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Dorokhina M, Siu E, Drope J, Chaloupka FJ. From capacity building to collaboration in tobacco economics research. Tob Control 2024; 33:s34-s37. [PMID: 38839097 PMCID: PMC11187379 DOI: 10.1136/tc-2022-057821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Margaret Dorokhina
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Erika Siu
- Law School, University of Chicago, Chicago, Illinois, USA
| | - Jeffrey Drope
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Abimbola S, van de Kamp J, Lariat J, Rathod L, Klipstein-Grobusch K, van der Graaf R, Bhakuni H. Unfair knowledge practices in global health: a realist synthesis. Health Policy Plan 2024; 39:636-650. [PMID: 38642401 PMCID: PMC11145905 DOI: 10.1093/heapol/czae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024] Open
Abstract
Unfair knowledge practices easily beset our efforts to achieve health equity within and between countries. Enacted by people from a distance and from a position of power ('the centre') on behalf of and alongside people with less power ('the periphery'), these unfair practices have generated a complex literature of complaints across various axes of inequity. We identified a sample of this literature from 12 journals and systematized it using the realist approach to explanation. We framed the outcome to be explained as 'manifestations of unfair knowledge practices'; their generative mechanisms as 'the reasoning of individuals or rationale of institutions'; and context that enable them as 'conditions that give knowledge practices their structure'. We identified four categories of unfair knowledge practices, each triggered by three mechanisms: (1) credibility deficit related to pose (mechanisms: 'the periphery's cultural knowledge, technical knowledge and "articulation" of knowledge do not matter'), (2) credibility deficit related to gaze (mechanisms: 'the centre's learning needs, knowledge platforms and scholarly standards must drive collective knowledge-making'), (3) interpretive marginalization related to pose (mechanisms: 'the periphery's sensemaking of partnerships, problems and social reality do not matter') and (4) interpretive marginalization related to gaze (mechanisms: 'the centre's learning needs, social sensitivities and status preservation must drive collective sensemaking'). Together, six mutually overlapping, reinforcing and dependent categories of context influence all 12 mechanisms: 'mislabelling' (the periphery as inferior), 'miseducation' (on structural origins of disadvantage), 'under-representation' (of the periphery on knowledge platforms), 'compounded spoils' (enjoyed by the centre), 'under-governance' (in making, changing, monitoring, enforcing and applying rules for fair engagement) and 'colonial mentality' (of/at the periphery). These context-mechanism-outcome linkages can inform efforts to redress unfair knowledge practices, investigations of unfair knowledge practices across disciplines and axes of inequity and ethics guidelines for health system research and practice when working at a social or physical distance.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Judith van de Kamp
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Joni Lariat
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Lekha Rathod
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- Luxembourg Operational Research and Epidemiology Support Unit, Médecins Sans Frontières, Luxembourg City L-1617, Luxembourg
| | - Kerstin Klipstein-Grobusch
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Rieke van der Graaf
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
| | - Himani Bhakuni
- Department of Global Public Health and Bioethics, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
- York Law School, University of York, York YO10 5GD, United Kingdom
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Karuga R, Steege R, Chowdhury S, Squire B, Theobald S, Otiso L. A multi-step analysis and co-produced principles to support equitable partnership with Liverpool School of Tropical Medicine, 125 years on. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002091. [PMID: 38820344 PMCID: PMC11142479 DOI: 10.1371/journal.pgph.0002091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/10/2024] [Indexed: 06/02/2024]
Abstract
Transboundary health partnerships are shaped by global inequities. Perspectives from the "global South" are critical to understand and redress power asymmetries in research partnerships yet are not often included in current guidelines. We undertook research with partners working with the Liverpool School of Tropical Medicine (LSTM) to inform LSTM's equitable partnership strategy and co-develop principles for equitable partnerships as an entry point towards broader transformative action on research partnerships. We applied mixed-methods and participatory approaches. An online survey (n = 21) was conducted with LSTM's transboundary partners on fairness of opportunity, fair process, and fair sharing of benefits, triangulated with key informant interviews (n = 12). Qualitative narratives were analysed using the thematic framework approach. Findings were presented in a participatory workshop (n = 11) with partners to co-develop principles, which were refined and checked with stakeholders. Early inclusion emerged as fundamental to equitable partnerships, reflected in principle one: all partners to input into research design, agenda-setting and outputs to reflect priorities. Transparency is highlighted in principle two to guide all stages including agenda-setting, budgeting, data ownership and authorship. Principle three underscores the importance of contextually embedded knowledge for relevant and impactful research. Multi-directional capacity strengthening across all cadres is highlighted in principle four. Principle five includes LSTM leveraging their position for strategic and deliberate promotion of transboundary partners in international forums. A multi-centric model of partnership with no centralised power is promoted in principle six. Finally, principle seven emphasises commitment to the principles and Global Code of Conduct values: Fairness, Respect, Care, Honesty. The co-developed principles are part of ongoing reflections and dialogue to improve and undo harmful power structures that perpetuate coloniality within global health. While this process was conducted with LSTM-Liverpool's existing partners, the principles to strengthen equity are applicable to other institutions engaged in transboundary research partnerships and relevant for funders.
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Affiliation(s)
- Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Rosie Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bertie Squire
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lilian Otiso
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
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Kumar R, Khosla R, McCoy D. Decolonising global health research: Shifting power for transformative change. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003141. [PMID: 38656955 PMCID: PMC11042701 DOI: 10.1371/journal.pgph.0003141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Recent debates on decolonizing global health have spurred interest in addressing the power asymmetries and knowledge hierarchies that sustain colonial ideas and relationships in global health research. This paper applies three intersecting dimensions of colonialism (colonialism within global health; colonisation of global health; and colonialism through global health) to develop a broader and more structural understanding of the policies and actions needed to decolonise global health research. It argues that existing guidelines and checklists designed to make global health research more equitable do not adequately address the underlying power asymmetries and biases that prevail across the global health research ecosystem. Beyond encouraging fairer partnerships within individual research projects, this paper calls for more emphasis on shifting the balance of decision-making power, redistributing resources, and holding research funders and other power-holders accountable to the places and peoples involved in and impacted by global health research.
