The Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) has offered a fully-funded, one-year, non-degree training opportunity in research ethics to health professionals, ethics committee members, scholars, journalists and scientists from countries across sub-Saharan Africa. In the first 9 years of operation, 28 trainees from 13 African countries have trained with FABTP. Any capacity building investment requires periodic critical evaluation of the impact that training dollars produce. In this paper we describe and evaluate FABTP and the efforts of its trainees.Our (...) data show that since 2001, the 28 former FABTP trainees have authored or co-authored 105 new bioethics-related publications; were awarded 33 bioethics-related grants; played key roles on 78 bioethics-related research studies; and participated in 198 bioethics workshops or conferences. Over the past nine years, trainees have collectively taught 48 separate courses related to bioethics and have given 170 presentations on various topics in the field. Many former trainees have pursued and completed doctoral degrees in bioethics; some have become editorial board members for bioethics journals. Female trainees were, on average, less experienced at matriculation and produced fewer post-training outputs than their male counterparts. More comprehensive studies are needed to determine the relationships between age, sex, previous experience and training program outputs. (shrink)

The indigenous people of sub-Saharan Africa approach their Supreme Being and express their reverence in diverse ways, as depicted in the different local names that describe this supernatural being. The African cultural worldview foregrounds that virtuous rapport with the Supreme Being provides wisdom and facilitates good cohabitation among humans. It is argued in this article that teachings from the Christian Bible contribute negatively to the disintegration, fragmentation and death of indigenous knowledge systems, which include African cultural values, memory and (...) oral traditions. Recently, some African scholars have begun to create awareness of some of Africa’s lost treasures. However, such contributions are disappointingly few. This study argues that memory and orality among Africans should be promoted and supported through various platforms, such as academic writing. This article will discuss memory, orality and ‘God-talk’ in terms of the following: teachings on moral values (e.g. relationships, marriage, humaneness [ubuntu or hunhu]) and the preservation of cultural heritage. The discussion uses qualitative analysis of secondary data and personal observation.Contribution: Firstly, the present study will provide for the readership in general, and academia in particular, a new perspective on African customs and indigenous belief systems about a Supreme Being. For example, Musiki as a Shona local dialect name for ‘God’ was already in use before the emergence of Christianity in Southern Africa. Secondly, previous contributions have not sufficiently explored memory and orality. This investigation serves as a resource or starting point for further research on memory and orality. (shrink)

The Johns Hopkins‐Fogarty African Bioethics Training Program (FABTP) has offered a fully‐funded, one‐year, non‐degree training opportunity in research ethics to health professionals, ethics committee members, scholars, journalists and scientists from countries across sub‐Saharan Africa. In the first 9 years of operation, 28 trainees from 13 African countries have trained with FABTP. Any capacity building investment requires periodic critical evaluation of the impact that training dollars produce. In this paper we describe and evaluate FABTP and the efforts of its trainees.Our (...) data show that since 2001, the 28 former FABTP trainees have authored or co‐authored 105 new bioethics‐related publications; were awarded 33 bioethics‐related grants; played key roles on 78 bioethics‐related research studies; and participated in 198 bioethics workshops or conferences. Over the past nine years, trainees have collectively taught 48 separate courses related to bioethics and have given 170 presentations on various topics in the field. Many former trainees have pursued and completed doctoral degrees in bioethics; some have become editorial board members for bioethics journals. Female trainees were, on average, less experienced at matriculation and produced fewer post‐training outputs than their male counterparts. More comprehensive studies are needed to determine the relationships between age, sex, previous experience and training program outputs. (shrink)

Bioethics is gradually becoming an important part of the drive to increase quality healthcare delivery in sub‐Saharan African countries. Yet many healthcare service‐users in Africa are familiar with incidences of questionable health policies and poor healthcare delivery, leading to severe consequences for patients. We argue that the overarching rights‐based ethical administrative framework recently employed by healthcare authorities contributes to the poor uptake and enforcement of current normative tools. Taking Ghana as a case study, we focus on the cultural ethical (...) context and we tease out the concepts of the good and the ethical among the Akan and Bulsa ethnic groups. We point out three tenets towards building a normative framework that can resonate with service‐users and practitioners: ontological communitarianism; empathic humanism; and virtuous character. Finally, we indicate how these core tenets can be dovetailed into building an effective normative framework and into the training of healthcare providers. (shrink)

Background: The high disease burden of Africa, the emergence of new diseases and efforts to address the 10/90 gap have led to an unprecedented increase in health research activities in Africa. Consequently, there is an increase in the volume and complexity of protocols that ethics review committees in Africa have to review. Methods: With a grant from the Bill and Melinda Gates Foundation, the African Malaria Network Trust (AMANET) undertook a survey of 31 ethics review committees (ERCs) across sub-Saharan (...) Africa as an initial step to a comprehensive capacity-strengthening programme. The number of members per committee ranged from 3 to 21, with an average of 11. Members of 10 institutional committees were all from the institution where the committees were based, raising prima facie questions as to whether independence and objectivity could be guaranteed in the review work of such committees. Results: The majority of the committees (92%) cited scientific design of clinical trials as the area needing the most attention in terms of training, followed by determination of risks and benefits and monitoring of research. The survey showed that 38% of the ERC members did not receive any form of training. In the light of the increasing complexity and numbers of health research studies being conducted in Africa, this deficit requires immediate attention. Outcome: The survey identified areas of weakness in the operations of ERCs in Africa. Consequently, AMANET is addressing the identified needs and weaknesses through a 4-year capacity-building project. (shrink)

