Sylvester Chima - Academia.edu (original) (raw)

Papers by Sylvester Chima

Research paper thumbnail of A legal "right" to mental health care? Impediments to a global vision of mental health care access

Nigerian Journal of Clinical Practice, 2015

Mental health law across many jurisdictions provides a legal framework for the compulsory detenti... more Mental health law across many jurisdictions provides a legal framework for the compulsory detention and, where appropriate, treatment in hospital of people with mental health problems. Latent within many of these "systems" of mental health provision is the concern that the quality of care people receive does not always meet legal and ethical norms. For many, there remains the very serious recognition that access to mental health care in its entirety remains elusive. International human rights discourse has influenced the shaping of modern mental health laws in many developed countries. In 2008, the Convention on the Rights of Persons with Disabilities (CRPD) entered into force. For many countries, such as South Africa, the CRPD provides a human rights instrument with the scope to establish a worldwide means of bolstering human rights. This paper examines both the UK and the broader African position with regard to the extent redress can be sought if and when an individual does not receive the care and treatment needed. Within this, consideration will be given to one of the paradoxes of mental health care which bedevil mental health systems: How do legal frameworks for detaining and treating people without their consent work when there is no corresponding enforceable right that appropriate treatment or suitable conditions of detention must be provided. The focus of this paper is the question of whether there is indeed a legal "right" to mental health care.

Research paper thumbnail of Traditional Health Care Practitioners' Perspectives on Applying Informed Consent During African Traditional Medical Practice in Akwa Ibom State, Nigeria: A Cross-Sectional Qualitative Study

Journal of Integrative and Complementary Medicine

Research paper thumbnail of Evaluating Knowledge, Practice, and Barriers to Informed Consent Among Professional and Staff Nurses in South Africa: An Empirical Study

Canadian Journal of Bioethics

Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y ... more Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne.

Research paper thumbnail of Because I Want to Be Informed, to Be Part of the Decision-Making': Patients' Insights on Informed Consent Practices by Healthcare Professionals in South Africa

Social Science Research Network, Dec 1, 2015

BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitu... more BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitutionally protected rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. Healthcare providers must inform patients about diagnosis, risks, benefits, treatment options, and right of refusal in a language patients understand based their literacy level. This study reports an empirical study on patients' perceptions of IC as practiced by doctors and nurses in South Africa. MATERIALS AND METHODS A cross-sectional study, using a bilingual semi-structured questionnaire was conducted among patients attending randomly selected public hospitals in eThekwini Metropolitan Municipality (Durban), KwaZulu-Natal province. Competent patients or legal surrogates were eligible for inclusion. IC was obtained from all participants. RESULTS Four hundred and four participants completed questionnaires of which 68% were female. The median age of participants was 35 years (range 11-91 years). Most respondents spoke IsiZulu (55%), were single (56%), unemployed (66%), and with secondary school education (69%). Patients were generally informed about the diagnosis (81%), risks (57%), and benefits of treatment (61%). Few were informed about treatment options (41%), recommended treatment (28%), and right of refusal (25%). IC was obtained verbally in 73% of cases. Patients favored disclosure of all material risks (78%) and few consulted surrogates before decision-making (76%). There was an association between participant's age and knowledge of the age of consent (P = 0.005). Most patients were satisfied with information disclosed (91%) and did not feel coerced. Some were afraid to ask questions for fear of losing free treatment (8%). CONCLUSION This study reveals that South African patients are aware of the right to IC, but many were vulnerable due to indigence. Barriers to IC include poverty, language, and low educational level. South African patients prefer disclosure of all material risks, better communication skills by healthcare workers, and a shift toward informed or shared healthcare decision-making.

Research paper thumbnail of Additional file 1 of South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

Additional file 1. Interview guide. Original interview guide used for in-depth interviews.

Research paper thumbnail of Additional file 2 of South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

Additional file 2. COREQ checklist.

