Analysis of pan-African Centres of excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent.

A pool of 38 pan-African Centres of Excellence (CoEs) in health innovation has been selected and recognized by the African Network for Drugs and Diagnostics Innovation (ANDI), through a competitive criteria based process. The process identified a number of opportunities and challenges for health R&D and innovation in the continent: i) it provides a direct evidence for the existence of innovation capability that can be leveraged to fill specific gaps in the continent; ii) it revealed a research and financing pattern that is largely fragmented and uncoordinated, and iii) it highlights the most frequent funders of health research in the continent. The CoEs are envisioned as an innovative network of public and private institutions with a critical mass of expertise and resources to support projects and a variety of activities for capacity building and scientific exchange, including hosting fellows, trainees, scientists on sabbaticals and exchange with other African and non-African institutions.

IgE antibodies to Plasmodium falciparum and severity of malaria in children of one ethnic group living in Burkina Faso.

Plasmodium falciparum malaria infection induces elevated blood levels of both total immunoglobulin and anti-plasmodial antibodies belonging to different isotypes. We have previously shown that donors living in areas of malaria transmission develop malaria-specific IgE antibodies that are present at highest concentrations in patients with severe disease, suggesting a role for this isotype in malaria pathogenesis. To establish the possible importance of IgE in the course and severity of this disease, we have analyzed a large and homogenous group of African children (age range = 6 months to 15 years) belonging to one ethnic group (Mossi) living in identical epidemiologic conditions in the same urban area (Ougadougo) of Burkina Faso. While IgG antibodies to P. falciparum increased to high concentrations in very young children and then remained at these levels in older patients, IgE antibodies increased with age, becoming most significantly elevated in children more than four years of age. In older children, those with severe malaria had significantly higher IgE antibody levels than those with non-severe disease. No significant differences between the patient groups were seen for IgG antibodies to P. falciparum. However, when the patients with severe malaria were divided into two groups distinguished by the presence of absence of coma, both IgG and IgE antibodies against malaria were lower in the comatous patients than in the non-comatous patients. The results support the conclusion that IgE antibodies against malaria, regardless of their possible protectivity, also contribute to disease severity in this large and homogenous group of African children.

[Relevance of reactive fillets in detecting urinary infections in African paediatric environment]. / Intérêt des bandelettes réactives dans le déspistage des infections urinaires en milieu pédiatrique africain.

It is quite obvious that African paediatricians are facing numerous challenges. However, their daily fight against frequent pathologies such as malaria, diarrhoeal diseases and respiratory infections should not prevent them from taking into consideration the existence of other pathologies, particularly urinary infections. The clinical picture of urinary infections which is often polymorphic would require a systematic test among infants. Reactive fillets may therefore be relevant in detecting such urinary infections. This survey shows that the best intrinsic values of the fillets used (multistix 8 SG) are reached with leucocytes (sensibility: 95%) and with the combination of leucocytes and nitrites (specificity: 77.1%). The best predictable validities were obtained with the combination of leucocytes and nitrites (positive predictable value: 68.1%) as well as with the combination of leucocytes or nitrites (negative predictable value: 86%). In the daily practice, reactive fillets may turn out to be helpful to the clinician. The negativity of both tests speaks for the isolation and exclusion of urinary infections. On the other hand, the positivity of both tests highlights a strong urinary infection which is subject to a careful and rigorous use of fillets.

[Epidemiological features of tumors of the skin and mucosal membranes in the department of dermatology at the Yalgado Ouedraogo National Hospital, Ouagadougou, Burkina Faso]. / Tumeur cutanéo-muqueuses: aspects épidémiologiques dans le service de dermatologie du centre hospitalier national Yalgado Ouedraogo de Ouagadougou, Burkina Faso.

