feelings of guilt and (3) detrimental mental health impacts. Further challenges were (4) sexual harassment (5) safety risks and (6) political repression, particularly in postconflict, disaster-ridden or autocratic study contexts. Additionally, studies reported (7) inadequate working conditions and (8) power imbalances within research teams, while (9) ethics boards were found to be ill equipped to anticipate and address emerging risks, thus increasing the ethical liability of researchers. Conclusion This review revealed several complex ethical challenges that research staff may face during data collection. In order to achieve the Sustainable Development Goal 8.8 on ‘safe and secure working environments’ and to protect research staff from harm, amendments must urgently be made to current ethical standards. PROSPERO registration number CRD42019131013
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Affiliation(s)
- Janina Isabel Steinert
- TUM School of Governance, Technical University of Munich, Munich, Germany .,Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - David Atika Nyarige
- Independent Development Evaluation (IDEV), African Development Bank (AfDB), Abidjan, COTE D'IVOIRE
| | | | - Jana Kuhnt
- German Development Institute, Bonn, Germany
| | - Lennart Kaplan
- University of Göttingen, Gottingen, Germany.,Institute for the World Economy, Kiel, Germany
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11
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Masunaga Y, Jaiteh F, Manneh E, Balen J, Okebe J, D'Alessandro U, Nieto-Sanchez C, de Vries DH, Gerrets R, Peeters Grietens K, Muela Ribera J. The Community Lab of Ideas for Health: Community-Based Transdisciplinary Solutions in a Malaria Elimination Trial in The Gambia. Front Public Health 2021; 9:637714. [PMID: 34354972 PMCID: PMC8329351 DOI: 10.3389/fpubh.2021.637714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background: Community participation in global health interventions may improve outcomes and solve complex health issues. Although numerous community participatory approaches have been developed and introduced, there has been little focus on "how" and "who" to involve in the implementation of community-based clinical trials where unequal distribution of power between implementers and communities pre-exists. Addressing how to achieve community-based solutions in a malaria elimination trial in The Gambia, we developed the Community Lab of Ideas for Health (CLIH): a participatory approach that enabled communities to shape trial implementation. Methods: As part of transdisciplinary research, we conducted qualitative research with in-depth interviews, discussions, and observations in 17 villages in the North Bank Region of The Gambia between March 2016 and December 2017. We designed an iterative research process involving ethnography, stakeholder-analysis, participatory-discussions, and qualitative monitoring and evaluation, whereby each step guided the next. We drew upon ethnographic results and stakeholder-analysis to identify key-informants who became participants in study design and implementation. The participatory-discussions provided a co-creative space for sharing community-centric ideas to tackle trial implementation challenges. The proposed strategies for trial implementation were continuously refined and improved through our monitoring and evaluation. Results: The CLIH incorporated communities' insights, to co-create tailored trial implementation strategies including: village health workers prescribing and distributing antimalarial treatments; "compounds" as community-accepted treatment units; medicine distribution following compound micro-politics; and appropriate modes of health message delivery. Throughout the iterative research process, the researchers and communities set the common goal, namely to curtail the medical poverty trap by reducing malaria transmission and the burden thereof. This innovative collaborative process built trust among stakeholders and fully engaged researchers and communities in co-creation and co-implementation of the trial. Discussion: The CLIH approach succeeded in touching the local realities by incorporating a spectrum of perspectives from community-members and discerning project-derived knowledge from local-knowledge. This process allowed us to co-develop locally-oriented solutions and ultimately to co-establish an intervention structure that community-members were ready and willing to use, which resulted in high uptake of the intervention (92% adherence to treatment). Successfully, the CLIH contributed in bridging research and implementation.
