Opportunities and challenges for decentralised clinical trials in sub-Saharan Africa: a qualitative study

IntroductionDigital health has gained traction in research and development, and clinical decision support systems. The COVID-19 pandemic accelerated the adoption of decentralised clinical trials (DCTs) as a mitigation and efficiency improvement strategy. We assessed the opportunities and challenges of a digital transformation in clinical research in sub-Saharan Africa from different stakeholders’ perspectives.MethodsA qualitative study, including 40 in-depth semi structured interviews, was conducted with investigators of three leading research institutions in sub-Saharan Africa and Switzerland, contract research organisations and sponsors managing clinical trials in sub-Saharan Africa. A thematic approach was used for the analysis.ResultsInterviewees perceived DCTs as an opportunity for trial efficiency improvement, quality improvement and reducing the burden of people participating in clinical trials. However, to gain and maintain an optimal quality of clinical trials, a transition period is necessary to tackle contextual challenges before DCTs are being implemented. The main challenges are categorised into four themes: (1) usability and practicability of the technology; (2) paradigm shift and trial data quality; (3) ethical and regulatory hurdles and (4) contextual factors (site-specific research environment and sociocultural aspects).ConclusionThe transformation from a site to a patient-centric model with an increased responsibility of participants should be context adapted. The transformation requires substantial investment, training of the various stakeholders and an efficient communication. Additionally, commitment of sponsors, investigators, ethics and regulatory authorities and the buy-in of the communities are essential for this change

A qualitative study of community perception and acceptance of biological larviciding for malaria mosquito control in rural Burkina Faso

Background: Vector and malaria parasite’s rising resistance against pyrethroid-impregnated bed nets and antimalarial drugs highlight the need for additional control measures. Larviciding against malaria vectors is experiencing a renaissance with the availability of environmentally friendly and target species-specific larvicides. In this study,we analyse the perception and acceptability of spraying surface water collections with the biological larvicide Bacillus thuringiensis israelensis in a single health district in Burkina Faso. Methods: A total of 12focus group discussions and 12key informant interviews were performed in 10 rural villages provided with coverage of various larvicide treatments (all breeding sites treated, the most productive breeding sites treated, and untreated control). Results: Respondents’ knowledge about the major risk factors for malaria transmission was generally good. Most interviewees stated they performed personal protective measures against vector mosquitoes including the use of bed nets and sometimes mosquito coils and traditional repellents. The acceptance of larviciding in and around the villages was high and the majority of respondents reported a relief in mosquito nuisance and malarial episodes. There was high interest in the project and demand for future continuation. Conclusion: This study showed that larviciding interventions received positive resonance from the population. People showed a willingness to be involved and financially support the program. The positive environment with high acceptance for larviciding programs would facilitate routine implementation. An essential factor for the future success of such programs would be inclusion in regional or national malaria control guidelines

What are the impacts of climate change and the Ukrainian War on the Sustainable Development Goals? A case study for Burkina Faso

Repeated shocks to fragile economies call into question the achievement of sustainable development goals. This study uses a gender-dynamic computable general equilibrium model linked to a micro model to assess the impacts of the war in Ukraine and climate shocks on SDG1, SDG2, SDG5 and SDG8 for the Burkina Faso economy. The results reveal negative impacts on economic growth with an increase in food insecurity and household poverty. Urban households are the most affected by food insecurity while unskilled men are most likely to lose their job in the short run. In the long run however, women experience more job losses than men

Climate change impacts on migration and women's poverty in Burkina Faso

Burkina Faso faces significant challenges in terms of gender inequality, especially regarding employment and economic opportunities. Agriculture, the main provider of employment, is threatened by climate change. Our study contributes to the understanding of the gender distributive effects induced by climate change. The climate shock is introduced stochastically to accommodate the uncertainties related to the evolution of the climate and its effects on agricultural yields. An economywide framework is used to capture the backward and forward linkages of the agricultural sector to the non-agricultural sectors. Our results show that on average, climate change is slightly unfavourable for women's economic activities compared to men's economic activities. Climate shocks drive down employment and slightly more for women's employment. Furthermore, the simulation shows negative impacts on poverty, with rural households and female-headed households being the most affected. However, the high level of uncertainty surrounding the impact of climate change on agricultural yields makes it difficult to find significant gender bias in the distribution of economic effects of climate change in Burkina Faso

A Survey of Marine Natural Compounds and Their Derivatives with Anti-Cancer Activity Reported in 2012