We conducted a retrospective study of the files of all patients seen from 1 January 1992 through 31 December 1996 with tumors of the skin and mucosal membranes at the Yalgado Ouédraogo National Hospital in order to determine the epidemiologic features of this disease. The records revealed 988 patients presented 1024 tumors, which could be classified into 33 categories. Most of the patients (60.6%) were in the age bracket of 20 to 39 years. Nearly all cases (988 or 96.5%) were benign skin tumors, mainly of infectious origin, especially viral (51.7%). We observed a substantial number of sexually transmissible infections, such as condylomata. We also found 36 cases (3.5%) of malignant tumors, including 29 cases of Kaposi sarcoma, five skin carcinoma (13.8%), three spinocellular and two basocellular; we also noted two borderline malignant tumors: a dermatofibrosar-coma protuberans and a nodular hidradenoma. The elevated prevalence of condyloma (151 cases) may explain the predominance of the 20-39 year age group, which is the most sexually active. Our series also confirmed the relative rarity (3.5%) of cutaneous cancers among African blacks. The predominance of Kaposi sarcoma may be explained by the high prevalence of HIV infection in our country.

Institutional facilities in national health research systems in sub-Saharan African countries: results of a questionnaire-based survey.

OBJECTIVE: To describe the current status of institutional facilities and the supporting research infrastructure of surveyed health research institutions in Africa, including information on communication technologies and connectivity, library resources, and laboratory operations and resources. DESIGN: A structured questionnaire was used to solicit information on institutional facilities at health research institutions. SETTING: Health research institutions in 42 sub-Saharan African countries. PARTICIPANTS: Key informants from 847 health research institutions. MAIN OUTCOME MEASURES: The availability of laboratory, information and communication, and library facilities in health research institutions. RESULTS: Less than half of the respondent health research institutions had computer laboratories (49%), network computers (50%) and information technology support (38%). More than two-thirds (67%) had a library. Electronic subscriptions to international journals were observed to be very low, with an average of three subscriptions per institution. Almost two-thirds of the surveyed institutions (69%) reported having laboratories, about half of which (55%) were accredited nationally. Linkages and research collaborations were generally weak, particularly those with other laboratories in the Region. Challenges included financial and human resource constraints and the inability to communicate effectively with partners. CONCLUSIONS: Health research institutions in the Region have insufficient access to essential facilities such as laboratories, libraries, computers and the Internet to generate, access and share information.

Research output of health research institutions and its use in 42 sub-Saharan African countries: results of a questionnaire-based survey.

OBJECTIVE: To describe and analyse research output from surveyed national health research institutions in Africa. DESIGN: The survey used a structured questionnaire to solicit information from 847 health research institutions in 42 countries of the World Health Organization African Region. SETTING: Eight hundred and forty-seven health research institutions in 42 sub-Saharan African countries. PARTICIPANTS: Key informants from the health research institutions. MAIN OUTCOME MEASURES: Volume, type and medium of publications, and distribution of research outputs. RESULTS: Books or chapters for books accounted for the highest number of information products published (on average 16.7 per respondent institution), followed by patents registered in country (8.2), discussion or working papers (6.5) and conference proceedings (6.4). Publication in a peer-reviewed journal constituted only a minor part of research output (on average about 1 paper per institution). Radio and TV broadcasts on health research accounted for the highest number of products issued by institution staff (on average 5.5 per institution), followed by peer-reviewed journals indexed internationally (3.8) or nationally (3.1). There were, on average, 1.5 press releases, 1.5 newspaper or magazine articles, and 1.4 policy briefs per institution. Over half of respondent institutions (52%) developed briefs and summaries of articles to share with their target audiences, 43% developed briefs for possible actions and 37% provided articles and reports upon request. Only a small proportion of information products produced were available in institutional databases. CONCLUSIONS: The research output of health research institutions in the Region is significant, but more effort is needed to strengthen research capacity, including human and financial resources.

Research ethics policies and practices in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey.