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Affiliation(s)
- Yoriko Masunaga
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
| | - Fatou Jaiteh
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Ebrima Manneh
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Joseph Okebe
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Claudia Nieto-Sanchez
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
| | - Daniel H. de Vries
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
| | - René Gerrets
- Department of Sociology and Anthropology, Faculty of Social and Behavioural Science, University of Amsterdam, Amsterdam, Netherlands
| | - Koen Peeters Grietens
- Department of Public Health, Unit of Socio-Ecological Health Research, Institute of Tropical Medicine, Antwerp, Belgium
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Joan Muela Ribera
- PASS Suisse, Neuchâtel, Switzerland
- Medical Anthropology Research Centre (MARC) at Departament d'Antropologia, Filosofia i Treball Social, Universitat Rovira i Virgili, Tarragona, Spain
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12
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Hussaindeen JR. The extent of scam in the scientific world - How intellectual can the scam appear? JOURNAL OF OPTOMETRY 2021; 14:295-296. [PMID: 33419713 PMCID: PMC8258123 DOI: 10.1016/j.optom.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/18/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Jameel Rizwana Hussaindeen
- Binocular Vision Clinic, Sankara Nethralaya, Unit of Medical Research Foundation, 18, College Road, Nungambakkam, Chennai, 600006, India.
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13
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Fehr A, Nieto-Sanchez C, Muela J, Jaiteh F, Ceesay O, Maneh E, Baldeh D, Achan J, Dabira E, Conteh B, Bunders-Aelen J, Smekens T, Broekhuizen H, D'Alessandro U, Peeters Grietens K. From informed consent to adherence: factors influencing involvement in mass drug administration with ivermectin for malaria elimination in The Gambia. Malar J 2021; 20:198. [PMID: 33902611 PMCID: PMC8073909 DOI: 10.1186/s12936-021-03732-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/08/2021] [Indexed: 11/29/2022] Open
Abstract
Background The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement—coverage, adherence, and compliance—that cast doubts about the actual and potential epidemiological impact of MDA on disease control and elimination. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. Methods This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA. Results 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. Conclusions This study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03732-z.
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Affiliation(s)
- Alexandra Fehr
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Claudia Nieto-Sanchez
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joan Muela
- Medical Anthropology Research Center, Universitat Rovira I Virgill, Tarragona, Spain
| | - Fatou Jaiteh
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Omar Ceesay
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ebrima Maneh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Dullo Baldeh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Jane Achan
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Edgard Dabira
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bakary Conteh
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Tom Smekens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D'Alessandro
- Medical Research Council Unit Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Koen Peeters Grietens
- Unit of Socio-Ecological Health Research, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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14
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Lawrence DS, Tsholo K, Ssali A, Mupambireyi Z, Hoddinott G, Nyirenda D, Meya DB, Ndhlovu C, Harrison TS, Jarvis JN, Seeley J. The Lived Experience Of Participants in an African RandomiseD trial (LEOPARD): protocol for an in-depth qualitative study within a multisite randomised controlled trial for HIV-associated cryptococcal meningitis. BMJ Open 2021; 11:e039191. [PMID: 33820784 PMCID: PMC8030472 DOI: 10.1136/bmjopen-2020-039191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Individuals recruited into clinical trials for life-threatening illnesses are particularly vulnerable. This is especially true in low-income settings. The decision to enrol may be influenced by existing inequalities, poor healthcare infrastructure and fear of death. Where patients are confused or unconscious the responsibility for this decision falls to relatives. This qualitative study is nested in the ongoing AMBIsome Therapy Induction OptimisatioN (AMBITION) Trial. AMBITION is recruiting participants from five countries in sub-Saharan Africa and is trialling a novel treatment approach for HIV-associated cryptococcal meningitis, an infection known to affect brain function. We aim to learn from the experiences of participants, relatives and researchers involved in AMBITION. METHODS AND ANALYSIS We will collect data through in-depth interviews with trial participants and the next of kin of participants who were confused at enrolment and therefore provided surrogate consent. Data will be collected in Gaborone, Botswana; Kampala, Uganda and Harare, Zimbabwe. Interviews will follow a narrative approach including participatory drawing of participation timelines. This will be supplemented by direct observation of the research process at each of the three recruiting hospitals. Interviews will also take place with researchers from the African and European institutions that form the partnership through which the trial is administered. Interviews will be transcribed verbatim, translated (if necessary) and organised thematically for narrative analysis. ETHICS AND DISSEMINATION This study has been approved by the Health Research Development Committee, Gaborone (Reference: HPDME:13/18/1); Makerere School of Health Sciences Institutional Review Board, Kampala (Reference: 2019-061); University of Zimbabwe Joint Research Ethics Committee, Harare (Reference: 219/19), and the London School of Hygiene and Tropical Medicine (Reference: 17957). Study findings will be shared with research participants from the sites, key stakeholders at each research institution and ministries of health to help inform the development and implementation of future trials. The findings of this study will be published in journals and presented at academic meetings. TRIAL REGISTRATION Registered at www.clinicaltrials.gov:NCT04296292.