During the last two decades, economic development has been slow in most of the countries of Sub-Saharan Africa (World Bank, 1981). In the middle of the 1970s when the world economy experienced inflation and recession, no where did the crises hit with greater impact than in Sub-Saharan Africa. This region shows slow overall economic growth, sluggish agricultural performance, rapid rates of population increase, and a balance of payment crises. Between 1960 and 1979, per capita income in 19 countries (...) grew by less than 1% per annum. During the last decade 15 countries recorded a negative rate of income growth per capita (World Bank, 1981).The economic state of the oil exporting countries (Angola, Congo and Nigeria) in Sub-Saharan Africa is not any different. The average annual growth rate of GNP per capita from 1960–1979 shows Angola at –2.1%, Congo at 0.9% and Nigeria at 3.7%. (shrink)

SummaryA number of authors have identified multiple concurrent sexual partnerships by both men and women to lie at the root of the HIV/AIDS epidemic in sub-Saharan Africa. This study applies multilevel models to Demographic and Health Survey data collected during 2003–2008 in 20 sub-Saharan African countries to examine the influence of social and cultural context on involvement with multiple sexual partnerships in the region, above and beyond the effects of individual characteristics. The findings provide support for the ecological (...) argument that health behaviours are shaped and determined by societal conditions, in addition to the effects of individual and household characteristics. Involvement with multiple sex partners is most prevalent in societies in which sexual norms are widely permissive and where polygyny is common. Individual autonomy is substantial and attitudes towards sexuality are more liberal among men and women who live in communities in which sexual norms are widely permissive. Men and women who are most likely to have multiple sex partners in the sub-Saharan region are those who initiated sexual activity earlier and those who have the individual attributes that bring to them more rights and/or decision-making autonomy, but not necessarily more financial resources and economic security. On the other hand, involvement with multiple partners is determined by cultural norms and social change. The findings suggest a number of opportunities for more effective policy and programmatic responses to curb the prevalence of multiple partnerships in sub-Saharan Africa. (shrink)

Sub-Saharan Africa bears the brunt of the HIV epidemic, which is fueled by the many ethical, social, and political complexities that make up Africa. In turn, the pandemic has also caused many ethical, social, and political complexities that Africa now grapples with. Being infected with HIV is highly complex and challenging. Regrettably, gender inequality is still pervasive in Africa. The response by African leaders to the pandemic has been, on the whole, shamefully lethargic. For Africa to win its war (...) against HIV/AIDS, a paradigm shift is required from the perspective of its socio-political context. What is called for is positive political will that will address all aspects of the social determinants of AIDS. What is also required is that Ubuntu is embraced meaningfully. (shrink)

If the desert was long perceived as a hostile and inhospitable territory, it was gradually conquered during the 20th century by the practice of sports and leisure activities. The aim of this articl...

The author reviews various conceptions of autonomy to show that humans are actually not autonomous, strictly speaking. He argues for a need to rethink the personal autonomy approaches to HIV testing in sub-Saharan Africa (SSA) countries. HIV/AIDS has remained a leading cause of disease burden in SSA. It is important to bring this disease burden under control, especially given the availability of current effective antiretroviral regimens in low- and middle-income countries. In most SSA countries the ethic or value of (...) personal autonomy or self-determination is promoted as primary in HIV testing decision-making. SSA policymakers have an ontological and moral duty to adopt HIV testing policies that reflect human and medical realities, relationships, local contexts, and respect human rights for both individuals and others who are affected by HIV in society. Without rethinking the value of autonomy in HIV testing decision-making, the article cautions that attainment of the Sustainable Development Goal (SDG) 3 and the UNAIDS fast-track strategy that explicitly call to end the epidemic by 2030 will not be feasible for SSA. (shrink)

Bioethics urges us to question and debate fundamental moral issues that arise in health-related sciences. However, as a result of Western dominance and globalization, bioethical thinking and practice has inevitably been shaped and defined by Western theories. With recent discussions centering on the relationship between culture and bioethics, it is important to consider how and to what extent can bioethics reflect and accommodate non-Western values and beliefs? Debatably, many scholars working in the field of ‘African bioethics’ seek to construct a (...) bioethical practice that is grounded in indigenous African values. Yet, how relevant are ancient African cultural norms to the lives and realities of the 21st century Sub-Saharan-Africans? This edited volume explores bioethics in Africa from pluralistic and inter-cultural perspectives. The selected papers offer diverse theoretical and practical perspectives on the bioethical challenges that are common and specific to the lives of Sub-Sahara Africans. The contributors define bioethics broadly (beyond ethical issues relating to biomedical and biotechnological science) to include applied ethics that concern all aspects of life. Multidisciplinary in approach, the contributions to this book consider bioethics in relation to philosophy, social work, psychiatry, African studies, religious studies, psychology, and medicine. The broad scope of this volume means it will be of interest to those studying and working in bioethics as well as the fields mentioned above. (shrink)

