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Ng SH, Kaur S, Cheah PY, Ong ZL, Lim J, Voo TC. Migration health ethics in Southeast Asia: a scoping review. Wellcome Open Res 2024; 8:391. [PMID: 38595706 PMCID: PMC11002524 DOI: 10.12688/wellcomeopenres.19572.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 04/11/2024] Open
Abstract
Background Asia hosts the second-largest international migrant population in the world. In Southeast Asia (SEA), key types of migration are labour migration, forced migration, and environmental migration. This scoping review seeks to identify key themes and gaps in current research on the ethics of healthcare for mobile and marginalised populations in SEA, and the ethics of research involving these populations. Methods We performed a scoping review using three broad concepts: population (stateless population, migrants, refugees, asylum seekers, internally displaced people), issues (healthcare and ethics), and context (11 countries in SEA). Three databases (PubMed, CINAHL, and Web of Science) were searched from 2000 until May 2023 over a period of four months (February 2023 to May 2023). Other relevant publications were identified through citation searches, and six bioethics journals were hand searched. All searches were conducted in English, and relevant publications were screened against the inclusion and exclusion criteria. Data were subsequently imported into NVivo 14, and thematic analysis was conducted. Results We identified 18 papers with substantial bioethical analysis. Ethical concepts that guide the analysis were 'capability, agency, dignity', 'vulnerability', 'precarity, complicity, and structural violence' (n=7). Ethical issues were discussed from the perspective of research ethics (n=9), clinical ethics (n=1) and public health ethics (n=1). All publications are from researchers based in Singapore, Thailand, and Malaysia. Research gaps identified include the need for more research involving migrant children, research from migrant-sending countries, studies on quality of migrant healthcare, participatory health research, and research with internal migrants. Conclusions More empirical research is necessary to better understand the ethical issues that exist in the domains of research, clinical care, and public health. Critical examination of the interplay between migration, health and ethics with consideration of the diverse factors and contexts involved is crucial for the advancement of migration health ethics in SEA.
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Affiliation(s)
- Shu Hui Ng
- School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, 47500, Malaysia
| | - Sharon Kaur
- Faculty of Law, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand
- Centre for Tropical Medicine and Global Health, Oxford, OX3 7LG, UK
| | - Zhen Ling Ong
- Centre for Epidemiology and Evidence-based Practice, Department of Social and Preventive Medicine, University Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, 50603, Malaysia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Jane Lim
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
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Dhamanaskar R, Feldman WB, Merz JF. Practicalities of Impracticability: An Interim Review of Randomized Controlled Trials. J Empir Res Hum Res Ethics 2022; 17:329-345. [PMID: 35440213 DOI: 10.1177/15562646221092663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Impracticability is an ethical standard for waiver of informed consent in research. We examine how well the criterion of impracticability appears to have been fulfilled in a set of 36 completed randomized controlled trials (RCTs) that secured consent from some subjects or LARs and employed waivers to enroll others. These trials were identified among 155 RCTs using waivers of consent in a convenience sample drawn from 7 systematic reviews. Recruitment data were available for 19 of the 36 trials, revealing an average of 41.6% of subjects (range 0.2-98.7%, 95% CI: 24.8-58.4%) were enrolled without consent. Six trials enrolled less than 10% of subjects without consent and an overlapping set of 9 trials sought consent from all subjects or LARs at some sites while waiving consent at other sites. We question whether these trials were practicable without waivers and identify issues for consideration by investigators and ethics review boards.
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Affiliation(s)
- Roma Dhamanaskar
- Department of Health Research Methods, Evidence and Impact, 152969McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, Ontario, Canada L8S 4K1
| | - William B Feldman
- Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, 1861Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA
| | - Jon F Merz
- Department of Medical Ethics & Health Policy, 14640Perelman School of Medicine at the University of Pennsylvania, Blockley Hall Floor 14, 423 Guardian Drive, Philadelphia, Pennsylvania 19104-4884, USA
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Berkhout SG. Placebos in Schizophrenia Research: An Historical Overview and Introduction to Ethical Issues. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac051. [PMID: 39144788 PMCID: PMC11206101 DOI: 10.1093/schizbullopen/sgac051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
This short introduction provides a historical and ethical overview of placebos and placebo controls in relation to schizophrenia research, with a focus on long-term clinical trials. Drawing on historical and philosophical scholarship, it sketches a two-level analysis of ethical issues that placebos and the placebo effect raise for the field, particularly in light of shifts in clinical trial methodologies and clinical practices.
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Affiliation(s)
- Suze G Berkhout
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- University of Toronto Institute for the History & Philosophy of Science & Technology, Toronto, Ontario, Canada
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Data protection, data management, and data sharing: Stakeholder perspectives on the protection of personal health information in South Africa. PLoS One 2021; 16:e0260341. [PMID: 34928950 PMCID: PMC8687565 DOI: 10.1371/journal.pone.0260341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
The Protection of Personal Information Act (POPIA) 2013 came into force in South Africa on 1 July 2020. It seeks to strengthen the processing of personal information, including health information. While POPIA is to be welcomed, there are concerns about the impact it will have on the processing of health information. To ensure that the National Health Laboratory Service [NHLS] is compliant with these new strict processing requirements and that compliance does not negatively impact upon its current screening, treatment, surveillance and research mandate, it was decided to consider the development of a NHLS POPIA Code of Conduct for Personal Health. As part of the process of developing such a Code and better understand the challenges faced in the processing of personal health information in South Africa, 19 semi-structured interviews with stakeholders were conducted between June and September 2020. Overall, respondents welcomed the introduction of POPIA. However, they felt that there are tensions between the strengthening of data protection and the use of personal information for individual patient care, treatment programmes, and research. Respondents reported a need to rethink the management of personal health information in South Africa and identified 5 issues needing to be addressed at a national and an institutional level: an understanding of the importance of personal information; an understanding of POPIA and data protection; improve data quality; improve transparency in data use; and improve accountability in data use. The application of POPIA to the processing of personal health information is challenging, complex, and likely costly. However, personal health information must be appropriately managed to ensure the privacy of the data subject is protected, but equally that it is used as a resource in the individual's and wider public interest.
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Younis I, Longsheng C, Zulfiqar MI, Imran M, Shah SAA, Hussain M, Solangi YA. Regional disparities in Preventive measures of COVID-19 pandemic in China. A study from international students' prior knowledge, perception and vulnerabilities. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:40355-40370. [PMID: 33037960 PMCID: PMC7547302 DOI: 10.1007/s11356-020-10932-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/20/2020] [Indexed: 05/07/2023]
Abstract
The COVID-19 pandemic needs immediate solution before inflicting more devastation. So far, China has successfully controlled transmission of COVID-19 through implementing stringent preventive measures. In this study, we analyze the effectiveness of preventive measures taken in thirteen regions of China based on the feedback provided by 1135 international students studying in China. The study uses factor analysis combined with varimax rotation of variables. It was found that awareness raising and dispersing actionable knowledge regarding trust and adapting measures remained significantly important. Therefore, recognition of information gaps, improvements in the level of alertness, and development of preventive measures in each sector are imperative. The findings of this study revealed that trust, students' health, waste disposal, and the efforts of the Chinese government/international institute of education to prevent this pandemic were significantly and positively associated with preventive measures. The results showed that prior knowledge, global pandemics, and food and grocery purchases were firmly related to the preventive measures of COVID-19. Moreover, anxiety, transportation, and economic status were negatively related to the preventive measures. During this epidemic situation, international students suffered various types of mental stresses and anxiety, especially living in most affected regions of China. The study adopted a mixed (qualitative and quantitative) approach where the findings can act as a set of guidelines for governmental authorities in formulating, assisting in the preparation, instructing, and guiding policies to prevent and control the epidemic COVID-19 at national, local, and divisional levels.
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Affiliation(s)
- Ijaz Younis
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094 People’s Republic of China
| | - Cheng Longsheng
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094 People’s Republic of China
| | - Muhammad Imran Zulfiqar
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094 People’s Republic of China
| | - Muhammad Imran
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094 People’s Republic of China
| | - Syed Ahsan Ali Shah
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094 People’s Republic of China
| | - Mudassar Hussain
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094 People’s Republic of China
| | - Yasir Ahmed Solangi
- School of Economics and Management, Nanjing University of Science and Technology, Nanjing, 210094 People’s Republic of China
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Parsons MA. Toward an ethics of global health (de)funding: Thoughts from a maternity hospital project in Kabul, Afghanistan. Glob Public Health 2021; 17:1136-1151. [PMID: 33977857 DOI: 10.1080/17441692.2021.1924821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Funding and defunding decisions in global health are often not subject to ethical scrutiny although they carry the potential for iatrogenic violence. The funding and defunding of a maternal health project in Kabul, Afghanistan during the 2000s reveals the post 9/11 science-politics dynamics that resulted in the emergence of maternal mortality in Afghanistan as a humanitarian object. Despite concerns raised by the Afghan Ministry of Public Health, U.S. Department of Health and Human Services subcontractors renovated one of four public maternity hospitals in Kabul, doubling the number of births per year and increasing the rate of caesarean sections. Project defunding in 2011 was due to a confluence of primarily political factors. Project actors - Afghan and internationals - expressed ethical concerns about the abrupt defunding and the particular risks to women undergoing emergency caesarean sections at the hospital. The analysis presented here has wider relevance for the global surgery movement and concerns about fluctuations in donor funding in global health. There is a need for an ethics of global health funding and defunding decisions that encompasses policies, relationships, stronger local public health systems and civic participation. Global health (de)funding must be made more of an object of ethical deliberation and negotiation.
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Nichol AA, Mwaka ES, Luyckx VA. Ethics in Research: Relevance for Nephrology. Semin Nephrol 2021; 41:272-281. [PMID: 34330367 DOI: 10.1016/j.semnephrol.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research is crucial to progress in nephrology. It is important that studies are conducted rigorously from the scientific perspective, as well as in adherence to ethical standards. Traditional clinical research places a high value on individual research subject autonomy. Research questions often include the clinical effectiveness of new interventions studied under highly controlled conditions. Such research has brought the promise of new game-changers in nephrology, such as the sodium-glucose cotransporter 2 inhibitors. Implementation research takes such knowledge further and investigates how to translate it into broader-scale policy and practice, to achieve swift and global uptake, with a focus on justice and equity. Newer challenges arising globally in research ethics include those relating to oversight of innovation, biobanking and big data, human-challenge studies, and research during emergencies. This article details the history of clinical research ethics and the role of research ethics committees, describes the evolving spectrum of biomedical research in human medicine, and presents emerging clinical research ethics issues using illustrative examples and a hypothetical case study. It is imperative that researchers and research ethics committees are well versed in the ethical principles of all forms of human research such that research is conducted to the highest standards and that effective interventions can be implemented at scale as rapidly as possible.