Research paper thumbnail of INTRODUCTION Open Access Viewpoint discrimination and contestation of

ideas on its merits, leadership and organizational

Research paper thumbnail of KwaZulu-Natal, South Africa: a cross-sectional

Stigmatization of people living with HIV/AIDS by healthcare workers at a tertiary hospital in

Research paper thumbnail of RESEARCH ARTICLE Open Access Global medicine: Is it ethical or morally justifiable

for doctors and other healthcare workers to go on strike?

Research paper thumbnail of Progressive Multifocal Leukoencephalopathy and JC Virus Genotypes in West African Patients With Acquired Immunodeficiency Syndrome

Objective—Progressive multifocal leukoencephalopathy is caused by polyomavirus JC in immunosuppre... more Objective—Progressive multifocal leukoencephalopathy is caused by polyomavirus JC in immunosuppressed patients. JC virus genotypes are identified by sequence analysis of the viral genome. Despite the prevalence of acquired immunodeficiency syndrome in sub-Saharan Africa, few cases of progressive multifocal leukoencephalopathy have been reported from this region. Here we describe 4 African cases and provide an analysis of viral genotypes. Methods.—Immunohistochemical staining by labeled streptavidin-biotin for capsid protein antigen was performed on all cases. Polymerase chain reaction amplification of viral genomic DNA was followed by direct cycle sequencing. Results.—JC virus type 3 was identified in 2 cases, and type 6 was isolated in 1 case. The viral regulatory region from 1 case showed an uncommon rearrangement pattern. Conclusions.—Progressive multifocal leukoencephalopathy in West African patients with acquired immunodeficiency syndrome is caused by African genotypes of JC vi...

Research paper thumbnail of Impact of a short biostatistics course on knowledge and performance of postgraduate scholars: Implications for training of African doctors and biomedical researchers

Nigerian Journal of Clinical Practice, 2015

BACKGROUND AND OBJECTIVES This study was designed to evaluate the impact of a short biostatistics... more BACKGROUND AND OBJECTIVES This study was designed to evaluate the impact of a short biostatistics course on knowledge and performance of statistical analysis by biomedical researchers in Africa. It is recognized that knowledge of biostatistics is essential for understanding and interpretation of modern scientific literature and active participation in the global research enterprise. Unfortunately, it has been observed that basic education of African scholars may be deficient in applied mathematics including biostatistics. MATERIALS AND METHODS Forty university affiliated biomedical researchers from South Africa volunteered for a 4-day short-course where participants were exposed to lectures on descriptive and inferential biostatistics and practical training on using a statistical software package for data analysis. A quantitative questionnaire was used to evaluate participants' statistical knowledge and performance pre- and post-course. Changes in knowledge and performance were measured using objective and subjective criteria. Data from completed questionnaires were captured and analyzed using Statistical Package for Social Sciences. Participants' pre- and post-course data were compared using nonparametric Wilcoxon signed ranks tests for nonnormally distributed variables. A P < 0.05 was considered statistically significant. RESULTS Baseline testing of statistical knowledge showed a median score of 0, with 75th percentile at 28.6%, and a maximum score of 71.4%. Postcourse evaluation revealed improvement in participants' core knowledge with the median score increasing to 28.5%; and the 75th percentile score to 85.7%; signifying improved understanding of statistical concepts and ability to carry out data analyses. CONCLUSIONS This study just showed poor baseline knowledge of biostatistics among postgraduate scholars and health science researchers in this cohort and highlights the potential benefits of short-courses in biostatistics to improve the knowledge and skills of biomedical researchers and scholars in Africa.

Research paper thumbnail of Ethical and legal dilemmas around termination of pregnancy for severe fetal anomalies: A review of two African neonates presenting with ventriculomegaly and holoprosencephaly

