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Ssali A, Namugumya R, Nalubega P, Kyohere M, Seeley J, Doare KL. Exploring the consent process among pregnant and breastfeeding women taking part in a maternal vaccine clinical trial in Kampala, Uganda: a qualitative study. BMC Med Ethics 2024; 25:57. [PMID: 38755578 PMCID: PMC11097482 DOI: 10.1186/s12910-024-01055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The involvement of pregnant women in vaccine clinical trials presents unique challenges for the informed consent process. We explored the expectations and experiences of the pregnant women, spouses/partners, health workers and stakeholders of the consent process during a Group B Streptococcus maternal vaccine trial. METHODS We interviewed 56 participants including pregnant women taking part in the trial, women not in the trial, health workers handling the trial procedures, spouses, and community stakeholders. We conducted 13 in-depth interviews and focus group discussions with 23 women in the trial, in-depth interviews with 5 spouses, and 5 women not in the trial, key informant interviews with 5 health workers and 5 other stakeholders were undertaken. RESULTS Decision-making by a pregnant woman to join a trial was done in consultation with spouse, parents, siblings, or trusted health workers. Written study information was appreciated by all but they suggested the use of audio and visual presentation to enhance understanding. Women stressed the need to ensure that their male partners received study information before their pregnant partners joined a clinical trial. Confidentiality in research was emphasised differently by individual participants; while some emphasised it for self, others were keen to protect their family members from being exposed, for allowing them to be involved in research. However, others wanted their community participation to be acknowledged. CONCLUSION We found that pregnant women make decisions to join a clinical trial after consulting with close family. Our findings suggest the need for an information strategy which informs not only the pregnant woman, but also her family about the research she is invited to engage in.
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Affiliation(s)
- Agnes Ssali
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Rita Namugumya
- Makerere University -John Hopkins University Research Collaboration, Kampala, Uganda
| | - Phiona Nalubega
- Makerere University -John Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
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Petitt Z, Ordonez YT, Kelkar Y, Shakir M, Ott M, Patel Y, Agwu C, Khalafallah AM, Mullikin A, Tang A, Davis J, Ssembatya JM, Choi S, Deng DD, Headley J, Obiga O, Haglund MM, Fuller AT. A Mixed-Methods Assessment of the Feasibility of Conducting Neurosurgical Clinical Research in Uganda. World Neurosurg 2024; 183:e71-e87. [PMID: 38006934 DOI: 10.1016/j.wneu.2023.11.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Clinical research is necessary to evaluate neurosurgical interventions, yet clinical trials are conducted less frequently in low- and middle-income countries. Because specific barriers, facilitating factors, and strategies for neurosurgical clinical research in Uganda have not been previously identified, this study evaluated neurosurgical providers' perspectives on clinical research and documentation patterns of neurosurgical variables at Mulago National Referral Hospital. METHODS Retrospective review of 166 neurosurgical patient charts assessed the frequency of documentation of key variables. Twenty-two providers working in neurosurgery participated in 6 focus group discussions with qualitative analysis utilizing the framework method. RESULTS Chart review showed that primary diagnosis (99.4%), pupil light response (97.6%), and computed tomography scan results (93.3%) were documented for most patients. Cranial nerve exam (61.5%), pupil size (69.9%), and time to neurosurgical intervention (45%) were documented less frequently. On average, Glasgow Coma Scale was documented for 86.6% of days hospitalized, while vital signs were documented for 12.3%. In most focus group discussions, participants identified follow-up, financing, recruitment, time, approval, and sociocultural factors as research barriers. Participants described how the current health workforce facilitates successful research. To improve research capacity, suggested strategies focused on research networks, data collection, leadership, participant recruitment, infrastructure, and implementation. CONCLUSIONS At Mulago National Referral Hospital, there was variability in the frequency of documentation of neurosurgical variables, which may impact data collection for future studies. While multiple barriers were identified, sociocultural, financing, and time barriers greatly impacted neurosurgical clinical research. Despite that, identified facilitating factors and strategies could be utilized to support neurosurgical research capacity growth.
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Affiliation(s)
- Zoey Petitt
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA; Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Yesel Trillo Ordonez
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Yuveer Kelkar
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA
| | - Muhammad Shakir
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Aga Khan University Hospital, Karachi, Pakistan
| | - Maura Ott
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Yash Patel
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Chibueze Agwu
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Pritzker School of Medicine, The University of Chicago Medical Center, Chicago, Illinois, USA
| | - Adham M Khalafallah
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Alexandria Mullikin
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA
| | - Alan Tang
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Jenna Davis
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joseph Mary Ssembatya
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbararra, Uganda
| | - Shinbe Choi
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Di D Deng
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA
| | - Jennifer Headley
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA; TEACCH Autism Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Oscar Obiga
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda
| | - Michael M Haglund
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA; Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Anthony T Fuller
- Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; School of Medicine, Duke University, Durham, North Carolina, USA; Duke Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
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