OBJECTIVE: To describe the state of research ethics policies and practices in health research institutions in sub-Saharan African countries. DESIGN: A structured questionnaire was used to solicit information on research ethics from health research institutions. SETTING: Forty-two sub-Saharan African countries. PARTICIPANTS: Key informants from the health research institutions. MAIN OUTCOME MEASURES: Existence of institutional ethics review policies and mechanisms. RESULTS: About half (51%) of respondent institutions reported having policies on research ethics and 58% had written policies requiring that researchers obtain informed consent of research participants. About one-third of respondent institutions (34%) had established ethics review committees, 42% required that studies went through ethics review committees and 46% had linkages with national or regional ethics organisations. Regarding operating procedures for ethics review committees, 53% had adopted standard operating procedures. Less than one-quarter of respondent institutions reported having policies in place to monitor ongoing research. Of the institutions that monitored ongoing research, 34% did an annual ethical review and 74% required a periodic written report. Only 36% provided any type of ethics training for staff, including those conducting health research and those who were not members of the ethics review committee. CONCLUSIONS: There are substantial gaps in the capacity of health research institutions in the WHO African Region to undertake ethical review of studies before, during and after studies conducted. There is a need to strengthen such capacity in order to ensure the wellbeing of individuals enrolled in studies and that of communities that host these studies.

Knowledge systems in health in sub-Saharan Africa: results of a questionnaire-based survey.

OBJECTIVE: To describe the mechanisms and systems of knowledge acquisition, creation, diffusion, application and improvement of knowledge in two layers of the health system: health policy formulation and the provision of clinical services. DESIGN: A questionnaire-based survey. SETTING: Health research institutions in 46 countries of the World Health Organization (WHO) African Region. PARTICIPANTS: Key informants in ministries of health and health care institutions in 39 countries of the Region. MAIN OUTCOME MEASURES: Existence of knowledge management infrastructure or components of infrastructure in the countries of the Region. RESULTS: Central national bodies are always cited as having a major role in policy-setting. Non-national bodies most frequently provide advice and act in monitoring and evaluation, while decentralised entities are strongly involved in dissemination, implementation, and monitoring and evaluation. In general, ministries tend not to have an explicit knowledge management framework and do not map knowledge sources and flows for policy-making. The main sources of evidence are guidelines or recommendations from international or national agencies, although systematic reviews are rarely used. Routine monitoring and evaluation of quality and effectiveness of the process of policy development and its implementation was reported in 19 of the 39 respondent countries. In most respondent countries, electronic medical records were rarely used. CONCLUSIONS: As systematic reviews are rarely utilised as a source of evidence in policy development and few mechanisms exist to assess the performance of the policies, there are significant opportunities for improving policy development.

Surveying the knowledge landscape in sub-Saharan Africa: methodology.

OBJECTIVE: To describe in detail the methods followed in each of the qualitative and quantitative surveys of national health information, research and knowledge systems and research institutions. DESIGN: Cross-sectional surveys. SETTING: National health information and research systems, and 847 health research institutions in 42 countries in the World Health Organization (WHO) African Region. PARTICIPANTS: Key informants from health research institutions, ministries of health and statistical offices. MAIN OUTCOME MEASURES: Stewardship, financing, ethics, human and material resources and output of health information and research systems. RESULTS: Key informants were used to collect data to assess national research systems in 44 countries in the Region. The same method was followed in assessing national information systems in 17 countries and knowledge systems for health in 44 countries. These assessments included a detailed review of the state of data sources in the Region and their effect on measuring progress on the health-related Millennium Development Goals. A concurrent survey employed a structured questionnaire (the WHO Health Research Systems Analysis Questionnaire) to assess the capacity of 847 health research institutions in 42 countries. Stewardship, financing, ethics, human and material resources and research output were assessed. CONCLUSIONS: The logistics and resources involved in surveying the knowledge landscape in the 42 countries were substantial. However, the investment was worthwhile as the results of the surveys can be used to inform policy-making and decision-making, as well as to establish a regional database of national health information, research and knowledge systems.

Overview of national health research systems in sub-Saharan Africa: results of a questionnaire-based survey.

