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Informed consent in research in developing countries: Is there some unfinished business?Tsotsi, Norma Mabel 17 February 2010 (has links)
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.
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Prevalence and patterns of tobacco use among woman in Benin city, NigeriaOkwuolise, Ogheneruemu Vincent 20 November 2006 (has links)
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.
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Factors associated with drug shortages in PHC facilities in the Mopani district of the Limpopo provinceMatse, Patrick Muzi 10 November 2006 (has links)
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.
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The role of secondhand equipment in developing nationsBaxter, Randall Wayne January 2010 (has links)
Typescript (photocopy). / Digitized by Kansas Correctional Industries
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Long-term trends in terms of trade and economic developmentTavakkol, Abdolamir January 2010 (has links)
Digitized by Kansas Correctional Industries
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National policy approaches to reduce food insecurity in developing market economiesEtzold, Peter Eric January 2010 (has links)
Typescript (photocopy). / Digitized by Kansas Correctional Industries
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Bigger and more is not always better : self-help water supply system.Oh, Byungho January 1976 (has links)
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.
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Assessing the effects of pre-construction delay in hydropower projectsPlummer, Judith Kate January 2014 (has links)
No description available.
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Parents', teachers', and head teachers' perceptions of the Primary Education Stipend Programme (PESP) in improving access and quality of primary education in BangladeshHossain, Md. Altaf January 2017 (has links)
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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The contribution of multinational corporations to the economic development of less developed countries : the radical view consideredPryor, David January 2010 (has links)
Digitized by Kansas Correctional Industries
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