Decolonising global health in Africa: research agendas in public health, law, and human rights

Background

In recent years the Groningen Centre for Health Law (‘GCHL’ - formerly the Global Health Law Groningen Research Centre), Netherlands, has held annual summer schools on global health, law, and human rights. Responding to calls to decolonise global health (Fofana, 2021), in February 2022 GCHL convened an online academic colloquium to explore the issues in Africa. Panellists and discussants comprised leading African academics and advocates for public health, law, and human rights.

Objectives

1. Identify priority current and emerging issues in global health, law, and human rights in the African region with, where possible, reference to the climate crisis.

2. Explore opportunities for identifying academic institutions, networks, and researchers working these issues across Africa.

3. Identify opportunities to support collaboration between institutions, networks and researchers and other actors to address the issues identified across the region

Results

Top public health issues identified for further research included: public health law frameworks in Africa; One Health and climate change; inequality in the distribution of the determinants of health and disease; international trade and public health; the right to benefit from scientific progress (e.g. in accessing vaccines for COVID-19); gender-based violence; public health and agri-food systems; noncommunicable diseases; healthy diets; poverty; mental health; social protection; and plastic pollution. The first meeting of the network on health, law and human rights in Africa was held in May 2022. The second academic colloquium was held in July 2022, co-hosted with Moi University and the University of Nairobi, Kenya.

Conclusions

Public health and legal academics in Africa are ready to engage systematically with European partners to address key health-related law and human rights issues of global interest. Research agendas should reflect African priorities, and collaboration should be led by African institutions.

Key messages

• Capacity must be built to understand the links between public health, law and human rights in Africa.

• Collaboration with European institutions to build capacity in public health, law and human rights is welcome, however priorities should be identified by - and responses led by - African academics.

Pentoxifylline as a rescue treatment for DMD: a randomized double-blind clinical trial

OBJECTIVE

To determine whether pentoxifylline (PTX) slows the decline of muscle strength and function in ambulatory boys with Duchenne muscular dystrophy (DMD).

METHODS

This was a multicenter, randomized, double-blinded, controlled trial comparing 12 months of daily treatment with PTX or placebo in corticosteroid-treated boys with DMD using a slow-release PTX formulation (~20 mg/kg/day). The primary outcome was the change in mean total quantitative muscle testing (QMT) score. Secondary outcomes included changes in QMT subscales, manual muscle strength, pulmonary function, and timed function tests. Outcomes were compared using Student t tests and a linear mixed-effects model. Adverse events (AEs) were compared using the Fisher exact test.

RESULTS

A total of 64 boys with DMD with a mean age of 9.9 ± 2.9 years were randomly assigned to PTX or placebo in 11 participating Cooperative International Neuromuscular Research Group centers. There was no significant difference between PTX and the placebo group in total QMT scores (p = 0.14) or in most of the secondary outcomes after a 12-month treatment. The use of PTX was associated with mild to moderate gastrointestinal or hematologic AEs.

CONCLUSION

The addition of PTX to corticosteroid-treated boys with DMD at a moderate to late ambulatory stage of disease did not improve or halt the deterioration of muscle strength and function over a 12-month study period.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that treatment with PTX does not prevent deterioration in muscle function or strength in corticosteroid-treated boys with DMD.

Randomized, blinded trial of weekend vs daily prednisone in Duchenne muscular dystrophy

OBJECTIVE

To perform a double-blind, randomized study comparing efficacy and safety of daily and weekend prednisone in boys with Duchenne muscular dystrophy (DMD).

METHODS

A total of 64 boys with DMD who were between 4 and 10 years of age were randomized at 1 of 12 centers of the Cooperative International Neuromuscular Research Group. Efficacy and safety of 2 prednisone schedules (daily 0.75 mg/kg/day and weekend 10 mg/kg/wk) were evaluated over 12 months.

RESULTS

Equivalence was met for weekend and daily dosing of prednisone for the primary outcomes of quantitative muscle testing (QMT) arm score and QMT leg score. Secondary strength scores for QMT elbow flexors also showed equivalence between the 2 treatment groups. Overall side effect profiles of height and weight, bone density, cataract formation, blood pressure, and behavior, analyzed at 12 months, did not differ between weekend and daily dosing of prednisone.

CONCLUSIONS

Weekend dosing of prednisone is equally beneficial to the standard daily dosing of prednisone. Analysis of side effect profiles demonstrated overall tolerability of both dosing regimens.

CLASSIFICATION OF EVIDENCE

This study provides Class I evidence that weekend prednisone dosing is as safe and effective as daily prednisone in preserving muscle strength and preventing body mass index increases in boys with DMD over a 12-month period.