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Affiliation(s)
- Ramya Kumar
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Rajat Khosla
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
| | - David McCoy
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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Luthuli S, Daniel M, Corbin JH. Power imbalances and equity in the day-to-day functioning of a north plus multi-south higher education institutions partnership: a case study. Int J Equity Health 2024; 23:59. [PMID: 38491440 PMCID: PMC10943907 DOI: 10.1186/s12939-024-02139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Partnerships between Higher Education Institutions (HEIs) in the global north and south have commonly been used as a vehicle to drive global health research and initiatives. Among these initiatives, include health system strengthening, research capacity building, and human resource training in developing countries. However, the partnership functioning of many global north-south partnerships still carry legacies of colonialism through unrecognized behavior patterns, attitudes, and belief systems in how they function. Even with research literature calling for a shift from equality to equity in the functioning of these partnerships, many still struggle with issues of complex and unspoken power dynamics. To understand the successes and challenges of north-south partnerships, this paper explored partnership development and functioning of a northern and multi-southern HEIs partnership focused on nutrition education and research. METHODS A qualitative research approach was used; data were collected through in-depth interviews (IDIs) with questions developed from the Bergen Model of Collective Functioning (BMCF). Thirteen IDIs were conducted with partners from all institutions including stakeholders. FINDINGS The partnership was built on the foundation of experiences and lessons of a previous partnership. Partners used these experiences and lessons to devise strategies to improve partnership inputs, communication, leadership, roles and structures, and maintenance and communication tasks. However, these strategies had an impact on partnership functioning giving rise to issues of inequitable power dynamics. The northern partner had two roles: one as an equal partner and another as distributor of project funds; this caused a conflict in roles for this partner. The partners distinguished themselves according to partner resources - two partners were named implementing partners and two named supportive partners. Roles and partner resources were the greatest contributors to power imbalances and caused delays in project activities. CONCLUSION Using the BMCF to examine partnership dynamics illuminated that power imbalances caused a hierarchical stance in the partnership with northern partners having overall control and power of decision-making in the partnership. This could impact the effectiveness and sustainability of project in the southern institutions going forward.
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Affiliation(s)
- Silondile Luthuli
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Marguerite Daniel
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - J Hope Corbin
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
- Department of Health and Community Studies, Western Washington University, Bellingham, WA, USA
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Cakouros BE, Gum J, Levine DL, Lewis J, Wright AH, Dahn B, Talbert-Slagle K. Exploring equity in global health collaborations: a qualitative study of donor and recipient power dynamics in Liberia. BMJ Glob Health 2024; 9:e014399. [PMID: 38485141 PMCID: PMC10946382 DOI: 10.1136/bmjgh-2023-014399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/16/2024] [Indexed: 03/19/2024] Open
Abstract
IntroductionGlobal health collaborations between individuals from high-resource and low-resource settings are complex and often built on hierarchical structures and power differentials that are difficult to change. There have been many calls and frameworks developed to facilitate more equity within these collaborations, yet little is known about the lived experiences of global health donors and recipients working within such collaborations and how those experiences can facilitate more equitable collaboration. Liberia, a postconflict, post-Ebola country, provides an ideal setting to study lived experiences of global health collaborations.MethodsOur qualitative analysis used key informant interviews representing the perspectives of those working on behalf of the Liberian government, Liberian academics, foreign donors and non-governmental organisations and implementing partners. Thematic analysis guided this analysis to explore topics such as financial control, accountability and decision making.ResultsThe first phase of the analysis mapped the existing patterns of priority setting. Priority-setting power was most strongly held by those with financial control (donors), and implementation plans tended to be built on metrics that aim to meet donor expectations. The second phase of the analysis explored the interplay between underlying factors that we identified in our data associated with driving collaborative inequity: history of prior of engagement, level of transparency and patterns of accountability.ConclusionsOur findings highlight that global health collaborations in Liberia are structured to hinder equitable partnerships. The power structure tied to financial ownership offers little space for recipients to have an equitable role in collaborations, which maintains dependence on external aid and ensures that weak systems remain weak. While our study is limited to Liberia, we anticipate that these dynamics are common elsewhere and reinforce the importance of intentional efforts to ensure equitable decision making and power structures in similar settings worldwide.
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Affiliation(s)
| | | | | | | | | | - Bernice Dahn
- College of Health Sciences, University of Liberia, Monrovia, Liberia
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Bemme D, Roberts T, Ae-Ngibise KA, Gumbonzvanda N, Joag K, Kagee A, Machisa M, van der Westhuizen C, van Rensburg A, Willan S, Wuerth M, Aoun M, Jain S, Lund C, Mathias K, Read U, Taylor Salisbury T, Burgess RA. Mutuality as a method: advancing a social paradigm for global mental health through mutual learning. Soc Psychiatry Psychiatr Epidemiol 2024; 59:545-553. [PMID: 37393204 PMCID: PMC10944435 DOI: 10.1007/s00127-023-02493-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/23/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Calls for "mutuality" in global mental health (GMH) aim to produce knowledge more equitably across epistemic and power differences. With funding, convening, and publishing power still concentrated in institutions in the global North, efforts to decolonize GMH emphasize the need for mutual learning instead of unidirectional knowledge transfers. This article reflects on mutuality as a concept and practice that engenders sustainable relations, conceptual innovation, and queries how epistemic power can be shared. METHODS We draw on insights from an online mutual learning process over 8 months between 39 community-based and academic collaborators working in 24 countries. They came together to advance the shift towards a social paradigm in GMH. RESULTS Our theorization of mutuality emphasizes that the processes and outcomes of knowledge production are inextricable. Mutual learning required an open-ended, iterative, and slower paced process that prioritized trust and remained responsive to all collaborators' needs and critiques. This resulted in a social paradigm that calls for GMH to (1) move from a deficit to a strength-based view of community mental health, (2) include local and experiential knowledge in scaling processes, (3) direct funding to community organizations, and (4) challenge concepts, such as trauma and resilience, through the lens of lived experience of communities in the global South. CONCLUSION Under the current institutional arrangements in GMH, mutuality can only be imperfectly achieved. We present key ingredients of our partial success at mutual learning and conclude that challenging existing structural constraints is crucial to prevent a tokenistic use of the concept.