Ethical challenges surrounding the implementation of male circumcision as an HIV prevention strategyResearchers have been exploring the possibility of a correlation between male circumcision and lowered risk of HIV infection almost since the beginning of the HIV/AIDS epidemic.1 Results from a randomised controlled trial in South Africa in 2005 indicate that male circumcision protects men against the acquisition of HIV through heterosexual intercourse,2 confirming the findings from 20 years of observational studies.3 Circumcised men in the South African trial were 60% (...) less likely to acquire HIV than their uncircumcised counterparts. A mathematical modelling study, based on the South African trial, estimates that the practice of male circumcision could avert two million new HIV infections and 300 000 HIV-related deaths over the next 10 years in sub-Saharan Africa.4 More recently, two randomised controlled trials in Kisumu, Kenya and Rakai, Uganda showed, respectively, 53% and 48% reductions in HIV acquisition among circumcised men than uncircumcised men in the trial.5 These results strongly suggest that male circumcision could play an important role in the struggle against the continued rise in new HIV infections. However, as observers noted at the 2006 XVI International AIDS Conference in Toronto, Canada, excitement about the potential epidemiological impact has overshadowed the debate over the difficult translation of research on male circumcision, into policy and practice.6 Similar calls for caution have been raised before and elsewhere.7,8The topic of male circumcision carries an enormous amount of ethical baggage. Male infants, worldwide, are circumcised for various medical, social and/or religious reasons. Circumcision is a cultural act and a surgical procedure; medical reasons are not the only reasons to circumcise that people have found and continue to find as compelling. Benatar and Benatar9 have argued that—when …. (shrink)

Urban cities in the sub-Saharan Africa have witnessed unprecedented transformation because of the proliferation of religious orders within the social landscape. From Nigeria, Ghana and Cameroon to Uganda, religious practitioners are actively involved in the spatial transformation through the construction of sacred spaces or prayer camps. The Redeemed Christian Church of God (RCCG) typifies one of the several examples of African Pentecostal denominations with transnational status in 200 countries across the world with the hub of its international office situated (...) at the Redemption Camp, Mowe, Nigeria. The sacralisation of forest areas spanning 1600 ha of land has redefined religious institutions such as RCCG as perhaps one of the largest owners of private estate in Nigeria. However, there seems to be an intentional replication of the Redemption Camp, Mowe across Nigeria as well as across the Atlantic as part of the RCCG missionary enterprise. This study aims to utilise the ethnography of the Redemption Camps in Nigeria and Floyd, Texas, United States. The theoretical framework of social worlds is employed to examine the dynamics of religious creativity, innovations, contextual challenges of place-making involved in creating Redemption Camps across borders by the leadership of RCCG through the appropriation of religious capital of its community of sentiments. (shrink)

Many ethical concerns surrounding human genetics studies remain unresolved. We report here the situation in Cameroon.Objectives: To describe the profile of human genetic studies that used Cameroonian DNA samples, with specific focus on i) the research centres that were involved, ii) authorship, iii) population studied, iv) research topics and v) ethics disclosure, with the aim of raising ethical issues that emerged from these studies.Method: Bibliometric Studies; we conducted a PubMed-based systematic review of all the studies on human genetics that used (...) Cameroonian DNA samples from 1989 to 2009.Results and Discussion: Fifty articles were identified, involving predominantly research centres from Europe (64%) and America (32%). Only 7 (14%) Cameroonian institutions and 14 (28%) Cameroonian authors were associated with these publications.At least 52% of publications were devoted to population genetics (variation/migration patterns) amongst 30 Cameroonian ethnic groups. Very few studies concerned public health related genetic issues and only 5 (10%) references were found for hemoglobinopathies like sickle cell anaemia. Almost all DNA samples are ‘banked’ outside of the African continent.Capacity building, rights to the genetic information and benefits to the individuals, communities and populations who contribute to these studies are addressed.Conclusions: 1) Our data suggests the need for a wider debate towards building capacity and addressing ethical issues related to human genomic research in sub-Saharan Africa and specifically in Cameroon; 2) National ethical guidelines and regulations concerning the collection, use and storage of human DNA are urgently needed in Cameroon. (shrink)

We examined the universality of the curse of knowledge by investigating it in a unique cross-cultural sample; a nomadic Nilo-Saharan pastoralist society in East Africa, the Turkana. Forty Turkana children were asked eight factual questions and asked to predict how widely-known those facts were among their peers. To test the effect of their knowledge, we taught children the answers to half of the questions, while the other half were unknown. Based on findings suggesting the bias’s universality, we predicted that (...) children would estimate that more of their peers would know the answers to the questions that were taught versus the unknown questions. We also predicted that with age children would become less biased by their knowledge. In contrast, we found that only Turkana males were biased by their knowledge when inferring their peers’ perspectives, and the bias did not change with age. We discuss the implications of these findings. (shrink)

