Joseph Mfutso-Bengo

Kamuzu University of Health Sciences-former Malawi-College of Medicine Blantyre Malawi · School of Global and Public Health (SOGAPH)

Background Research ethics is intertwined with and depends on building robust and responsive research governance systems alongside researchers. Globally there has been substantial investment in agriculture, nutrition, and health (ANH) research motivated by the need to improve health outcomes, such as micronutrient deficiencies in Sub-Saharan Africa...

Objective The objective of this study was to assess the feasibility and acceptability of institutionalizing Health Technology Assessment (HTA) in Malawi. Methods This study employed a document review and qualitative research methods, to understand the status of HTA in Malawi. This was complemented by a review of the status and nature of HTA instit...

The existence and availability of evidence on its own does not guarantee that the evidence will be demanded and used by decision and policy makers. Decision and policy-makers, especially in low-income settings, often confront ethical dilemmas about determining the best available evidence and its utilization. This dilemma can be in the form of confl...

Background In 2007 WHO and UNAIDS recommended communication interventions as a key strategy for creating demand for Voluntary Medical Male Circumcision (VMMC) in Southern Africa. In Malawi, VMMC communication interventions, implemented by health communication agencies, have effectively raised awareness of services. However, high awareness of VMMC h...

Equitable access and utilization of the COVID-19 vaccine is the main exit strategy from the pandemic. This paper used proceedings from the Second Extraordinary Think-Tank conference, which was held by the Health Economics and Policy Unit at the Kamuzu University of Health Sciences in collaboration with the Malawi Ministry of Health, complemented by...

Environmental surveillance of rivers and wastewater for SARS-CoV-2 detection has been explored as an innovative way to surveil the pandemic. This study estimated the economic costs of conducting wastewater-based environmental surveillance for SARS-CoV-2 to inform decision making if countries consider continuing these efforts. We estimated the cost...

AimMalawi officially launched Voluntary Male Medical Circumcision (VMMC) in 2012 after the 2007 joint WHO /UNAIDSrecommendation that VMMC be a key HIV prevention strategy for Sub-Sahara African region. Malawi data, however, contradicted thefindings of three randomized studies conducted in Uganda, Kenya and South Africa between 2005 and 2007. While...

Background Road traffic injuries are a significant cause of death and disability globally. However, in some countries the exact health burden caused by road traffic injuries is unknown. In Malawi, there is no central reporting mechanism for road traffic injuries and so the exact extent of the health burden caused by road traffic injuries is hard to...

Health technology assessment (HTA) offers a set of analytical tools to support health systems' decisions about resource allocation. Although there is increasing interest in these tools across the world, including in some middle-income countries, they remain rarely used in low-income countries (LICs). In general, the focus of HTA is narrow, mostly l...

Introduction: By 2030, the non-communicable diseases (NCDs) are expected to overtake communicable, maternal, neonatal, and nutritional (CMNN) diseases combined as the leading cause of mortality in sub-Saharan Africa (SSA). With the increasing trend in NCDs, the NCD risk factors (NCDRF) need to be understood at local level in order to guide NCD risk...

Background In 2007 WHO and UNAIDS recommended communication interventions as a key strategy for creating demand for Voluntary Medical Male Circumcision (VMMC) in Southern Africa. In Malawi, VMMC communication interventions, implemented by health communication agencies, have effectively raised awareness of services. Ironically, high awareness of VMM...

This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under...

Background Severe neonatal jaundice can result in long term morbidities and mortality when left untreated. Phototherapy is the main-stay intervention for treating moderate jaundice and for prevention of the development of severe jaundice. However, in resource-limited health care settings, phototherapy has been inconsistently used. The objective of...

Background Road traffic injuries are a significant cause of death and disability globally. However, in some countries the exact health burden caused by road traffic injuries is unknown. In Malawi, there is no central reporting mechanism for road traffic injuries and so the exact extent of the health burden caused by road traffic injuries is hard to...

The existence and availability of evidence on its own does not guarantee that the evidence will be demanded and used by decision-makers or health policymakers for decision making and policy formulation. In addition to effective resource allocation, decision-makers, especially in low-income settings often confront ethical dilemmas about determining...

Introduction: In 2016, the WHO published recommendations increasing the number of recommended antenatal care (ANC) visits per pregnancy from four to eight. Prior to the implementation of this policy, coverage of four ANC visits has been suboptimal in many low-income settings. In this study we explore socio-demographic factors associated with early...