Nigerian Journal of Clinical Practice, 2015

Termination of pregnancy (TOP) or feticide for severe fetal anomalies is ethically and morally ch... more Termination of pregnancy (TOP) or feticide for severe fetal anomalies is ethically and morally challenging and maybe considered illegal in countries with restrictive abortion laws. While diagnostic modalities such as fetal ultrasound, magnetic resonance imaging, and genetic screening have improved prenatal diagnosis, these technologies remain scarce in many African countries making diagnosis and counseling regarding TOP difficult. Ethical dilemmas such as women's autonomy rights may conflict with fetus' right to personhood, and doctor's moral obligations to society. In liberal jurisdictions, previable fetuses may not have legal rights of personhood; therefore, appropriate action would be to respect pregnant women's decisions regarding TOP. However, in countries with restrictive abortion laws the fetus maybe imbued with the right of personhood at conception, making TOP illegal and exposing doctors and patients to potential criminal prosecution. Birth of a severely disabled baby with independent legal rights creates further conflicts between parents and clinicians complicating healthcare decision-making. Irrespective of the maternal decision to accept or refuse TOP, the psychological and emotional impact of an impaired fetus or neonate, often lead to moral distress and posttraumatic stress reactions in parents. Doctors have legal and ethical obligations to provide an accurate antenatal diagnosis with full disclosure to enable informed decision making. Failure to provide timely or accurate diagnosis may lead to allegations of negligence with potential liability for "wrongful birth" or "wrongful life" following birth of severely disabled babies. Mismanagement of such cases also causes misuse of scarce healthcare resources in resource-poor countries. This paper describes ethical challenges in clinical management of two neonates born following declined and failed feticide for severe central nervous system anomalies with a critical appraisal of the relevant literature.

Research paper thumbnail of Because I want to be informed, to be part of the decision-making": Patients' insights on informed consent practices by healthcare professionals in South Africa

Nigerian Journal of Clinical Practice, 2015

BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitu... more BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitutionally protected rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. Healthcare providers must inform patients about diagnosis, risks, benefits, treatment options, and right of refusal in a language patients understand based their literacy level. This study reports an empirical study on patients' perceptions of IC as practiced by doctors and nurses in South Africa. MATERIALS AND METHODS A cross-sectional study, using a bilingual semi-structured questionnaire was conducted among patients attending randomly selected public hospitals in eThekwini Metropolitan Municipality (Durban), KwaZulu-Natal province. Competent patients or legal surrogates were eligible for inclusion. IC was obtained from all participants. RESULTS Four hundred and four participants completed questionnaires of which 68% were female. The median age of participants was 35 years (range 11-91 years). Most respondents spoke IsiZulu (55%), were single (56%), unemployed (66%), and with secondary school education (69%). Patients were generally informed about the diagnosis (81%), risks (57%), and benefits of treatment (61%). Few were informed about treatment options (41%), recommended treatment (28%), and right of refusal (25%). IC was obtained verbally in 73% of cases. Patients favored disclosure of all material risks (78%) and few consulted surrogates before decision-making (76%). There was an association between participant's age and knowledge of the age of consent (P = 0.005). Most patients were satisfied with information disclosed (91%) and did not feel coerced. Some were afraid to ask questions for fear of losing free treatment (8%). CONCLUSION This study reveals that South African patients are aware of the right to IC, but many were vulnerable due to indigence. Barriers to IC include poverty, language, and low educational level. South African patients prefer disclosure of all material risks, better communication skills by healthcare workers, and a shift toward informed or shared healthcare decision-making.

Research paper thumbnail of Correlates of Knowledge and Practice of Medical Waste Management Among Healthcare Workers in Ethekwini District Public Hospitals, Kwazulu-Natal Province, South Africa

