Thomas Senghore

Until recently, there has been no formal research ethics training program in The Gambia, despite decades of conducting research. This study aimed to evaluate the awareness, knowledge, attitudes, and practices of research ethics and Research ethics committees (RECs) among health professionals across various health cadres before the commencement of a postgraduate certificate program. A cross-sectional survey was conducted using an online questionnaire. Chi-square tests and multivariable binary logistic regression models were used to examine the associations between independent variables and knowledge, attitudes, and practices of research ethics and RECs. Among 147 participants, 42.1% were unaware of the availability of ethics training programs in The Gambia. Over two-thirds were aware of the research ethics principles (69.7%), the presence of RECs in their institutions (61.2%), and their functions (61.8%). About half (47.9%) demonstrated adequate knowledge of research ethics, while 45.8% and 44.4% had a positive attitude toward research ethics and RECs, respectively. Alarmingly, 85.5% exhibited low levels of research ethics practice. Having an undergraduate degree or higher showed statistically significant odds of a positive attitude toward research ethics compared to holding a college diploma or lower (aOR 2.98; 95% CI: 1.09–8.18, p = 0.034). The low level of practice and average knowledge and attitude of the participants toward research ethics and RECs is likely a reflection of the lack of formal research ethics training programs. Greater awareness and local training opportunities are needed.

Despite growing interest in African bioethics, aligning it with Western bioethical principles remains challenging. This integrated review aimed to develop adaptable research bioethics for African socio-cultural contexts. A comprehensive search yielded 7,175 articles of which 68 were selected for analysis. Only three studies analyzed a framework, but none was adapted in the African socio-cultural contexts. From the 68 papers, six themes emerged, leading to the development of the Socio-Cultural Research Ethics Conceptual Model (SCREM). Translating bioethical principles in Africa is essential for culturally sensitive, inclusive, and equitable research. The SCREM framework is a significant and timely contribution to African bioethics, offering a novel, flexible, context-sensitive approach relevant and applicable to the realities of Africa’s diversity. Future research will validate and refine SCREM to address the unique health research ethical challenges in Africa. This work highlights the importance of culturally tailored bioethics in advancing ethical research in Africa and could profoundly impact bioethics research in Africa and globally.

Introduction: Interventions addressing malnutrition (under- and overnutrition) among adolescents have not been developed in The Gambia. We aim to coproduce the first phase of ‘The Health-Secure Partnership’ (HSP) – an innovative multicomponent intervention for adolescents in rural areas of The Gambia. Inference drawn from existing evidence and public contribution suggest that the future intervention would ideally involve nutrition-specific components coupled with changes to wider school and community contexts, delivered in partnerships between schools and local communities. Methods: The design of HSP is underpinned by health promoting school and community centred approaches, informed by a systems-thinking lens. The project activities will be conducted in three linked stages. Stage 1: Current nutrition-related activities and environments will be observed in four rural Gambian schools, their local village communities, and one additional village which does not have a school. Around 50 key stakeholders (such as teachers, parents, community members, and wider systems stakeholders) will complete questionnaires on their views on the current nutrition-related context and systems, cultural norms, and actions needed to address adolescent malnutrition. Focus groups and interviews will then be conducted with approximately 70 adolescent girls and boys to understand their experiences and opinions about their intervention needs. Stage 2: Potential intervention components, session content and mode/s of delivery will be explored in meetings and workshops with the consortium and stakeholders (including adolescents) to achieve consensus on the intervention format. Examples of session content, and intervention resources will be made, and a community event held to see what the public think of the ideas and materials. Stage 3: A description of the intervention and a codesigned evaluation plan will be documented. Dissemination will include publications, presentations, song and drama to suit a range of audiences (adolescents and their communities, other stakeholders, academics, and policy makers). Discussion: This study protocol presents our plans for the HSP intervention development project, addressing a critical gap in the evidence base. Findings will inform subsequent research phases exploring the feasibility and acceptability of the intervention among adolescents.

This article reviews the development and evolution of Fogarty International Center–funded research ethics training programs in West Africa over the past decade. In response to local and global challenges in bioethics and biomedical research, these programs are fostering ethical awareness, shaping local and national ethics review systems, and enhancing bioethics capacity in the region. These efforts have expanded alongside increased democratic governance, technological advances, and significant increases in global research funding and international research collaborations, particularly related to HIV/AIDS and malaria. We believe that the West Africa Bioethics (WAB) Training Program in Nigeria played a central role in this growth, serving as a model for subsequent programs in Ghana, Mali, and The Gambia. This paper describes the nature, successes, and challenges of these programs. It also outlines an agenda and strategies for future work to enhance research ethics and bioethics capacities in the region, both in terms of education and governance.