I argue that one way in which a problem such as mass poverty in the sub-Saharan Africa can be addressed is through inclusive development, which is a pro poor, pro all, programme. However, it appears that the theoretical framework that can deliver the values of inclusive development has yet to be clearly sorted out. This is because, while bringing together all actors and factors, inclusive development should not subsume individual endowments to collective values. I fault Amartya Sen’s Capabilities approach (...) which mounts a defence of development through democratic deliberation as treating the individual in a way that seemingly trivialises the sort of relationship—a complementary one— required for inclusive development to happen, and Thaddeus Metz’s ubuntu approach which though upholds individual endowments, tends to also appeal to the collective in a way that appears to place premium on some collective values like solidarity which, I think, can blur the line between individual endowments and collective values. So, I claim that inclusive development can better be delivered using the approach of conversational thinking which has the capacity to drive the values of inclusive development such as complementarity and comprehensiveness while at the same time sufficiently isolating the endowments of the individuals from the trappings of the collective. Conversational thinking achieves this by taking the nature of the relationships of the relevant variables to factor into the effort aimed at combating social protection problems such as poverty. Keywords : Sub-Saharan Africa, Inclusive development, Conversational thinking, Mass poverty, African philosophy. (shrink)

The concern for ethical principles and values is not limited to health professionals alone. However, ethical principles in nursing act as safety valves for social control to prevent professional misconduct and abuse of the rights of clients. As a result of colonial experience, developing countries like Botswana usually follow the European lead, especially examples from the UK. This article examines the ethical problems and dilemmas associated with rural nursing practice in Botswana, a developing country in sub-Saharan Africa. The major (...) ethical problems identified are related to the distribution of and access to health resources in rural communities. It is proposed that nurses must assume responsibility in the field of access and allocation by working collaboratively with governments and other professional bodies, and that nurses as a global community must work together as a team to support each other. (shrink)

This study investigates the complex relationship between the physical and digital spaces of the city of Douala, Cameroon by comparing its online representation with the social representations emerging orally by locals. Using the results of two existing studies reporting on the online image of the city, we investigate the social representations foreigners and locally relevant people have of Douala and uncover similarities and discrepancies of the two resulting representations. Outcomes from the analysis permit reflection on the implications of these and (...) show an unripe, intermediate stage of the “hybrid Douala,” where the virtual space seems still not to be affecting the way the physical space is experienced, as well as where the gaps in the digital divide are perpetuated. At the same time, strong local ownership of certain digital activities suggests how the online image of the city is in the process of being constructed and developed locally. As the spaces of the city start appearing online, the process of hybridization between physical and digital Douala is slowly taking place and offline and online narratives, now rather separated, will possibly communicate a different image of the city to global online narratives. (shrink)

The word “epidemic” seems inadequate to describe the spread of the HIV virus in sub-Saharan Africa. The latest estimates suggest that 28.5 million people in this region are infected, including 5 million in South Africa alone. The HIV and AIDS pandemic, with infection rates of over 20 percent in seven African countries, rivals the worst of history's disease outbreaks, including the bubonic plague of medieval times. The devastating effects of the disease on the continent are compounded by extreme poverty (...) in the region and the lack of medical infrastructure essential for delivering the full range of available treatments for HIV infection, AIDS, and the opportunistic infections associated with the disease. Of the 40 million people infected with HIV worldwide, only 730,000 receive combination antiretroviral therapies. In the entire African continent, only 30,000 infected people currently receive such forms of treatment. (shrink)

BackgroundLiterature on issues relating to comprehension during the process of obtaining informed consent (IC) has largely focused on the challenges potential participants can face in understanding the IC documents, and the strategies used to enhance comprehension of those documents. In this review, we set out to describe the factors that have an impact on comprehension and the strategies used to enhance the IC process in sub-Saharan African countries.MethodsFrom November 2021 to January 2022, we conducted a literature search using a (...) PRISMA tool. We searched electronic databases (PubMed, EMBASE, EBSCOHOST) to identify relevant peer reviewed studies. We then reviewed the references of these articles to find additional literature that might have been missed through the initial search. We were particularly interested in full text articles in English that focused on the IC process in SSA published between 2006 and 2020. We included systematic reviews, and studies from Western and Asian countries that included data about SSA. We excluded articles that focused on medical interventions and studies that did not require IC.ResultsOut of the 50 studies included most were multi-country (n = 13) followed by single country studies in South Africa (n = 12); Kenya, Tanzania, Uganda (n = 5) each; Gambia, Ghana and Nigeria (n = 2)each ; and one each for Botswana, Malawi, Mali, Mozambique. We identified three areas of focus: (1) socio-cultural factors affecting IC; (2) gaps in the ethical and legal frameworks guiding the IC process; and (3) strategies used to improve participants’ understanding of IC.ConclusionOur review showed wide recognition that the process of achieving IC in SSA is inherently challenging, and there are limitations in the strategies aimed at improving comprehension in IC. We suggest that there is a need for greater flexibility and negotiation with communities to ensure that the approach to IC is suited to the diverse socio-cultural contexts. We propose moving beyond the literal translations and technical language to understanding IC comprehension from the participants’ perspectives and the researchers’ views, while examining contextual factors that impact the IC process. (shrink)