African Journal of Biomedical Research, Jan 31, 2021

Waste management especially medical waste is essential to preservation of health and integrity of... more Waste management especially medical waste is essential to preservation of health and integrity of the environment. There are several factors that may influence the adequacy of knowledge and practice regarding waste management. The main purpose of the study was to evaluate factors that influence awareness and practice of medical waste management among healthcare workers. This was a mixed-methods study carried out from October to November 2019 at four public hospitals in EThekwini metropolitan municipality of KwaZulu-Natal province, South Africa, among doctors, nurses, laboratory staff and waste-handlers. Quantitative data were analysed using statistical analysis system (SAS) software. Results showed that respondents' professional category was strongly associated with general knowledge of healthcare waste management, and median scores showed that a higher proportion of nurses had higher scores when compared to laboratory scientists/technicians and medical doctors. Further, general knowledge scores were significantly positively correlated with the practice scores, while waste segregation was significantly, but weakly, associated with training regarding healthcare waste differentiation (p=0.025; V=0.14). Also, knowledge of recommendations in the medical waste management implementation plan was significantly, but weakly associated with waste segregation (p=0.028; V=0.14). Findings revealed a strong correlation between training, availability of waste management related workshops, and proper medical waste management amongst healthcare workers. We conclude that knowledge appeared essential to proper waste segregation and proper medical waste management practice correlates with having the requisite knowledge about waste. We recommend that education and training in waste management be provided to all healthcare workers during formal training in addition to ongoing refresher courses through regular workshops on healthcare waste management.

Research paper thumbnail of Additional file 3 of South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

Additional file 3. Informed consent documents for participants.

Research paper thumbnail of Is there Evidence of Viewpoint Discrimination Against Academic Research from the Global South: Implications for Global Justice, Institutionalized Racism, and Global Inequalities in Healthcare

Research paper thumbnail of Progressive Multifocal Leukoencephalopathy and JC Virus Genotypes in West African Patients With Acquired Immunodeficiency Syndrome

Research paper thumbnail of Primary Progressive Multifocal Leukoencephalopathy

Archives of Neurology, 1972

The authors describe a case of primary progressive multifocal leukoencephalopathy (pPML). Unlike ... more The authors describe a case of primary progressive multifocal leukoencephalopathy (pPML). Unlike previous similar reports, our patient underwent up-to-date and extensive in vivo and post-mortem investigations that established beyond doubt the competence of his immune system and the absence of underlying predisposing disorders. The various implications of this case, both clinical and related to the possible pathogenetic mechanisms of JC virus infection, are discussed.

Research paper thumbnail of Assessing knowledge, attitudes, and practices of healthcare workers regarding medical waste management at a tertiary hospital in Botswana: A cross-sectional quantitative study

Background: Medical waste management (MWM) is of concern to the medical and general community. Ad... more Background: Medical waste management (MWM) is of concern to the medical and general community. Adequate knowledge regarding management of healthcare waste is an important precursor to the synthesis of appropriate attitudes and practices of proper handling and disposal of medical waste by healthcare workers (HCWs). Aims and Objectives: This study was designed to investigate knowledge, attitudes, and practices of doctors, nurses, laboratory technicians, and housekeeping staff, regarding MWM at a tertiary hospital in Gaborone, Botswana. Materials and Methods: This was a cross-sectional quantitative study using a self-administered questionnaire involving 703 participants. Data were analyzed using SAS software. Descriptive statistics were used to summarize the data. Responses for attitude of respondents were analyzed using nonparametric tests. Results: The completion rate for this study was 90% with (632/703) questionnaires analyzed. Majority of respondents were nurses 60% (422/703), fol...

Research paper thumbnail of Patients’ Experience on Practice and Applicability of Informed Consent in Traditional Medical Practice in KwaZulu-Natal Province, South Africa

Evidence-Based Complementary and Alternative Medicine

Background. Informed consent (IC) is constitutionally protected in South Africa based on individu... more Background. Informed consent (IC) is constitutionally protected in South Africa based on individual rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. This study explored patients’ experience on practice and applicability of IC in African traditional medicine (ATM) in Msunduzi and eThekwini municipalities, KwaZulu-Natal province, South Africa, to evaluate whether important elements of IC such as full information disclosure, capacity, understanding, and volition are considered or being applied during ATM. Methods. This cross-sectional quantitative study was conducted using semistructured questionnaires administered to patients attending traditional health practitioners’ (THPs’) treatment centres. Stata V15.1 was used to analyse variables including descriptive and inferential data analysis. Results. One hundred and twenty-nine (129) participants completed this study, of which 62% were females. Most p...