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Affiliation(s)
- David S Lawrence
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Katlego Tsholo
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Agnes Ssali
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Deborah Nyirenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - David B Meya
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Chiratidzo Ndhlovu
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Thomas S Harrison
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Joseph N Jarvis
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Social Aspects of Health Programme, MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
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15
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Laar AK, Redman BK, Ferguson K, Caplan A. Institutional Approaches to Research Integrity in Ghana. SCIENCE AND ENGINEERING ETHICS 2020; 26:3037-3052. [PMID: 32779114 DOI: 10.1007/s11948-020-00257-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/01/2020] [Indexed: 05/12/2023]
Abstract
Research misconduct (RM) remains an important problem in health research despite decades of local, national, regional, and international efforts to eliminate it. The ultimate goal of every health research project, irrespective of setting, is to produce trustworthy findings to address local as well as global health issues. To be able to lead or participate meaningfully in international research collaborations, individual and institutional capacities for research integrity (RI) are paramount. Accordingly, this paper concerns itself not only with individuals' research skills but also with institutional and national policies and governance. Such policies and governance provide an ethical scaffold for the production of knowledge and structure incentives. This paper's operational definition of research therefore draws from Institute of Medicine's articulation of health research as an inquiry that aims to produce knowledge about the structure, processes, or effects of personal health services; and from an existing health systems framework. The paper reviews the research regulatory environment and the ethics apparatus in Ghana, and describes a project jointly undertaken by Ghanaian researchers in collaboration with New York University to assess the perceived adequacy of current institutional practices, opportunities, and incentives for promoting RI.
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Affiliation(s)
- Amos K Laar
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Box LG 13, Legon, Accra, Ghana.
| | - Barbara K Redman
- Division of Medical Ethics, New York University Grossman School of Medicine, New York, NY, USA
| | - Kyle Ferguson
- Division of Medical Ethics, New York University Grossman School of Medicine, New York, NY, USA
| | - Arthur Caplan
- Division of Medical Ethics, New York University Grossman School of Medicine, New York, NY, USA
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16
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Goodman R. Getting Creative with Data: Managing Relationships and Quantitative Proof in an Indian NGO. AMERICAN ANTHROPOLOGIST 2020. [DOI: 10.1111/aman.13477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rachael Goodman
- International and Global Studies Mercer University Macon GA 31207 USA
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17
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Lorway R. Experimental Entanglements: Surveillance Science, Sex Worker Activism, and Evidentiary Politics in Kenya. Med Anthropol Q 2020; 34:398-419. [PMID: 32521087 DOI: 10.1111/maq.12593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
In Kenya, globally circulating HIV surveillance techniques are implicated in an emergent experimental terrain that merges scientific interest with health administration agendas. Sex worker activists reroute and repurpose this technocratic knowledge to more precisely pinpoint and defy the undemocratic imperatives of an encroaching experimental order that aims to govern the health of key populations. Reconstructing the conditions of emergence of these evidentiary politics reveals growing interdependencies between sex workers and scientific and technical experts as they are brought into increasing interaction with each other.
