MSc (Med)Bioethics and Health Law, Faculty of Health Sciences, University of the Witwatersrand, 2009 / The application of informed consent in research in developing countries continues to be a topical and complex issue. The debate concerning informed consent has become even more relevant in light of the groundswell of international collaborative research that is conducted in developing countries. The discussion centres on the uncertainties of the application of informed consent in developing countries based on the normative criteria set out in international codes and regulations. Although the ethical and legal basis of obtaining valid informed consent is incontestable, contextual differences between developed and developing countries is a key problem. For example, it is debated if the tenets of ‘Western’ research ethics, mainly in the application of a written informed consent model can truly be applied in the African context. The question is whether the participants of research when conducted in developing countries actually are “informed” in the consent process. There are perceptions that the protective instruments that guide researchers on how to obtain informed consent from research participants are not robust and sensitive enough for developing countries needs. In literature, some have questioned the relevance of its purist application in the context of developing countries as ‘overly paternalistic’. Others have argued from the view point that the Eurocentric approach recommended in obtaining informed consent in developing countries has the potential to undermine cultural norms and traditions. In the latter argument, concerns are raised about the principle of respect for persons / ‘autonomy’ and its applicability in so-called communitarian societies. To overcome some unique hurdles, there are voices that call for tailor-made processes for obtaining informed consent to suit the prevailing context, suggesting therefore that there should be some variance in its application. The importance of the issue of informed consent becomes critical as much international collaborative research takes place in Africa where health services are often inadequate and research is perceived by participants as a means of ameliorating some of their suffering. Given the philosophical and the ‘universal’ ethical foundations at the heart of the international regulations and codes on the issue of informed consent, there is a need to further explore the foundation of these perceptions as they raise various ethical issues which need to be discussed. The question concerned in this research report is “is there unfinished business not addressed in the process of obtaining informed consent in developing countries?” In order to answer this question, it is necessary to look at some of the requisites for the application of informed consent principles. I will examine whether the content of the commonly cited ethical codes and regulations (originally initiated in developed countries) are sufficiently broad enough to explain the aims of obtaining informed consent, the steps to be taken in obtaining informed consent and the structures necessary for its facilitation. In addition I will examine whether the intent of the codes and regulations take cognizance of socio-cultural variations. In other words, is the environment sufficiently conducive to apply the concept and are the guidelines flexible enough to deal with “unusual circumstances”. In consideration of the latter, I consider the question of the adequacy of structures to ensure the essence of respect for persons is not lost in dealing with “unusual circumstances”. I contend that if the answer is in the affirmative it is only then can it be said that the principles of informed consent are being adequately addressed and meet the moral, ethical, and legal obligations of research activities.

FACULTY OF HEALTH SCIENCES MASTER OF PUBLIC HEALTH 0209663k / Background: Tobacco use is one of the single biggest causes of preventable deaths and is increasingly affecting developing countries and men and women alike. Tobacco use is historically more common in men but is becoming more common among women. In the absence of population-based health information in many dev eloping countries and sub- Saharan Africa in particular, public health planning and priority setting is in disarray. Most of the prevalence studies on tobacco have concentrated on smoked tobacco and men in particular. This cross-sectional study design looked at the prevalence, patterns and determinants of tobacco use among women in Benin City, an urban area in Nigeria. Methods: 491 face-to-face interviews were conducted in 45 enumeration areas randomly sampled in Oredo LGA in Benin City, Nigeria. Twelve households were randomly sampled in each EA and eligible woman over the age of 18 years was identified in each household. Results: The prevalence of tobacco use was 8.8% comprising of smoking (3.3%) and smokeless (5.5%) initiation occur during the teenage years mostly. Smoking cigarettes was more common among the younger, more educated women and Tabba (a mixture of powdered dry tobacco leaf and sodium bicarbonate) used mostly by older less educated women (RR = 3.10, CI = 1.01 - 9.48). The participants perceived friends using tobacco as a reason for their starting to use tobacco. Determinants of tobacco use were education, exposure to tobacco advertising and / or promotions which occurs almost unrestricted despite some tobacco control legislations. Dr. OV Okwuolise; 0209663K/2005 Page 2 of 2 Conclusions: The findings suggest that tobacco use is going on unhindered and unless something is done to curtail the activities of the tobacco industry, a major public health catastrophe is looming.