Research paper thumbnail of A legal "right" to mental health care? Impediments to a global vision of mental health care access

Nigerian Journal of Clinical Practice, 2015

Mental health law across many jurisdictions provides a legal framework for the compulsory detenti... more Mental health law across many jurisdictions provides a legal framework for the compulsory detention and, where appropriate, treatment in hospital of people with mental health problems. Latent within many of these "systems" of mental health provision is the concern that the quality of care people receive does not always meet legal and ethical norms. For many, there remains the very serious recognition that access to mental health care in its entirety remains elusive. International human rights discourse has influenced the shaping of modern mental health laws in many developed countries. In 2008, the Convention on the Rights of Persons with Disabilities (CRPD) entered into force. For many countries, such as South Africa, the CRPD provides a human rights instrument with the scope to establish a worldwide means of bolstering human rights. This paper examines both the UK and the broader African position with regard to the extent redress can be sought if and when an individual does not receive the care and treatment needed. Within this, consideration will be given to one of the paradoxes of mental health care which bedevil mental health systems: How do legal frameworks for detaining and treating people without their consent work when there is no corresponding enforceable right that appropriate treatment or suitable conditions of detention must be provided. The focus of this paper is the question of whether there is indeed a legal "right" to mental health care.

Research paper thumbnail of Traditional Health Care Practitioners' Perspectives on Applying Informed Consent During African Traditional Medical Practice in Akwa Ibom State, Nigeria: A Cross-Sectional Qualitative Study

Journal of Integrative and Complementary Medicine

Research paper thumbnail of Evaluating Knowledge, Practice, and Barriers to Informed Consent Among Professional and Staff Nurses in South Africa: An Empirical Study

Canadian Journal of Bioethics

Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y ... more Ce document est protégé par la loi sur le droit d'auteur. L'utilisation des services d'Érudit (y compris la reproduction) est assujettie à sa politique d'utilisation que vous pouvez consulter en ligne.

Research paper thumbnail of Because I Want to Be Informed, to Be Part of the Decision-Making': Patients' Insights on Informed Consent Practices by Healthcare Professionals in South Africa

Social Science Research Network, Dec 1, 2015

BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitu... more BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitutionally protected rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. Healthcare providers must inform patients about diagnosis, risks, benefits, treatment options, and right of refusal in a language patients understand based their literacy level. This study reports an empirical study on patients' perceptions of IC as practiced by doctors and nurses in South Africa. MATERIALS AND METHODS A cross-sectional study, using a bilingual semi-structured questionnaire was conducted among patients attending randomly selected public hospitals in eThekwini Metropolitan Municipality (Durban), KwaZulu-Natal province. Competent patients or legal surrogates were eligible for inclusion. IC was obtained from all participants. RESULTS Four hundred and four participants completed questionnaires of which 68% were female. The median age of participants was 35 years (range 11-91 years). Most respondents spoke IsiZulu (55%), were single (56%), unemployed (66%), and with secondary school education (69%). Patients were generally informed about the diagnosis (81%), risks (57%), and benefits of treatment (61%). Few were informed about treatment options (41%), recommended treatment (28%), and right of refusal (25%). IC was obtained verbally in 73% of cases. Patients favored disclosure of all material risks (78%) and few consulted surrogates before decision-making (76%). There was an association between participant's age and knowledge of the age of consent (P = 0.005). Most patients were satisfied with information disclosed (91%) and did not feel coerced. Some were afraid to ask questions for fear of losing free treatment (8%). CONCLUSION This study reveals that South African patients are aware of the right to IC, but many were vulnerable due to indigence. Barriers to IC include poverty, language, and low educational level. South African patients prefer disclosure of all material risks, better communication skills by healthcare workers, and a shift toward informed or shared healthcare decision-making.

Research paper thumbnail of Additional file 1 of South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

Additional file 1. Interview guide. Original interview guide used for in-depth interviews.

Research paper thumbnail of Additional file 2 of South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

Additional file 2. COREQ checklist.

