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1.
COMMENT: "All in this together": the global duty to contribute towards combating the Covid-19 pandemic.
D'Souza, Jeff; Kamaara, Eunice; Nderitu, David.
Indian J Med Ethics ; VII(1): 1-12, 2022.
Article in English | MEDLINE | ID: mdl-35712840

ABSTRACT

This paper explores the unique realities and effects of Covid-19 as experienced in the global North and global South with special reference to Canada and sub-Saharan Africa; it also examines the moral responsibilities countries have towards their own people and the duty they have to work together to minimise and mitigate the devastating effects of the pandemic worldwide. We illuminate the importance of countries sharing their own world views, strengths, and expertise, and learning from one another in order to better situate all in tackling the pandemic. We argue that it is only insofar as all countries work collaboratively commensurate to each party's capacity to contribute towards the tackling of the Covid-19 pandemic that we may truly be said to be "all in this together". Keywords; Covid-19, global North, global South, solidarity, sub-Saharan Africa, global health

.


Subject(s)
COVID-19 , Africa South of the Sahara/epidemiology , Global Health , Humans , Pandemics
2.
The Africa Ethics Working Group (AEWG): a model of collaboration for psychiatric genomic research in Africa.
Kamuya, Dorcas; Bitta, Mary A; Addissie, Adamu; Naanyu, Violet; Palk, Andrea; Mwaka, Erisa; Kamaara, Eunice; Tadele, Getnet; Wolde, Telahun Teka; Nakigudde, Janet; Manku, Kiran; Musesengwa, Rosemary; Singh, Ilina.
Wellcome Open Res ; 6: 190, 2021.
Article in English | MEDLINE | ID: mdl-35071797

ABSTRACT

The Africa Ethics Working Group (AEWG) is a South-South-North collaboration of bioethics and mental health researchers from sub-Saharan Africa, working to tackle emerging ethical challenges in global mental health research. Initially formed to provide ethical guidance for a neuro-psychiatric genomics research project, AEWG has evolved to address cross cutting ethical issues in mental health research aimed at addressing equity in North-South collaborations. Global South refers to economically developing countries (sub-Saharan Africa in this context) and Global North to economically developed countries (primarily Europe, UK and North America). In this letter we discuss lessons that as a group we have learnt over the last three years; lessons that similar collaborations could draw on. With increasing expertise from Global South as an outcome of several capacity strengthening initiatives, it is expected that the nature of scientific collaborations will shift to a truly equitable partnership. The AEWG provides a model to rethink contributions that each partner could make in these collaborations.

3.
Gambling with COVID-19 Makes More Sense: Ethical and Practical Challenges in COVID-19 Responses in Communalistic Resource-Limited Africa.
Nderitu, David; Kamaara, Eunice.
J Bioeth Inq ; 17(4): 607-611, 2020 Dec.
Article in English | MEDLINE | ID: mdl-32840829

ABSTRACT

Informed by evidence from past studies and experiences with epidemics, an intervention combining quarantine, lockdowns, curfews, social distancing, and washing of hands has been adopted as "international best practice" in COVID-19 response. With massive total lockdowns complemented by electronic surveillance, China successfully controlled the pandemic in country within a few months. But would this work for Africa and other communalistic resource-poor settings where social togetherness translates to effective sharing of basic needs? What ethical and practical challenges would this pose? How would communalism be translated in special contexts to be useful in contributing to the ultimate common good? This paper uses examples from the current situation of COVID-19 in Kenya to address these questions.


Subject(s)
Bioethical Issues , COVID-19/prevention & control , Communicable Disease Control/organization & administration , Social Control, Formal , Africa/epidemiology , COVID-19/epidemiology , Developing Countries , Humans , Kenya/epidemiology , Pandemics , SARS-CoV-2
4.
The Aristotelian model of friendship and the IU-Kenya Partnership.
Nderitu, David; Kamaara, Eunice.
Indian J Med Ethics ; V(2): 107-116, 2020.
Article in English | MEDLINE | ID: mdl-32393462

ABSTRACT

Disparity in economic development between high-income countries (HICs) and low- and medium-income countries (LMICs) has necessitated collaborations, some in health-related activities. Globalisation frameworks indicate that, in fair collaborations, the ultimate aim should be to improve the situation in LMICs. In this paper we present the findings of a research study in which we used Aristotle's concept of friendship among unequal parties as an analytic framework to engage with the issue of inequality in an existing international partnership in health, the Indiana University-Kenya Partnership (IU-Kenya Partnership). This is a collaborative health programme involving a consortium of North American universities and schools of the Moi University College of Health Sciences in Kenya. We carried out in-depth oral interviews and focus group discussions with a sample of 41 partners of various IU-Kenya Partnership programmes. We did a comparison of obtained themes to the Aristotelian pointers of aspects of friendship among unequal parties. We eventually identified good and bad aspects of North-South partnerships as perceived in the IU-Kenya Partnership restricted to the Aristotelian model. Key terms: health research collaborations, HICs-LMICs Partnerships, IU-Kenya Partnership, inequality, good and bad partnership, Aristotelian model.