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Affiliation(s)
- Ariadne A Nichol
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | - Erisa S Mwaka
- Department of Anatomy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Memon R, Asif M, Khoso AB, Tofique S, Kiran T, Chaudhry N, Husain N, Edwards SJL. Recognising values and engaging communities across cultures: towards developing a cultural protocol for researchers. BMC Med Ethics 2021; 22:47. [PMID: 33902560 PMCID: PMC8072318 DOI: 10.1186/s12910-021-00608-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 03/28/2021] [Indexed: 11/30/2022] Open
Abstract
Efforts to build research capacity and capability in low and middle income countries (LMIC) has progressed over the last three decades, yet it confronts many challenges including issues with communicating or even negotiating across different cultures. Implementing global research requires a broader understanding of community engagement and participatory research approaches. There is a considerable amount of guidance available on community engagement in clinical trials, especially for studies for HIV/AIDS, even culturally specific codes for recruiting vulnerable populations such as the San or Maori people. However, the same cannot be said for implementing research in global health. In an effort to build on this work, the Pakistan Institute of Living and Learning and University College London in the UK sought to better understand differences in beliefs, values and norms of local communities in Pakistan. In particular, they have sought to help researchers from high income countries (HIC) understand how their values are perceived and understood by the local indigenous researchers in Pakistan. To achieve this end, a group discussion was organised with indigenous researchers at Pakistan Institute of Living and Learning. The discussion will ultimately help inform the development of a cultural protocol for researchers from HIC engaging with communities in LMIC. This discussion revealed five common themes; (1) religious principles and rules, (2) differing concepts of and moral emphasis on autonomy and privacy, (3) importance of respect and trust; (4) cultural differences (etiquette); (5) custom and tradition (gift giving and hospitality). Based on the above themes, we present a preliminary cultural analysis to raise awareness and to prepare researchers from HIC conducting cross cultural research in Pakistan. This is likely to be particularly relevant in collectivistic cultures where social interconnectedness, family and community is valued above individual autonomy and the self is not considered central to moral thinking. In certain cultures, HIC ideas of individual autonomy, the notion of informed consent may be regarded as a collective family decision. In addition, there may still be acceptance of traditional professional roles such as ‘doctor knows best’, while respect and privacy may have very different meanings.
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Affiliation(s)
| | - Muqaddas Asif
- Pakistan Institute of Living and Learning (PILL), Karachi, Pakistan
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning (PILL), Karachi, Pakistan
| | - Sehrish Tofique
- Pakistan Institute of Living and Learning (PILL), Karachi, Pakistan
| | - Tayyaba Kiran
- Pakistan Institute of Living and Learning (PILL), Karachi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning (PILL), Karachi, Pakistan
| | - Nusrat Husain
- University of Manchester, Manchester, UK.,Honorary Consultant Psychiatrist Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
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Abstract
In this short commentary, the author reflects on his experience working with researchers from developing nations and argues that it is the professional responsibility of those researchers privileged by conducting research in a developed, English-speaking nation to pursue collaboration with researchers in more disadvantageous positions. As noted in a recent article from Matthews et al., researchers from developing countries experience tremendous barriers to identifying collaborators and publishing in top research journals. This commentary notes that researchers from developed countries have both humanitarian and symbiotic rationales for seeking international collaborations with researchers from developing countries. These relationships support the growth of research fields and help deconstruct a western hemispheric hegemony present in much of existing research approaches and thought and publishing practices.
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Affiliation(s)
- Brady D Lund
- Emporia State University, School of Library and Information Management, Emporia, Kansas, USA
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Andrade-Narvaez FJ. Desafíos y consideraciones bioéticas de la investigación para la salud en colaboración entre países del Norte y del Sur. REVISTA LATINOAMERICANA DE BIOÉTICA 2020. [DOI: 10.18359/rlbi.4474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
La investigación para la salud es esencial para enfrentar los retos actuales y futuros mediante la generación de nuevos conocimientos, que a su vez deben ser traducidos en mejores formas de prevenir y tratar las enfermedades, todo con el fin de lograr un desarrollo humano global sostenible. La tan necesaria investigación colaborativa Norte-Sur para la salud ha ido en franco aumento en las últimas décadas como respuesta a lo anterior. Por diversas razones, en esta interacción han surgido desafíos y cuestionamientos bioéticos que deben ser afrontados. En el presente trabajo se identifican 1) la asimetría; 2) el colonialismo; 3) la explotación; 4) la información, y 5) los comités de ética en investigación como los principales desafíos y se revisan los aspectos bioéticos que son necesarios atender. Resulta evidente la urgencia de construir una bioética de la investigación para la salud en colaboración entre países del Norte y países del Sur.
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Kintossou AK, N'dri MK, Money M, Cissé S, Doumbia S, Soumahoro MK, Coulibaly AF, Djaman JA, Dosso M. Study of laboratory staff' knowledge of biobanking in Côte d'Ivoire. BMC Med Ethics 2020; 21:88. [PMID: 32917182 PMCID: PMC7488401 DOI: 10.1186/s12910-020-00533-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/06/2020] [Indexed: 12/23/2022] Open
Abstract
Background A biobank is a structure which collects and manages biological samples and their associated data. The collected samples will then be made available for various uses. The sharing of those samples raised ethical questions which have been answered through specific rules. Thus, a Biobank functioning under tight ethical rules would be immensely valuable from a scientific and an economic view point. In 2009, Côte d’Ivoire established a biobank, which has been chosen to house the regional biobank of Economic Community of West African States (ECOWAS) countries in 2018. To ensure optimal and efficient use of this biobank, the scientific community must be aware of its existence and its role. It was therefore necessary to evaluate the knowledge of laboratories staff on the role and activities of a biobank. Methods This descriptive study was done by questioning staff from laboratories working on human’s health, animals or plants. The laboratories were located in southern Côte d’Ivoire. Results A total of 205 people completed the questionnaire. Of these 205 people, 34.63% were biologists, 7.32% engineers, 48.78% technicians and 9.27% PhD students. The average length of work experience was 10.11 ± 7.83 years. In this study, 43.41% of the participants had never heard of biobanking. Only 48.78% of participants had a good understanding of the role of a biobank. Technicians and PhD students were less educated on the notion of biobank (p < 0.000001). Although biologists were more educated on this issue, 21.13% of them had a misconception of biobank. Good knowledge of the role of a biobank was not significantly related to the work experience’s length (p > 0.88). Conclusion The level of knowledge of laboratory staff about biobanking needs to be improved. Training on the role, activities and interests of the biobank is important.
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Affiliation(s)
- Ambroise Kouamé Kintossou
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire. .,Training and Research Unit of Biosciences, Felix Houphouët Boigny University, Abidjan, Côte d'Ivoire.
| | - Mathias Kouamé N'dri
- Department of Epidemiology and Clinical Research, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Marcelle Money
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire
| | - Souleymane Cissé
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire
| | - Simini Doumbia
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire
| | - Man-Koumba Soumahoro
- Department of Epidemiology and Clinical Research, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | - Joseph Allico Djaman
- Training and Research Unit of Biosciences, Felix Houphouët Boigny University, Abidjan, Côte d'Ivoire
| | - Mireille Dosso
- Biobank, Pasteur Institute of Côte d'Ivoire, 01 BP 490, Abidjan, Côte d'Ivoire.,Department of Epidemiology and Clinical Research, Pasteur Institute of Côte d'Ivoire, Abidjan, Côte d'Ivoire.,Training and Research Unit of Medical Sciences, Felix Houphouët Boigny University, Abidjan, Côte d'Ivoire
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What Is Dissemination and Implementation Science?: An Introduction and Opportunities to Advance Behavioral Medicine and Public Health Globally. Int J Behav Med 2020; 27:3-20. [PMID: 32060805 DOI: 10.1007/s12529-020-09848-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There has been a well-documented gap between research (e.g., evidence-based programs, interventions, practices, policies, guidelines) and practice (e.g., what is routinely delivered in real-world community and clinical settings). Dissemination and implementation (D&I) science has emerged to address this research-to-practice gap and accelerate the speed with which translation and real-world uptake and impact occur. In recent years, there has been tremendous development in the field and a growing global interest, but much of the introductory literature has been U.S.-centric. This piece provides an introduction to D&I science and summarizes key concepts and progress of the field for a global audience, provides two case studies that highlight examples of D&I research globally, and identifies opportunities and innovations for advancing the field of D&I research globally.
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Davies A, Mwango G, Appiah B, Callery JJ, Duy Thanh V, Gumede N, Inglis R, McCracken S, Mkoola K, Montjane K, Ochanda A, Shonai C, Woods-Townsend K. Initiating a network to support engagement between health researchers and schools: recommendations from an international meeting of schools engagement practitioners held in Kilifi, Kenya. Wellcome Open Res 2020; 4:180. [PMID: 32734003 PMCID: PMC7372533 DOI: 10.12688/wellcomeopenres.15556.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2020] [Indexed: 11/20/2022] Open
Abstract
Engagement between health researchers and local schools, or School Engagement, has become incorporated into the engagement strategies of many research institutions worldwide. Innovative initiatives have emerged within Wellcome Trust-funded African and Asian Programmes (APPs) and elsewhere, and continued funding from the Wellcome Trust and other funders is likely to catalyse further innovation. Engagement between scientists and schools is well-described in the scientific literature (1-4), however, engagement between health researchers and schools is much newer, particularly in sub-Saharan Africa, and rarely documented. In November 2018 the KEMRI-Wellcome Trust Research Programme (KWTRP) hosted an international workshop in Kilifi, Kenya, drawing on an emerging community of School Engagement practitioners towards exploring the broad range of goals for School Engagement, learning about the breadth of evaluation approaches and exploring the potential usefulness of establishing a practitioner network. The workshop was attended by 29 engagement researchers/practitioners representing 21 institutions from 10 countries in sub-Saharan Africa and South East Asia and the UK. Workshop sessions combining small group discussions with plenary presentations, enabled a range of goals, activities and evaluation approaches to be shared. This report summarises these discussions, and shares participant views on the possible functions of a network of School Engagement practitioners. A breadth of 'deep' and 'wide' engagement activities were described addressing four broad goals: contributing to science education; capacity strengthening for health research; contributing to goals of community engagement; and health promotion. While wide approaches have greater outreach for raising student awareness, deeper approaches are more likely enable informed student views to be incorporated into research. All activities ultimately aimed at improving health, but also at supporting development in low- and middle-income countries through promoting science-career uptake. Participants identified a range of potential benefits which could emerge from a practitioner network: sharing experiences and resources; facilitating capacity strengthening; and fostering collaboration.
