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"Akpa-Inyang, Francis"
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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
2021
Background
The Western-European concept of libertarian rights-based autonomy, which advocates respect for individual rights, may conflict with African cultural values and norms. African communitarian ethics focuses on the interests of the collective whole or community, rather than rugged individualism. Hence collective decision-making processes take precedence over individual autonomy or consent. This apparent conflict may impact informed consent practice during biomedical research in African communities and may hinder ethical principlism in African bioethics. This study explored African biomedical researchers' perspectives regarding informed consent and potential limitations to the principle of respect for autonomy in African communities.
Methods
We conducted a qualitative study based on in-depth interviews with 12 biomedical researchers, five females and seven males aged 34 to 74 years, currently working at an African university. Interviews lasted 35–40 min each and involved semi-structured open-ended interviews, which allowed participants to offer information about their perceptions and feelings regarding respect for autonomy and informed consent as practised in Africa. Empirical data from the interviews were recorded, transcribed, and analysed using thematic content analysis, together with an interrogation of relevant scientific literature about African communitarian ethics, making evaluations and drawing inferences consistent with the empirical bioethics approach.
Results
Based on these interviews and analysis of relevant literature, we found that informed consent is difficult to apply in an African context because it derives from a Western conception of libertarian rights-based autonomy. Most respondents pointed out that it was challenging to implement informed consent in the African setting. Furthermore, communalism, customary beliefs, spirituality, and relational autonomy are predominant in most African communities, as exemplified by the African moral philosophies of
Ubuntu/Botho
and
Ukama
, which emphasize communitarianism over individual rights. We also found that language, education, poverty, and cultural beliefs are barriers to obtaining proper informed consent in African communities.
Conclusions
We conclude that there are limitations to applying the principle of respect for autonomy and informed consent in African communities, especially in the context of human biomedical research. We recommend using a more relational approach, such as Ross’s prima facie duties, to implement informed consent in African communities.
Journal Article
The San Code of Ethics Versus International Ethical Guidelines: A Cross-Cultural Analysis
This study was designed to compare the San (Khoisan) code of ethics against key elements of the revised Council for International Organization of Medical Sciences (CIOMS) ethical guidelines, and the World Medical Association (WMA) Declaration of Helsinki. The study aimed to identify similarities and draw inferences in applying the San code of ethics when conducting biomedical research among indigenous populations groups in Africa and globally. In-depth interviews lasting 45 to 55 minutes were conducted among a group of 12 purposively sampled biomedical researchers in South Africa. Interviews were recorded, transcribed, and analysed using thematic content analysis. Participants observed some important similarities between the San Code of Ethics, the CIOMS ethical guidelines and the Declaration of Helsinki. Nevertheless, the research discovered that San peoples were of the opinion, that community involvement in biomedical research reduces exploitation, and enhances human dignity, and should be based on mutual respect, honesty, justice, fairness, and the ethics of care.
Journal Article
Physical Activity Assessment—Self-Reported Versus Pedometer-Measured, and Associations with Health Markers Among University Students in South Africa
by
Haffejee, Firoza
,
Pillay, Julian David
,
Akpa-Inyang, Francis Fabian
in
Adolescent
,
Adult
,
Analysis
2025
Accurate measurement of physical activity is crucial for promoting health and preventing non-communicable diseases, particularly in Sub-Saharan Africa, where the dual burden of infectious and chronic diseases presents significant public health challenges. While self-reported tools are commonly used, they are often limited by recall and social desirability biases. This study aimed to compare self-reported physical activity with objectively measured pedometer data and explore their associations with fitness and anthropometric indicators among university students. A cross-sectional study was conducted among 60 full-time students at a South African university. The study was conducted in two phases: For phase 1, participants completed the International Physical Activity Questionnaire (IPAQ). For phase two, participants wore pedometers for seven consecutive days to measure total and aerobic step counts. Fitness was assessed using the Harvard Step Test to calculate the Physical Efficiency Index (PEI), and anthropometric data (BMI, waist-to-hip ratio, body fat percentage) were recorded. Statistical analyses included Spearman’s correlations, Mann–Whitney U test, Kruskal–Wallis H test, and multivariable linear regression. While 83.3% of participants self-reported high physical activity levels, pedometer data indicated that 61.7% accumulated fewer than 1500 aerobic steps per day and 53.3% recorded fewer than 5000 total steps. No significant association was found between self-reported activity and pedometer-measured steps (p-value = 0.748 and p-value = 0.835, respectively). Objective measures showed significant positive correlations between aerobic steps and PEI (r = 0.274, p-value = 0.034) and significant negative correlations with BMI (r = −0.489, p-value < 0.001) and body fat percentage (r = −0.255, p-value = 0.046). Older age and female gender were associated with lower step counts. This study reveals a significant overestimation of physical activity in self-reports compared to objective measures and stronger links between objectively measured steps and key health outcomes. The findings highlight the need to integrate objective monitoring tools into public health practice and youth-focused interventions in Sub-Saharan Africa. They underscore the importance of exploring context-specific factors influencing activity levels. Enhancing measurement accuracy is vital for advancing evidence-based strategies and achieving Sustainable Development Goal 3.
