International Health
Volume 8 Issue 3 May 2016
http://inthealth.oxfordjournals.org/content/current

.
EDITORIAL
Africa in transition: the case of malaria
Kevin Marsh
Extract
Int. Health (2016) 8 (3): 155-156 doi:10.1093/inthealth/ihw022
In 2000, the Economist carried an infamous cover describing Africa as ‘the hopeless continent’. In 2013 this was replaced with one designating Africa ‘the hopeful continent’. The idea of ‘Africa rising’ is in the air and although this is a hotly debated area, no one doubts that Africa is in a period of dramatic transition. Most African economies are growing at around 5% per annum; the current GDP of Africa of around $2.4 trillion is expected to rise more than tenfold by 2050, when its population is predicted to be above 2 billion, with 60% living in urban areas. These changes will be paralleled by equally dramatic changes in health, a process which is already well underway. Much has been written about the dual challenges of persisting infectious diseases at the same time as an increasing burden of non-communicable diseases. Tackling these challenges will call for a major investment in research and here there are exciting transitions too. The launch by the African Academy of Sciences (ASS), in-partnership with NEPAD and a group of international partners, of the Alliance for Accelerating Excellence in Science in Africa (AESA) (http://aasciences.ac.ke/programmes/easa/alliance-for-accelerating-excellence-in-science-in-africa-aesa/) marks a genuine shift in the centre of gravity for health research in Africa. One particularly welcome manifestation of this …

.
Commentaries
Collecting data on violence against children and young people: need for a universal standard
Karen M. Devriesa,*, Dipak Nakerb, Adrienne Monteath-van Dokc, Claire Milligand and Alice Shirleyd
Author Affiliations
aLondon School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, WC1H 9SH, UK
bRaising Voices, 16 Tufnell Drive, Kamwokya P. O. Box 6770, Kampala, Uganda
cPlan International, Dukes Court, Block A, Duke Street, Woking, Surrey GU21 5BH, UK
dSave the Children, St John’s Lane, London, EC1 M 4AR, UK
*Corresponding author: E-mail: karen.devries@lshtm.ac.uk
Abstract
Preventing and responding to violence against children is an aim of the new Sustainable Development Goals. Numerous agencies are now collecting data from children about violence, including academics, non-governmental organisations, government agencies, consultants and others. Data are necessary to ensure appropriate prevention and response, but there is a real risk of harm to children if ethical standards are not adhered to. There are additional complexities in settings where child protection systems are not well developed. We propose specific suggestions for good practice, based on our past experience and policies, and call for all agencies to adhere to high ethical standards.
.

Original Articles
Ethical challenges in research with orphans and vulnerable children: a qualitative study of researcher experiences
Int. Health (2016) 8 (3): 187-196 doi:10.1093/inthealth/ihw020
Maureen C. Kelley, Tracy Brazg, Benjamin S. Wilfond, Liliana J. Lengua, Beth E. Rivin, Susanne P. Martin-Herz, and Douglas S. Diekema
Corresponding author: Present address: The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus – Roosevelt Drive, Oxford OX3 7LF; Tel: +44 186 561 7805; E-mail: maureen.kelley@ethox.ox.ac.uk
Abstract
Background Orphans and vulnerable children (OVCs) represent a significant population worldwide, enduring poor health and living conditions. Evidence-based interventions are needed. However, without parents, ethical concerns about including OVCs in research persist. The aim of our study was to better understand the ethical challenges facing researchers who work with OVCs.
Methods We conducted semi-structured interviews with 12 international pediatric researchers working with OVCs in seven countries. We used descriptive content analysis to characterize the ethical rationale for inclusion and associated challenges.
Results Researchers believed research was justified as a necessary means for informing evidence-based interventions to benefit OVCs directly or as a population. Ethical challenges included difficulty identifying OVCs given variation among children living without parents; difficulty identifying guardians among a range of caregivers; concerns about meaningfulness of guardian consent; difficulty assessing risk; and responding to children’s many needs.
Conclusions A range of caregivers bear responsibility to protect OVC’s interests in place of parents in research but are often not prepared to do so. This places greater burden on researchers to assess risks and respond to children’s needs. Findings suggest that we should improve support and rethink the roles of guardians, researchers and older children in research participation and protection.