Background There have been notable investments in large multi-partner research programmes across the agriculture-nutrition-health (ANH) nexus. These studies often involve human participants and commonly require research ethics review. These ANH studies are complex and can raise ethical issues that need pre-field work, ethical oversight and also nee...

Background: Selenium deficiency is widespread in the Malawi population. The selenium concentration in maize, the staple food crop of Malawi, can be increased by applying selenium-enriched fertilizers. It is unknown whether this strategy, called agronomic biofortification, is effective at alleviating selenium deficiency. Objectives: The aim of the A...

Background The participant recruitment process is a key ethical pivot point when conducting robust research. There is a need to continuously review and improve recruitment processes in research trials and to build fair and effective partnerships between researchers and participants as an important core element in ensuring the ethical delivery of hi...

Background The objective of this study was to assess the feasibility and acceptability of institutionalizing Health Technology Assessment (HTA) in Malawi focusing on the form, scope, capacity and financing requirements for a limited resource setting such as Malawi.Methods This study employed a desk review and qualitative research methods. An extens...

INTRODUCTION In 2016, the WHO published recommendations increasing the number of recommended antenatal care (ANC) visits per pregnancy from four to eight. Prior to the implementation of this policy, coverage of four ANC visits has been suboptimal in many low-income settings. In this study we explore socio-demographic factors associated with early i...

Background Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspect...

Background: COVID-19 mitigation strategies have been challenging to implement in resource-limited settings due to the potential for widespread disruption to social and economic well-being. Here we predict the clinical severity of COVID-19 in Malawi, quantifying the potential impact of intervention strategies and increases in health system capacity...

Background: This study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium...

Background This study reports findings from formative research conducted to assess the feasibility and inform the design and implementation of the Addressing Hidden Hunger with Agronomy (AHHA) trial. The AHHA trial was a randomised, controlled trial conducted in rural Malawi, in which participants were given maize flour biofortified with selenium o...

Introduction Kangaroo mother care (KMC) involves continuous skin-to-skin contact of baby on mother’s chest to provide warmth, frequent breastfeeding, recognizing danger signs of illness, and early discharge. Though KMC is safe, effective and recommended by the World Health Organization, implementation remains limited in practice. The objective of t...

Background Kangaroo mother care (KMC) is an effective intervention for preterm and low birth weight infants. Effective implementation of KMC relies on a multidisciplinary team centering on the newborn’s caregiver, who delivers care with support from health care workers. This study explored the experiences of caregivers on the implementation of KMC....

Introduction: Health seeking behaviour (HSB) refers to actions taken by individuals who are ill in order to find appropriate remedy. Most studies on HSB have only examined one symptom or covered only a specific geographical location within a country. In this study, we used a representative sample of adults to explore the factors associated with HS...

Background COVID-19 mitigation strategies have been challenging to implement in resource-limited settings such as Malawi due to the potential for widespread disruption to social and economic well-being. Here we estimate the clinical severity of COVID-19 in Malawi, quantifying the potential impact of intervention strategies and increases in health s...

Objective: To characterize health seeking behavior (HSB) and determine its predictors amongst children in Malawi in 2016. Methods: We used the 2016 Malawi Integrated Household Survey dataset. The outcome of interest was HSB, defined as seeking care at a health facility amongst people who reported one or more of a list of possible symptoms given...

Background: There is growing interest in the collection, storage and reuse of biological samples for future research. Storage and future use of biological samples raise ethical concerns and questions about approaches that safeguard the interests of participants. The situation is further complicated in Africa where there is a general lack of govern...

Background Preterm birth complications are the leading cause of neonatal deaths. Malawi has high rates of preterm birth, with 18.1 preterm births per 100 live births. More than 50% of preterm neonates develop respiratory distress which if left untreated, can lead to respiratory failure and death. Term and preterm neonates with respiratory distress...

Background: Micronutrient deficiencies including selenium (Se) are widespread in Malawi and potentially underlie a substantial disease burden, particularly among poorer and marginalised populations. Concentrations of Se in staple cereal crops can be increased through application of Se fertilisers - a process known as agronomic biofortification (ag...

Background Micronutrient deficiencies including selenium (Se) are widespread in Malawi and potentially underlie a substantial disease burden, particularly among poorer and marginalised populations. Concentrations of Se in staple cereal crops can be increased through application of Se fertilisers – a process known as agronomic (agro-) biofortificati...

Background Micronutrient deficiencies including selenium (Se) are widespread in Malawi and potentially underlie a substantial disease burden, particularly among poorer and marginalised populations. Concentrations of Se in staple cereal crops can be increased through application of Se fertilisers – a process known as agronomic (agro-) biofortificati...