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Affiliation(s)
- Alun Davies
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford, UK
| | - Grace Mwango
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108, Kenya
| | - Bernard Appiah
- Research Program on Public and International Engagement for Health, Texas A&M University School of Public Health, Texas, 77843, USA
- Centre for Science and Health Communication, PMB M71, Ministries, Accra, Ghana
| | - James J. Callery
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Vu Duy Thanh
- Oxford University Clinical Research Unit (OUCRU), 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | | | - Robert Inglis
- Science Spaza, an initiative of Jive Media Africa, P.O.Box 22106, Mayor’s Walk, 3208, South Africa
| | | | - Kestern Mkoola
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
| | - Kagisho Montjane
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Alice Ochanda
- UNESCO Natural Sciences (SC/PCB), Regional Office for Eastern Africa, UN Gigiri Complex, Block C, Upper level, Nairobi, P.O. Box 30592, 00100, Kenya
| | - Charity Shonai
- Zimbabwe Early Intervention in Psychosis, Plot P Arnott Road, Westgate, Harare, Zimbabwe
| | - Kathryn Woods-Townsend
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Khumalo G, Desai R, Xaba X, Moshabela M, Essack S, Lutge E. Prioritising health research in KwaZulu-Natal: has the research conducted met the research needs? Health Res Policy Syst 2020; 18:32. [PMID: 32183821 PMCID: PMC7079502 DOI: 10.1186/s12961-020-0538-7] [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: 07/12/2019] [Accepted: 02/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background The KwaZulu-Natal (KZN) Health Act of 2009 mandates the Provincial Health Research and Ethics Committee to develop health research priorities for the province. During 2013, the KZN Department of Health embarked on a research prioritisation process for the province. Priority research questions were generated by an inclusive process, in which a variety of stakeholders in health research in the province were engaged. The aim of this study was to determine whether research conducted at public health facilities in KZN between 01 January 2014 and 31 March 2017 met the research priorities of the province developed through the provincial research prioritisation process of 2013. Methods This was a mixed methods study. Qualitative thematic analysis was used to categorise priority research questions generated in the priority-setting process and the titles of research projects conducted after that process into themes. Quantitative analysis was used to determine the correlation between themes of the priority questions, and those of the research projects conducted after the prioritisation exercise. Statistical Package for Social Science version 25 was used to analyse the data. Results In 72% of thematic areas, there were disproportionately more priority questions than there were research projects conducted. There is thus a large disjuncture between the priorities developed through the provincial research prioritisation process of 2013 and the research projects conducted after that process in terms of major research areas. Conclusions Ensuring that research conducted responds to priority questions raised is important because it ensures that research responds to locally important issues and to the concerns of local actors. Local health managers, communities and researchers should work together to ensure that the research conducted in their areas respond to the research priorities of those areas. Health Research Committees and local ethics committees can play important roles in facilitating the responsiveness to research priorities.
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Affiliation(s)
- G Khumalo
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa.
| | - R Desai
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa
| | - X Xaba
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa
| | - M Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Glenwood, Durban, South Africa
| | - S Essack
- School of Health Sciences, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Glenwood, Durban, South Africa
| | - E Lutge
- KwaZulu-Natal Department of Health, Health Research & Knowledge Management Unit, 330 Langalibalele Street, Pietermaritzburg, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, 238 Mazisi Kunene Road, Glenwood, Durban, South Africa
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15
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Davies A, Mwango G, Appiah B, Callery JJ, Duy Thanh V, Gumede N, Inglis R, McCracken S, Mkoola K, Montjane K, Ochanda A, Shonai C, Woods-Townsend K. Initiating a network to support engagement between health researchers and schools: recommendations from an international meeting of schools engagement practitioners held in Kilifi, Kenya. Wellcome Open Res 2019; 4:180. [PMID: 32734003 PMCID: PMC7372533 DOI: 10.12688/wellcomeopenres.15556.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/09/2023] Open
Abstract
Engagement between health researchers and local schools, or School Engagement, has become incorporated into the engagement strategies of many health research institutions worldwide. Innovative initiatives have emerged within Wellcome Trust-funded African and Asian Programmes (APPs) and elsewhere, and continued funding from the Wellcome Trust and other funders is likely to catalyse further innovation. Worldwide, engagement between scientists and schools is well-described in the scientific literature (1-4), however, engagement between health researchers and schools is much newer, particularly in Africa, and rarely documented in the academic literature. In November 2018 the KEMRI-Wellcome Trust Research Programme (KWTRP) hosted an international meeting in Kilifi, Kenya, drawing on an emerging community of School Engagement practitioners towards exploring the broad range of goals for School Engagement, learning about the breadth of evaluation approaches and exploring the usefulness of a practitioner network. The workshop was attended by 29 participants representing 21 institutions in 11 countries and comprised: engagement staff from Wellcome Trust-funded Africa and Asia Programmes (AAPs); facilitators of previously funded Wellcome Trust African School Engagement projects; collaborators of Wellcome Trust funded school engagement projects; and long-established UK and Africa-based School Engagement with research projects. Workshop sessions combining small group discussions with plenary presentations, enabled a range of goals, activities and evaluation approaches to be shared. This report summarises these dicussions, and shares the possible function of a network of School Engagement practitioners. Four broad goals for schools engagement emerged: contributing to science education; capacity strengthening for health research; contributing to goals of community engagement; and health promotion. These aimed ultimately at improving health, but also at supporting development in low- and middle-income countries through promoting science-career uptake. Practitioners identified a range of benefits for creating a network to strengthen School Engagement practice: sharing experiences and resources; facilitating capacity strengthening; and fostering collaboration.
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Affiliation(s)
- Alun Davies
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford, UK
| | - Grace Mwango
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108, Kenya
| | - Bernard Appiah
- Research Program on Public and International Engagement for Health, Texas A&M University School of Public Health, Texas, 77843, USA
- Centre for Science and Health Communication, PMB M71, Ministries, Accra, Ghana
| | - James J. Callery
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Vu Duy Thanh
- Oxford University Clinical Research Unit (OUCRU), 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
| | | | - Robert Inglis
- Science Spaza, an initiative of Jive Media Africa, P.O.Box 22106, Mayor’s Walk, 3208, South Africa
| | | | - Kestern Mkoola
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
| | - Kagisho Montjane
- Division of Human Genetics, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Alice Ochanda
- UNESCO Natural Sciences (SC/PCB), Regional Office for Eastern Africa, UN Gigiri Complex, Block C, Upper level, Nairobi, P.O. Box 30592, 00100, Kenya
| | - Charity Shonai
- Zimbabwe Early Intervention in Psychosis, Plot P Arnott Road, Westgate, Harare, Zimbabwe
| | - Kathryn Woods-Townsend
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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16
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St. Fleur RG, Schwartz SJ. Increased research literacy to facilitate community ownership of health research in low and middle income countries. ETHICS & BEHAVIOR 2019. [DOI: 10.1080/10508422.2019.1691556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ruth G. St. Fleur
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Seth J. Schwartz
- Department of Public Health Sciences, University of Miami Miller School of Medicine
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17
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Dawson A, Lignou S, Siriwardhana C, O'Mathúna DP. Why research ethics should add retrospective review. BMC Med Ethics 2019; 20:68. [PMID: 31597565 PMCID: PMC6785872 DOI: 10.1186/s12910-019-0399-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022] Open
Abstract
Research ethics is an integral part of research, especially that involving human subjects. However, concerns have been expressed that research ethics has come to be seen as a procedural concern focused on a few well-established ethical issues that researchers need to address to obtain ethical approval to begin their research. While such prospective review of research is important, we argue that it is not sufficient to address all aspects of research ethics. We propose retrospective review as an important complement to prospective review. We offer two arguments to support our claim that prospective review is insufficient. First, as currently practiced, research ethics has become for some a ‘tick box’ exercise to get over the ‘hurdle’ of ethics approval. This fails to capture much of what is important in ethics and does not promote careful reflection on the ethical issues involved. Second, the current approach tends to be rules-based and we argue that research ethics should go beyond this to develop people’s capacity to be sensitive to the relevant moral features of their research, their ethical decision-making skills and their integrity. Retrospective review of a project’s ethical issues, and how they were addressed, could help to achieve those aims better. We believe that a broad range of stakeholders should be involved in such retrospective review, including representatives of ethics committees, participating communities and those involved in the research. All stakeholders could then learn from others’ perspectives and experiences. An open and transparent assessment of research could help to promote trust and understanding between stakeholders, as well as identifying areas of agreement and disagreement and how these can be built upon or addressed. Retrospective review also has the potential to promote critical reflection on ethics and help to develop ethical sensitivity and integrity within the research team. Demonstrating this would take empirical evidence and we suggest that any such initiatives should be accompanied by research into their effectiveness. Our article concludes with a discussion of some possible objections to our proposal, and an invitation to further debate and discussion.
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Affiliation(s)
| | | | | | - Dónal P O'Mathúna
- Dublin City University, Dublin, Ireland. .,The Ohio State University, Columbus, USA.
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18
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Abdelhafiz AS, Sultan EA, Ziady HH, Ahmed E, Khairy WA, Sayed DM, Zaki R, Fouda MA, Labib RM. What Egyptians think. Knowledge, attitude, and opinions of Egyptian patients towards biobanking issues. BMC Med Ethics 2019; 20:57. [PMID: 31399100 PMCID: PMC6689171 DOI: 10.1186/s12910-019-0394-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/31/2019] [Indexed: 01/20/2023] Open
Abstract
Background Biobanking is a relatively new concept in Egypt. Building a good relationship with different stakeholders is essential for the social sustainability of biobanks. To establish this relationship, it is necessary to assess the attitude of different groups towards this concept. The objective of this work is to assess the knowledge, attitude, and opinions of Egyptian patients towards biobanking issues. Methods We designed a structured survey to be administered to patients coming to the outpatient clinics in 3 university hospitals in Egypt. The survey included questions estimating the level of knowledge about the term “Biobank”, together with questions about the attitudes and opinions about related issues. Results Two hundred and fifty-nine patients participated in the survey. Eighty-one percent of participants reported that they never heard about the term before. About 85% expressed that they would be willing to donate their samples for research and about 87% thought that sample donation did not contradict their religious beliefs. Fifty eight percent were willing to participate in a genetic research project, 27.8% supported sharing their sample with pharmaceutical companies, and 32.4% agreed to share their samples with institutions abroad. Conclusion Although there is limited knowledge about biobanking among Egyptian patients, many had a positive attitude towards sample donation and didn’t show religious concerns against it. However, they showed concerns regarding participation in genetic research and with sharing their samples across borders or with pharmaceutical companies. Public education about biobanking is possible, taking into consideration the specific cultural and legal framework in Egypt. Electronic supplementary material The online version of this article (10.1186/s12910-019-0394-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ahmed S Abdelhafiz
- Department of Clinical pathology, National Cancer Institute, Cairo University, Kasr Al-Aini Street, Fom Elkhalig square, Cairo, 11796, Egypt.
| | - Eman A Sultan
- Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hany H Ziady
- Department of Community Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ebtesam Ahmed
- College of Pharmacy and Health Sciences, St. John's University, New York, NY, USA
| | - Walaa A Khairy
- Department of Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Douaa M Sayed
- Department of Clinical pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Rana Zaki
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Merhan A Fouda
- Department of Clinical pathology, National Cancer Institute, Cairo University, Kasr Al-Aini Street, Fom Elkhalig square, Cairo, 11796, Egypt
| | - Rania M Labib
- Research Department, Children's Cancer Hospital Egypt, 57357, Cairo, Egypt
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19
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Attributing Air Pollutant Exposure to Emission Sources with Proximity Sensing. ATMOSPHERE 2019. [DOI: 10.3390/atmos10070395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Biomass burning for home energy use contributes to negative health outcomes and environmental degradation. As part of the REACCTING study (Research on Emissions, Air quality, Climate, and Cooking Technologies in Northern Ghana), personal exposure to carbon monoxide (CO) was measured to gauge the effects of introducing two different cookstove types over four intervention groups. A novel Bluetooth Low-Energy (BLE) Beacon system was deployed on a subset of those CO measurement periods to estimate participants’ distances to their most-used cooking areas during the sampling periods. In addition to presenting methods and validation for the BLE Beacon system, here we present pollution exposure assessment modeling results using two different approaches, in which time-activity (proximity) data is used to: (1) better understand exposure and behaviors within and away from homes; and (2) predict personal exposure via microenvironment air quality measurements. Model fits were improved in both cases, demonstrating the benefits of the proximity measurements.