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Affiliation(s)
| | | | | | | | | | - Ashraf Kagee
- Stellenbosch University, Stellenbosch, South Africa
| | | | | | - André van Rensburg
- University of Kwazulu-Natal, Centre for Rural Health, Durban, South Africa
| | - Samantha Willan
- South African Medical Research Council, Cape Town, South Africa
| | | | - May Aoun
- Save the Children, New York, USA
| | | | - Crick Lund
- King's College London, London, UK
- University of Cape Town, Cape Town, South Africa
| | - Kaaren Mathias
- University of Canterbury, Christchurch, New Zealand
- Burans, Herbertpur Christian Hospital, Atten Bagh, India
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Gjerde H, Huestis MA, Mulima G, Kajombo C, Sundet M, Pechansky F. Recommendations for effective collaboration and capacity building in epidemiological studies on the effect of alcohol and drug use on traffic safety in low- and middle-income countries. TRAFFIC INJURY PREVENTION 2024; 25:313-321. [PMID: 38426896 DOI: 10.1080/15389588.2024.2316720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Alcohol or drug impairment is a major risk factor for road traffic crashes, and studies on this issue are essential to provide evidence-based data for policymakers. In low- and middle-income countries (LMICs), such studies are often conducted in partnership with one or more organizations in high-income countries (HICs). The aim of this article is to provide recommendations for improving project planning and decision-making processes in epidemiological studies on alcohol, drug and traffic safety in LMICs involving HICs. METHODS We searched Pubmed, Google Scholar, and Google Search for articles and reports in English about lessons learned when conducting collaborative research in LMIC as well as papers presenting recommendations for effective research collaboration with partners in LMICs. RESULTS Based on the search results, we selected 200 papers for full text examination. Few were related to studies on the effect of alcohol or drug use on road traffic safety. However, several conclusions and recommendations from other studies were found to be relevant. We combined the findings with our own experience in a narrative review. We also present a checklist for risk and quality assessment. CONCLUSIONS Many papers presented similar recommendations, which included the importance of addressing local needs, ensuring adequate resources, local project ownership and leadership, establishing strong partnerships among all involved stakeholders, promoting shared decision-making and planning, and implementing strategies to translate research findings into policy, practice, and publications. It is also important to avoid HIC bias, which prioritizes the interests or perspectives of HICs over those of LMICs.
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Affiliation(s)
- Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- International Council on Alcohol, Drugs and Traffic Safety (ICADTS)
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Severna Park, Maryland
| | | | | | - Mads Sundet
- Centre for Treatment of Rheumatic and Musculoskeletal Disease (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Flavio Pechansky
- International Council on Alcohol, Drugs and Traffic Safety (ICADTS)
- Center for Drug and Alcohol Research, Hospital de Clinicas of Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Skrivankova VW, Hossmann S, Cornell M, Ballif M, Dupont C, Huwa J, Seintaridis K, Kalua T, Wandeler G, Kassanjee R, Haas AD, Technau KG, Fenner L, Low N, Davies MA, Egger M. Authorship inequalities in global health research: the IeDEA Southern Africa collaboration. BMJ Glob Health 2023; 8:e013316. [PMID: 38103897 PMCID: PMC10729048 DOI: 10.1136/bmjgh-2023-013316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The International epidemiology Databases to Evaluate AIDS conducts research in several regions, including in Southern Africa. We assessed authorship inequalities for the Southern African region, which is led by South African and Swiss investigators. METHODS We analysed authorships of publications from 2007 to 2020 by gender, country income group, time and citation impact. We used 2020 World Bank categories to define income groups and the relative citation ratio (RCR) to assess citation impact. Authorship parasitism was defined as articles without authors from the countries where the study was conducted. A regression model examined the probability of different authorship positions. RESULTS We included 313 articles. Of the 1064 contributing authors, 547 (51.4%) were women, and 223 (21.0%) were from 32 low-income/lower middle-income countries (LLMICs), 269 (25.3%) were from 13 upper middle-income countries and 572 (53.8%) were from 25 high-income countries (HICs). Most articles (150/157, 95.5%) reporting data from Southern Africa included authors from all participating countries. Women were more likely to be the first author than men (OR 1.74; 95% CI 1.06 to 2.83) but less likely to be last authors (OR 0.63; 95% CI 0.40 to 0.99). Compared with HIC, LLMIC authors were less likely to publish as first (OR 0.21; 95% CI 0.11 to 0.41) or last author (OR 0.20; 95% CI 0.09 to 0.42). The proportion of women and LLMIC first and last authors increased over time. The RCR tended to be higher, indicating greater impact, if first or last authors were from HIC (p=0.06). CONCLUSIONS This analysis of a global health collaboration co-led by South African and Swiss investigators showed little evidence of authorship parasitism. There were stark inequalities in authorship position, with women occupying more first and men more last author positions and researchers from LLMIC being 'stuck in the middle' on the byline. Global health research collaborations should monitor, analyse and address authorship inequalities.
