Issues specific to resource-poor settings

The impact of kidney disease in low income regions is enormous and further research is urgently needed. The research environment in low- and middle-income countries is changing rapidly, but wide variations exist and the challenges for clinical researchers are different to high-income countries. Some of the key issues and potential solutions are presented below.

There is often a lack of well-trained and experienced research staff to support clinical research. In addition, it is also often difficult for inexperienced researchers to find a mentor, or senior expert who can guide them in a specific topics or techniques.

Potential solutions include

Research training programs including degree training, re-entry grants, and career development fellowships. Research networks and working groups also help to strengthen collaboration in research, training, production of analytical reports and build consensus or protocols.

The ISN and ERA-EDTA both offer Fellowships to international applicants from resource poor regions. The American Society of Nephrology provides contact details for US institutions willing to support visiting international fellows. Researchers are encouraged to also investigate fellowships, scholarships or other sources of funding from regional nephrology societies.

Many under-resourced regions lack adequate infrastructure for research in their hospitals and laboratories. Generally speaking, hospitals are short of basic equipment and resources including lack of necessary communication facilities, electronic filing systems, laboratory equipment.

Potential solutions include

Institutional programme-based support to acquire sustainable research and training capabilities e.g. the sister-renal and transplant center programs of the ISN.

ISN Sister Renal Center program

Most universities and institutions do not provide adequate incentives to physicians who are attracted to research. Consequently, researchers usually provide time, energy and money to research in the time left to them outside their clinical work.

Potential solutions include

International, regional and national grants to support priority research and knowledge management activities

See Funding topic of this toolkit for the possible funding sources.

In some regions, social and cultural factors impact engagement with health systems and with research in particular. It is critically important that local context is taken into account when research is designed. In particular, researchers are encouraged to target their research and communication to local community needs and to consider organized public educational activities to accompany their work or to increase its acceptability.

Some points to consider

  1. Cultural differences can be present between those organising or funding the research and the participants.
  2. Developing countries may lack a research culture and consequently, little attention is paid to directing resources to conduct research or evaluating a project. Moreover, participants are often unfamiliar with the concept of research and may be sensitive to some practices, such as taking blood samples.
  3. In many developing countries, concepts of respect for the family and community are equally as important as, or more important than, the concepts of individual autonomy and rights which underpins Western concepts of research ethics.
  4. Weak regulatory frameworks and industry support in developing countries means researchers may have uncertain financial and legal standing.

Many strategies have been proposed for increasing the amount of research in developing countries such as increasing health budget to research, giving local researchers incentives, improving telecommunications and internet access, encouraging twinning programs with a developed country institution and strengthening national research institutions and local research networks. These efforts vary from country to country. Nephrologists with an interst in research are encouraged to become in such activities in their own region.

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