Diabetic foot ulcer is the most common complication causing lots of admissions among diabetic patients. Understanding patients' level of foot self‐care knowledge, practice and associated factors is important for planning interventions to control and prevent diabetic foot complications. This study aimed to assess the level of knowledge and practice of foot self‐care among diabetic patients attending diabetic clinics in The Gambia. Two hundred and seventeen patients attending diabetic clinics in two public hospitals were selected using a successive sampling technique. Data were collected using a validated interviewer‐administered questionnaire. Descriptive statistics were used to summarize the demographic and clinical data. Multivariate logistic regression was used to identify factors associated with foot self‐care knowledge and practice. The findings showed a poor level of foot self‐care knowledge (n = 114; 52.5%) and practice (n = 149; 68.7%). Patients' educational level was statistically significantly association with diabetic foot self‐care knowledge (p = 0.02). Diabetic foot ulcer history (aOR = 0.23, 95% CI: 0.08–0.63; p < 0.001), diabetic hospitalization (aOR = 2.41, 95% CI: 1.23–4.75, p = 0.01) and diabetic foot care education (aOR = 2.65, 95% CI: 1.39–5.06, p < 0.001) were statistically significantly associated with foot self‐care practice. The poor diabetic foot self‐care knowledge and practice among these patients emphasize the need for a diabetic health education program in these clinics.

Background: Type 2 Diabetes Mellitus (DM) is a significant public health problem in The Gambia. While therapeutic non-adherence is widely recognized as a common and costly problem, very little is known about therapeutic adherence behavior among patients with diabetes in The Gambia. Purpose: The objective of this study was to determine the prevalence and factors that influence diabetic therapeutic non-adherence behavior among patients with type 2 diabetes in The Gambia. Methods: A cross-sectional study design was used, and participants were recruited from Edward Francis Small Teaching Hospital (EFSTH) and Kanifing General Hospital (KGH). The sample size of 145 patients with type 2 diabetes was included and data was collected using a structured questionnaire. Adherence to anti-diabetic medications was measured using the Morisky Medications Adherence Scale (MMAS-8). Logistic regression was used to determine the factors associated with diabetic therapeutic non-adherence. Results: The prevalence of non-adherence to anti-diabetic treatment was 27.6%. Perceived barrier (forgetfulness, long-term medication use, and medication side effects) to diabetic treatment (OR = 0.265, 95% CI: 0.113– 0.621, p = 0.041) was statistically significantly associated with non-adherence to anti-diabetic treatment. However, the frequency of doctor’s visits (OR = 0.310, 95% CI: 0.046– 2.111) was not significantly associated with non-adherence to anti-diabetic treatment. Conclusion: The rate of non-adherence to antidiabetic treatment in this study was high. Perceived barriers to antidiabetic treatment such as forgetfulness, long-term medication use, and medication side effects influenced therapeutic non-adherence to antidiabetic treatment. While interventions should focus on how to eliminate these barriers, health education on diabetic self-care may help reinforce the importance of medication adherence to prevent complications.

Genetic variations in DNA base excision repair (BER) genes may affect tumor sensitivity to chemotherapy and radiotherapy. Thus, we investigated the effects of single-nucleotide polymorphisms (SNPs) in key BER pathway genes on clinical outcomes in male patients who received concurrent chemoradiotherapy (CCRT). Seven SNPs from XRCC1, OGG1, APEX1, and MUTYH were genotyped using the Sequenom iPLEX MassARRAY system in samples from 319 men with advanced oral squamous cell carcinoma. The disease-free survival (DFS) rates of the MUTYH rs3219489 genotypes and those of the other genotypes differed significantly (log-rank test p = 0.027). Multivariate Cox proportional hazard analysis showed that the MUTYH rs3219489 GG genotype was associated with poor DFS (recessive model: hazard ratio [HR] = 2.01, 95% confidence interval [CI] = 1.31–3.10; p = 0.002). The CT + TT genotypes of XRCC1 rs1799782 (dominant model: HR = 0.65, 95% CI = 0.43–0.99; p = 0.044) and GG genotype of APEX1 rs1760944 (recessive model: HR = 1.64, 95% CI = 1.00–2.70; p = 0.050) were associated with overall survival (OS). Carrying the two risk genotypes, CC and GG of XRCC1 rs1799782 and APEX1 rs1760944, respectively, (HR = 2.95, 95% CI = 1.47–5.88; p = 0.002) increased mortality risk. Our findings showed that carrying the two risk genotypes of XRCC1 rs1799782 and APEX1 rs1760944 was associated with poor OS, while the GG genotype of MUTYH rs3219489 was associated with poor DFS. Patients carrying the risk genotypes may not benefit from CCRT; therefore, they will need alternative treatments.