Within the context of global health development approaches, surgical missions to provide care for underserved populations remain the least studied interventions with regard to their methodology. Because of the unique logistical needs of delivering operative care, surgical missions are often described solely in terms of cases performed, with a paucity of discourse on medical ethics. Within surgery, subspecialties that serve patients on a non-elective basis should, it could be argued, create mission strategies that involve a didactic approach and the propagation (...) of sustainable surgical care. The ethical considerations have yet to be described for paediatric neurosurgical outreach missions. We present here the perspectives of neurosurgeons who have participated in surgical outreach missions in Central America, South America, Eastern Europe and sub-Saharan Africa from the vantage point of both the visiting mission team and the host team that accommodates the mission efforts. (shrink)

Sub-Saharan Africa is the epicenter of the HIV/AIDS epidemic, and in this issue of the Journal, seven authors discuss the moral, social and medical implications of having 70% of those stricken living in this area. Anton A. van Niekerk considers complexities of plague in this region (poverty, denial, poor leadership, illiteracy, women's vulnerability, and disenchantment of intimacy) and the importance of finding responses that empower its people. Solomon Benatar reinforces these issues, but also discusses the role of global politics (...) in sub-Saharan Africa, especially discrimination, imperialism and its exploitation by first world countries. Given the public health crisis, Udo Schüklenk and Richard E. Ashcroft defend compulsory licensing of essential HIV/AIDS medications on consequentialist grounds. Keymanthri Moodley discusses the importance of conducting research and the need to understand a moderate form of communitarianism, also referred to as "ubuntu" or "communalism", to help some Africans understand research as an altruistic endeavour. Godfrey B. Tangwa also defends traditional African values of empathy and ubuntu, discussing how they should be enlisted to fight this pandemic. Loretta M. Kopelman criticizes the tendency among those outside Africa to dismiss the HIV/AIDS pandemic, attributing one source to the ubiquitous and misguided punishment theory of disease. The authors conclude that good solutions must be cooperative ventures among countries within and outside of sub-Saharan Africa with far more support from wealthy countries. (shrink)

Corporate social responsibility in developing countries has recently received increasing attention, and scholars have pointed to the strong contextuality of CSR in the respective regions. Regarding the latter, however, sub-Saharan Africa has been scrutinized only marginally by academia. Moreover, empirical research on the impact of the institutional context has been scant, despite its attributed importance for CSR. Our article seeks to fill a part of this research gap by investigating CSR website reporting of 211 companies in seven sub-Saharan (...) countries. The study’s aim is twofold: First, we identify to what extent sub-Saharan companies report on CSR and which contents they disclose. Second, by building on institutional theory, we investigate how the socio-economic and political environments influence CSR reporting. For this purpose, we examine the impact of country-level and company-level determinants. We find that the sample African companies’ CSR efforts focus strongly on local philanthropy and therefore differ substantially from Western CSR approaches. Furthermore, we evidence that GDP and level of governance standard positively affect CSR reporting. Our study contributes to the literature by empirically evidencing the contextuality of CSR in Africa and by explaining how specific country- and company-level determinants contribute to or hamper the development of CSR in developing countries. (shrink)

Africa has a colonial past that renders it a linguistic melting pot, where language is not only important for communication but is inextricably related to cultural identity. In Africa, there are over 2000 languages that are still being used and spoken. Language diversity coupled with cultural diversity may affect the process of obtaining informed consent in data-intensive research. We explore some of the challenges and opportunities of multilingualism in handling informed consent in the context of data-intensive research. In multilingual contexts, (...) as in most African countries, language is exceptionally central, and translation has potential cultural, social, historical, functional and scientific importance. However, it is recognised that terminological and translation activities may not always be cost-effective or feasible. We consider alternative mechanisms of harmonisation of data-related terminology and concepts in multilingual contexts, such as iconography, graphic elicitation and other multimedia formats of information sharing. The inclusion of visual or multimedia explanations in informed consent forms can improve comprehension, enhance information transfer and learning, reduce potential vulnerabilities associated with low literacy levels or the inability to interpret technical language associated with data-intensive research, build trust with participants and their communities, and promote autonomy of potential participants. We recognise that the inclusion of visual or multimedia content to facilitate information transfer is only one component of the informed consent process for data-intensive research. Research ethics committees (RECs) should be mindful of other key considerations and challenges of informed consent for data-intensive research in sub-Saharan Africa (SSA), and to explore whether these alternative forms of consent are ethical and effective in multilingual contexts. (shrink)

ABSTRACTMother‐to‐child transmission of HIV represents a particularly dramatic aspect of the HIV epidemic with an estimated 600,000 newborns infected yearly, 90% of them living in sub‐Saharan Africa. Since the beginning of the HIV epidemic, an estimated 5.1 million children worldwide have been infected with HIV. MTCT is responsible for 90% of these infections. Two‐thirds of the MTCT are believed to occur during pregnancy and delivery, and about one‐third through breastfeeding. As the number of women of child bearing age infected (...) with HIV rises, so does the number of infected children. It is apparent that voluntary testing in Botswana has made some valuable inroads in decreasing perinatal HIV transmission, but the statistics showing the increased rate of HIV infection among women 15–24 years of age are not very promising. After reviewing all the pertinent scientific data it is clear that mandatory HIV testing of all pregnant women in conjunction with the implementation of a full package of interventions would save thousands of lives – mothers, newborns and others who could be infected as a result of these women not being aware of their HIV status. If the protection and preservation of human life is a priority in Botswana, then it is time to allow for mandatory HIV testing of all pregnant women, before it is too late for those who are the most vulnerable. To do less would be medically inappropriate and ethically irresponsible. (shrink)