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20
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Behera SK, Das S, Xavier AS, Selvarajan S, Anandabaskar N. Indian Council of Medical Research's National Ethical Guidelines for biomedical and health research involving human participants: The way forward from 2006 to 2017. Perspect Clin Res 2019; 10:108-114. [PMID: 31404208 PMCID: PMC6647898 DOI: 10.4103/picr.picr_10_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The Indian Council of Medical Research (ICMR) recently published the third revised guidelines "National Ethical Guidelines for Biomedical and Health-Related Research Involving Human Participants" in 2017. The changes to the guidelines were needed to acculturate the rapid advances in the research environment and advances in science and technology. The revised guidelines propose substantial changes/ modifications compared to the previous version. These include the introduction of broad consent, ethical issues related to deception, review of multi-centric research by a single ethics committee and ethical issues involved in implementation research and other issues related to public health research. The revised guidelines also incorporate modifications and minor changes to the previous version. Although most of the changes in the revised guidelines are in parallel to most of the international guidelines, we have also highlighted the minor differences compared to other international guidelines.
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Affiliation(s)
- Sapan Kumar Behera
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Saibal Das
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Alphienes Stanley Xavier
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- IEC (Human Studies), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nishanthi Anandabaskar
- Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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21
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Gardiner SA, Laing N, Mall S, Wonkam A. Perceptions of parents of children with hearing loss of genetic origin in South Africa. J Community Genet 2019; 10:325-333. [PMID: 30465126 PMCID: PMC6591331 DOI: 10.1007/s12687-018-0396-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/06/2018] [Indexed: 01/15/2023] Open
Abstract
More than 80% of people with hearing loss (HL) live in low- and middle-income countries. Up to 90% of deaf children are born to hearing parents, leading to novel parenting, communication, educational, and psychosocial experiences. Half of congenital pre-lingual HL is genetic, with a relatively high recurrence risk that may lead to specific challenges for parents of affected children. Currently, little is known of genes implicated and causative mutations for most populations who have HL in Sub-Saharan Africa, as well as genetic counseling services needs for this population. Therefore, this study aimed to explore parents' perceptions and understanding of the genetic etiology of their child's HL, in order to inform policies and services. In-depth qualitative interviews were conducted with 11 parents of children who have non-syndromic HL of putative genetic origin. Data were analyzed through the framework approach. Three salient themes emerged, namely comprehension and understanding of the cause, in which most parents were unable to identify the potential hereditary cause of their child's HL; responsibility and blame; and their perception of genetic counseling and testing. Most of the participants had positive attitudes towards genetic testing, describing that it may provide answers and that the information gained would be helpful for the future. The data could assist in understanding the challenges faced by parents, in the absence of genetic testing, emphasizing the need for accurate genetic testing to support counseling services to parents of children with HL in an African Setting.
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Affiliation(s)
- Sinead Amber Gardiner
- Division of Human Genetics, Falmouth Building, Faculty of Health Sciences, Department of Pathology, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Nakita Laing
- Division of Human Genetics, Groote Schuur Hospital/Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Sumaya Mall
- Department of Psychiatry and Mental Health, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Falmouth Building, Faculty of Health Sciences, Department of Pathology, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
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22
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van den Berg M, Ogutu B, Sewankambo NK, Merten S, Biller-Andorno N, Tanner M. Clinical trials in low-resource settings: the perspectives of caregivers of paediatric participants from Uganda, Tanzania and Kenya. Trop Med Int Health 2019; 24:1023-1030. [PMID: 31215122 PMCID: PMC6852514 DOI: 10.1111/tmi.13281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives Vaccine clinical trials in low‐resource settings have unique challenges due to structural and financial inequities. Specifically, protecting participant and caregiver autonomy to participate in the research study can be a major challenge, so understanding the setting and contextual factors which influence the decision process is necessary. This study investigates the experience of caregivers consenting on behalf of paediatric participants in a malaria vaccine clinical trial where participation enables access to free, high‐quality medical care. Methods We interviewed a total of 78 caregivers of paediatric participants previously enrolled in a phase II or III malaria vaccine clinical trial in Uganda, Tanzania and Kenya. Interviews were qualitative and analysed using a thematic framework analysis focusing on the embodied caregiver in the political, economic and social reality. Results Caregivers of participants in this study made the decision to enrol their child based on economic, social and political factors that extended beyond the trial into the community and the home. The provision of health care was the dominant reason for participation. Respondents reported how social networks, rumours, hierarchal structures, financial constraints and family dynamics affected their experience with research. Conclusions The provision of medical care was a powerful motivator for participation. Caregiver choice was limited by structural constraints and scarce financial resources. The decision to participate in research extended beyond individual consent and was embedded in community and domestic hierarchies. Future research should assess other contexts to determine how the choice to participate in research is affected when free medical care is offered.
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Affiliation(s)
- Machteld van den Berg
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Bernhards Ogutu
- Kenya Medical Research Institute, Nairobi, Kenya.,CREATES, Strathmore University, Nairobi, Kenya
| | | | - Sonja Merten
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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23
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Davies A, Mwangome N, Yeri B, Mwango G, Mumba N, Marsh V, Kamuya D, Molyneux S, Kinyanjui S, Jones C. Evolution of a programme to engage school students with health research and science in Kenya. Wellcome Open Res 2019; 4:39. [PMID: 30906884 PMCID: PMC6419976 DOI: 10.12688/wellcomeopenres.15106.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 01/28/2023] Open
Abstract
Facilitating mutually-beneficial educational activities between researchers and school students is an increasingly popular way for research institutes to engage with communities who host health research, but these activities have rarely been formally examined as a community or public engagement approach in health research. The KEMRI-Wellcome Trust Research Programme (KWTRP) in Kilifi, Kenya, through a Participatory Action Research (PAR) approach involving students, teachers, researchers and education stakeholders, has incorporated 'school engagement' as a key component into their community engagement (CE) strategy. School engagement activities at KWTRP aim at strengthening the ethical practice of the institution in two ways: through promoting an interest in science and research among school students as a form of benefit-sharing; and through creating forums for dialogue aimed at promoting mutual understanding between researchers and school students. In this article, we provide a background of CE in Kilifi and describe the diverse ways in which health researchers have engaged with communities and schools in different parts of the world. We then describe the way in which the KWTRP school engagement programme (SEP) was developed and scaled-up. We conclude with a discussion about the challenges, benefits and lessons learnt from the SEP implementation and scale-up in Kilifi, which can inform the establishment of SEPs in other settings.
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Affiliation(s)
- Alun Davies
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nancy Mwangome
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Betty Yeri
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Grace Mwango
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Noni Mumba
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Vicki Marsh
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dorcas Kamuya
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Samson Kinyanjui
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,IDEAL, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Biochemistry, Pwani University, Kilifi, Kenya
| | - Caroline Jones
- Health Sysytems and Research Ethics, Center for Geographical Medicine, KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Abstract
New health technologies are rapidly emerging from various areas of bioscience research, such as gene editing, regenerative medicine and synthetic biology. These technologies raise promising medical possibilities but also a range of ethical considerations. Apart from the issues involved in considering whether novel health technologies can or should become part of mainstream medical treatment once established, the process of research translation to develop such therapies itself entails particular ethical concerns. In this paper I use synthetic biology as an example of a new and largely unexplored area of health technology to consider the ways in which novel health technologies are likely to emerge and the ethical challenges these will present. I argue that such developments require us to rethink conventional attitudes towards clinical research, the roles of doctors/researchers and patients/participants with respect to research, and the relationship between science and society; and that a broader framework is required to address the plurality of stakeholder roles and interests involved in the development of treatments based on novel technologies.
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25
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Negotiating access to research sites and participants within an African context: The case of Cameroon. RESEARCH ETHICS 2019. [DOI: 10.1177/1747016118798874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article argues that localizing access – a general ethical principle – is a workable strategy that can be used in approaching participants in qualitative research across disciplines and in coping with respective institutional practices in order to collect meaningful data. This article is based on the autobiographical, lived experiences of the authors during the period of their data collection in Cameroon in 2013 and 2015, by the second and first author, respectively. Therefore, generalization across a broader context is somewhat restricted, and a closer analysis of specific cultural and situational realities is needed. The article addresses two main objectives, that is, to identify factors that inhibit and factors that facilitate access to individuals and institutions. To this end, the article employs self-reflexivity and provides valuable explanations on the workability of applying skills of negotiating access in a local cultural context.
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26
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Stadler J, MacGregor H, Saethre E, Delany-Moretlwe S. 'Hold on' (Bambelela)! Lyrical interpretations of participation in an HIV prevention clinical trial. CULTURE, HEALTH & SEXUALITY 2018; 20:1199-1213. [PMID: 29419358 DOI: 10.1080/13691058.2017.1422151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
During a five-day workshop, former clinical trial participants and local musicians wrote the lyrics and recorded a song about an HIV prevention trial. Born of concerns about misconceptions regarding experimental drug trials, the aim was to engender engagement with medical researchers and open dialogue about the risks and benefits of trial participation. Composing lyrics that highlighted their credibility as communicators of medical scientific knowledge and their selfless sacrifice to stem the transmission of HIV, women performed their social positioning and cultural authority in contrast to men as well as other women not part of the trial. While involvement in HIV prevention initiatives often attracts stigma, scorn and criticism, the song's lyrics highlighted women's new-found identities as heroines searching for a solution to the spread of HIV, challenging these stereotypes. Methodologically, the paper describes a novel approach that uses artistic expression for public engagement with biomedical research.