Research paper thumbnail of INTRODUCTION Open Access Viewpoint discrimination and contestation of

ideas on its merits, leadership and organizational

Research paper thumbnail of KwaZulu-Natal, South Africa: a cross-sectional

Stigmatization of people living with HIV/AIDS by healthcare workers at a tertiary hospital in

Research paper thumbnail of RESEARCH ARTICLE Open Access Global medicine: Is it ethical or morally justifiable

for doctors and other healthcare workers to go on strike?

Research paper thumbnail of Progressive Multifocal Leukoencephalopathy and JC Virus Genotypes in West African Patients With Acquired Immunodeficiency Syndrome

Objective—Progressive multifocal leukoencephalopathy is caused by polyomavirus JC in immunosuppre... more Objective—Progressive multifocal leukoencephalopathy is caused by polyomavirus JC in immunosuppressed patients. JC virus genotypes are identified by sequence analysis of the viral genome. Despite the prevalence of acquired immunodeficiency syndrome in sub-Saharan Africa, few cases of progressive multifocal leukoencephalopathy have been reported from this region. Here we describe 4 African cases and provide an analysis of viral genotypes. Methods.—Immunohistochemical staining by labeled streptavidin-biotin for capsid protein antigen was performed on all cases. Polymerase chain reaction amplification of viral genomic DNA was followed by direct cycle sequencing. Results.—JC virus type 3 was identified in 2 cases, and type 6 was isolated in 1 case. The viral regulatory region from 1 case showed an uncommon rearrangement pattern. Conclusions.—Progressive multifocal leukoencephalopathy in West African patients with acquired immunodeficiency syndrome is caused by African genotypes of JC vi...

Research paper thumbnail of Impact of a short biostatistics course on knowledge and performance of postgraduate scholars: Implications for training of African doctors and biomedical researchers

Nigerian Journal of Clinical Practice, 2015

BACKGROUND AND OBJECTIVES This study was designed to evaluate the impact of a short biostatistics... more BACKGROUND AND OBJECTIVES This study was designed to evaluate the impact of a short biostatistics course on knowledge and performance of statistical analysis by biomedical researchers in Africa. It is recognized that knowledge of biostatistics is essential for understanding and interpretation of modern scientific literature and active participation in the global research enterprise. Unfortunately, it has been observed that basic education of African scholars may be deficient in applied mathematics including biostatistics. MATERIALS AND METHODS Forty university affiliated biomedical researchers from South Africa volunteered for a 4-day short-course where participants were exposed to lectures on descriptive and inferential biostatistics and practical training on using a statistical software package for data analysis. A quantitative questionnaire was used to evaluate participants' statistical knowledge and performance pre- and post-course. Changes in knowledge and performance were measured using objective and subjective criteria. Data from completed questionnaires were captured and analyzed using Statistical Package for Social Sciences. Participants' pre- and post-course data were compared using nonparametric Wilcoxon signed ranks tests for nonnormally distributed variables. A P < 0.05 was considered statistically significant. RESULTS Baseline testing of statistical knowledge showed a median score of 0, with 75th percentile at 28.6%, and a maximum score of 71.4%. Postcourse evaluation revealed improvement in participants' core knowledge with the median score increasing to 28.5%; and the 75th percentile score to 85.7%; signifying improved understanding of statistical concepts and ability to carry out data analyses. CONCLUSIONS This study just showed poor baseline knowledge of biostatistics among postgraduate scholars and health science researchers in this cohort and highlights the potential benefits of short-courses in biostatistics to improve the knowledge and skills of biomedical researchers and scholars in Africa.

Research paper thumbnail of Ethical and legal dilemmas around termination of pregnancy for severe fetal anomalies: A review of two African neonates presenting with ventriculomegaly and holoprosencephaly