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Affiliation(s)
- Robert Lorway
- The Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba
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18
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Yi N, Nemery B, Dierickx K. Perceptions of research integrity and the Chinese situation: In-depth interviews with Chinese biomedical researchers in Europe. Account Res 2019; 26:405-426. [DOI: 10.1080/08989621.2019.1652096] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nannan Yi
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Department of Medical Humanities, Southeast University, China
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Kris Dierickx
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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19
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Kingori P, Gerrets R. The masking and making of fieldworkers and data in postcolonial Global Health research contexts. CRITICAL PUBLIC HEALTH 2019; 29:494-507. [PMID: 31391710 PMCID: PMC6636901 DOI: 10.1080/09581596.2019.1609650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
Abstract
This paper centres on the roles and contributions of fieldworkers-local data-collectors in Global Health research in postcolonial contexts. It is informed by two separate ethnographies, conducted in two different East African biomedical research institutions. It discusses how common characterisations of fieldworkers as 'low-skilled' and 'local' make them attractive to research institutions in two important ways - as community-embedded data-collectors thus facilitating community participation and as being unlikely to fabricate data because they lack the skills to avoid detection. This paper questions these assumptions. It draws on Daston's idea of the 'scientific persona' and Fanon's concepts of mask-making to explore how fieldworkers construct identities and data within their liminal roles. Fieldworkers create particular pseudo-personae or masks for getting and staying employed. They dumb-down CVs and emphasise their similarities with community members in ways which are partially 'real' but also 'fake'. These constructed identities provide fieldworkers with a persona that allows them to fabricate or modify data without raising suspicions. They frequently engage in practices known as 'genuine fake' data fabrication which is data perceived as factually correct and verifiable yet methodologically incorrect, hence it is real and fake in varying degrees. We understand the 'pseudo' as the blurry space between real and fake where fieldworkers construct their identities and data. Given the seemingly laudable aims of Global Health, we argue that fieldworkers' masking and making up data signal the need for greater attention by those designing its research, to better understand and address why and how these practices unfold.
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Affiliation(s)
- Patricia Kingori
- The Ethox Centre, and Wellcome Centre of Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - René Gerrets
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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20
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Affiliation(s)
- Patricia Kingori
- The Ethox Centre, and Wellcome Centre of Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - René Gerrets
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
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21
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Affiliation(s)
- Susan Erikson
- Faculty of Health Sciences, Simon Fraser, Burnaby, British Columbia, Canada
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22
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Douglas-Jones R. Getting inside ethical review: anxious bureaucracies of revelation, anticipation and virtue. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1591615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rachel Douglas-Jones
- Technologies in Practice, Department of Business IT, IT University of Copenhagen, Copenhagen, Denmark
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23
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Alenichev A, Nguyen VK. Precarity, clinical labour and graduation from Ebola clinical research in West Africa. Glob Bioeth 2019; 30:1-18. [PMID: 30692879 PMCID: PMC6338271 DOI: 10.1080/11287462.2019.1566973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/04/2019] [Indexed: 12/03/2022] Open
Abstract
The provision of gifts and payments for healthy volunteer subjects remains an important topic in global health research ethics. This paper provides empirical insights into theoretical debates by documenting participants' perspectives on an Ebola vaccine trial in West Africa. This trial provided hundreds of Africans with regular payments, food packages and certificates for participation. The researchers conducting the trials considered these socioeconomic provisions to be gifts in accordance with contemporary ethical standards and principles. Trial participants viewed them differently, however, approaching trial participation as a means for training and employment in what was from their perspective a new job market: the post-Ebola expansion of research and health care systems. This paper analyses participation in contemporary research by viewing the context-specific histories of trial participants through the lens of prior interventions, specifically participatory reintegration programmes conducted in Anglophone West Africa to overcome civil war crises. In particular, we argue that participation in the Ebola vaccine trial was inadvertently shaped by the design and outcomes of past reintegration programmes. Our results highlight the need to investigate existing socioeconomic landscapes which surround and indeed permeate clinical research as a prerequisite for understanding the participatory motives of vulnerable participants in West Africa and elsewhere.