BackgroundEthical and regulatory guidance on the collection and use of human biospecimens for research forms an essential component of national health systems in Sub-Saharan Africa, where rapid advances in genetic- and genomic-based technologies are fueling clinical trials involving HBS and the establishment of large-scale biobanks.MethodsAn extensive multi-level search for publicly available ethics regulatory guidance was conducted for each SSA country. A second review documented active trials listed in the WHO International Clinical Trials Registry Platform as of January 2015 in (...) which HBS collection was specified in the protocol. Findings were combined to determine the extent to which countries that are study sites for HBS-related research are supported by regulatory guidance language on the collection, use, ownership and storage of biospecimens.ResultsOf the 49 SSA countries, 29 had some form of national ethics guidance, yet only 17 provided language relating to HBS-related research, with specific guidance on consent, ownership, reuse, storage, and export/import/transfer. Ten countries accounted for 84 % of the active clinical trials involving the collection of HBS in SSA. All except one of these countries were found to have some national guidance in the form of regulations, codes of ethics, and/or standard operating procedures; however, only seven of the ten offered any language specific to HBS.ConclusionsDespite the fact that the bulk of registered clinical trials in SSA involving HBS, as well as existing and proposed sites for biorepositories under the H3Africa Initiative, are currently situated in countries with the most complete ethics and regulatory guidance, variability in the regulations themselves may create challenges for planned and future pan-African collaborations and may require legislative action at the national level to revise. Countries in SSA that still lack regulatory guidance on HBS will require extensive health system strengthening in ethics governance before they can be full participants in the modern research enterprise. (shrink)

Western scholarship on religion and gender has devoted considerable attention to women’s entry into leadership roles across various religious traditions and denominations. However, very little is known about the dynamics of women’s religious authority and leadership in developing settings, especially in sub-Saharan Africa, a region of powerful and diverse religious expressions. This study employs a combination of uniquely rich and diverse data to examine women’s formal religious authority in a predominantly Christian setting in Mozambique. I first use survey data (...) to test hypotheses regarding the prevalence and patterns of women’s formal leadership across different denominational groups. I then support and extend the quantitative results with insights on pathways and consequences of women’s ascent to formal congregation authority drawn from qualitative data. The analysis illustrates how women’s religious authority both defies and reasserts the gendered constraints of the religious marketplace and the broader gender ideology in this developing context. (shrink)

This paper discusses the significance of gender-based conflicts for thefailure of Gambian irrigated rice projects. In particular, it illustrateshow resource control of a gendered crop, rice, shifts from females to maleswith the development of pump-irrigated rice projects. Irrigation imposes aradically different labor regime on household producers, demanding thatthey intensify labor for year-round cultivation. Yet, the Gambian farmingsystem evolved for a five month agricultural calendar, in which women wereaccorded specific land and labor rights. The need to restructure familylabor, specifically skilled female (...) labor, to meet the cultivation demandsof pump irrigation is crucial for understanding the pattern of gender-basedconflicts in Gambian rice schemes. The case study illustrates thatirrigation involves more than technology transfer. Appropriate irrigationdemands sensitivity to the social structure of household production systems. The paper concludes by emphasizing the centrality of gender issuesfor improving food security in sub-Saharan Africa. (shrink)

BackgroundPrevention of mother to child transmission of HIV remains a key public health priority in most developing countries. The provider Initiated Opt – Out Prenatal HIV Screening Approach, recommended by the World Health Organization lately has been adopted and translated into policy in most Sub – Saharan African countries. To better ascertain the ethical reasons for or against the use of this approach, we carried out a literature review of the ethics literature.MethodsPapers published in English and French Languages between (...) 1990 and 2015 from the following data bases were searched: Pubmed, Cochrane literature, Embase, Cinhal, Web of Science and Google Scholar. After screening from 302 identified relevant articles, 21 articles were retained for the critical review.DiscussionMost authors considered this approach ethically justifiable due to its potential benefits to the mother, foetus and society. The breaching of respect for autonomy was considered acceptable on the grounds of libertarian paternalism. Most authors considered the Opt - Out approach to be less stigmatizing than the Opt - In. The main arguments against the Opt - Out approach were: non respect of patient autonomy, informed consent becoming a meaningless concept and the HIV test becoming compulsory, risk of losing trust in health care providers, neglect of social and psychological implications of doing an HIV test, risk of aggravation of stigma if all tested patients are not properly cared for and neglect of sociocultural peculiarities.ConclusionsThe Opt – Out approach could be counterproductive in case gender sensitive issues within the various sociocultural representations are neglected, and actions to offer holistic care to all women who shall potentially test positive for HIV were not effectively ascertained. The Provider Initiated Opt – Out Prenatal HIV Screening option remains ethically acceptable, but deserves caution, active monitoring and evaluation within the translation of this approach into to practice. (shrink)