Journal Article
Ergonomic Challenges and Musculoskeletal Pain During Remote Working: A Study of Academic Staff at a Selected University in South Africa During the COVID-19 Pandemic
by
Govender, Nalini
,
Pillay, Julian David
,
Akpa-Inyang, Francis Fabian
in
Adult
,
Backache
,
COVID-19
2025
The COVID-19 pandemic led to a rapid shift to remote working, which affected ergonomic conditions and increased the risk of upper body musculoskeletal pain (MSP). This study assessed the prevalence and impact of upper body MSP (affecting the head, neck, shoulders, and back) among academic staff at a University of Technology during the pandemic. Data were collected from 110 participants through an online, descriptive, cross-sectional survey adapted from the Dutch Musculoskeletal Questionnaire, the Standardized Nordic Questionnaire, and the McCaffrey Initial Pain Assessment Tool. The survey examined demographics, ergonomic practices, MSP, and psychological well-being before and during the pandemic. The sample included 59.1% female participants, with most being middle-aged. Persistent MSP was common, with 54.5% reporting neck pain and 59.1% experiencing back pain during the pandemic, alongside a significant decline in wrists in neutral position ergonomics (p = 0.012). Psychological well-being also worsened, as participants reported lower levels of cheerfulness, calmness, and energy than before the pandemic. While 81.9% of 90.9% participants with pre-existing MSP continued to experience pain, a small (9%) but notable proportion saw a decline in MSP during this period. These findings highlight a strong relationship between remote working conditions and MSP, with poor ergonomics and psychological distress contributing significantly to persistent pain. The results emphasise the need for institutions to provide ergonomic support, such as appropriate equipment and workstation adjustments, alongside mental health resources to mitigate the long-term impacts of remote working on physical and mental health.
Journal Article
The Impact of Religion on the Political Culture of Nigerians in the South-South Region of Nigeria
2026
This study explored the impact of religion on the political culture of Nigerians in the South-South region of Nigeria. The study was guided by three research questions and three null hypotheses. A descriptive survey research design was adopted, and it was carried out in the South-South region of Nigeria. The region consists of six states: Akwa-Ibom, Bayelsa, Cross River, Delta, Edo, and Rivers. The target population for the study was the twelve million, eight hundred and forty-one thousand, two hundred and seventy-nine (12,841,279) registered voters from the South-South region, in the 2023 Nigerian General Elections, from this population, a sample size of one thousand and sixty-eight (1,068), comprising five hundred and thirty-four (534) males and five hundred and thirty-four (534) females was obtained using Cochran’s Formula. A structured questionnaire was used for data collection, and it was face-validated by three experts; one from the Social Work department and two from the Test and Measurement unit of the Department of Educational Foundation, all from the University of Calabar, Cross River State. Cronbach alpha reliability method was used to ascertain the internal consistency of the instrument and a reliability coefficient of 0.86 was obtained. Data collection was carried out by the researcher and three research assistants. Mean, standard deviation, and t-tests were used to analyze the data collected. The findings revealed eleven (11) influences of religion on political party affiliations and voting patterns in the South-South region of Nigeria; ten (10) roles of religious leaders in shaping the political culture of Nigerians in the South-South region; and thirteen (13) impacts of religion in shaping political attitudes and behaviours, among Nigerians in the South-South region. The study therefore, concluded that by understanding the complex relationships between religion, 100 politics, and culture, policy makers and stakeholders can develop effective strategies for promoting peaceful coexistence, democratic governance, and sustainable development in the South-South region. Based on the research findings, the following recommendations were made: South-South governments should encourage interfaith dialogues and cooperation among religious leaders and organizations in the region to promote mutual understanding, respect, and peaceful coexistence; government and religious leaders should foster a culture of tolerance and respect for diversity, particularly in the context of religion and politics, among others.”
Journal Article
Assessing Infection Control Knowledge and Compliance of Cardiovascular Perfusionists in Theatre at a Private Hospital in Kwazulu-Natal, South Africa
by
Naidoo, Elizabeth
,
Odayan, Myenderan
,
Adam, Jamila
in
cardiovascular perfusionist
,
Compliance
,
Disease control
2023
Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.
Journal Article
Patients’ Experience on Practice and Applicability of Informed Consent in Traditional Medical Practice in KwaZulu-Natal Province, South Africa
by
Ojewole, Elizabeth
,
Chima, Sylvester C.
,
Akpa-Inyang, Francis
in
Councils
,
Decision making
,
Ethics
2022
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 participants were in the age range of 26–35 (38.8%). All respondents were IsiZulu home-language speakers, single (62.8%), employed (48%), and with some tertiary education (48.8%). Most patients were informed about their diagnosis (58.9%), treatment benefits (79.8%), and recommended treatment (79.8%). Fewer were informed about risks of treatment (36.4%), right of refusal (3.1%), and risks of refusing recommended treatment (0.8%). All participants reported satisfaction with information disclosed by the THPs and did not feel coerced to accept treatment. Consent was obtained verbally in all cases. The majority of participants (76.7%) sought surrogate assistance when consulting THPS, and 81.4% preferred being informed about all treatment risks. Most respondents also preferred involvement in healthcare decision-making during ATM. Conclusion. This study reveals that most patients consulting THPs in the KwaZulu-Natal province for treatment are aware of their right to information disclosure and the need to reach agreement before involvement in ATM treatment procedures. The study also showed that some key elements of IC are currently being applied during ATM practice in South Africa.
Journal Article
Assessing Infection Control Knowledge and Compliance of Cardiovascular Perfusionists in Theatre at a Private Hospital in Kwazulu-Natal, South Africa
by
Francis Akpa-inyang
,
Jamila Adam
,
Myenderan Keith Odayan
in
cardiovascular perfusionist
,
compliance
,
infection control
2023
Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.
Journal Article
Assessing Infection Control Knowledge and Compliance of Cardiovascular Perfusionists in Theatre at a Private Hospital in Kwazulu-Natal, South Africa
by
Francis Akpa-inyang
,
Jamila Adam
,
Myenderan Keith Odayan
in
cardiovascular perfusionist
,
compliance
,
infection control
2023
Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.
Journal Article