Subject(s)
Friends , Focus Groups , Humans , Kenya , Universities
5.
Investigating assumptions of vulnerability: A case study of the exclusion of psychiatric inpatients as participants in genetic research in low- and middle-income contexts.
Palk, Andrea C; Bitta, Mary; Kamaara, Eunice; Stein, Dan J; Singh, Ilina.
Dev World Bioeth ; 20(3): 157-166, 2020 09.
Article in English | MEDLINE | ID: mdl-31943750

ABSTRACT

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long-term benefits of such research, and seemingly minimal risk, a strong claim could be made that all non-acute psychiatric inpatients, including forensic and involuntary patients, should be included in such research, provided they have capacity to consent. There are tensions, however, regarding the ethics of recruiting psychiatric inpatients into such studies. In this paper our intention is to elucidate the source of these tensions from the perspective of research ethics committee interests and decision-making. We begin by defining inpatient status and outline some of the assumptions surrounding the structures of inpatient care. We then introduce contemporary conceptions of vulnerability, including Florencia Luna's account of vulnerability which we use as a framework for our analysis. While psychiatric inpatients could be subject to consent-related vulnerabilities, we suggest that a particular kind of exploitation-related vulnerability comes to the fore in the context of our case study. Moreover, a subset of these ethical concerns takes on particular weight in the context of genetic research in low- and middle-income countries. At the same time, the automatic exclusion of inpatients from research elicits justice-related vulnerabilities.


Subject(s)
Developing Countries , Genetic Research , Inpatients , Mental Disorders , Patient Selection , Africa South of the Sahara , Ethics Committees, Research , Humans , Informed Consent
6.
Prioritising African perspectives in psychiatric genomics research: Issues of translation and informed consent.
Kamaara, Eunice; Kong, Camillia; Campbell, Megan.
Dev World Bioeth ; 20(3): 139-149, 2020 09.
Article in English | MEDLINE | ID: mdl-31724268

ABSTRACT

Psychiatric genomics research with African populations comes with a range of practical challenges around translation of psychiatric genomics research concepts, procedures, and nosology. These challenges raise deep ethical issues particularly around legitimacy of informed consent, a core foundation of research ethics. Through a consideration of the constitutive function of language, the paper problematises like-for-like, designative translations which often involve the 'indigenization' of English terms or use of metaphors which misrepresent the risks and benefits of research. This paper argues that effective translation of psychiatric genomics research terminology in African contexts demands substantive engagement with African conceptual schemas and values. In developing attenuated forms of translational thinking, researchers may recognise the deeper motivational reasons behind participation in research, highlighting the possibility that such reasons may depart from the original meaning implied within informed consent forms. These translational issues might be ameliorated with a critical re-examination of how researchers develop and present protocols to institutional ethics review boards.


Subject(s)
Ethics, Research , Genomics , Informed Consent , Psychiatry , Africa , Ethics Committees, Research , Holistic Health , Humans , Research Design , Translational Research, Biomedical
7.
Faith and healthcare providers' perspectives about enhancing HIV biomedical interventions in Western Kenya.
Kamaara, Eunice; Oketch, Dismas; Chesire, Irene; Coats, Cassandra Sutten; Thomas, Gladys; Ransome, Yusuf; Willie, Tiara C; Nunn, Amy.
Glob Public Health ; 14(12): 1744-1756, 2019 12.
Article in English | MEDLINE | ID: mdl-31390958

ABSTRACT

Adult HIV prevalence in Kenya was 5.9% in 2017. However, in the counties of Kisumu, Siaya, and Homa Bay, HIV prevalence was over 15%. Biomedical interventions, including home-based testing and counselling (HBTC), HIV treatment and pre-exposure prophylaxis (PrEP) provide opportunities to reduce HIV transmission, particularly in rural communities with limited access to health services. Faith-based institutions play an important role in the Kenyan social fabric, providing over 40% of all health care services in Kenya, but have played limited roles in promoting HIV prevention interventions. We conducted qualitative interviews with 45 medical professionals and focus groups with 93 faith leaders in Kisumu and Busia Counties, Kenya. We explored their knowledge, opinions, and experiences in promoting biomedical HIV prevention modalities, including HBTC and PrEP. Knowledge about and engagement in efforts to promote HIV prevention modalities varied; few health providers had partnered with faith leaders on HIV prevention programmes. Faith leaders and health providers agreed about the importance of increasing faith leaders' participation in HIV prevention and were positive about increasing their HIV prevention partnerships. Most faith leaders requested capacity building to better understand biomedical HIV prevention modalities and expressed interest in collaborating with clinical partners to spread awareness about HIV prevention modalities.