Background: Research activities in sub-Saharan Africa may be limited to delegated tasks due to the strong control from Western collaborators, which could lead to scientific production of little value in terms of its impact on social and economic innovation in less developed areas. However, the current contexts of international biomedical research including the development of public-private partnerships and research institutions in Africa suggest that scientific activities are growing in sub-Saharan Africa. This study aims to describe the patterns of (...) clinical research activities at a sub-Saharan biomedical research center. Methods: In-depth interviews were conducted with a core group of researchers at the Medical Research Unit of the Albert Schweitzer Hospital from June 2009 to February 2010 in Lambarene, Gabon. Scientific activities running at the MRU as well as the implementation of ethical and regulatory standards were covered by the interview sessions. Results: The framework of clinical research includes transnational studies and research initiated locally. In transnational collaborations, a sub-Saharan research institution may be limited to producing confirmatory and late-stage data with little impact on economic and social innovation. However, ethical and regulatory guidelines are being implemented taking into consideration the local contexts. Similarly, the scientific content of studies designed by researchers at the MRU, if local needs are taken into account, may potentially contribute to a scientific production with long-term value on social and economic innovation in sub-Saharan Africa. Conclusion: Further research questions and methods in social sciences should comprehensively address the construction of scientific content with the social, economic and cultural contexts surrounding research activities. (shrink)

Bioethics, Volume 36, Issue 5, Page 576-586, June 2022.

Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

A growing number of countries in sub-Saharan Africa are considering legalizing the growth of genetically modified organisms. Furthermore, several projects are underway to develop transgenic crops tailored to the region. Given the contentious nature of GMOs and prevalent anti-GMO sentiments in Africa, a robust ethical analysis examining the concerns arising from the development, adoption, and regulation of GMOs in sub-Saharan Africa is warranted. To date, ethical analyses of GMOs in the global context have drawn predominantly on Western philosophy, (...) dealing with Africa primarily on a material level. Yet, a growing number of scholars are articulating and engaging with ethical theories that draw upon sub-Saharan African value systems. One such theory, Ubuntu, is a well-studied sub-Saharan African communitarian morality. I propose that a robust ethical analysis of Africa's agricultural future necessitates engaging with African moral theory. I articulate how Ubuntu may lead to a novel and constructive understanding of the ethical considerations for introducing GMOs into sub-Saharan Africa. However, rather than reaching a definitive prescription, which would require significant engagement with local communities, I consider some of Ubuntu's broader implications for conceptualizing risk and engaging with local communities when evaluating GMOs. I conclude by reflecting on the implications of using local moral theory in bioethics by considering how one might negotiate between universalism and particularism in the global context. Rather than advocating for a form of ethical relativism, I suggest that local moral theories shed light on salient ethical considerations that are otherwise overlooked. (shrink)

A powerful feature of global health research is data‐sharing with regions which bear the heaviest burden of disease. It offers novel opportunities for aggregating data to address critical global health challenges in ways higher than relying on individual studies. Yet there exist important stratifiers of the capacity to share data, particularly across the Global North‐South divide. Systemic challenges that characterize sub‐Saharan Africa and disadvantage the region's scientific productivity threaten the burgeoning data‐sharing culture too. Like all endeavors requiring equal commitments (...) under unequal circumstances, a strong ethical impetus is needed to help reduce inequities and imbalances to encourage adherence. This article discusses mandatory data‐sharing in relation to peculiar challenges faced by sub‐Saharan African scientists to suggest ethical principles for rethinking and reframing solutions. We propose six principles which mirror guidelines from the Institute of Medicine and encapsulate principles from the Emanuel Framework, Nairobi Data Sharing Principles, and the COHRED guidelines. (shrink)

It is becoming evident that failure to reconcile African Christians and Muslims is partly due to the misinterpretation of the African epistemology of peace. This work argues that Christian-Muslim peacemaking must be conceived apart from the Western epistemology whereby conferences, lectures, chart signing, religious fora, and systematic military strategies are common practices. For Africans, peacemaking involves creating a space where members of a community connect with each other at a deeper level. This paper explores the process of reconciling African Christians (...) and Muslims, not exclusively from a diplomatic tact and religious slant, but from intrinsic cultural constituents like the African ubuntu, Fulbe’s pulaaku, and the Ethiopian medemer which are entrenched in the notion of kinship. A Fulbe proverb constitutes a tool for illustrating kinship and peace. (shrink)

This article seeks to broaden understanding of issues and controversies addressed in social science research on women’s and gender studies by researchers and activists based in English-speaking sub-Saharan Africa. The topics covered were selected from those ratified by African women in the Africa Platform for Action in 1995 as well as from current debates on the politics of identity. The common feminist issues the authors identified were health; gender-based violence; sexuality, education, globalization and work; and politics, the state, and (...) nongovernmental organizations. In addition, the authors address theoretical and methodological trends. All four coauthors are feminist sociologists: One scholar is based in an African academic institution, two are Africans based in U.S. academic institutions, and one is an African American based in a U.S. academic institution. (shrink)