Nigerian Journal of Clinical Practice, 2015

Termination of pregnancy (TOP) or feticide for severe fetal anomalies is ethically and morally ch... more Termination of pregnancy (TOP) or feticide for severe fetal anomalies is ethically and morally challenging and maybe considered illegal in countries with restrictive abortion laws. While diagnostic modalities such as fetal ultrasound, magnetic resonance imaging, and genetic screening have improved prenatal diagnosis, these technologies remain scarce in many African countries making diagnosis and counseling regarding TOP difficult. Ethical dilemmas such as women's autonomy rights may conflict with fetus' right to personhood, and doctor's moral obligations to society. In liberal jurisdictions, previable fetuses may not have legal rights of personhood; therefore, appropriate action would be to respect pregnant women's decisions regarding TOP. However, in countries with restrictive abortion laws the fetus maybe imbued with the right of personhood at conception, making TOP illegal and exposing doctors and patients to potential criminal prosecution. Birth of a severely disabled baby with independent legal rights creates further conflicts between parents and clinicians complicating healthcare decision-making. Irrespective of the maternal decision to accept or refuse TOP, the psychological and emotional impact of an impaired fetus or neonate, often lead to moral distress and posttraumatic stress reactions in parents. Doctors have legal and ethical obligations to provide an accurate antenatal diagnosis with full disclosure to enable informed decision making. Failure to provide timely or accurate diagnosis may lead to allegations of negligence with potential liability for "wrongful birth" or "wrongful life" following birth of severely disabled babies. Mismanagement of such cases also causes misuse of scarce healthcare resources in resource-poor countries. This paper describes ethical challenges in clinical management of two neonates born following declined and failed feticide for severe central nervous system anomalies with a critical appraisal of the relevant literature.

Research paper thumbnail of Because I want to be informed, to be part of the decision-making": Patients' insights on informed consent practices by healthcare professionals in South Africa

Nigerian Journal of Clinical Practice, 2015

BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitu... more BACKGROUND Informed consent (IC) is a legally enforceable right in South Africa based on constitutionally protected rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. Healthcare providers must inform patients about diagnosis, risks, benefits, treatment options, and right of refusal in a language patients understand based their literacy level. This study reports an empirical study on patients' perceptions of IC as practiced by doctors and nurses in South Africa. MATERIALS AND METHODS A cross-sectional study, using a bilingual semi-structured questionnaire was conducted among patients attending randomly selected public hospitals in eThekwini Metropolitan Municipality (Durban), KwaZulu-Natal province. Competent patients or legal surrogates were eligible for inclusion. IC was obtained from all participants. RESULTS Four hundred and four participants completed questionnaires of which 68% were female. The median age of participants was 35 years (range 11-91 years). Most respondents spoke IsiZulu (55%), were single (56%), unemployed (66%), and with secondary school education (69%). Patients were generally informed about the diagnosis (81%), risks (57%), and benefits of treatment (61%). Few were informed about treatment options (41%), recommended treatment (28%), and right of refusal (25%). IC was obtained verbally in 73% of cases. Patients favored disclosure of all material risks (78%) and few consulted surrogates before decision-making (76%). There was an association between participant's age and knowledge of the age of consent (P = 0.005). Most patients were satisfied with information disclosed (91%) and did not feel coerced. Some were afraid to ask questions for fear of losing free treatment (8%). CONCLUSION This study reveals that South African patients are aware of the right to IC, but many were vulnerable due to indigence. Barriers to IC include poverty, language, and low educational level. South African patients prefer disclosure of all material risks, better communication skills by healthcare workers, and a shift toward informed or shared healthcare decision-making.

Research paper thumbnail of Correlates of Knowledge and Practice of Medical Waste Management Among Healthcare Workers in Ethekwini District Public Hospitals, Kwazulu-Natal Province, South Africa

