Academic journal article Bulletin of the World Health Organization

International Collaboration, Funding and Association with Burden of Disease in Randomized Controlled Trials in Africa

Academic journal article Bulletin of the World Health Organization

International Collaboration, Funding and Association with Burden of Disease in Randomized Controlled Trials in Africa

Article excerpt

Introduction

Developing countries need to perform research, particularly on conditions and settings specific to their context, in order to maximize their yield from scarce health-care resources. Developing countries need support to conduct this research and to develop local research capacity. Increased research capacity in developing countries is believed to have beneficial consequences for developed nations, for example in preventing the global spread of infectious agents (1, 2). The nature of the support from developed countries has, however, been debated, and the ethics of research collaboration between developed and developing nations have been widely discussed (3-5). Collaboration may sometimes be seen as reflecting a form of colonialism that serves the interests of foreign collaborators more than those of the host countries (6, 7). One means of improving the nature of the support from developed countries would be to allow local priorities to shape both basic and applied research studies (2, 5, 6, 8). However, a regional consultative process conducted in Africa in preparation for the International Conference on Health Research for Development in 2000 concluded that in the post-independence period priority setting has been haphazard and determined by institutions or individuals instead of being based on the needs of the country or region (9).

The empirical relationship between international collaboration and local relevance has not been quantitatively assessed. The relevance of interventions to a specific context is difficult to define in operational terms. Frequently suggested criteria for determining research priorities include, in addition to the burden of disease existing from a target condition, the expected effectiveness and cost of an intervention, the probability of finding a solution, the effect on equity (i.e. the likely impact of the research on the poorer segments of the population), the feasibility of the research, its ethical acceptability, and the impact on capacity strengthening (10). Most of these criteria are difficult to assess objectively, require specialist knowledge of a wide range of local conditions, and vary greatly depending on local conditions. Because an operational definition that incorporates all of these factors remains elusive, we limited our study to burden of disease as expressed in disability-adjusted life years (DALYs) for which widely accepted quantitative estimates by geographical region are available.

This study aimed to assess whether randomized controlled trials conducted in Africa with collaborators from outside Africa were more closely associated with health conditions that have a burden of disease that is of specific importance to Africa than with conditions of more general global importance or with conditions important to developed countries. We also assessed whether the source of funding influenced the relevance of a study to Africa. This study received ethical approval from the Research Ethics Committee of the University of Cape Town.

Methods

Definitions

We compared trials performed in Africa that studied diseases specifically relevant to Africa with two groups of control trials: those that studied diseases of a more general global importance (globally relevant diseases) and those that studied diseases relevant to developed countries.

We categorized diseases according to the size and distribution of the burden of disease in 1990 in Africa, globally, and in established market economies (developed countries) (11) (Table 1). Diseases categorized as being specifically African diseases were those that were important to Africa in both absolute and relative terms (burden of disease > 500 000 DALYs and burden of disease in sub-Saharan Africa > 50% of global burden of disease). These diseases included HIV/AIDS, malaria, trypanosomiasis, schistosomiasis, onchocerciasis, and measles. Globally relevant diseases were those important to Africa in absolute terms but not in relative terms (burden of disease > 500 000 DALYs and burden of disease in sub-Saharan Africa < 15% of global burden). …

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