Advancing neuropsychiatric genetics training and collaboration in Africa
Authors: Celia van der Merwe, Emmanuel K Mwesiga, Nathaniel W McGregor, Abebe Ejigu, Abigiya Wondimagegnehu Tilahun, Allan Kalungi, Benedict Akimana, Benyam Worku Dubale, Felicita Omari, Jackline Mmochi, Lerato Majara, Linnet Ongeri, Melkam Alemayehu, Nastassja Koen, Shareefa Dalvie, Symon M Kariuki, Michelle Hoogenhout
Journal: The Lancet Global Health (2018)

Neuropsychiatric disorders are a major contributor to functional impairment and mortality in low-income and middle-income (LMIC) settings, such as sub-Saharan Africa.1Patel V Chisholm D Parikh R et al.Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities.Lancet. 2016; 387 (3rd edition): 1672-1685Summary Full Text Full Text PDF PubMed Scopus (408) Google Scholar Given the increasing population size and life expectancy in this region, years lived with disabilities associated with psychiatric diseases are estimated to double in the next 30 years.2Charlson FJ Diminic S Lund C Degenhardt L Whiteford HA Mental and substance use disorders in sub-Saharan Africa: predictions of epidemiological changes and mental health workforce requirements for the next 40 years.PLoS One. 2014; 9: e110208Crossref PubMed Scopus (72) Google Scholar To compound the severity of these statistics, available treatment options are largely ineffective, only yielding desirable results in about 50% of cases.3Insel TR Translating scientific opportunity into public health impact: a strategic plan for research on mental illness.Arch Gen Psychiatry. 2009; 66: 128-133Crossref PubMed Scopus (387) Google Scholar Despite the clinical burden and high heritability of neuropsychiatric disorders, their genetic backgrounds are poorly understood. Furthermore, populations of African ancestry are substantially under-represented in global research of neuropsychiatric genetics.4Duncan LE Ratanatharathorn A Aiello AE et al.Largest GWAS of PTSD (n=20 070) yields genetic overlap with schizophrenia and sex differences in heritability.Mol Psychiatry. 2017; (published online April 25.)DOI:10.1038/mp.2017.77Crossref PubMed Scopus (241) Google Scholar, 5Dalvie S Koen N Duncan L et al.Large scale genetic research on neuropsychiatric disorders in African populations is needed.EBioMedicine. 2015; 2: 1259-1261Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 6Schizophrenia Working Group of the Psychiatric Genomics ConsortiumBiological insights from 108 schizophrenia-associated genetic loci.Nature. 2014; 511: 421Crossref PubMed Scopus (5107) Google Scholar From a scientific perspective, the study of modern African genomes might provide key insights into gene discovery and mapping of disease-associated variants.7Hansen ME Hunt SC Stone RC et al.Shorter telomere length in Europeans than in Africans due to polygenetic adaptation.Hum Mol Genet. 2016; 25: 2324-2330Crossref PubMed Scopus (70) Google Scholar, 8Hassanein MT Lyon HN Nguyen TT et al.Fine mapping of the association with obesity at the FTO locus in African-derived populations.Hum Mol Genet. 2010; 19: 2907-2916Crossref PubMed Scopus (68) Google Scholar The genetics of African populations, which feature increased allelic variability and reduced linkage disequilibrium compared with European populations, might reveal the missing layer of human variation that arose between 100 000 and 5 million years ago.9McClellan JM Lehner T King MC Gene discovery for complex traits: lessons from Africa.Cell. 2017; 171: 261-264Summary Full Text Full Text PDF PubMed Scopus (19) Google Scholar From a clinical perspective, discovering the genetic make-up of these populations is integral to addressing global inequities in neuropsychiatric service delivery and health-care infrastructure and to translating empirical data into public health interventions in sub-Saharan Africa. To date, advancements in neuropsychiatric genetics research in sub-Saharan Africa have been limited by low capacity—funding availability, appropriate infrastructure, and qualified researchers are under-represented in African institutions compared with counterparts in high-income countries (HICs). To improve representation of African institutions in neuropsychiatric genetics research, researchers and funding bodies should prioritise projects involving collaborations between institutions in HICs and LMICs that contain a capacity-building component. Initiatives such as Human Hereditary and Health in Africa (H3Africa), the International Brain Research Organization (IBRO), and the Wellcome Trust Developing Excellence in Leadership, Training, and Science Initiative (DELTAS) programme have been invaluable in building these collaborations and in providing genomics-related research training opportunities for researchers from African institutions.10Rotimi C Abayomi A Abimiku A et al.Research capacity. Enabling the genomic revolution in Africa.Science. 2014; 344: 1346-1348Crossref PubMed Scopus (253) Google Scholar Training events, online courses, and workshops have provided unprecedented learning strategies for medical, bioinformatics, and public health education in LMICs. However, most of the existing training components are often developed without input from prospective trainees, not specifically focused on neuropsychiatric genomics, and convened over a restricted time period. Therefore, a tailored approach, wherein researchers from the targeted populations continuously participate in defining neuropsychiatric training needs, might add value to the established methods through ensuring ownership and effectiveness of research training programmes. The Global Initiative for Neuropsychiatric Genetics Education in Research (GINGER) programme seeks to address these limitations. GINGER is a collaboration between the Stanley Center for Psychiatric Research at the Broad Institute of Massachusetts Institute of Technology and the Harvard T H Chan School of Public Health, and several academic institutions in sub-Saharan Africa (University of Addis Ababa, Ethiopia; University of Cape Town and Stellenbosch University, South Africa; Moi University and the Kenya Medical Research Institute, Kenya; and Makerere University, Uganda). Comprising 17 investigators from these countries, GINGER aims to enhance the capacity of neuropsychiatric genetics research in Africa by training early-career researchers in genetics analysis, psychiatric phenotyping, epidemiology, bioinformatics, biostatistics, ethics, and manuscript and grant writing. A unique feature of the 2 year GINGER programme is the active participation of the fellows and African mentors in selection of programme topics on the basis of the individual and collective needs of the fellows and their host institutions. Intra-African networking and collaborations are strongly encouraged to expand the training and capacity-building of the first GINGER cohort and to contribute to innovative research driven by African investigators. Furthermore, the initiative seeks to increase the awareness of key stakeholders and policy makers about the burden of neuropsychiatric disorders in sub-Saharan Africa. The first cohort of GINGER fellows aims to establish an interdisciplinary group of African researchers, with the potential for sustainability beyond GINGER. Through continued conversations, skills building, and collaborative efforts between African institutions, this group will be equipped to produce first-class research equal to that produced in HICs. This Comment, therefore, serves as a call to action to develop and reaffirm the relationships needed to study neuropsychiatric genetics research in Africa. Improved characterisation of the prevalence and molecular causes of neuropsychiatric disorders in Africa might lead to development of population-specific and individual-specific treatment methods. These discoveries might ultimately improve global health-care strategies. We thank Lori Chibnik, Bizu Gelaye, Kristianna Post, and Wairimu Mwaura at GINGER, and Karestan Koenen at NeuroGAP. We declare no competing interests.