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Affiliation(s)
| | - Stefanie Hossmann
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Marie Ballif
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Carole Dupont
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
| | | | | | - Thokozani Kalua
- Department of HIV and AIDS, Malawi Ministry of Health, Lilongwe, Malawi
| | - Gilles Wandeler
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
- Department of Infectious Diseases, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Reshma Kassanjee
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andreas D Haas
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
| | - Karl-Gunter Technau
- Department of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lukas Fenner
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), Universität Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023; 8:120. [PMID: 38089903 PMCID: PMC10714106 DOI: 10.12688/wellcomeopenres.18915.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods Based on informal literature reviews and a meeting with leaders of one of the multinational COVID-19 adaptive platform trials, we describe some important considerations about research partnership equity in this context. Results We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation and dissemination, and 8) research capacity strengthening and maintenance. Within each category we review normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion In aggregate, these observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
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Affiliation(s)
- Chelsea Modlin
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
| | - Jeremy Sugarman
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Gershom Chongwe
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nancy Kass
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Winfred Nazziwa
- Uganda National Council for Science and Technology, Kampala, Uganda
| | - Jemee Tegli
- Family Health International Clinical/Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Joseph Ali
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
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Zee TW, Abdul Aziz MFB, Wei PC. Ethical challenges of conducting and reviewing human genomics research in Malaysia: An exploratory study. Dev World Bioeth 2023:10.1111/dewb.12435. [PMID: 37997006 PMCID: PMC11111594 DOI: 10.1111/dewb.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023]
Abstract
Even though there is a significant amount of scholarly work examining the ethical issues surrounding human genomics research, little is known about its footing in Malaysia. This study aims to explore the experience of local researchers and research ethics committee (REC) members in developing it in Malaysia. In-depth interviews were conducted from April to May 2021, and the data were thematically analysed. In advancing this technology, both genomics researchers and REC members have concerns over how this research is being developed in the country especially the absence of a clear ethical and regulatory framework at the national level as a guidance. However, this study argues that it is not a salient issue as there are international guidelines in existence and both researchers and RECs will benefit from a training on the guidelines to ensure genomics research can be developed in an ethical manner.
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Kang J, Kang P. Relationship Building between International Healthcare Volunteers and Local Healthcare Providers in Ethiopia: Real-Life Experiences in Low-Income Country. Healthcare (Basel) 2023; 11:1969. [PMID: 37444804 DOI: 10.3390/healthcare11131969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers' experiences in Ethiopia in building relationships with local healthcare providers. METHODS Six participants were enrolled in the study, and data were collected through individual in-depth interviews conducted between September and October 2018. The collected data were analyzed using Colaizzi's phenomenological method. RESULTS Ten subthemes emerged from five themes: "facing new situations", "accepting myself as an outsider in Ethiopia", "impact on the wall of prejudice", "adapting to a new culture", and "positive outlook". CONCLUSIONS This study shows that international healthcare volunteers in Ethiopia experienced challenges in building relationships with local healthcare providers due to linguistic and cultural gaps. Nevertheless, they strived to accept the culture and play their part as helpers in providing healthcare services.
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Affiliation(s)
- Jiwon Kang
- School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Purum Kang
- College of Nursing, Woosuk University, Wanju 55338, Jeollabuk-do, Republic of Korea
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Modlin CE, Kankaka EN, Chang LW, Sewankambo NK, Ali J. Exploring HIV/AIDS investigator perceptions of equity within research partnerships between low-and middle-income and high-income countries: a pilot survey. Health Res Policy Syst 2023; 21:32. [PMID: 37127604 PMCID: PMC10152781 DOI: 10.1186/s12961-023-00977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Recommendations for research partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs) stress the importance of equity within the collaboration. However, there is limited knowledge of the practical challenges and successes involved in establishing equitable research practices. This study describes the results of a pilot survey assessing key issues on LMIC/HIC partnership equity within HIV/AIDS research collaborations and compares perspectives of these issues between LMIC- and HIC-based investigators. METHODS Survey participants were selected using clustered, random sampling and snowball sampling. Responses were compared between LMIC and HIC respondents using standard descriptive statistics. Qualitative respondent feedback was analyzed using a combination of exploratory and confirmatory thematic analysis. RESULTS The majority of categories within four themes (research interests and resources; leadership, trust, and communication; cultural and ethical competence; representation and benefits) demonstrated relative consensus between LMIC and HIC respondents except for 'lack of trust within the partnership' which was rated as a more pronounced challenge by LMIC respondents. However, subcategories within some of the themes had significant differences between respondent groups including: equitable setting of the research agenda, compromise within a partnership, the role of regulatory bodies in monitoring partnerships for equity, and post-study access to research technology. CONCLUSIONS These efforts serve as a proof-of-concept survey characterizing contemporary issues around international research partnership equity. The frequency and severity of specific equity issues can be assessed, highlighting similarities versus differences in experiences between LMIC and HIC partners as potential targets for further discussion and evaluation.
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Affiliation(s)
- Chelsea E Modlin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA.
| | - Edward Nelson Kankaka
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Rakai Health Sciences Program, Rakai, Uganda
| | - Larry W Chang
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nelson K Sewankambo
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Blasiak R, Jouffray JB, Amon DJ, Claudet J, Dunshirn P, Søgaard Jørgensen P, Pranindita A, Wabnitz CCC, Zhivkoplias E, Österblom H. Making marine biotechnology work for people and nature. Nat Ecol Evol 2023; 7:482-485. [PMID: 36690733 DOI: 10.1038/s41559-022-01976-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Robert Blasiak
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden.
- Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan.
| | | | - Diva J Amon
- SpeSeas, D'Abadie, Trinidad and Tobago
- Marine Science Institute, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Joachim Claudet
- National Center for Scientific Research, PSL Université Paris, CRIOBE, CNRS-EPHE-UPVD, Paris, France
| | - Paul Dunshirn
- Research Platform Governance of Digital Practices, University of Vienna, Vienna, Austria
| | - Peter Søgaard Jørgensen
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- The Global Economic Dynamics and the Biosphere Academy Program, Royal Swedish Academy of Science, Stockholm, Sweden
| | - Agnes Pranindita
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Bolin Centre for Climate Research, Stockholm University, Stockholm, Sweden
| | - Colette C C Wabnitz
- Stanford Centre for Ocean Solutions, Stanford University, Stanford, CA, USA
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, BC, Canada
| | - Erik Zhivkoplias
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Henrik Österblom
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
- Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
- South American Institute for Resilience and Sustainability Studies, Maldonado, Uruguay
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15
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Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18915.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background: Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods: Based on informal literature reviews and meetings with leaders of one of the multinational COVID-19 adaptive platform trials, we describe what can be learned about research partnership equity from these experiences. Results: We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation, and 8) research capacity strengthening and maintenance. Within each category we review the normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion: These observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
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Alayande BT, Hughes Z, Fitzgerald TN, Riviello R, Bekele A, Rice HE. With equity in mind: Evaluating an interactive hybrid global surgery course for cross-site interdisciplinary learners. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001778. [PMID: 37141197 PMCID: PMC10159197 DOI: 10.1371/journal.pgph.0001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
There is limited understanding of the role of transcultural, cross-site educational partnerships for global surgery training between high- and low- or middle-income country (LMIC) institutions. We describe the development, delivery, and appraisal of a hybrid, synchronous, semester-long Global Surgical Care course by global health collaborators from widely different contexts, and evaluate the equity of the collaboration. The course was collaboratively modified by surgical educators and public health professionals with emphasis on collaboration ethics. Faculty from high-income and LMICs were paired to deliver lectures. To collaborate internationally, students and faculty participated either onsite or online. Perceptions and knowledge gained were quantitatively evaluated through participant and faculty cross-sectional surveys, using Likert scales, prioritization rankings, and free text responses analysed qualitatively. Equity was assessed using the Fair Trade Learning rubric and additional probes. Thirty-five learners from six institutions participated. Teams produced mock National, Surgical, Obstetric, and Anaesthesia Plans (NSOAPs) for selected LMICs, and reported a 9% to 65% increase in self-reported global health competencies following the course. Online learners had favourable perceptions of learning, but experienced connectivity challenges. Barriers to effective group work included time differences and logistics of communication for dispersed team members. Individuals taking the course for academic credit scored significantly higher than other learners in peer assessments of participation (8.56±1.53 versus 5.03±3.14; p<0.001). Using the Fair Trade Rubric, 60% of equity indicators were ideal, and no respondents perceived neo-colonialism in the partnership. Blended, synchronous, interdisciplinary global surgery courses based on "North-South" partnerships with a focus on equity in design and delivery are feasible but require careful and deliberate planning to minimize epistemic injustice. Such programs should address surgical systems strengthening, and not create dependency. Equity in such engagements should be evaluated and monitored in an ongoing fashion to stimulate discussion and continuous improvement.
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Affiliation(s)
- Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Zoe Hughes
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Tamara N Fitzgerald
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
| | - Robert Riviello
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke University School of Medicine, Duke University, Durham, North Carolina, United States of America
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Voller S, Chitalu CCM, Nyondo-Mipando AL, Opobo T, Bangirana CA, Thorogood N, Schellenberg J, Chi P. "We should be at the table together from the beginning": perspectives on partnership from stakeholders at four research institutions in sub-Saharan Africa. Int J Equity Health 2022; 21:111. [PMID: 35978323 PMCID: PMC9387072 DOI: 10.1186/s12939-022-01707-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Global health research partnerships have been scrutinised for how they operate and criticised for perpetuating inequities. Guidance to inform fair partnership practice has proliferated and the movement to decolonise global health has added momentum for change. In light of this evolving context, we sought in this study to document contemporary experiences of partnership from the perspective of stakeholders in four sub-Saharan African research institutions. Methods We conducted qualitative interviews with 20 stakeholders at research institutions in four countries in anglophone eastern and southern Africa. Interview questions were informed by published guidance on equitable research partnerships. Data was analysed through an iterative process of inductive and deductive coding, supported by NVivo software. Results Early-career, mid-career and senior researchers and research administrators from four sub-Saharan African research institutions described wide-ranging experiences of partnership with high-income country collaborators. Existing guidelines for partnership provided good coverage of issues that participants described as being the key determinants of a healthy partnership, including mutual respect, role clarity and early involvement of all partners. However, there was almost no mention of guidelines being used to inform partnership practice. Participants considered the key benefits of partnership to be capacity strengthening and access to research funding. Meanwhile, participants continued to experience a range of well-documented inequities, including exclusion from agenda setting, study design, data analysis and authorship; and relationships that were exploitative and dominated by high-income country partners’ interests. Participants also reported emerging issues where their institution had been the prime recipient of funds. These included high-income country partners being unwilling to accept a subordinate role and failing to comply with reporting requirements. Conclusions Insights from stakeholders in four sub-Saharan African research institutions suggest that contemporary global health research partnerships generate considerable benefits but continue to exhibit longstanding inequities and reveal emerging tensions. Our findings suggest that long-term support targeted towards institutions and national research systems remains essential to fulfil the potential of research led from sub-Saharan Africa. High-income country stakeholders need to find new roles in partnerships and stakeholders from sub-Saharan Africa must continue to tackle challenges presented by the resource-constrained contexts in which they commonly operate. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01707-3.
