Ethical considerations in surgical research conducted in African LMICs: a comprehensive narrative review

Abstract

Introduction: Surgical research has revolutionized healthcare by improving the efficacy, safety, and efficiency of surgical interventions. This research has the potential to significantly impact healthcare delivery in Africa, where surgical diseases pose a major public health burden. Studies suggest surgery alone could reduce the global disease burden by 11%, with a substantial portion stemming from conditions prevalent in sub-Saharan Africa like traumatic injuries, childbirth complications, and surgical infections. However, conducting surgical research in Africa presents unique ethical challenges. The continent's diverse socio-economic environments and rich cultural contexts necessitate careful consideration of ethical principles. Traditional research models often don't translate well to African settings, raising concerns about informed consent, community engagement, and benefit-sharing. Aim: This review aims to shed light on various ethical dilemmas posed within surgical research, conducted in African countries. Further, standard practices and recommendations that involve a multi-pronged approach to mitigate said issues were explored. Materials and methods: A meticulous analysis of the existing literature pertaining to the ethical issues proffered in Africa was performed. Databases employed comprised PubMed/MEDLINE, Embase, Scopus, and EBSCOhost. Pertinent case studies were also reviewed to comprehend said issues, providing comprehensive recommendations. Results: In addressing the ethical challenges in the research, the importance of resource limitation, sociocultural factors, informed consent barriers, technological obsolescence, training deficits, power dynamics, vulnerable populations, regulatory oversight, and compliance was highlighted. The proposed approaches include conducting focused research lectures and practical workshops on surgery, organizing surgical boot camps for medical students, interns, and residents, promoting research in related fields such as anesthesia, radiology, and pathology, ensuring the presence of on-site surgeons as needed, and arranging outreach surgical and educational camps for patients. Conclusion: Promoting community engagement and training local researchers and surgeons are crucial for navigating the unique ethical landscape in Africa. By prioritizing ethical considerations, surgical research can contribute to improved healthcare outcomes and a more equitable healthcare system across the continent.

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