This article explored health determinants on successful, healthy ageing in sub-Saharan Africa, using the case of Ramotswa in Botswana. The study used contextual, descriptive and qualitative approaches. It also explored the integrative nature of determinants to healthy and successful ageing by examining the biopsychological and physiological challenges. The article made use of the pastoral theological approach in understanding the complexity of ageing and revealing solutions for mitigating the health challenges encountered by older persons. While the article was theological in (...) its approach, it acknowledged the interconnectedness with other disciplines, such as sociology and psychology, as fundamental in dealing with this topic. The findings revealed the elderly caregivers’ need for emotional support. This study maintained that emotional support could minimise the burden on elderly caregivers, because reports during the study indicated that elderly caregivers experienced a mixture of emotions such as loneliness, frustration, anger, depression, guilt, anxiety, love, acceptance and warmth, which could have negative consequences on them. Contribution: In conclusion, the article suggested that given the complexity of the understanding of successful and healthy ageing, as well as the integrative nature of determinants of successful ageing, it is crucial for caregivers and policymakers to avoid a blanket approach in dealing with elderly persons in a context of care. (shrink)

This article is the attempt of an historically oriented analysis focused on the role of Nigerian music as a cultural hub for the export of African cultural influences into the Black diaspora in the United States and its anticipation by the Free Jazz/Avantgarde-scene as well as the import of key-values related to the Black Power-movement to the African continent. The aim is to demonstrate the leading role and international impact of Nigeria's cultural industry among sub-saharan African nation states and (...) its specific ability to absorb and incorporate elements of Western culture. -/- After a short discussion of African influences on jazz music in general and the socio-political, cultural, and artistic context in which Free Jazz emerged, examples for the articulation of African consciousness among influencing key figures such as saxophonist John Coltrane or the Art Ensemble of Chicago are being presented. Furthermore, the personal and ideological links between the Avantgarde Jazz-scene and the Black Power-movement - especially the Black Panther Party - are made transparent. -/- In a second step the central influence of the Nigerian drum-pioneer Babatunde Olatunji on the Africanization of US-Jazz musicians, his personal and creative impact on John Coltrane, as well as the Black Power-movement is being highlighted. On the other hand, Coltrane, Free Jazz, and the Black Panther Party are being portrayed as a central creative and ideological turn in the career and work of Fela Kuti and towards political activism and his efforts to implement and apply the Africa-inspired Black Power -struggle of the US on the African continent in order to fight post-colonial forms of oppression. -/- . (shrink)

The UNESCO research projects focusing on The Silk Routes and The Slave Routes were launched at just the right time to remind us that globalization is not a novel dimension of the history of humanity. Not only am I among those who analyze capitalism as a worldwide system from its very inception, but I have also found it pertinent to recall that prior to the sixteenth century, societies were not at all isolated from one another but rather competing within regional (...) systems (and perhaps within one global system). To underestimate this fact is to condemn ourselves to a misunderstanding of the very dynamics of change within societies. At the same time, I maintain that in the history of the world, capitalism represents a qualitative rupture that had its beginnings around 1500. Accordingly I emphasize the distinction that must be made between the integrated structure of the worldwide capitalist system and the protocapitalist elements that are to be found in earlier societies; I also underline the specificity of the contrast between centers and peripheries, which is unique to global capitalism and which differs from previous forms of polarization. (shrink)

The COVID-19 pandemic has highlighted the question, ‘What do we owe each other as members of a global community during a global health crisis?’ In tandem, it has raised underlying concerns about how we should prepare for the next infectious disease outbreak and what we owe to people in other countries during normal times. While the prevailing bioethics literature addresses these questions drawing on values and concepts prominent in the global north, this paper articulates responses prominent in sub-Saharan Africa. (...) The paper first introduces a figurative ‘global health village’ to orient readers to African traditional thought. Next, it considers ethical requirements for governing a global health village, drawing on the ethic of ubuntu to formulate African renderings of solidarity, relational justice and sufficiency. The final section of the paper uses these values to critique current approaches, including COVAX, the vaccines pillar of the Access to COVID-19 Tools (ACT) accelerator, and a proposed international Pandemic Treaty. It proposes a path forward that better realizes ubuntu in global health. (shrink)

The conventional approach to international development by civil society—that is, the installation of “Western” programs and institutions by “Western” groups in “underdeveloped” regions—has remained largely unchanged since global poverty reduction, whether for political or social justice motivations, gained prominence in public discourse after World War II. Yet poverty rates, literacy, life expectancy, and unemployment in one of the poorest regions of the world, sub-Saharan Africa, has remained the same if not worsened since the 1970s . And, still, the great (...) Development Project continues: Problems in under-resourced areas are identified by well-meaning people from well-resourced areas, proposals to solve those problems are crafted by project managers and submitted to government and nongovernmental agencies, and successful projects are implemented by other well-meaning people who, for the most part, honestly want to make a difference. This is the system in which Priya seems to .. (shrink)