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Affiliation(s)
- Shirine Voller
- Epidemiology and Demography Department, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya.
| | | | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences (Formerly College of Medicine), Blantyre, Malawi
| | - Timothy Opobo
- The AfriChild Centre, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Clare Ahabwe Bangirana
- The AfriChild Centre, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Nicki Thorogood
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Primus Chi
- Health Systems and Research Ethics Department, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
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Rajabzadeh V, McGrath M, Van Loggerenberg F, Bird VJ, Priebe S. What are the expectations and experiences of a GMH research programme delivered in Bosnia-Herzegovina, Colombia and Uganda? A prospective longitudinal qualitative study. BMJ Open 2022; 12:e059590. [PMID: 36691243 PMCID: PMC9171268 DOI: 10.1136/bmjopen-2021-059590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/09/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES Global health research collaborations between partners in high-income countries and low-income and middle-income countries (LMICs) aim to generate new evidence, strengthen research capacity, tackle health inequalities and improve outcomes. Previous evaluations of such programmes have identified areas for improvement but consisted only of retrospective experiences. We conducted the first prospective study to assess the initial expectations as well as the final experiences of participants of a global health research programme. DESIGN, SETTINGS AND PARTICIPANTS This study adopted a prospective longitudinal qualitative study, 38 participants of a global mental health research programme with partners in Bosnia-Herzegovina, Colombia, Uganda and the (UK). The interviewees included senior investigators, coordinators and researchers. Framework analysis was used to analyse the data. OUTCOME MEASURES Participants were interviewed about their initial expectations at the inception of the research programme and their final experiences at the end. RESULTS Many of the original expectations were later reported as met or even exceeded. They included experiences of communication, relationships, developed research expertise, further research opportunities and extending networks. However, other expectations were not met or only partially met, mainly on developing local leadership, strengthening institutional research capacity and opportunities for innovation and for mutual learning. Around equity of partnership and ownership of research the views of participants in the UK tended to be more critical than those of partners in LMICs. CONCLUSIONS The findings suggest that global health research programmes can achieve several of their aims, and that partners in LMICs feel equity has been established in the partnership despite the imbalance of the funding arrangement. Aims of global health research projects should have a realistic focus and be proportionate to the parameters of the funding arrangement. More resources and longer time scales may be required to address sustainable structural capacity and long-standing local leadership sufficiently.
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Affiliation(s)
- Vian Rajabzadeh
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Michael McGrath
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Francois Van Loggerenberg
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Victoria Jane Bird
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Pompili C, Ugalde Figueroa P, Molena D, Lerut T. Women in Thoracic Surgery in Africa: a call for intersocietal coalition. Interact Cardiovasc Thorac Surg 2022; 34:721-722. [PMID: 35020901 PMCID: PMC9070527 DOI: 10.1093/icvts/ivab368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute of Medical Research at St James’s, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Thoracic Surgery Unit, Verona University Hospital, Verona, Italy
| | - Paula Ugalde Figueroa
- Division of Cardio-Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Daniela Molena
- Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
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20
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Voller S, Schellenberg J, Chi P, Thorogood N. What Makes Working Together Work? A Scoping Review of the Guidance on North-South Research Partnerships. Health Policy Plan 2022; 37:523-534. [PMID: 35089994 PMCID: PMC9006068 DOI: 10.1093/heapol/czac008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/29/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
At their best, research partnerships provide a mechanism to optimize each partner’s strengths, make scientific discoveries and achieve development goals. Each partner stands to gain from the relationship and perceives it to be fair. However, partnerships between institutions in the global North and the global South have been beleaguered by structural inequalities and power imbalances, and Northern stakeholders have been criticized for perpetuating paternalistic or neo-colonial behaviours. As part of efforts to redress imbalances and achieve equity and mutual benefit, various principles, guidelines, frameworks and models for partnership have been developed. This scoping review maps the literature and summarizes key features of the guidelines for North–South research partnerships. The review was conducted between October 2020 and January 2021. Three academic journal databases and Google were searched, and additional resources were identified through a hand search of reference lists and expert recommendation. Twenty-two guidelines were identified published between 1994 and 2021 and originating predominantly in the fields of international development and global health. The themes addressed within the guidelines were aggregated using NVivo qualitative analysis software to code the content of each guideline. Topics featuring most prominently in the guidelines were: partner roles, responsibilities and ways of working; capacity strengthening; motivation and goals; resource contributions; agenda setting and study design; governance structures and institutional agreements; dissemination; respect for affected populations; data handling and ownership; funding and long-term commitments. The current study reinforces many of the themes from two recent scoping reviews specific to the field of global health, but gaps remain, which need to be addressed: Southern stakeholders continue to be under-represented in guideline development, and there is limited evidence of how guidelines are used in practice. Further exploration is needed of Southern stakeholder priorities and whether and how guidelines are operationalized.
