FACTS FINDING ON TEACHING IMMUNISATION IN MEDICAL SCHOOLS IN SUB SAHARAN AFRICA

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FACTS FINDING ON TEACHING IMMUNISATION IN MEDICAL
SCHOOLS IN SUB SAHARAN AFRICA

• Presented By
• GANAPATI J. BHAT
• SCHOOL OF MEDICINE, UNIVERSITY TEACHING GOSPITAL
• P.O. BOX 50110, LUSAKA, ZAMBIA
• 15th October 2004, Cape Town, South Africa
• Introduction of New Vaccines into EPI Programme

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OBJECTIVES

• To describe the current practice of teaching
  immunization to undergraduate and post-graduate
  medical students, clinical officer trainees and
  other cadres of health workers in medical schools
• To identify the gaps and weaknesses
• To discuss the ways of strengthening teaching
  immunisation

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METHODS

• Review of Following reports, presentations and
  chapters
• Report submitted by the participants on
  pre-service training at MLM training Pretoria
  June 2003
• Teaching on immunisation in medical schools
• -In Kenya by Dr. E Obimbo
• -In Tanzania by Dr. S. Kubhoja
• -In Uganda by Dr. C Zirabamuzaale
• During Introduction to New Vaccines in East
  Africa, Nairobi, Dec 2002.

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Methods.Continued

• Childhood Immunisation by C. Chintu, H. Beyene,
  and O. Lulembo in Primary Health Care Manual, 2nd
  Edition
• -Edited by K. Mukelabai, N. O. Bwibo and F.
  E. Onyango, Published by UNICEF, Nairobi, 1995
• Formal and Informal interviews with the lecturers
  and professors teaching at the medical schools in
  Sub-Saharan Africa.

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Methods ..Continued

• Written reports reviewed from Ethiopia, Ghana,
  Kenya, South Africa, Tanzania, Uganda, Zambia and
  Zimbabwe.
• Presentations from Kenya, Tanzania and Uganda
• Interviews with the lecturers and Professors from
  the above countries and Liberia and Malawi

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Methods ..Continued

• Hence the findings based on the information
  gathered from 10 countries and 40 training
  institutions in Sub Saharan Africa
• Teaching Immunisation is assessed by looking at
  the stated curriculum, contents, methods of
  teaching and evaluation.66

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FINDINGS

• Immunisation is taught in a traditional way
  through pre-clinical and clinical years in
  medical students training.
• Immunisation is an important element of Primary
  Health Care (PHC).
• Immunisation is also an integral part of child
  survival and development revolution (CSDR)
  strategies, which is popularly remembered by the
  mnemonic GOBI FFF.

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TEACHING ON IMMUNISATION

• Pre-clinical years
• - Micro biology and immunology
• Specific diseases aetiology,
  pathogenesis and prevention
• Example TB, Diphtheria, Pertusis,
  Tetanus, Polio, Measles, Hep-B,
  Haemophilus influenza,
• - Basics of human Immunology
• - Natural and acquired Immunity
• - Humoral and Cell mediated Immunity
• - Mechanisms of Human immune response to
  various antigens
• - Vaccines
• - Science of Vaccine production8

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Continued..

• Clinical Years
• Vaccines and Immunisations
• EPI Origin, aims, programmes
• National Immunisation Schedules
• EPI immunisable diseases ..
• EPI vaccine composition, handling, indications,
  contra indications, age of administration
• Vaccine related adverse events
• Vaccine management and cold chain
• Missed opportunities for immunisation
• Communication and Social Mobilization

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Continued..

• When is it taught?
• During Pediatrics and Child Health Rotation
• During Community Medicine Training
• During Community based education (CBE)
• Part of IMCI introduction/ training
• How is it taught?
• Didactic teaching lectures
• Self teaching Study reference material
• Field Work Case Studies, House Visiitng
• Participation during NIDs
• Practical Training Vaccine handling and
  immunisation

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OBJECTIVES OF LEARINING

• At the end of the training students should be
  able to
• List vaccine preventable deseases
• Identify diseases covered in EPI
• Outline immunisation delivery strategies
• Immunisation schedule
• Adminisatraion of Vaccines
• Describe the vaccine cold chain
• Identify common problems in EPI
• Educate health workers and Community Mobilisation
• Evaluation
• Future developments

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Learning activities

• Observation of EPI facilities
• Participation in administration of vaccines
• Communicating with the parents
• Identification of missed opportunities
• Assessment of EPI Programme

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EVALUATION

• Part of Clinical Examination during long case
  immunization history
• Oral Examination
• -Immunization Schedule
• -Indications, Contra Indications,
• -Adverse events
• -Cold Chain Management
• Continuous Assessment
• -Written Case History
• -Follow up Children at Home

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Undergraduate Programmes

• Durations differ but most of their curricula have
  a dose on immunisation
• Graduates are deployed as leaders, managers and
  implementers of health programmes at district
  levels, nation wide.
• Many graduates struggle for opportunities in
  postgraduate training and continuing medical
  education

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Post Graduate Programmes

• Upgrading knowledge and skills
• Appropriate research and surveys
• Interpretation Implementation of Politics
• Administration of district and national prog.
• Involved in evidence based planning
• Involved in management of resources
• Accumulate facts on new technology eradication
  of diseases.

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UON B Pharm Students

• Taught in final year, 4 years
• Content of vaccinology course
• History of Vaccinology
• Basics of human immunology
• Classification of Vaccines
• Specific Vaccines KEPI Vaccines
• EPI Eradication of Polio, Progress on measeles

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Medical Trainin Centers Registered Clinical
Officer Training

• RCO backbone of health care delivery
• Immunization taught , during basic training, and
  during pediatric specialization training.
• Cover KEPI vaccines, theory and practical
  administration.
• Cover vaccine handling and cold storage at health
  facility level.

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GAPS

• Current concepts on Immunisation is not updated
  into the teaching curriculum on a timely manner.
• Gaps in knowledge and skills among faculty
  members18

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DISCUSSIONS

• Success of Immunisation Programmes depends on
  collaboration between health workers training
  institutions, Government, MOH, health system,
  NGOs, WHO, UNICEF, NESI, and Population in
  general.
• Investing in Pre-service training is a great
  opportunity
• Training institute can contribute in disease
  surveillance and elimination of immunisable
  diseases.