Faculty of Health Sciencs School of Public Health 961299p muzi@hst.org.za / Most leading causes of death and disability in developing countries can be prevented, treated, or at least alleviated with cost effective essential drugs. However, hundreds of millions of people do not have regular access to essential drugs despite the fact that essential drugs can prevent many deaths. The aim of this study was to determine factors associated with essential drugs shortages in Primary Health Care (PHC) facilities (i.e. clinics and community health centres) in Mopani District in the Limpopo Province. Forty-five facilities were selected by means of stratified (by sub-district) random sampling. Forty-five professional nurses, who were in charge of the facility on the day of the interviews, were interviewed. A structured questionnaire was used for the data collection. Six pharmacists, from the six hospitals that supply drugs to the PHC facilities, were interviewed using a structured questionnaire. A one-on-one informal interview was held with 2 Hospital Superintendents and the Acting Provincial Chief Pharmaceutical Director. The study was both a retrospective and prospective observational study based on review of historical data, interviews with key players and direct observation of current practice. The tools used to collect and analyse the data were based on those developed by the World Health Organisation (WHO) and the Health Systems Trust (HST) with some adjustments and adaptation. The District STI Quality of Care (DISCA) Tool was used in the other thirty-six facilities, at which the structured questionnaire was not administered, to test prescribing indicators in relation to diagnosis, the correctness of and dosage of drugs dispensed and also drugs availability.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Digitized by Kansas Correctional Industries

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Thesis. 1976. M.C.P.--Massachusetts Institute of Technology. Dept. of Urban Studies and Planning. / Microfiche copy available in Archives and Rotch. / Bibliography: leaves 157-162. / M.C.P.

No description available.

The Primary Education Stipend Programme (PESP) receives accolades and support from the government and policy partners (such as ADB, World Bank, DFID) in spite of deficiencies in its implementation. The general impression is that the programme is increasing equitable access to quality education for poor children. However, there is no study to understand how and to what extent PESP receiving children are benefiting and how it influences and affects the school. This study was undertaken to understand the policy gap between the introduction and implementation of the PESP by examining parents' and teachers' perceptions of the strengths and weaknesses of the PESP and its effects on teaching and learning, and school management. These perspectives provide a broader understanding of the effectiveness of the programme in realizing its goals. This study uses a qualitative case study approach and selects one rural primary school for in-depth investigation. Three groups of parents of children were interviewed: those who completed primary cycle; those who dropped out of school, and; those whose PESP benefits had been rescinded due to poor attendance and performance. Two parents were included from each group in this study. The head teacher and one assistant teacher are also included in this study to explore the effects of the PESP on the schoolcommunity relationship and school management processes. The study found different types of deception in selecting beneficiaries. The strategy of not including more than one child from a single family is evident that results in many poor children's exclusion from the benefit. Conditionality is used to exclude lowperforming children from the benefit which restricts access to education for a considerable number of poor children and many non-poor children receive the benefit. Thus, the PESP benefits the non-poor people. The amount of stipend money is also found insufficient for ensuring necessary learning materials for the poor children. Lower amounts due to unmet conditionality and other charges at times trigger discord and dispute and hamper children's learning. The stipend money increases private investment in education in the form of private coaching fees. The PESP does not incentivize poor children to learn. In addition, it does not increase the teacher's confidence of their educability or increase children's confidence in their capacity to learn. Rather, a sense of the incorrigibility of poor children has been established and teachers allege deteriorating learning condition in crowded classrooms caused by the PESP. With regard to the parent-teacher relationship, this study finds a bitter antagonistic stance brew between the two groups and creates unintended effects. The teacher and the head teacher accuse parents of not providing adequate support at home and parents allege the school for not providing required care and attention for their children. This mutual disregard affects the teacher-student relationship and undermines poor children's confidence to be educated equally with non-poor children. As a consequence of the conflicting perceptions of the aims and objectives of the programme and the perceived inadequacy of the PESP policy in society, this thesis will look for new insights into the process of implementation and the effectiveness of the PESP policy. This may encourage policy makers to reflect upon the efficacy of the programme as a strategy to increase access and quality education for poor children.

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