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Affiliation(s)
- Jonathan Stadler
- a Department of Anthropology and Development Studies , University of Johannesburg , Johannesburg , South Africa
- b Wits Reproductive Health and HIV Institute , University of Witwatersrand , Johannesburg , South Africa
| | - Hayley MacGregor
- c Institute of Development Studies , University of Sussex , Brighton , UK
| | - Eirik Saethre
- d Department of Anthropology , University of Hawaii Manoa , Honolulu , HI , USA
| | - Sinead Delany-Moretlwe
- b Wits Reproductive Health and HIV Institute , University of Witwatersrand , Johannesburg , South Africa
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Humphreys S. Drip-Feeding: How the Pharmaceutical Industry Influences Research Ethics Committees. RESEARCH ETHICS 2018. [DOI: 10.1177/174701610700300403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Whilst research ethics committees (RECs) exist to represent society's interests by placing appropriate checks on the economic power of ‘big pharma’, the political sphere is here seen to have generally acquiesced to economic interests and allowed industry to influence how it is regulated. RECs are accordingly urged to remain vigilant about the prospects of their being the subject of hidden influences.
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D’souza NA, Guzder J, Hickling F, Groleau D. The ethics of relationality in implementation and evaluation research in global health: reflections from the Dream-A-World program in Kingston, Jamaica. BMC Med Ethics 2018; 19:50. [PMID: 29945592 PMCID: PMC6020003 DOI: 10.1186/s12910-018-0282-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite recent developments aimed at creating international guidelines for ethical global health research, critical disconnections remain between how global health research is conducted in the field and the institutional ethics frameworks intended to guide research practice. DISCUSSION In this paper we attempt to map out the ethical tensions likely to arise in global health fieldwork as researchers negotiate the challenges of balancing ethics committees' rules and bureaucracies with actual fieldwork processes in local contexts. Drawing from our research experiences with an implementation and evaluation project in Jamaica, we argue that ethical research is produced through negotiated spaces and reflexivity practices that are centred on relationships between researchers and study participants and which critically examine issues of positionality and power that emerge at multiple levels. In doing so, we position ethical research practice in global health as a dialectical movement between the spoken and unspoken, or, more generally, between operationalized rules and the embodied relational understanding of persons. Global health research ethics should be premised not upon passive accordance with existing guidelines on ethical conduct, but on tactile modes of knowing that rely upon being engaged with, and responsive to, research participants. Rather than focusing on the operationalization of ethical practice through forms and procedures, it is crucial that researchers recognize that each ethical dilemma encountered during fieldwork is unique and rooted in social contexts, interpersonal relationships, and personal narratives.
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Affiliation(s)
- Nicole A. D’souza
- Department of Psychiatry, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada
| | - Jaswant Guzder
- Department of Psychiatry, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada
| | - Frederick Hickling
- CARIMENSA (Caribbean Institute of Mental Health and Substance Abuse), University of the West Indies, Kingston, Jamaica
| | - Danielle Groleau
- Department of Psychiatry, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada
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Ossemane EB, Moon TD, Were MC, Heitman E. Ethical issues in the use of SMS messaging in HIV care and treatment in low- and middle-income countries: case examples from Mozambique. J Am Med Inform Assoc 2018; 25:423-427. [PMID: 29088384 PMCID: PMC5885800 DOI: 10.1093/jamia/ocx123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 11/14/2022] Open
Abstract
The introduction of mobile communication technologies in health care in low- and middle-income countries offers an opportunity for increased efficiencies in provision of care, improved utilization of scarce resources, reductions in workload, and increased reach of services to a larger target population. Short message service (SMS) technologies offer promise, with several large-scale SMS-based implementations already under way. Still largely lacking in the research literature are evaluations of specific ethical issues that arise when SMS programs are implemented and studied in resource-limited settings. In this paper, we examine the ethical issues raised by the deployment of SMS messaging to support patient retention in HIV care and treatment and in the research conducted to evaluate that deployment. We use case studies that are based in Mozambique and ground our discussion in the ethical framework for international research proposed by Emanuel et al., highlighting ethical considerations needed to guide the design and implementation of future SMS-based interventions. Such guidance is increasingly needed in countries such as Mozambique, where the local capacity for ethical study design and oversight is still limited and the scale-up and study of mHealth initiatives are still driven predominantly by international collaborators. These issues can be complex and will need ongoing attention on a case-by-case basis to ensure that appropriate protections are in place, while simultaneously maximizing the potential benefit of new mHealth technologies.
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Affiliation(s)
| | - Troy D Moon
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin C Were
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth Heitman
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Program on Ethics in Science and Medicine, University of Texas Southwestern, Dallas, TX, USA
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Tasker L, Getty SF, Briggs JR, Benka VA. Exploring the Gaps in Practical Ethical Guidance for Animal Welfare Considerations of Field Interventions and Innovations Targeting Dogs and Cats. Animals (Basel) 2018; 8:ani8020019. [PMID: 29382052 PMCID: PMC5836027 DOI: 10.3390/ani8020019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/15/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022] Open
Abstract
Simple Summary Large populations of domestic dogs and cats are found living, or in close association with humans. They are often targeted by field interventions or innovations to enhance their welfare or to reduce conflict with communities or wildlife. Ethical review is a cornerstone of responsible engagement that aims to promote animal and human wellbeing. For the review process to be robust, identifying and understanding the ethical dilemmas that may be encountered when working with dogs and cats in field contexts, together with their human communities and in multi-stakeholder partnerships would be advantageous. We explored existing guidance from other disciplines (regulated animal research, veterinary and human clinical trials, and research conducted on wildlife) and identified gaps in ethical frameworks that do not adequately address the specific and practical needs of nongovernmental or intergovernmental organizations, government agencies or independent researchers working with dogs and cats in field contexts. Navigating practical ethical concerns in complex, highly variable field contexts necessitates the development of additional resources that can better inform reliable ethical review processes, and subsequently enhance the humaneness and effectiveness of future interventions and innovations. Abstract Domestic dogs (Canis lupus familiaris) and cats (Felis silvestris catus) are common species targeted by nongovernmental or intergovernmental organizations, veterinarians and government agencies worldwide, for field interventions (e.g., population management, rabies vaccination programs) or innovations (e.g., development of technologies or pharmaceuticals to improve animal welfare). We have a moral responsibility to ensure that the conduct of this work is humane for dogs or cats, and to consider the human communities in which the animals live. Ethical review is widely accepted as being integral to responsible practice, and it is fundamental to good science that underpins innovation. Despite the necessity of field interventions or innovations to advance the welfare of individuals or populations of animals, we found a lack of specific guidance and review processes to help navigate ethical dilemmas surrounding the conduct of such work. This can be detrimental to the wellbeing of animals and their human communities. Here we identify the gaps in existing ethical frameworks (specifically application of Reduction and Refinement principles, challenges of obtaining meaningful informed consent with variations in the quality of human-animal relationships, and limited resources regarding considerations of local stakeholders), and outline the need for additional tools to promote ethical conduct in the field.
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Affiliation(s)
- Louisa Tasker
- Independent Consultant, Hillcrest, Stanton-by-Dale, Derbyshire DE7 4QQ, UK
- Correspondence: ; Tel.: +44-(0)-758-087-3353
| | - Susan F. Getty
- Alliance for Contraception in Cats & Dogs, 11145 NW Old Cornelius Pass Road, Portland, OR 97231, USA; (S.F.G.); (J.R.B.); (V.A.W.B.)
| | - Joyce R. Briggs
- Alliance for Contraception in Cats & Dogs, 11145 NW Old Cornelius Pass Road, Portland, OR 97231, USA; (S.F.G.); (J.R.B.); (V.A.W.B.)
| | - Valerie A.W. Benka
- Alliance for Contraception in Cats & Dogs, 11145 NW Old Cornelius Pass Road, Portland, OR 97231, USA; (S.F.G.); (J.R.B.); (V.A.W.B.)
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Darmadji A, Prasojo LD, Riyanto Y, Kusumaningrum FA, Andriansyah Y. Publications of Islamic University of Indonesia in Scopus Database: A bibliometric assessment. COLLNET JOURNAL OF SCIENTOMETRICS AND INFORMATION MANAGEMENT 2018. [DOI: 10.1080/09737766.2017.1400754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ahmad Darmadji
- Master of Islamic Studies and Department of Islamic Education, Faculty of Islamic Studies, Islamic University of Indonesia, Jl. Demangan Baru No. 24 Yogyakarta, D.I. Yogyakarta, 55281, Indonesia
| | - Lantip Diat Prasojo
- Department of Educational Management, Faculty of Pedagogy, State University of Yogyakarta, Jl. Colombo No. 1, Yogyakarta, D.I. Yogyakarta, 55281, Indonesia,
| | - Yatim Riyanto
- Master of Educational Management, Faculty of Educational Sciences, State University of Surabaya, Jl. Lidah Wetan, Surabaya, East Java, 60231, Indonesia,
| | - Fitri Ayu Kusumaningrum
- Department of Psychology, Faculty of Psychology and Socio-Cultural Sciences, Islamic University of Indonesia, Jl. Kaliurang KM 14, 5 Kaliurang, Sleman, D.I. Yogyakarta 55584, Indonesia,
| | - Yuli Andriansyah
- Department of Islamic Economics, Faculty of Islamic Studies, Islamic University of Indonesia, Jl. Kaliurang KM 14, 5 Kaliurang, Sleman, D.I. Yogyakarta 55584, Indonesia,
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O’Neal CR, Gosnell NM, Ng WS, Clement J, Ong E. Global Consultation Processes: Lessons Learned from Refugee Teacher Consultation Research in Malaysia. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2017. [DOI: 10.1080/10474412.2017.1293544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Denholm JT, Bissell K, Viney K, Durand AM, Cash HL, Roseveare C, Merilles OE, Harries AD, Biribo S. Research ethics committees in the Pacific Islands: gaps and opportunities for health sector strengthening. Public Health Action 2017; 7:6-9. [PMID: 28913174 DOI: 10.5588/pha.16.0076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/12/2016] [Indexed: 11/10/2022] Open
Abstract
There has been a range of developments in recent years to stimulate increasing public health research activity throughout the Pacific. Development of local capacity for ethics committee review and oversight is, however, frequently underdeveloped. This is reflected in the number of Pacific Island nations where ethics committees have not been established or where only informal processes exist for ethics review and oversight. This is problematic for the optimal development of relevant and culturally appropriate research, and building up local ethics committees should be part of continued research development in the Pacific. Three areas in which local ethics committees may add value are 1) offering better capacity to reflect local priorities, 2) providing broader benefits for research capacity building, and 3) assisting to strengthen systems beyond research ethics. This article considers benefits and challenges for ethics committees in the Pacific, and suggests directions for regional development to further strengthen public health research activity.