Although intimate partner violence (IPV) against women is prevalent in sub-Saharan Africa, studies that investigated factors associated with IPV among Gambian women are limited. In this study, we examined the prevalence and factors associated with the different forms of IPV against Gambian women. We used a sample of 3,116 currently married women age (15 ~ 49 years) from The Gambia Demographic and Health Survey 2013. Logistic regression models were used to examine factors associated with Physical Violence (PV), Sexual Violence (SV), and Emotional Violence (EV). Over 40% (n = 1,248) of women reported at least one form of IPV. The prevalence of PV, SV and EV was 20.6%, 4.3%, and 15.1% respectively. Women married at age 18 ~ 24 (adjusted Odds Ratio [aOR]_SV = 1.55), lived with 3 ~ 4 (aOR_PV = 1.69; aOR_EV = 2.10) and ≥5 (aOR_PV = 1.77; aOR_EV = 2.64) children, witnessed parental violence (aOR_PV = 1.66; aOR_SV = 2.75; aOR_EV = 2.25), partner’s primary education (aOR_PV = 1.76), accused of unfaithfulness (aOR_PV = 2.42; aOR_SV = 3.62; aOR_EV4.10), and partner’s alcohol consumption (aOR_PV = 2.56; OR_SV = 3.91; aOR_EV = 2.82) are more likely to report IPV. Conversely, women who lived in Kerewan area (aOR_PV = 0.43; aOR_SV = 0.38; aOR_EV = 0.50), had high income (aOR_PV = 0.65), Wolof (aOR_PV = 0.68) and Jola (aOR_PV = 0.65) ethnicity and unemployed (aOR_PV = 0.59; aOR_SV = 0.56) were less likely to report IPV. Interventions to prevent IPV should focus on education on its effects, and programs that reject sociocultural practices as determinants of IPV.

Background: The nucleotide excision repair (NER) pathway plays a major role in the repair of DNA damaged by exogenous agents including chemo-and radiotherapeutic agents. Thus, we investigate the association between key potentially functional single nucleotide polymorphisms (SNPs) in the NER pathway and clinical outcomes in oral squamous cell carcinoma (OSCC) patients treated with concurrent chemoradiotherapy (CCRT). Methods: Thirteen SNPs in five key NER genes were genotypes in 319 OSCC patients using iPLEX MassARRAY. Multivariate Cox proportional hazards models and Kaplan-Meier survival curves were used to estimate risk of death or recurrence. Results: Carriers of the XPC rs2228000 TT genotype showed a borderline significant increased risk for poor overall survival under the recessive model (hazard ratio [HR]=1.81, 95% confidence interval [CI]=0.99–3.29). The CC genotypes of ERCC5 rs17655 (HR=1.54, 95% CI=1.03–2.29) and ERCC1 rs735482 (HR=1.65, 95% CI=1.06–2.58) were associated with an increased risk for worse disease-free survival under the recessive model. In addition, participants carrying both CC genotype of ERCC5 rs17655 and ERCC1 rs735482 exhibited an enhanced susceptibility for recurrence (HR=2.60, 95% CI=1.11–6.09). However, no statistically significant interaction was observed between them. Conclusion: Our findings show that the ERCC5 rs17655 CC and ERCC1 rs735482 CC genotypes were associated with an increased risk for recurrence in OSCC patients treated with CCRT. Therefore, CCRT may not be beneficial and alternative treatments are required for them. Citation Format: Chih-Ching Yeh, Thomas Senghore, Huei-Tzu Chien, Wen-Chang Wang, You-Xin Chen, Chi-Kuan Young, Shiang-Fu Huang. Polymorphisms in nucleotide excision repair genes were associated with the survival of post-operative oral squamous cell carcinoma patients treated with adjuvant concurrent chemoradiotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1564.