OBJECTIVE: To assess the state of national health research systems of countries in the World Health Organization (WHO) African Region. DESIGN: A questionnaire-based survey METHODS: Structured questionnaires were used to solicit health research systems' relevant information from key informants in each country. SETTING: Forty-six Member States of the WHO African Region. PARTICIPANTS: Key informants from the ministry of health in each country, with the support of WHO Country Offices. MAIN OUTCOME MEASURES: Presence of national health research policy or strategy, priority setting and ethical review of research. RESULTS: Of the 44 responding countries, 39 (89%) reportedly had an official national health policy and 37 (84%) had a strategic health plan. A total of 16 (36%) countries reportedly had a functional national health research governance mechanism, nine of which had clear terms of reference; nine (20%) countries had a functional national health research management forum. Functional ethical review committees were reported in 33 countries (75%). CONCLUSIONS: National health research systems were weak in the countries assessed. Significantly more resources should be allocated to strengthening these systems.

Research and its governance in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey.

SUMMARY: Objective: To describe governance and stewardship of research in health research institutions in the World Health Organization (WHO) African Region. Design: A structured questionnaire was used to solicit information on governance and stewardship from health research institutions. Setting: Forty-two Member States of the WHO African Region. Participants: Key informants from the respondent health research institutions in the respondent sub-Saharan African countries. Main outcome measures: Institutions' participation in setting the national health research agenda. Institutional research priorities, scientific reviews and governance structure. Results: During the previous 12 months, the heads of 49% of respondent health research institutions participated in the setting or coordination of national research priorities. The most frequently cited priorities for contributing to or performing research were improving health programmes, producing new knowledge, influencing health policies and conducting operational research. For 78% of respondent institutions, scientific review was required for research funded directly by the institution, and for 73% of respondent institutions, scientific review was required for research not funded by the institution. However, most respondent institutions did not have written policies or guidelines, either for the scientific review of proposals (70%) or regarding conflict of interest on scientific review committees (80%). Conclusions: Some health research institutions demonstrate good practice in terms of the establishment of structures and processes for governance and stewardship, many others do not. There is a need for the strengthening of the stewardship capacity of research institutions in the Region.

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey.

OBJECTIVE: To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). DESIGN: A structured questionnaire was used to solicit financial information from health research institutions. SETTING: Forty-two sub-Saharan African countries. PARTICIPANTS: Key informants in 847 health research institutions in the 42 sub-Saharan African countries. MAIN OUTCOME MEASURES: Expenditure on health research by institutions, funders and subject areas. RESULTS: An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding, ministries of health, other government ministries, own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research, with medical schools spending 82% and government agencies 62%. Hospitals spent 38% of their resources on management, and other institutions (universities, firms, etc.) spent 87% of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30% of funds, followed by research on other communicable diseases and maternal, perinatal and nutritional conditions (23%). CONCLUSIONS: Research on major health problems of the Region, such as communicable diseases, accounts for most of the research expenditures. However, the total expenditure is very low compared with other WHO regions.

Human resources in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey.

OBJECTIVE: To describe human capacity and staff movement in national health research institutions in 42 sub-Saharan African countries. DESIGN: A structured questionnaire was used to solicit information on governance and stewardship from health research institutions. SETTING: Eight hundred and forty-seven health research institutions in 42 sub-Saharan African countries. PARTICIPANTS: Key informants from 847 health research institutions. MAIN OUTCOME MEASURES: The availability, mix and quality of human resources in health research institutions. RESULTS: On average, there were 122 females employed per respondent health research institution, compared with 159 males. For researchers, the equivalent figures were nine females to 17 males. The average annual gross salary of researchers varied between US$ 12,260 for staff with 5-10 years of experience and US$ 14,772 for the institution head. Of those researchers who had joined the institution in the previous 12 months, 55% were employed on a full-time basis. Of the researchers who left the institutions in the same period, 71% had a full-time contract. Among all those who left, those who left to a non-research sector and to another country accounted for two-thirds. CONCLUSIONS: The study revealed significant gaps in the area of human capacity development for research in Africa. The results showed a serious shortage of qualified staff engaged in health research, with a dearth of staff that held at least a master's degree or doctoral degree. Major efforts will be required to strengthen human resource capacity, including addressing the lack of motivation or time for research on the part of existing capable staff.