Subject(s)
HIV Infections/prevention & control , Health Knowledge, Attitudes, Practice , Health Personnel/psychology , Religion , AIDS Serodiagnosis , Adult , Counseling , Female , Focus Groups , HIV Infections/epidemiology , Humans , Interviews as Topic , Kenya/epidemiology , Male , Pre-Exposure Prophylaxis , Prevalence , Qualitative Research
8.
Acceptability of a Pilot Intervention of Voluntary Medical Male Circumcision and HIV Education for Street-Connected Youth in Western Kenya.
Kibel, Mia; Shah, Pooja; Ayuku, David; Makori, Dominic; Kamaara, Eunice; Choge, Emily; Nyairo, Joyce; Abuya, Pamela; Wahome, Mary; Wachira, Juddy; Braitstein, Paula.
J Adolesc Health ; 64(1): 43-48, 2019 01.
Article in English | MEDLINE | ID: mdl-30327277

ABSTRACT

PURPOSE: Street-connected youth (SCY) in Kenya and elsewhere in sub-Saharan Africa are at high risk of HIV. Voluntary Male Medical Circumcision (VMMC) reduces the risk of female-to-male HIV transmission. Circumcision is also a traditional coming-of-age process in many Kenyan ethnic groups. This paper describes the acceptability of VMMC delivered as part of a ten-day healing, educational, and 'coming-of-age' retreat implemented as a pilot with SCY. METHODS: Male SCY aged between 12 and 24 living on the street for more than 3 months were eligible to participate. The study took place over 10 days. After medical circumcision, youth participated in education modules. Data collected included qualitative semi-structured exit interviews featuring structured and open-ended questions about factors relevant to this intervention's acceptability. RESULTS: There were 116 SCY (median age 14, IQR 13-15) who participated in the study. All were circumcised successfully, with no major complications. The majority of participants (81%) agreed that the circumcision procedure was uncomplicated, and 99% agreed the education was an important part of the initiation process. Thematic analysis of interview data highlighted four factors important to the program's acceptability: providing food, shelter, security; providing a safe place to heal; including traditional elements; and being with peers. CONCLUSIONS: This novel implementation of VMMC was found to be acceptable to SCY participants and could likely be adapted and scaled for HIV prevention and education with SCY elsewhere in Kenya and sub-Saharan Africa where circumcision is part of traditional coming-of-age processes.


Subject(s)
Circumcision, Male , HIV Infections/prevention & control , Adolescent , Child , Circumcision, Male/education , Circumcision, Male/psychology , Health Education/methods , Homeless Youth/education , Homeless Youth/psychology , Humans , Interviews as Topic , Kenya , Male , Pilot Projects , Young Adult
9.
An analysis of India's 2017 National Ethical Guidelines for Biomedical and Health Research Involving Human Participants: The Social and Behavioural Sciences aspect.
Nderitu, David; Kamaara, Eunice.
Indian J Med Ethics ; 3(3): 204-209, 2018.
Article in English | MEDLINE | ID: mdl-30211676

ABSTRACT

In this commentary on Section 9 (Social and Behavioural Sciences Research for Health) of the National Ethical Guidelines for Biomedical and Health Research Involving Human Participants (2017) by the Indian Council of Medical Research (ICMR), we appreciate that the guidelines clarify that human beings are "research participants" and not merely "subjects". Further, we appreciate and commend the ICMR for: i) contextualising the guidelines to India's unique sociocultural and economic situation and ii) affirming the multidisciplinary nature of health research and the wide scope of social and behavioural research. However, we question the prominence given to the difference between biomedical research and other aspects of health research and the description of social and psychological risks and discomforts as minor risks. Finally, we suggest that the guidelines would express greater value and diversity of the social aspects of health if they recommended wider representation of these aspects in the composition of research ethics committees.


Subject(s)
Behavioral Sciences , Biomedical Research/ethics , Ethical Review , Ethics Committees, Research , Guidelines as Topic , Human Experimentation , Ethics, Research , Humans , India , Organizations , Research Subjects , Risk , Social Sciences , Socioeconomic Factors
10.
Research Ethics Governance in Times of Ebola.
Schopper, Doris; Ravinetto, Raffaella; Schwartz, Lisa; Kamaara, Eunice; Sheel, Sunita; Segelid, Michael J; Ahmad, Aasim; Dawson, Angus; Singh, Jerome; Jesani, Amar; Upshur, Ross.
Public Health Ethics ; 10(1): 49-61, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28567113

ABSTRACT

The Médecins Sans Frontières (MSF) ethics review board (ERB) has been solicited in an unprecedented way to provide advice and review research protocols in an 'emergency' mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at (very) early development stages. This article examines the MSF ERB's experience addressing issues related to both the process of review and substantive ethical issues in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees (ECs), we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the 'optimal' ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process.