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Affiliation(s)
- J T Denholm
- Victorian Tuberculosis Program, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria, Australia
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France.,School of Population Health, University of Auckland, Tamaki, New Zealand
| | - K Viney
- National Centre of Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - A M Durand
- Pacific Island Health Officers Association, Honolulu, Hawaii, USA
| | - H L Cash
- Pacific Island Health Officers Association, Honolulu, Hawaii, USA
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - O E Merilles
- The Pacific Community, Noumea, South Province, New Caledonia
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - S Biribo
- College of Medicine, Nursing & Health Sciences, Fiji National University, Suva, Fiji
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Barber DA, Casquejo E, Ybañez PL, Pinote MT, Casquejo L, Pinote LS, Estorgio M, Young AM. Prevalence and correlates of antibiotic sharing in the Philippines: antibiotic misconceptions and community-level access to non-medical sources of antibiotics. Trop Med Int Health 2017; 22:567-575. [PMID: 28187247 DOI: 10.1111/tmi.12854] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify sociodemographic, knowledge and attitudinal correlates to antibiotic sharing among a community-based sample of adults (age 18 and older) in a low-income setting of the Philippines and to explore community-level data on informal antibiotic distribution in roadside stands (i.e., sari-sari stands). METHODS Participants (n = 307) completed self-administered surveys. Correlates to antibiotic sharing were assessed using logistic regression with Firth's bias-adjusted estimates. Study staff also visited 106 roadside stands and collected data on availability and characteristics of antibiotics in the stands. RESULTS 78% had shared antibiotics in their lifetime, most often with family members. In multivariable analysis, agreement with the belief that it is safe to prematurely stop an antibiotic course (OR: 2.8, CI: 1.3-5.8) and concerns about antibiotic side effects (OR: 2.1, CI: 1.1-4.4) were significantly associated with increased odds of reported antibiotic sharing. Antibiotic sharing was not associated with sociodemographic characteristics or antibiotic knowledge. Antibiotics were widely available in 60% of sampled sari-sari stands, in which 59% of antibiotics were missing expiration dates. Amoxicillin and cephalexin were the most commonly available antibiotics for sale at the stands (60% and 21%, respectively). CONCLUSIONS Antibiotic sharing was common and was associated with misconceptions about proper antibiotic use. Antibiotics were widely available in sari-sari stands, and usually without expiration information. This study suggests that multipronged and locally tailored approaches to curbing informal antibiotic access are needed in the Philippines and similar Southeast-Asian countries.
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Affiliation(s)
- Daniel A Barber
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Efren Casquejo
- Island Ventures, Inc., Lapu-Lapu City, Cebu, Philippines
| | | | | | - Luz Casquejo
- Island Ventures, Inc., Lapu-Lapu City, Cebu, Philippines
| | - Lucia S Pinote
- Island Ventures, Inc., Lapu-Lapu City, Cebu, Philippines
| | | | - April M Young
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
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Chiumento A, Rahman A, Frith L, Snider L, Tol WA. Ethical standards for mental health and psychosocial support research in emergencies: review of literature and current debates. Global Health 2017; 13:8. [PMID: 28178981 PMCID: PMC5299703 DOI: 10.1186/s12992-017-0231-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies. DISCUSSION Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.
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Affiliation(s)
- Anna Chiumento
- University of Liverpool, Institute of Psychology, Health and Society, 2nd Floor, Block B, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Atif Rahman
- University of Liverpool, Institute of Psychology, Health and Society, 2nd Floor, Block B, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Lucy Frith
- University of Liverpool, Institute of Psychology, Health and Society, 2nd Floor, Block B, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Leslie Snider
- Independent Consultant, Peace in Practice, Amsterdam, The Netherlands
| | - Wietse A. Tol
- Johns Hopkins University, School of Public Health and The Peter C. Alderman Foundation, Baltimore, USA
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Morrison K, Tomsons S, Gomez A, Forde M. Network of Ethical Relationships model for global North-South population health research. Glob Public Health 2017; 13:819-842. [PMID: 28081659 DOI: 10.1080/17441692.2016.1276948] [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
Although a substantial body of literature exists that details how to address ethical issues and provide oversight for traditional research study designs, there currently is very little guidance available to researchers on how to deal with the unique and novel challenges that arise when conducting research that goes outside of these well-defined boundaries. One such example is North-South (N-S) team-based global population health (GPH) research. This paper presents a Network of Ethical Relationships (NER) model which can allow GPH researchers better understand and resolve ethical issues that arise in N-S collaborative research efforts. The NER model elucidates some of the core relationships involved in GPH research and sheds light on the complex milieu of moral, institutional, societal and legal processes in which it is embedded. The utility of the NER model is examined by reviewing 14 GPH research teams, looking at two relationships in more detail - Researcher-Ethics Board, and Researcher-Funder relationships. The paper argues that improved dialogue and flexibility in the application of formal ethical rules and procedures can lead to research being conducted in a more ethical manner since it better accounts for the multitude of voices and perspectives influencing researchers' choices and actions.
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Affiliation(s)
- Karen Morrison
- a Faculty of Environmental Studies , York University , Toronto , Canada
| | - Sandra Tomsons
- b Department of Philosophy , University of Winnipeg , Winnipeg , Canada
| | | | - Martin Forde
- d Department of Public Health and Preventive Medicine , St. George's University , Grenada , West Indies
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Walsh A, Brugha R, Byrne E. "The way the country has been carved up by researchers": ethics and power in north-south public health research. Int J Equity Health 2016; 15:204. [PMID: 27955670 PMCID: PMC5153695 DOI: 10.1186/s12939-016-0488-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/28/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the recognition of power as being central to health research collaborations between high income countries and low and middle income countries, there has been insufficient detailed analysis of power within these partnerships. The politics of research in the global south is often considered outside of the remit of research ethics. This article reports on an analysis of power in north-south public health research, using Zambia as a case study. METHODS Primary data were collected in 2011/2012, through 53 in-depth interviews with: Zambian researchers (n = 20), Zambian national stakeholders (n = 8) and northern researchers who had been involved in public health research collaborations involving Zambia and the global north (n = 25). Thematic analysis, utilising a situated ethics perspective, was undertaken using Nvivo 10. RESULTS Most interviewees perceived roles and relationships to be inequitable with power remaining with the north. Concepts from Bourdieu's theory of Power and Practice highlight new aspects of research ethics: Northern and southern researchers perceive that different habituses exist, north and south - habituses of domination (northern) and subordination (Zambian) in relation to researcher relationships. Bourdieu's hysteresis effect provides a possible explanation for why power differentials continue to exist. In some cases, new opportunities have arisen for Zambian researchers; however, they may not immediately recognise and grasp them. Bourdieu's concept of Capitals offers an explanation of how diverse resources are used to explain these power imbalances, where northern researchers are often in possession of more economic, symbolic and social capital; while Zambian researchers possess more cultural capital. CONCLUSIONS Inequities and power imbalances need to be recognised and addressed in research partnerships. A situated ethics approach is central in understanding this relationship in north-south public health research.
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Affiliation(s)
- Aisling Walsh
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
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Gopichandran V, Luyckx VA, Biller-Andorno N, Fairchild A, Singh J, Tran N, Saxena A, Launois P, Reis A, Maher D, Vahedi M. Developing the ethics of implementation research in health. Implement Sci 2016; 11:161. [PMID: 27938400 PMCID: PMC5148832 DOI: 10.1186/s13012-016-0527-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/29/2016] [Indexed: 02/03/2023] Open
Abstract
Implementation research (IR) is growing in recognition as an important generator of practical knowledge that can be translated into health policy. With its aim to answer questions about how to improve access to interventions that have been shown to work but have not reached many of the people who could benefit from them, IR involves a range of particular ethical considerations that have not yet been comprehensively covered in international guidelines on health research ethics. The fundamental ethical principles governing clinical research apply equally in IR, but the application of these principles may differ depending on the IR question, context, and the nature of the proposed intervention. IR questions cover a broad range of topics that focus on improving health system functioning and improving equitable and just access to effective health care interventions. As such, IR designs are flexible and often innovative, and ethical principles cannot simply be extrapolated from their applications in clinical research. Meaningful engagement with all stakeholders including communities and research participants is a fundamental ethical requirement that cuts across all study phases of IR and links most ethical concerns. Careful modification of the informed consent process may be required in IR to permit study of a needed intervention. The risks associated with IR may be difficult to anticipate and may be very context-specific. The benefits of IR may not accrue to the same groups who participate in the research, therefore justifying the risks versus benefits of IR may be ethically challenging. The expectation that knowledge generated through IR should be rapidly translated into health policy and practice necessitates up-front commitments from decision-makers to sustainability and scalability of effective interventions. Greater awareness of the particular ethical implications of the features of IR is urgently needed to facilitate optimal ethical conduct of IR and uniform ethical review.
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Affiliation(s)
- Vijayaprasad Gopichandran
- Department of Community Medicine, ESIC Medical College and Postgraduate Institute of Medical Sciences and Research, KK Nagar, Chennai, 600078, India.
| | - Valerie A Luyckx
- Institute of Biomedical Ethics and History of Medicine, Center for Medical Humanities, University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, Center for Medical Humanities, University of Zurich, Winterthurerstrasse 30, CH-8006, Zurich, Switzerland
| | - Amy Fairchild
- Associate Dean of Academic Affairs, Texas A & M School of Public Health, College Station, Texas, USA
| | - Jerome Singh
- University of KwaZulu-Natal, Nelson Mandela School of Medicine, 719 Umbilo Road, Durban, 4001, South Africa
| | - Nhan Tran
- Alliance for Health Systems and Policy Research, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Abha Saxena
- Global Health Ethics Unit, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Pascal Launois
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
| | - Andreas Reis
- Global Health Ethics Unit, World Health Organization, 20, Avenue Appia, 1211, Geneva, Switzerland
| | - Dermot Maher
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
| | - Mahnaz Vahedi
- Special Programme for Research and Training in Tropical Diseases (WHO/TDR), Geneva, Switzerland
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Natukunda L, Johnson P, Dibben P. A tale from the field: Reflexivity during management research in an African-based development organisation. AFRICA JOURNAL OF MANAGEMENT 2016. [DOI: 10.1080/23322373.2016.1253406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Loice Natukunda
- Management, University of Sheffield, Sheffield, United Kingdom
| | - Phil Johnson
- Management, University of Sheffield, Sheffield, United Kingdom
| | - Pauline Dibben
- Management, University of Sheffield, Sheffield, United Kingdom
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Kass NE, Ali J, Hallez K, Hyder AA. Bioethics training programmes for Africa: evaluating professional and bioethics-related achievements of African trainees after a decade of Fogarty NIH investment. BMJ Open 2016; 6:e012758. [PMID: 27633644 PMCID: PMC5030587 DOI: 10.1136/bmjopen-2016-012758] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our primary aim was to evaluate the impact of US National Institutes of Health (NIH)-funded bioethics training programmes (Fogarty bioethics training programmes, FBTPs) that trained individuals from Africa over the programme's first 10 years to examine changes between pretraining and post-training in individual achievement and to document any associations between individual, training programme and post-training accomplishments. DESIGN We surveyed trainees from the 10 bioethics programmes funded by NIH Fogarty International Center from 2000 to 2011 that included African trainees. McNemar's and Wilcoxon signed rank-sum tests were used to analyse pre-post levels of general and bioethics-related professional achievement. Likelihood of specific post-training achievement outcomes was measured using logistic regression including demographic, pretraining and intratraining variables. SETTING 10 different FBTPs that trained individuals from Africa from 2000 to 2011. PARTICIPANTS Of 253 eligible respondents, 171 completed the survey (response rate 67.6%). PRIMARY OUTCOME MEASURES Pre-post comparisons of professional achievement indicators (eg, serving in leadership roles, teaching, publishing manuscripts); likelihood of specific post-training achievement outcomes. RESULTS Post-training, respondents were significantly more likely to report serving in a leadership role, being an investigator on a research grant, serving on international committees, serving as a mentor, and publishing manuscripts than at pretraining. Post-training, significantly greater numbers of respondents reported bioethics-related achievements including being a bioethics instructor, serving on an Institutional Review Board (IRB), being an investigator on a bioethics grant and publishing bioethics-related manuscripts than pretraining. Controlling for other factors, there were no significant differences by gender in the post-training success of these participants in terms of leadership roles, being instructors, investigators on grants and holding IRB roles. CONCLUSIONS African trainees who participated in FBTPs reported significantly higher levels of professional achievement after training. There was no single factor-either demographic, related to a trainee's professional background, or in programme design-that consistently predicted greater levels of post-training achievement.