African Journal of Biomedical Research, Jan 31, 2021

Waste management especially medical waste is essential to preservation of health and integrity of... more Waste management especially medical waste is essential to preservation of health and integrity of the environment. There are several factors that may influence the adequacy of knowledge and practice regarding waste management. The main purpose of the study was to evaluate factors that influence awareness and practice of medical waste management among healthcare workers. This was a mixed-methods study carried out from October to November 2019 at four public hospitals in EThekwini metropolitan municipality of KwaZulu-Natal province, South Africa, among doctors, nurses, laboratory staff and waste-handlers. Quantitative data were analysed using statistical analysis system (SAS) software. Results showed that respondents' professional category was strongly associated with general knowledge of healthcare waste management, and median scores showed that a higher proportion of nurses had higher scores when compared to laboratory scientists/technicians and medical doctors. Further, general knowledge scores were significantly positively correlated with the practice scores, while waste segregation was significantly, but weakly, associated with training regarding healthcare waste differentiation (p=0.025; V=0.14). Also, knowledge of recommendations in the medical waste management implementation plan was significantly, but weakly associated with waste segregation (p=0.028; V=0.14). Findings revealed a strong correlation between training, availability of waste management related workshops, and proper medical waste management amongst healthcare workers. We conclude that knowledge appeared essential to proper waste segregation and proper medical waste management practice correlates with having the requisite knowledge about waste. We recommend that education and training in waste management be provided to all healthcare workers during formal training in addition to ongoing refresher courses through regular workshops on healthcare waste management.

Research paper thumbnail of Additional file 3 of South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study

Additional file 3. Informed consent documents for participants.

Research paper thumbnail of Is there Evidence of Viewpoint Discrimination Against Academic Research from the Global South: Implications for Global Justice, Institutionalized Racism, and Global Inequalities in Healthcare

Research paper thumbnail of Progressive Multifocal Leukoencephalopathy and JC Virus Genotypes in West African Patients With Acquired Immunodeficiency Syndrome

Research paper thumbnail of Primary Progressive Multifocal Leukoencephalopathy

Archives of Neurology, 1972

The authors describe a case of primary progressive multifocal leukoencephalopathy (pPML). Unlike ... more The authors describe a case of primary progressive multifocal leukoencephalopathy (pPML). Unlike previous similar reports, our patient underwent up-to-date and extensive in vivo and post-mortem investigations that established beyond doubt the competence of his immune system and the absence of underlying predisposing disorders. The various implications of this case, both clinical and related to the possible pathogenetic mechanisms of JC virus infection, are discussed.

Research paper thumbnail of Assessing knowledge, attitudes, and practices of healthcare workers regarding medical waste management at a tertiary hospital in Botswana: A cross-sectional quantitative study

Background: Medical waste management (MWM) is of concern to the medical and general community. Ad... more Background: Medical waste management (MWM) is of concern to the medical and general community. Adequate knowledge regarding management of healthcare waste is an important precursor to the synthesis of appropriate attitudes and practices of proper handling and disposal of medical waste by healthcare workers (HCWs). Aims and Objectives: This study was designed to investigate knowledge, attitudes, and practices of doctors, nurses, laboratory technicians, and housekeeping staff, regarding MWM at a tertiary hospital in Gaborone, Botswana. Materials and Methods: This was a cross-sectional quantitative study using a self-administered questionnaire involving 703 participants. Data were analyzed using SAS software. Descriptive statistics were used to summarize the data. Responses for attitude of respondents were analyzed using nonparametric tests. Results: The completion rate for this study was 90% with (632/703) questionnaires analyzed. Majority of respondents were nurses 60% (422/703), fol...

Research paper thumbnail of Patients’ Experience on Practice and Applicability of Informed Consent in Traditional Medical Practice in KwaZulu-Natal Province, South Africa

Evidence-Based Complementary and Alternative Medicine

Background. Informed consent (IC) is constitutionally protected in South Africa based on individu... more Background. Informed consent (IC) is constitutionally protected in South Africa based on individual rights to bodily integrity and well-being. In terms of the law, patients cannot be involved in medical treatment or research without IC. This study explored patients’ experience on practice and applicability of IC in African traditional medicine (ATM) in Msunduzi and eThekwini municipalities, KwaZulu-Natal province, South Africa, to evaluate whether important elements of IC such as full information disclosure, capacity, understanding, and volition are considered or being applied during ATM. Methods. This cross-sectional quantitative study was conducted using semistructured questionnaires administered to patients attending traditional health practitioners’ (THPs’) treatment centres. Stata V15.1 was used to analyse variables including descriptive and inferential data analysis. Results. One hundred and twenty-nine (129) participants completed this study, of which 62% were females. Most p...