Although community engagement is increasingly promoted in global health research to improve ethical research practice, there is sometimes a disconnect between the broader moral ambitions for community engagement in the literature and guidelines on the one hand and its rather narrower practical application in health research on the other. In practic...

Most children die in low and middle-income countries as a result of structural injustice, and while it may not be possible to prove causality between economic policies and breaches of rights, it is possible to audit policy and practices through the lens of human rights. Child health advocates need to highlight the fact that technical interventions,...

Background Ensuring that countries have adequate research capacities is essential for an effective and efficient response to infectious disease outbreaks. The need for ethical principles and values embodied in international research ethics guidelines to be upheld during public health emergencies is widely recognized. Public health officials, resear...

This chapter contextualises health rights and ethics to health programmes and interventions which have been of crucial importance in Africa. It clarifies how ethics principles are applied in ethics. it also shows how human rights and principles of bioethics are interrelated.

What makes a good person good? Can a wrong action be a good action and consequently a right action be a bad action? These are questions which have plagued the philosophers and wise persons of antiquity and is still relevant all over the world, including Africa. The aim of this chapter is to position African ethics within the framework of Global Bio...

Although community engagement is increasingly promoted in global health research to improve ethical research practice, there is sometimes a disconnect between the broader moral ambitions for community engagement in the literature and guidelines on the one hand and its rather narrower practical application in health research on the other. In practic...

Controlled human infection (CHI) models are gaining recognition as an approach to accelerating vaccine development, for use in both non-endemic and endemic populations: they can facilitate identification of the most promising candidate vaccines for further trials and advance understanding of protective immunity. Helminths present a continuing healt...

Controlled human infection (CHI) models are gaining recognition as an approach to accelerating vaccine development, for use in both non-endemic and endemic populations: they can facilitate identification of the most promising candidate vaccines for further trials and advance understanding of protective immunity. Helminths present a continuing healt...

The aim of this paper is to present a new framework to design and run a responsive and resilient health system. It can be used by both private and public, profit and non-profit organizations in order to translate strategic goals of an organization into desirable and intended best practice, and results. This includes the health sector. The framework...

A 107 presenter Jospeh Mfutso-Bengo Introduction: CHIM studies are currently and mainly being conducted in higher income countries. Very few CHIM studies are taking place in less developed parts of the world and the justification for this difference is not clear. FDA, EMEA and Singaporean Drug Agency have approved CHIM studies. The new most advance...

P108 LEGS Framework = Leadership, Ethics, Governance, Systems- Framework

Bioethics is moral capital. Many countries have been investing their resources in knowledge and skills development (human capital) only, while ignoring right attitude (value-based learning and character formation).This book gives practical guidance on the use of bioethics in evidence and value based decision-making process and mind-building. From A...

Autonomy is a central principle in bioethics and research ethics. In this essay, a historical account of the moral and philosophical foundations for the principle of autonomy and its conceptualization in bioethical discourse is presented. An explanation on the application of autonomy in clinical practice and biomedical research by contextualizing i...

Background: This paper discusses the contentious issue of reuse of stored biological samples and data obtained from research participants in past clinical research to answer future ethical and scientifically valid research questions. Many countries have regulations and guidelines that guide the use and exportation of stored biological samples and...

A field report on ethical and cultural consideration of acceptability of the use of community based therapeutic feeding in Malawi

Autonomy is a central principle in bioethics and research ethics. In this essay, a historical account of the moral and philosophical foundations for the principle of autonomy and its conceptualization in bioethical discourse is presented. An explanation on the application of autonomy in clinical practice and biomedical research by contextualizing i...

Obtaining effective informed consent from research participants is a prerequisite to the conduct of an ethically sound research. Yet it is believed that obtaining quality informed consent is generally difficult in settings with low socioeconomic status. This is so because of the alleged undue inducements and therapeutic misconception among particip...

This chapter presents an overview of the strides made in the area of bioethics in Malawi. Specifically, it covers how bioethics has developed through teaching, discourse, practice, legislation, and current bioethics infrastructure. The Centre for Bioethics in Eastern and Central Africa (CEBESA) established in 2001 under the University of Malawi, Co...

Contemporary bioethics, now roughly 40 years old as a discipline, originated in the United States with a primarily Anglo-American cultural ethos. It continues to be professionalized and institutionalized as a maturing discipline at the intersections of philosophy, medicine, law, social sciences, and humanities. Increasingly bioethics—along with its...