11.
"We Hide Under the Scriptures": Conceptualization of Health Among United Methodist Church Clergy in Kenya.
Walther, Nikki Georggi; Proeschold-Bell, Rae Jean; Benjamin-Neelon, Sara; Adipo, Sherine; Kamaara, Eunice.
J Relig Health ; 54(6): 2235-48, 2015 Dec.
Article in English | MEDLINE | ID: mdl-25371345

ABSTRACT

As community leaders, clergy are well-positioned to impact the health of their congregants. Clergy's conceptualizations of health influence their own self-care and how they minister to others. Interviews and focus group discussions on health conceptualizations and health-seeking behaviors were conducted with 49 United Methodist Church clergy in Western Kenya. Data were analyzed using interpretative phenomenological methods. Participants defined health holistically using an environmental health model. Some participants reported not seeking health care so their congregants would believe that their faith kept them healthy. Participants who believed that health comes directly from God reported seeking health care less often. Participants also reported combining traditional indigenous medicine with Western medicine. This study has implications for health promotion among Kenyan clergy and offers the first study of health conceptualization among clergy in Africa.


Subject(s)
Attitude to Health , Clergy/psychology , Health Behavior , Protestantism/psychology , Self Care/psychology , Focus Groups , Health Promotion/methods , Humans , Interviews as Topic , Kenya , Professional Role , Self Care/methods
12.
Community perspectives on research consent involving vulnerable children in Western Kenya.
Vreeman, Rachel; Kamaara, Eunice; Kamanda, Allan; Ayuku, David; Nyandiko, Winstone; Atwoli, Lukoye; Ayaya, Samuel; Gisore, Peter; Scanlon, Michael; Braitstein, Paula.
J Empir Res Hum Res Ethics ; 7(4): 44-55, 2012 Oct.
Article in English | MEDLINE | ID: mdl-23086047

ABSTRACT

Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers, community leaders, and even community assemblies could participate in the consent process. Community members believed research involving orphans and street children could benefit these vulnerable populations, but would require special processes for consent.


Subject(s)
Attitude , Community Participation , Ethics, Research , Informed Consent/ethics , Residence Characteristics , Vulnerable Populations , Adult , Aged , Caregivers , Child , Child, Orphaned , Cultural Competency , Culture , Female , Homeless Youth , Humans , Internationality , Kenya , Leadership , Male , Parents , Personal Autonomy
13.
A qualitative study using traditional community assemblies to investigate community perspectives on informed consent and research participation in western Kenya.
Vreeman, Rachel; Kamaara, Eunice; Kamanda, Allan; Ayuku, David; Nyandiko, Winstone; Atwoli, Lukoye; Ayaya, Samuel; Gisore, Peter; Scanlon, Michael; Braitstein, Paula.
BMC Med Ethics ; 13: 23, 2012 Sep 25.
Article in English | MEDLINE | ID: mdl-23009744

ABSTRACT

BACKGROUND: International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings. METHODS: We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on biomedical research and informed consent within a collaborative, multinational research network in western Kenya. Analyses included manual, progressive coding of transcripts from mabaraza to identify emerging central concepts. RESULTS: Our findings from two mabaraza with 108 community members revealed that, while participants understood some principles of biomedical research, they emphasized perceived benefits from participation in research over potential risks. Many community members equated health research with HIV testing or care, which may be explained in part by the setting of this particular study. In addition to valuing informed consent as understanding and accepting a role in research activities, participants endorsed an increased role for the community in making decisions about research participation, especially in the case of children, through a process of community consent. CONCLUSIONS: Our study suggests that international biomedical research must account for community understanding of research and informed consent, particularly when involving children. Moreover, traditional community forums, such as mabaraza in East Africa, can be used effectively to gather these data and may serve as a forum to further engage communities in community consent and other aspects of research.


Subject(s)
Clinical Trials as Topic/ethics , Comprehension , Human Experimentation/ethics , Informed Consent , Residence Characteristics , Biomedical Research/ethics , Ethics, Research , HIV Infections/diagnosis , HIV Infections/therapy , Humans , Kenya , Patient Selection , Qualitative Research , Research Design , Research Subjects , Third-Party Consent
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