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Affiliation(s)
- Nancy E Kass
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Kristina Hallez
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Adnan A Hyder
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Opoku EC, Olsen A, Browne E, Hodgson A, Awoonor-Williams JK, Yelifari L, Williams J, Magnussen P. Impact of combined intermittent preventive treatment of malaria and helminths on anaemia, sustained attention, and recall in Northern Ghanaian schoolchildren. Glob Health Action 2016; 9:32197. [PMID: 27633035 PMCID: PMC5025525 DOI: 10.3402/gha.v9.32197] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/03/2016] [Accepted: 08/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The benefits of integrated control of malaria, schistosomiasis, and soil-transmitted helminth infections have not been fully explored in Ghanaian schoolchildren. OBJECTIVE To assess the impact of co-administered artemether-lumefantrine plus albendazole, and artemether-lumefantrine plus albendazole plus praziquantel compared to albendazole plus praziquantel on anaemia, sustained attention, and recall in schoolchildren. DESIGN This three-arm, open-label intervention study was carried out in Ghana among class three schoolchildren. Artemether-lumefantrine and albendazole were co-administered to 131 schoolchildren in Study Arm 1; artemether-lumefantrine, albendazole, and praziquantel to 90 children in Study Arm 2 versus albendazole and praziquantel to 127 children in Control Arm 3. Medicines were administered to all children at least 30 min after a meal. A HemoCue(®) photometer was used to measure haemoglobin (Hb), while the code transmission test (CTT), adapted from the Test of Everyday Attention for Children (TEA-Ch), was used to measure sustained attention and recall before-and-after interventions in June 2011 and June 2012. RESULTS We observed significant malaria parasite prevalence reductions of 62.8 and 59.2% in Study Arm 1 from 24.2 to 9.0%, p<0.01, and 59.2% in Study Arm 2 from 26.7 to 10.9%, p<0.01), respectively, compared to 8.93% in Control Arm 3 (from 34.7 to 31.6%, p>0.05). Meanwhile, anaemia prevalence reduced significantly (p<0.01) in all three study arms after interventions by 38.4% (from 19.8 to 12.2%), 20.7% (from 26.6 to 21.1%), and 36.0% (from 28.3 to 18.1%) in Study Arms 1, 2, and 3, respectively. Although the interventions had no significant effects on Hb levels, anaemia prevalence reduced insignificantly by 38.4 and 20.7% in Study Arms 1 and 2, respectively, compared to 36.0% in Control Arm 3. Among schoolchildren in Study Arms 1 and 2, mean CTT score improved significantly after interventions by 10.4% (from 3.18 to 3.55, p=0.01) and 20.5% (from 2.83 to 3.56, p=0.01) respectively, compared to 5.75% in Control Arm 3 (from 2.95 to 3.13, p=0.09). Likewise, mean recall test score improvements after interventions were 16.9% (from 2.07 to 2.49, p=0.01) and 27.9% (from 1.91 to 2.65, p=0.01) in Study Arms 1 and 2, respectively, compared to 18.3% (from 1.92 to 2.35, p=0.01) in Control Arm 3. CONCLUSION Combined intermittent preventive treatment of malaria and deworming reduced prevalence of anaemia and improved sustained attention and recall in schoolchildren. Best results for sustained attention and recall were seen in Study Arm 2.
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Affiliation(s)
- Ernest Cudjoe Opoku
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.,Copenhagen School of Global Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Annette Olsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Edmund Browne
- Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abraham Hodgson
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | | | - Lawrence Yelifari
- Regional Health Directorate, Ghana Health Service, Bolgatanga, Ghana
| | - John Williams
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Pascal Magnussen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark.,Centre for Medical Parasitology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Yassi A, Adu PA, Nophale L, Zungu M. Learning from a cluster randomized controlled trial to improve healthcare workers' access to prevention and care for tuberculosis and HIV in Free State, South Africa: the pivotal role of information systems. Glob Health Action 2016; 9:30528. [PMID: 27341793 PMCID: PMC4920939 DOI: 10.3402/gha.v9.30528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 12/02/2022] Open
Abstract
Background Occupational tuberculosis (TB) continues to plague the healthcare workforce in South Africa. A 2-year cluster randomized controlled trial was therefore launched in 27 public hospitals in Free State province, to better understand how a combined workforce and workplace program can improve health of the healthcare workforce. Objective This mid-term evaluation aimed to analyze how well the intervention was being implemented, seek evidence of impact or harm, and draw lessons. Methods Both intervention and comparison sites had been instructed to conduct bi-annual and issue-based infection control assessments (when healthcare workers [HCW] are diagnosed with TB) and offer HCWs confidential TB and HIV counseling and testing, TB treatment and prophylaxis for HIV-positive HCWs. Intervention sites were additionally instructed to conduct quarterly workplace assessments, and also offer HCWs HIV treatment at their occupational health units (OHUs). Trends in HCW mortality, sick-time, and turnover rates (2005–2014) were analyzed from the personnel salary database (‘PERSAL’). Data submitted by the OHUs were also analyzed. Open-ended questionnaires were then distributed to OHU HCWs and in-depth interviews conducted at 17 of the sites to investigate challenges encountered. Results OHUs reported identifying and treating 23 new HCW cases of TB amongst the 1,372 workers who used the OHU for HIV and/or TB services; 39 new cases of HIV were also identified and 108 known-HIV-positive HCWs serviced. Although intervention-site workforces used these services significantly more than comparison-site healthcare staff (p<0.001), the data recorded were incomplete for both the intervention and comparison OHUs. An overall significant decline in mortality and turnover rates was documented over this period, but no significant differences between intervention and comparison sites; sick-time data proved unreliable. Severe OHU workload as well as residual confidentiality concerns prevented the proper implementation of protocols, especially workplace assessments and data recording. Particularly, the failure to implement computerized data collection required OHU staff to duplicate their operational data collection duties by also entering research paper forms. The study was therefore halted pending the implementation of a computerized system. Conclusions The significant differences in OHU use documented cannot be attributable to the intervention due to incomplete data reporting; unreliable sick-time data further precluded ascertaining the benefit potentially attributable to the intervention. Computerized data collection is essential to facilitate operational monitoring while conducting real-world intervention research. The digital divide still requires the attention of researchers along with overall infrastructural constraints.
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Affiliation(s)
- Annalee Yassi
- Global Health Research Program, The University of British Columbia (UBC), Vancouver, BC, Canada;
| | - Prince A Adu
- Global Health Research Program, The University of British Columbia (UBC), Vancouver, BC, Canada
| | - Letshego Nophale
- Provincial Occupational Health Unit, Free State Department of Health, University of the Free State, Bloemfontein, South Africa
| | - Muzimkhulu Zungu
- National Institute for Occupational Health, A Division of the National Health Laboratory Service, Johannesburg, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Molyneux S, Sariola S, Allman D, Dijkstra M, Gichuru E, Graham S, Kamuya D, Gakii G, Kayemba B, Kombo B, Maleche A, Mbwambo J, Marsh V, Micheni M, Mumba N, Parker M, Shio J, Yah C, van der Elst E, Sanders E. Public/community engagement in health research with men who have sex with men in sub-Saharan Africa: challenges and opportunities. Health Res Policy Syst 2016; 14:40. [PMID: 27234212 PMCID: PMC4884401 DOI: 10.1186/s12961-016-0106-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/19/2016] [Indexed: 11/23/2022] Open
Abstract
Background Community engagement, incorporating elements of the broader concepts of public and stakeholder engagement, is increasingly promoted globally, including for health research conducted in developing countries. In sub-Saharan Africa, community engagement needs and challenges are arguably intensified for studies involving gay, bisexual and other men who have sex with men, where male same-sex sexual interactions are often highly stigmatised and even illegal. This paper contextualises, describes and interprets the discussions and outcomes of an international meeting held at the Kenya Medical Research Institute-Wellcome Trust in Kilifi, Kenya, in November 2013, to critically examine the experiences with community engagement for studies involving men who have sex with men. Discussion We discuss the ethically charged nature of the language used for men who have sex with men, and of working with ‘representatives’ of these communities, as well as the complementarity and tensions between a broadly public health approach to community engagement, and a more rights based approach. We highlight the importance of researchers carefully considering which communities to engage with, and the goals, activities, and indicators of success and potential challenges for each. We suggest that, given the unintended harms that can emerge from community engagement (including through labelling, breaches in confidentiality, increased visibility and stigma, and threats to safety), representatives of same-sex populations should be consulted from the earliest possible stage, and that engagement activities should be continuously revised in response to unfolding realities. Engagement should also include less vocal and visible men who have sex with men, and members of other communities with influence on the research, and on research participants and their families and friends. Broader ethics support, advice and research into studies involving men who have sex with men is needed to ensure that ethical challenges – including but not limited to those related to community engagement – are identified and addressed. Summary Underlying challenges and dilemmas linked to stigma and discrimination of men who have sex with men in Africa raise special responsibilities for researchers. Community engagement is an important way of identifying responses to these challenges and responsibilities but itself presents important ethical challenges.