Although considerable effort and progress has been made in the search for new anticancer drugs and treatments in the last several decades, cancer remains a major public health problem and one of the major causes of death worldwide. Many sources, including plants, animals, and minerals, are of interest in cancer research because of the possibility of identifying novel molecular therapeutics. Moreover, structure-activity-relationship (SAR) investigations have become a common way to develop naturally derived or semi-synthetic molecular analogues with improved efficacy and decreased toxicity. In 2012, approximately 138 molecules from marine sources, including isolated compounds and their associated analogues, were shown to be promising anticancer drugs. Among these, 62% are novel compounds. In this report, we review the marine compounds identified in 2012 that may serve as novel anticancer drugs

A Survey of Marine Natural Compounds and Their Derivatives with Anti-Cancer Activity Reported in 2011

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Operational Differences between Product Development Partnership, Pharmaceutical Industry, and Investigator Initiated Clinical Trials

Medicine development is a lengthy endeavour. Increasing regulatory stringency and trial complexity might lead to reduced efficiency, dwindled output, and elevated costs. However, alternative models are possible. We compared the operational differences between pharmaceutical industry sponsored trials, product development partnership trials, and investigator-initiated trials to identify key drivers of inefficiency in clinical research. We conducted an exploratory mixed-methods study with stakeholders, including clinical trial sponsors, contract research organisations, and investigators. The qualitative component included 40 semi-structured interviews, document reviews of 12 studies and observations through work shadowing in research institutions in Burkina Faso, Mali, and Switzerland. The findings were triangulated with an online survey polling clinical research professionals. The operational differences were grouped under five categories: (i) trial start-up differences including governance and management structure; (ii) study complexity; (iii) site structural and organisational differences; (iv) study conduct, quality approaches, and standard operating procedures; and (v) site capacity strengthening and collaboration. Early involvement of sites in the planning and tailored quality approaches were considered critical for clinical operations performance. Differences between the types of trials reviewed pertained to planning, operational complexities, quality approaches, and support to the sites. Integration of quality-by-design components has the potential to alleviate unnecessary process burden

Cytotoxic, Antiproliferative and Pro-Apoptotic Effects of 5-Hydroxyl-6,7,3′,4′,5′-Pentamethoxyflavone Isolated from Lantana ukambensis

Lantana ukambensis (Vatke) Verdc. is an African food and medicinal plant. Its red fruits are eaten and highly appreciated by the rural population. This plant was extensively used in African folk medicinal traditions to treat chronic wounds but also as anti-leishmanial or cytotoxic remedies, especially in Burkina Faso, Tanzania, Kenya, or Ethiopia. This study investigates the in vitro bioactivity of polymethoxyflavones extracted from a L. ukambensis as anti-proliferative and pro-apoptotic agents. We isolated two known polymethoxyflavones, 5,6,7,3′,4′,5′-hexamethoxyflavone (1) and 5-hydroxy-6,7,3′,4′,5′-pentamethoxyflavone (2) from the whole plant of L. ukambensis. Their chemical structures were determined by spectroscopic analysis and comparison with published data. These molecules were tested for the anti-proliferative, cytotoxic and pro-apoptotic effects on human cancer cells. Among them, 5-hydroxy-6,7,3′,4′,5′-pentamethoxyflavone (2) was selectively cytotoxic against monocytic lymphoma (U937), acute T cell leukemia (Jurkat), and chronic myelogenous leukemia (K562) cell lines, but not against peripheral blood mononuclear cells (PBMCs) from healthy donors, at all tested concentrations. Moreover, this compound exhibited significant anti-proliferative and pro-apoptotic effects against U937 acute myelogenous leukemia cells. This study highlights the anti-proliferative and pro-apoptotic effects of 5-hydroxy-6,7,3′,4′,5′-pentamethoxyflavone (2) and provides a scientific basis of traditional use of L. ukambensis

Conserving wildlife amongst the cotton fields. A third of a century of experience at the Nazinga Game Ranch, Burkina Faso

peer reviewedEstablished in the early 1970 as a participatory wildlife production area, the Nazinga Game Ranch turned into an island of conservation surrounded by cultivation.We asked ourselves how long-term ungulate trends are affected in a context of continuous human pressure. To find out, we compiled and analysed the data of yearly line-transect counts of mammals carried out since 1985. Results showed that large species such as the elephant (Loxodonta africana) and large antelopes increased or showed stable populations. In contrast, medium and small ungulates showed continuously decreasing trends. During the same period, rainfall, water availability from artificial water points and the crop encroaching outside Nazinga Game Ranch increased. After an initial significant reduction, illegal human signs increased. However, we showed that human signs were positively correlated with the abundance of large ungulates but negatively correlated with the abundance of medium and small ones. In conclusion, this study showed that some isolated mammal populations could be restored and maintained in the long term, in spite of being surrounded by highly cultivated areas