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Affiliation(s)
- Arsenii Alenichev
- Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands.,ISGlobal, Barcelona, Spain
| | - Vinh-Kim Nguyen
- Graduate Institute of International and Development Studies, Geneva, Switzerland
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24
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Wang MQ, Yan AF, Katz RV. Researcher Requests for Inappropriate Analysis and Reporting: A U.S. Survey of Consulting Biostatisticians. Ann Intern Med 2018; 169:554-558. [PMID: 30304365 DOI: 10.7326/m18-1230] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inappropriate analysis and reporting of biomedical research remain a problem despite advances in statistical methods and efforts to educate researchers. OBJECTIVE To determine the frequency and severity of requests biostatisticians receive from researchers for inappropriate analysis and reporting of data during statistical consultations. DESIGN Online survey. SETTING United States. PARTICIPANTS A randomly drawn sample of 522 American Statistical Association members self-identifying as consulting biostatisticians. MEASUREMENTS The Bioethical Issues in Biostatistical Consulting Questionnaire soliciting reports about the frequency and perceived severity of specific requests for inappropriate analysis and reporting. RESULTS Of 522 consulting biostatisticians contacted, 390 provided sufficient responses: a completion rate of 74.7%. The 4 most frequently reported inappropriate requests rated as "most severe" by at least 20% of the respondents were, in order of frequency, removing or altering some data records to better support the research hypothesis; interpreting the statistical findings on the basis of expectation, not actual results; not reporting the presence of key missing data that might bias the results; and ignoring violations of assumptions that would change results from positive to negative. These requests were reported most often by younger biostatisticians. LIMITATIONS The survey provides information on the reported frequency of inappropriate requests but not on how such requests were handled or whether the requests reflected researchers' maleficence or inadequate knowledge about statistical and research methods. In addition, other inappropriate requests may have been made that were not prespecified in the survey. CONCLUSION This survey suggests that researchers frequently make inappropriate requests of their biostatistical consultants regarding the analysis and reporting of their data. Understanding the reasons for these requests and how they are handled requires further study. PRIMARY FUNDING SOURCE U.S. Department of Health and Human Services.
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Affiliation(s)
- Min Qi Wang
- University of Maryland School of Public Health, College Park, Maryland (M.Q.W.)
| | - Alice F Yan
- University of Wisconsin-Milwaukee Joseph J. Zilber School of Public Health, Milwaukee, Wisconsin (A.F.Y.)
| | - Ralph V Katz
- New York University College of Dentistry, New York, New York (R.V.K.)
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25
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Melberg A, Diallo AH, Storeng KT, Tylleskär T, Moland KM. Policy, paperwork and ‘postographs’: Global indicators and maternity care documentation in rural Burkina Faso. Soc Sci Med 2018; 215:28-35. [DOI: 10.1016/j.socscimed.2018.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 09/01/2018] [Accepted: 09/03/2018] [Indexed: 11/17/2022]
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26
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Phiri M, Gooding K, Nyirenda D, Sambakunsi R, Kumwenda MK, Desmond N. "Not just dogs, but rabid dogs": tensions and conflicts amongst research volunteers in Malawi. Glob Bioeth 2018; 29:65-80. [PMID: 30202397 PMCID: PMC6127836 DOI: 10.1080/11287462.2018.1509925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 08/05/2018] [Indexed: 12/01/2022] Open
Abstract
Building trust between researchers and communities involved in research is one goal of community engagement. This paper examines the implications of community engagement for trust within communities, including trust among community volunteers who assist with research and between these volunteers and other community members. We describe the experiences of two groups of community volunteers recruited as part of an HIV and TB intervention trial in Malawi: cluster representatives, recruited both to act as key informants for TB suspects and mortality reporting and to identify and report community concerns, and community counsellors, recruited to provide semi-supervised HIV self-testing. We examine tensions experienced due to playing multiple roles, and the implications of volunteer responsibilities for short- and long-term community relationships. Data was collected through a workshop, in-depth interviews and focus group discussions with volunteers and community members. While the volunteer system initially enhanced trust among volunteers and with the community, relationships deteriorated when cluster representatives assumed an additional supervisory role part-way through the trial. Combined with challenging recruitment targets and unequal power relations between volunteers, this new role damaged trust, with implications for volunteer well-being and social relationships. These experiences suggest researchers should consider potential social implications when designing community engagement systems.