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Affiliation(s)
- Shirine Voller
- *Corresponding author. Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. E-mail:
| | - Joanna Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Primus Chi
- Health Systems and Research Ethics Department, KEMRI Wellcome Trust Research Programme, CGMRC, PO Box 230-80108 Kilifi, Kenya
| | - Nicki Thorogood
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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Ravi K, Bentounsi Z, Tariq A, Brazeal A, Daudu D, Back F, Elhadi M, Badwi N, Shah SSNH, Bandyopadhyay S, Khalil H, Kimura H, Sekyi-Djan MN, Abdelrahman A, Shaheen A, Mbonda Noula AG, Wong AT, Ndajiwo A, Souadka A, Maina AN, Nyalundja AD, Sabry A, Hind B, Nteranya DS, Ngugi DW, de Wet E, Tolis EA, Wafqui FZ, Essangri H, Moujtahid H, Moola H, Narain K, Ravi K, Wassim K, Odiero LA, Nyaboke LS, Metwalli M, Naisiae M, Pueschel MG, Turabi N, El Aroussi N, Makram OM, Shawky OA, Outani O, Carides P, Patil P, Halley-Stott RP, Kurbegovic S, Marchant S, Moujtahid S, El Hadrati S, Agarwal T, Kidavasi VA, Agarwal V, Steyn W, Matumo W, Fahmy YA, Omar Z, Amod Z, Eloff M, Hussein NA, Sharma D. Systematic analysis of authorship demographics in global surgery. BMJ Glob Health 2021; 6:bmjgh-2021-006672. [PMID: 34666988 PMCID: PMC8527109 DOI: 10.1136/bmjgh-2021-006672] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/09/2021] [Indexed: 02/06/2023] Open
Abstract
Background Global surgery has recently gained prominence as an academic discipline within global health. Authorship inequity has been a consistent feature of global health publications, with over-representation of authors from high-income countries (HICs), and disenfranchisement of researchers from low-income and middle-income countries (LMICs). In this study, we investigated authorship demographics within recently published global surgery literature. Methods We performed a systematic analysis of author characteristics, including gender, seniority and institutional affiliation, for global surgery studies published between 2016 and 2020 and indexed in the PubMed database. We compared the distribution of author gender and seniority across studies related to different topics; between authors affiliated with HICs and LMICs; and across studies with different authorship networks. Results 1240 articles were included for analysis. Most authors were male (60%), affiliated only with HICs (51%) and of high seniority (55% were fully qualified specialist or generalist clinicians, Principal Investigators, or in senior leadership or management roles). The proportion of male authors increased with increasing seniority for last and middle authors. Studies related to Obstetrics and Gynaecology had similar numbers of male and female authors, whereas there were more male authors in studies related to surgery (69% male) and Anaesthesia and Critical care (65% male). Compared with HIC authors, LMIC authors had a lower proportion of female authors at every seniority grade. This gender gap among LMIC middle authors was reduced in studies where all authors were affiliated only with LMICs. Conclusion Authorship disparities are evident within global surgery academia. Remedial actions to address the lack of authorship opportunities for LMIC authors and female authors are required.
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Affiliation(s)
- Krithi Ravi
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zineb Bentounsi
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aiman Tariq
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | | | - Davina Daudu
- The University of Western Australia Faculty of Health and Medical Sciences, Perth, Western Australia, Australia
| | - Francesca Back
- University of Oxford Medical Sciences Division, Oxford, UK
| | | | - Nermin Badwi
- Zagazig University Faculty of Human Medicine, Zagazig, Egypt.,InciSioN Egypt, Zagazig, Egypt
| | | | | | - Halimah Khalil
- Birmingham Medical School, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | | | | | | | - Ahmed Shaheen
- Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Ai-Ting Wong
- Red Cross War Memorial Children's Hospital, Rondebosch, South Africa
| | | | - Amine Souadka
- National Institute of Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | | | | | | | - Bourja Hind
- Ibn Rochd University Hospital Center, Casablanca, Morocco
| | - Daniel Safari Nteranya
- Department of Surgery, Official University of Bukavu, Bukavu, Congo.,Association of Future African Neurosurgeons, Yaoundé, Cameroon
| | | | - Elsa de Wet
- University of the Free State, Bloemfontein, South Africa
| | | | - F Z Wafqui
- Faculty of Medicine and Pharmacy, Casablanca, Morocco
| | - Hajar Essangri
- National Institute of Oncology, Mohammed V University of Rabat, Rabat, Morocco
| | - Hajar Moujtahid
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Husna Moola
- University of Cape Town, Rondebosch, South Africa
| | - Kapil Narain
- University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | - Krupa Ravi
- University of Oxford Medical Sciences Division, Oxford, UK
| | - Kyrillos Wassim
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | | | | | | | - Maryanne Naisiae
- University of Nairobi College of Health Sciences, Nairobi, Kenya
| | | | - Nafisa Turabi
- Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
| | - Nouhaila El Aroussi
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Omar Mohamed Makram
- Department of Cardiology, Faculty of Medicine, October 6 University, 6th of October City, Egypt.,London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Omar A Shawky
- Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Oumaima Outani
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | - Peter Carides
- University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | | | - Sabina Kurbegovic
- Medical Faculty, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Sara Moujtahid
- Ibn Sina University Hospital Center, Rabat, Morocco.,Mohammed V University, Rabat, Morocco
| | - Soukaina El Hadrati
- Faculty of Medicine and Pharmacy, Mohammed V University of Rabat, Rabat, Morocco
| | | | | | | | - Wilme Steyn
- Chris Hani Baragwanath Hospital, Bertsham, South Africa
| | | | | | - Zaayid Omar
- Rondebosch Medical Centre, Cape Town, South Africa
| | - Zachary Amod
- University of Cape Town, Rondebosch, South Africa
| | - Madelein Eloff
- University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
| | | | - Dhananjaya Sharma
- Department of Surgery, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
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22
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Aarestrup FM, Bonten M, Koopmans M. Pandemics- One Health preparedness for the next. LANCET REGIONAL HEALTH-EUROPE 2021; 9:100210. [PMID: 34642673 PMCID: PMC8495373 DOI: 10.1016/j.lanepe.2021.100210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The majority of emerging infectious diseases originate in animals. Current routine surveillance is focused on known diseases and clinical syndromes, but the increasing likelihood of emerging disease outbreaks shows the critical importance of early detection of unusual illness or circulation of pathogens - prior to human disease manifestation. In this Viewpoint, we focus on one key pillar of preparedness—the need for early warning surveillance at the human, animal, environmental interface. The COVID-19 pandemic has revolutionized the scale of sequencing of pathogen genomes, and the current investments in global genomic surveillance offer great potential for a novel, truly integrated Disease X (with epidemic or pandemic potential) surveillance arm provided we do not make the mistake of developing them solely for the case at hand. Generic tools include metagenomic sequencing as a catch-all technique, rather than detection and sequencing protocols focusing on what we know. Developing agnostic or more targeted metagenomic sequencing to assess unusual disease in humans and animals, combined with random sampling of environmental samples capturing pathogen circulation is technically challenging, but could provide a true early warning system. Rather than rebuilding and reinforcing the pre-existing silo's, a real step forward would be to take the lessons learned and bring in novel essential partnerships in a One Health approach to preparedness.