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Affiliation(s)
- Sassy Molyneux
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya. .,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK. .,The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Salla Sariola
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK.,Faculty of Social Sciences, University of Torku, Torku, Finland
| | - Dan Allman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Maartje Dijkstra
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Evans Gichuru
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Susan Graham
- Kenya Research Group, University of Washington, Seattle, USA
| | - Dorcas Kamuya
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Gloria Gakii
- University of Nairobi, Nairobi, Kenya.,University of Manitoba, Manitoba, USA
| | | | - Bernadette Kombo
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Allan Maleche
- KELIN - Reclaiming rights, Rebuilding Live, Nairobi, Kenya
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vicki Marsh
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK.,The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Murugi Micheni
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Noni Mumba
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Michael Parker
- The Ethox Centre, Department of Public Health, University of Oxford, Oxford, UK
| | - Jasmine Shio
- Department of Project Management, Deloitte Consulting Ltd, Dar es Salaam, Tanzania
| | - Clarence Yah
- Wits Reproductive Health & HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elise van der Elst
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Eduard Sanders
- Department of Health Systems and Research Ethics, KEMRI/Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya.,Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Bonde S, Briant C, Firenze P, Hanavan J, Huang A, Li M, Narayanan NC, Parthasarathy D, Zhao H. Making Choices: Ethical Decisions in a Global Context. SCIENCE AND ENGINEERING ETHICS 2016; 22:343-366. [PMID: 25962719 DOI: 10.1007/s11948-015-9641-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
The changing milieu of research--increasingly global, interdisciplinary and collaborative--prompts greater emphasis on cultural context and upon partnership with international scholars and diverse community groups. Ethics training, however, tends to ignore the cross-cultural challenges of making ethical choices. This paper confronts those challenges by presenting a new curricular model developed by an international team. It examines ethics across a very broad range of situations, using case studies and employing the perspectives of social science, humanities and the sciences. The course has been developed and taught in a highly collaborative way, involving researchers and students at Zhejiang University, the Indian Institute of Technology, Bombay and Brown University. The article presents the curricular modules of the course, learning outcomes, an assessment framework developed for the project, and a discussion of evaluation findings.
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Affiliation(s)
- Sheila Bonde
- Department of History of Art and Architecture, Brown University, Box 1855, Providence, RI, 02912, USA
| | - Clyde Briant
- School of Engineering, Brown University, Box D, 184 Hope Street, Providence, RI, 02912, USA.
| | - Paul Firenze
- Humanities and Social Sciences, Wentworth Institute of Technology, 550 Huntingdon Avenue, Boston, MA, 02115, USA
| | - Julianne Hanavan
- Research Ethics and Education Policy, Office of the Vice President for Research, Brown University, 47 George Street, Providence, RI, 02912, USA
| | - Amy Huang
- Department of History of Art and Architecture, Brown University, Box 1855, Providence, RI, 02912, USA
| | - Min Li
- Department of Linguistics, Zhejiang University, 308 Alumni Center, Hangzhou, 310058, China
| | - N C Narayanan
- Centre for Technology Alternatives for Rural Areas, Indian Institute of Technology, Bombay, India
| | - D Parthasarathy
- Department of Humanities and Social Science, Indian Institute of Technology, Bombay, India
| | - Hongqin Zhao
- School of International Studies, Zhejiang University, Hangzhou, 310058, China
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45
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Grant JM. From subjects to relations: Bioethics and the articulation of postcolonial politics in the Cambodia Pre-Exposure Prophylaxis trial. SOCIAL STUDIES OF SCIENCE 2016; 46:236-258. [PMID: 27263238 DOI: 10.1177/0306312716632617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Controversies about global clinical trials, particularly HIV trials, tend to be framed in terms of ethics. In this article, I explore debates about ethics in the Cambodia Pre-Exposure Prophylaxis trial, which was designed to test the safety and efficacy of tenofovir as a prevention for HIV infection. Bringing together studies of public participation in science with studies of bioethics, I show how activists around the Cambodian Pre-Exposure Prophylaxis trial circulated and provoked debates about standards of research ethics, as opposed to research methodology. This postcolonial bioethics was configured through the circulation of and debate about ethics guidelines, and historically and culturally specific relations of vulnerability and responsibility between foreigners and Cambodians and between Cambodian leaders and Cambodian subjects. I argue that this shift in the object of ethical concern, from the experimental human subject to the relation between subjects and researchers, illustrates how a postcolonial field of articulation reformulates classical bioethics.
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46
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Joseph PD, Caldwell PHY, Tong A, Hanson CS, Craig JC. Stakeholder Views of Clinical Trials in Low- and Middle-Income Countries: A Systematic Review. Pediatrics 2016; 137:e20152800. [PMID: 26812926 DOI: 10.1542/peds.2015-2800] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides. OBJECTIVE To describe stakeholder beliefs and experiences of conducting trials in children in LMICs. DATA SOURCES Electronic databases were searched to August 2014. STUDY SELECTION Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs. DATA EXTRACTION Findingswere analyzed by using thematic synthesis. RESULTS Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives' pivotal role, managing expectations, and retaining involvement); cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust); contending with power differentials (exploitation, stigmatization, and disempowerment); translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism); and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits). LIMITATIONS Studies not published in English were excluded. CONCLUSIONS Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.
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Affiliation(s)
- Pathma D Joseph
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, and The Pharmacy Department, The Children's Hospital at Westmead, Sydney, Australia
| | - Patrina H Y Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, and
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
| | - Camilla S Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
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Munung NS, Marshall P, Campbell M, Littler K, Masiye F, Ouwe-Missi-Oukem-Boyer O, Seeley J, Stein DJ, Tindana P, de Vries J. Obtaining informed consent for genomics research in Africa: analysis of H3Africa consent documents. JOURNAL OF MEDICAL ETHICS 2016; 42:132-137. [PMID: 26644426 PMCID: PMC4752624 DOI: 10.1136/medethics-2015-102796] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 05/29/2023]
Abstract
BACKGROUND The rise in genomic and biobanking research worldwide has led to the development of different informed consent models for use in such research. This study analyses consent documents used by investigators in the H3Africa (Human Heredity and Health in Africa) Consortium. METHODS A qualitative method for text analysis was used to analyse consent documents used in the collection of samples and data in H3Africa projects. Thematic domains included type of consent model, explanations of genetics/genomics, data sharing and feedback of test results. RESULTS Informed consent documents for 13 of the 19 H3Africa projects were analysed. Seven projects used broad consent, five projects used tiered consent and one used specific consent. Genetics was mostly explained in terms of inherited characteristics, heredity and health, genes and disease causation, or disease susceptibility. Only one project made provisions for the feedback of individual genetic results. CONCLUSION H3Africa research makes use of three consent models-specific, tiered and broad consent. We outlined different strategies used by H3Africa investigators to explain concepts in genomics to potential research participants. To further ensure that the decision to participate in genomic research is informed and meaningful, we recommend that innovative approaches to the informed consent process be developed, preferably in consultation with research participants, research ethics committees and researchers in Africa.
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Affiliation(s)
| | - Patricia Marshall
- Center for Genetic Research Ethics and Law Department of Bioethics, School of Medicine, Case Western Reserve University, Cleaveland, Ohio, USA
| | - Megan Campbell
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Francis Masiye
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Odile Ouwe-Missi-Oukem-Boyer
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
- Cameroon Bioethics Initiative (CAMBIN), Yaounde, Cameroon
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - D J Stein
- MRC Unit on Anxiety & Stress Disorders Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Morris N. Providing ethical guidance for collaborative research in developing countries. RESEARCH ETHICS REVIEW 2015; 11:211-235. [PMID: 26640509 PMCID: PMC4647303 DOI: 10.1177/1747016115586759] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Experience has shown that the application of ethical guidelines developed for research in developed countries to research in developing countries can be, and often is, impractical and raises a number of contentious issues. Various attempts have been made to provide guidelines more appropriate to the developing world context; however, to date these efforts have been dominated by the fields of bioscience, medical research and nutrition. There is very little advice available for those seeking to undertake collaborative social science or natural science research in developing countries and what is there tends to be held within disparate sources. Charting the development of a set of ethics documentation for future use by the Ecosystem Services for Poverty Alleviation (ESPA) programme research community, this paper outlines past and present attitudes towards ethics procedures amongst this community and suggests ways in which ethics procedures might be made more relevant and user-friendly to researchers working in this area.
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49
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Ssali A, Poland F, Seeley J. Volunteer experiences and perceptions of the informed consent process: Lessons from two HIV clinical trials in Uganda. BMC Med Ethics 2015; 16:86. [PMID: 26630924 PMCID: PMC4668674 DOI: 10.1186/s12910-015-0073-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Informed consent as stipulated in regulatory human research guidelines requires that a volunteer is well-informed about what will happen to them in a trial. However researchers are faced with a challenge of how to ensure that a volunteer agreeing to take part in a clinical trial is truly informed. We conducted a qualitative study among volunteers taking part in two HIV clinical trials in Uganda to find out how they defined informed consent and their perceptions of the trial procedures, study information and interactions with the research team. METHODS Between January and December 2012, 23 volunteers who had been in the two trials for over 6 months, consented to be interviewed about their experience in the trial three times over a period of nine months. They also took part in focus group discussions. Themes informed by study research questions and emerging findings were used for content analysis. RESULTS Volunteers defined the informed consent process in terms of their individual welfare. Only two of the volunteers reported having referred during the trial to the participant information sheets given at the start of the trial. Volunteers remembered the information they had been given at the start of the trial on procedures that involved drawing blood and urine samples but not information about study design and randomisation. Volunteers said that they had understood the purpose of the trial. They said that signing a consent form showed that they had consented to take part in the trial but they also described it as being done to protect the researcher in case a volunteer later experienced side effects. CONCLUSION Volunteers pay more attention during the consent process to procedures requiring biological tests than to study design issues. Trust built between volunteers and the research team could enhance the successful conduct of clinical trials by allowing for informal discussions to identify and review volunteers' perceptions. These results point to the need for researchers to view informed consent as a process rather than an event.
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Affiliation(s)
- Agnes Ssali
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Kampala, Uganda.
| | | | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) Uganda Research Unit on AIDS, Kampala, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
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Paul C, Brookes B. The Rationalization of Unethical Research: Revisionist Accounts of the Tuskegee Syphilis Study and the New Zealand "Unfortunate Experiment". Am J Public Health 2015; 105:e12-9. [PMID: 26270295 PMCID: PMC4568718 DOI: 10.2105/ajph.2015.302720] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/04/2022]
Abstract
Two studies, widely condemned in the 1970s and 1980s-the Tuskegee study of men with untreated syphilis and the New Zealand study of women with untreated carcinoma in situ of the cervix-received new defenses in the 21st century. We noted remarkable similarities in both the studies and their defenses. Here we evaluate the scientific, political, and moral claims of the defenders. The scientific claims are largely based on incomplete or misinterpreted evidence and exaggeration of the uncertainties of science. The defenders' political arguments mistakenly claim that identity politics clouded the original critiques; in fact such politics opened the eyes of the public to exploitation. The moral defenses demonstrate an overreliance on codes of conduct and have implications for research ethics today.
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Affiliation(s)
- Charlotte Paul
- Charlotte Paul is emeritus professor in the Department of Preventive and Social Medicine and Barbara Brookes is with the Department of History and Art History, University of Otago, Dunedin, New Zealand
| | - Barbara Brookes
- Charlotte Paul is emeritus professor in the Department of Preventive and Social Medicine and Barbara Brookes is with the Department of History and Art History, University of Otago, Dunedin, New Zealand
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