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Affiliation(s)
- Mackwellings Phiri
- Malawi Liverpool Welcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Kate Gooding
- Malawi Liverpool Welcome Trust Clinical Research Programme, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Deborah Nyirenda
- Malawi Liverpool Welcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rodrick Sambakunsi
- Malawi Liverpool Welcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Nicola Desmond
- Malawi Liverpool Welcome Trust Clinical Research Programme, Blantyre, Malawi.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
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27
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Hutchinson E, Nayiga S, Nabirye C, Taaka L, Staedke SG. Data value and care value in the practice of health systems: A case study in Uganda. Soc Sci Med 2018; 211:123-130. [PMID: 29935402 DOI: 10.1016/j.socscimed.2018.05.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
Abstract
In anthropology, interest in how values are created, maintained and changed has been reinvigorated. In this case study, we draw on this literature to interrogate concerns about the relationship between data collection and the delivery of patient care within global health. We followed a pilot study conducted in Kayunga, Uganda that aimed to improve the collection of health systems data in five public health centres. We undertook ethnographic research from July 2015 to September 2016 in health centres, at project workshops, meetings and training sessions. This included three months of observations by three fieldworkers; in-depth interviews with health workers (n = 15) and stakeholders (n = 5); and six focus group discussions with health workers. We observed that measurement, calculation and narrative practices could be assigned care-value or data-value and that the attempt to improve data collection within health facilities transferred 'data-value' into health centres with little consideration among project staff for its impact on care. We document acts of acquiescence and resistance to data-value by health workers. We also describe the rare moments when senior health workers reconciled these two forms of value, and care-value and data-value were enacted simultaneously. In contrast to many anthropological accounts, our analysis suggests that data-value and care-value are not necessarily conflicting. Actors seeking to make changes in health systems must, however, take into account local forms of value and devise health systems interventions that reinforce and enrich existing ethically driven practice.
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Affiliation(s)
- Eleanor Hutchinson
- London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, Kampala, Uganda
| | - Christine Nabirye
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, Kampala, Uganda
| | - Lilian Taaka
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, Kampala, Uganda
| | - Sarah G Staedke
- Infectious Diseases Research Collaboration, Plot 2C Nakasero Hill Road, Kampala, Uganda; London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
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28
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Tichenor M. Data Performativity, Performing Health Work: Malaria and Labor in Senegal. Med Anthropol 2017; 36:436-448. [DOI: 10.1080/01459740.2017.1316722] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marlee Tichenor
- Global Health Governance Programme, Usher Institute for Population Health Sciences and Informatics, University of Edinburgh Medical School, Edinburgh, United Kingdom
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Abstract
Globally, HIV programs face pressure to document their accountability and achievements using “evidence-based” criteria or “monitoring and evaluation” (“M&E”), yet little is known about how M&E occurs on the ground or its social and political effects. This paper explores how NGO actors in Ghana experienced routine documentation of a USAID-funded HIV program. Drawing upon 20 months of ethnographic fieldwork, I illustrate how M&E documentation reproduces hierarchical aid relations by engaging NGO actors to self-govern through unexpected strict adherence to documentation requirements. I explore institutional supervisors' frustration with their deference to documentation to further show how inequality is indirectly reproduced.
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Pigg SL, Erikson SL, Inglis K. Introduction: Document/ation : Pouvoir, intérêts, redevabilités. ANTHROPOLOGICA 1969. [DOI: 10.3138/anth.60.1.t17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dans cette introduction, nous avançons que l'attention ethnographique portée aux documents, un élément banal de notre quotidien, peut révéler des manœuvres sociales qui accélèrent ou préservent des configurations particulières de pouvoir et d'imputabilité. Nous employons l'expression « document/ation » pour rendre compte des possibles relevant des moments d'action. Les articles de ce numéro spécial mettent en évidence les tensions dynamiques entre la systématisation et l'ambigüité qui résultent des situations de vérification, d'appréciation et de validation.
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Pigg SL, Erikson SL, Inglis K. Introduction: Document/ation: Power, Interests, Accountabilities. ANTHROPOLOGICA 1969. [DOI: 10.3138/anth.60.1.t16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this introduction we argue that ethnographic attention to documents, as a mundane feature of everyday life, can reveal social manoeuvres that accelerate or detain particular configurations of power and accountability. We use the term “document/ation” to convey this space of possibility in moments of action. The articles collected in this special issue foreground the dynamic tensions between systematisation and ambiguity that arise in situations of verification, appraisal or validation.
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