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Affiliation(s)
| | - Marc Bonten
- Utrecht University Medical Centre, Utrecht, The Netherlands
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23
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Faure MC, Munung NS, Ntusi NAB, Pratt B, de Vries J. Considering equity in global health collaborations: A qualitative study on experiences of equity. PLoS One 2021; 16:e0258286. [PMID: 34618864 PMCID: PMC8496851 DOI: 10.1371/journal.pone.0258286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/24/2021] [Indexed: 12/19/2022] Open
Abstract
International collaborations have become the standard model for global health research and often include researchers and institutions from high income countries (HICs) and low- and middle-income countries (LMICs). While such collaborations are important for generating new knowledge that will help address global health inequities, there is evidence to suggest that current forms of collaboration may reproduce unequal power relations. Therefore, we conducted a qualitative study with scientists, researchers and those involved in research management, working in international health collaborations. Interviews were conducted between October 2019 and March 2020. We conducted 13 interviews with 15 participants. From our findings, we derive three major themes. First, our results reflect characteristics of equitable, collaborative research relationships. Here we find both relational features, specifically trust and belonging, and structural features, including clear contractual agreements, capacity building, inclusive divisions of labour, and the involvement of local communities. Second, we discuss obstacles to develop equitable collaborations. These include exclusionary labour practices, donor-driven research agendas, overall research culture, lack of accountability and finally, the inadequate financing of indirect costs for LMIC institutions. Third, we discuss the responsibilities for promoting science equity of funders, LMIC researchers, LMIC institutions, and LMIC governments. While other empirical studies have suggested similar features of equity, our findings extend these features to include local communities as collaborators in research projects and not only as beneficiaries. We also suggest the importance of funders paying for indirect costs, without which the capacity of LMIC institutions will continually erode. And finally, our study shows the responsibilities of LMIC actors in developing equitable collaborations, which have largely been absent from the literature.
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Affiliation(s)
- Marlyn C. Faure
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Nchangwi S. Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Ntobeko A. B. Ntusi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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24
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Sam-Agudu NA, Abimbola S. Using scientific authorship criteria as a tool for equitable inclusion in global health research. BMJ Glob Health 2021; 6:e007632. [PMID: 34649868 PMCID: PMC8506888 DOI: 10.1136/bmjgh-2021-007632] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nadia Adjoa Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Paediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Julius Global Health, University Medical Center, Utrecht University, Utrecht, The Netherlands
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25
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Cavalerie L, Wardeh M, Lebrasseur O, Nanyingi M, McIntyre KM, Kaba M, Asrat D, Christley R, Pinchbeck G, Baylis M, Mor SM. One hundred years of zoonoses research in the Horn of Africa: A scoping review. PLoS Negl Trop Dis 2021; 15:e0009607. [PMID: 34270551 PMCID: PMC8318308 DOI: 10.1371/journal.pntd.0009607] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/28/2021] [Accepted: 06/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND One Health is particularly relevant to the Horn of Africa where many people's livelihoods are highly dependent on livestock and their shared environment. In this context, zoonoses may have a dramatic impact on both human and animal health, but also on country economies. This scoping review aimed to characterise and evaluate the nature of zoonotic disease research in the Horn region. Specifically, it addressed the following questions: (i) what specific zoonotic diseases have been prioritised for research, (ii) what data have been reported (human, animal or environment), (iii) what methods have been applied, and (iv) who has been doing the research? METHODOLOGY/PRINCIPAL FINDINGS We used keyword combinations to search online databases for peer-reviewed papers and theses. Screening and data extraction (disease, country, domain and method) was performed using DistillerSR. A total of 2055 studies focusing on seven countries and over 60 zoonoses were included. Brucellosis attracted the highest attention in terms of research while anthrax, Q fever and leptospirosis have been comparatively under-studied. Research efforts did not always align with zoonoses priorities identified at national levels. Despite zoonoses being a clear target for 'One Health' research, a very limited proportion of studies report data on the three domains of human, animal and environment. Descriptive and observational epidemiological studies were dominant and only a low proportion of publications were multidisciplinary. Finally, we found that a minority of international collaborations were between Global South countries with a high proportion of authors having affiliations from outside the Horn of Africa. CONCLUSIONS/SIGNIFICANCE There is a growing interest in zoonoses research in the Horn of Africa. Recommendations arising from this scoping review include: (i) ensuring zoonoses research aligns with national and global research agendas; (ii) encouraging researchers to adopt a holistic, transdisciplinary One Health approach following high quality reporting standards (COHERE, PRISMA, etc.); and (iii) empowering local researchers supported by regional and international partnerships to engage in zoonoses research.
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Affiliation(s)
- Lisa Cavalerie
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- International Livestock Research Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Maya Wardeh
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Department of Mathematical Sciences, University of Liverpool, Peach Street, Liverpool, United Kingdom
| | - Ophélie Lebrasseur
- International Livestock Research Institute, Addis Ababa, Ethiopia
- Department of Archaeology, Classics and Egyptology; School of Histories, Language and Cultures, University of Liverpool, Liverpool, United Kingdom
| | - Mark Nanyingi
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Department of Epidemiology and Public Health, School of Public Health, University of Nairobi, Nairobi, Kenya
| | - K. Marie McIntyre
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daniel Asrat
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences Addis Ababa University, Addis Ababa, Ethiopia
| | - Robert Christley
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Gina Pinchbeck
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
| | - Matthew Baylis
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Siobhan M. Mor
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Brownlow Hill, Liverpool, United Kingdom
- International Livestock Research Institute, Addis Ababa, Ethiopia
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