The objective of this empirical study was to understand the perspectives and attitudes of policy-makers towards the use and impact of research in the health sector in low- and middle-income countries. The study used data from 83 semi-structured, in-depth interviews conducted with purposively selected policy-makers at the national level in Argentina...

The main objective of the situation analysis was to generate relevant data that could be used to inform and guide initiatives to promote male circumcision as part of a comprehensive HIV prevention strategy in Malawi The specific objectives of the situation analysis were: 1. To determine current rates, service providers and behaviours that determ...

HIV/AIDS prevention campaigns have been overshadowed by conflicting, competing, and contradictory views between those who support condom use as a last resort and those who are against it for fear of promoting sexual immorality. We argue that abstinence and faithfulness to one partner are the best available moral solutions to the HIV/AIDS pandemic....

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented cha...

Current literature suggests that therapeutic misconception a belief by participants in a clinical trial that they are in fact simply being given clinical care is common, especially among illiterate populations in developing countries. Therapeutic misconception reects problems in informed consent, as people agree to participate in clinical trials wi...

Trial participants from limited resource settings often are given very little or nothing in terms of compensation for time, inconvenience and risks as compared to their counterparts from developed countries. The reason that is often sited by researchers, ethics committees, and sponsors is the avoidance of undue inducements. We discuss the inherent...

Research is vital to accurately describe phenomena in humanitarian emergency situations and to evaluate the effectiveness and appropriateness of interventions. Although the ethical principles of justice, beneficence and respect for autonomy respect for persons should be upheld in research, their application in emergency situations may differ from n...

This study was aimed at researching the reasons why mothers enrol their children in malaria clinical research and how family members or relatives are involved in the decision-making process. Issues related to informed consent were also a particular focus of this study. A total of 81 participants took part in 8 focus group discussions. Thirty-nine p...

Participants refusal to take part in research is an unpleasant experience that investigators face. This paper highlights some of the reasons why people from resource-poor settings refuse to take part in health research. This paper also highlights standards which investigators can adopt to avoid unnecessary refusals and at the same time ensure that...

There is wide acknowledgement of the need for community engagement in biomedical research, particularly in developing countries. Today, engaging communities has become a critical aspect of planning and implementing biomedical research. The current international research ethics guidelines talk of community engagement as an ethical requirement for re...

Researchers and others involved in the research enterprise from 12 African countries met with those working in ethics and oversight in the United States as part of an effort to develop research ethics capacity. Drawing on a wealth of experience among participants, discussions at the meeting revealed five categories of issues that warrant careful at...

The world has experienced phenomenal growth in science and knowledge since the second-world war. Infectious disease conditions that were almost always fatal in the early 1900s are now being effectively treated with antibiotics and other modalities emanating from science and prevented through the general improvements in vaccination, nutrition, sanit...

Research collaboration beyond national jurisdiction is one aspect of the globalisation of health research. It has potential to complement researchers in terms of research skills, equipment and lack of adequate numbers of potential research subjects. Collaboration at an equal level of partnership though desirable, may not be practicable. Sometimes,...

This chapter describes the research governance capacity that is found in Malawi. It explains existing structures, institutions and the jurisdiction of various committees established in Malawi that facilitate and monitor biomedical research in Malawi. It gives practical information on the submission of research proposals to various institutions, in...

HIV/AIDS is a major public health problem in Africa. Stigmatization, discrimination and lack of appropriate health care are among the commonest challenges that HIV infected persons and their families face. It has been suggested that among the tools available in the fight against stigmatization and discrimination is public disclosure of a person's H...

Clinical drug testing is an unavoidable aspect of drug development and approval. Although most therapeutic drugs are developed by Northern scientists and pharmaceutical companies, clinical drug testing may still be conducted in developing nations for a variety of reasons. At the Global Forum for Bioethics in Malawi 2005, the issue of post-trial ben...

Southern African countries have the highest HIV infection rates in the world. In most of the countries in the region, the rate among adults is at least 10%. The fight against HIV/ AIDS has mostly been inadequate owing to the lack of proper consideration of ethical and cultural issues. In this article, the authors discuss the ethical and cultural di...

We previously reported an HIV prevalence of 24% among rural adolescent girls living in the Shire Valley southern Malawi. Voluntary HIV counselling and testing (VCT) could help prevent HIV among adolescents by encouraging informed decision-making and behavioural change. The Malawian National AIDS Control Programme has prioritized VCT as an HIV preve...