Health Promotion capacity building through PhD training in developing countries

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Health Promotion capacity building through PhD
training in developing countries

• CAPHRI April 3, 2012

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Content

• Rational, background and assumptions
• Supervision
• Research topics
• Funding an scholarships
• A sample of a research theme
• Relevance does it work?
• Continuation?

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Rational and how it started

• Growing need for disease prevention and health
  promotion
• Relatively high costs of medical care in
  developing countries
• Need for HE/HP expertise among young researchers
  from developing countries
• Summer course participants
• Personal development needs

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Basic assumptions and ways of working

• Motivation of the candidate
• Candidates have an education comparable with a
  Dutch master diploma
• Embedding of candidate in a local (research)
  organization
• Support from local organization (s)
• Presence of a local supervisor
• Research preferably focused on a local health
  problem
• Research primarily conducted in the developing
  country

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Supervision

• Focus on development of an independent
  researcher
• Main focus of supervision is on learning
  application of theories and research methods
• Candidates receive courses and individual
  teaching and training and instruction based on
  individual needs. (Summer courses like HE/HP
  theories, IM, qualitative research, data
  analysis, systematic reviewing)
• Candidates have a local supervisor.
• Candidate receives supervisory visits ones or
  twice/year
• Candidate visits Maastricht about ones a year
• Candidates are encouraged to participate in
  international research networks

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Supervisory team

• Mostly 2 Dutch supervisors (depending on
  expertise from UM or different)
• Always one supervisor from developing country

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Strategies in supervision

• Candidate prepares proposal (in cooperation with
  supervisors)
• Provisional publication plan
• Time planning for publications
• Attitudes towards authorship

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Health Promotion Collaborative sites in Africa
Djibouti 1
Rwanda 1
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Research topics and health problems

• STI and HIV/AIDS (prevention, stigma, care)
• Malaria
• Tuberculosis
• Lymphatic filariasis
• Cardiovascular diseases
• Nutrition, under-nutrition
• Substance abuse (smoking, drugs)
• Adolescent health and life style behaviour
• Mental health (depression, suicide, traumas)
• Health services organization and use

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Research funding

• NOW/WOTRO (5 grants)
• Nuffic (6 grants)
• Bilateral research funding (SANPAD) (2 grants)
• Scholarships from other countries
• MUNDO
• Local developing country scholarship/research
  funding
• International funds acquired by local
  organizations or universities

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Developing countries dissertation completed and
in progress

• Dissertations completed 15
• Dissertations in progress 17
• (Dutch Master students 20-25)

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Example Malaria (3 PhDs)
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The malaria problem

• Mosquito-borne parasitic disease
• 300-500 million cases annually
• gt1 millions deaths annually
• 90 in African children
• 1 child death every 30 seconds
• US 12b annual losses
• Main control challenges
• Drug-resistant parasite
• Insecticide-resistant mosquitoes
• Poverty
• Poor infrastructure
• Weak health systems

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Insecticide-treated bednets (ITNs) for malaria
control

• Alaii JA,
• Kenya Medical Research Institute,
• Centers for Disease Control and Prevention,
  Atlanta, GA.
• CAPHRI, Maastricht University, NL.

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The study location
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Homestead close range
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(No Transcript)
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Effect of insecticide-treated bednets on malaria
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Study objectives

• To assess the acceptability of insecticide-treated
  bednets for malaria control
• To describe sleeping arrangements and existing
  bednet use
• To describe malaria knowledge, beliefs, and care
  seeking
• To determine the perceived role of bednets in
  malaria control
• To determine environmental and social variables
  affecting adherence
• To assess potential child roles in ensuring
  correct bednet use
• To make recommendations on ITN use in western
  Kenya

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Socio-behavioral studies
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Formative evaluative research

• Minimal (lt5) bednet coverage
• Bednets ranked low in household expenditure
  priorities
• Nuisance biting versus disease prevention
• Adults given priority access to existing bednets
• Children predominantly sleep in temporary bed
  spaces
• Multiple concept of malaria causation
• Bednets prevent mosquitoes and not malaria per se
• Safety concerns about use of chemical
  (insecticide) in bednets

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Malaria knowledge including care seeking

• Increased perception of mosquito-malaria link
  (85 vs. 75.1)
• Persistent concept of multiple causation
• Malaria likely to be treated using modern
  medicines
• Self-medication the norm
• Health facility used mainly as a last resort
• Persistent low rank of bednets in household
  expenditure priorities
• Lacking perception of bednet re-treatment as
  essential

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Adherence study

• Social factors affecting bednet use pose major
  challenge (sleeping arrangements, family
  hierarchy systems)
• Mothers sometimes not at home to put child to bed
• Mothers to tired to hang nets after work
• Older children (6-12) were not involved in
  bednet mounting

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A section of trainees
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Tools of the trade mat, net, twine
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The pre-training and evaluation interviews
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Okay, lets see you sort out the tools
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This is how I want it spread out
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Net too high upchecking where we went wrong
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Here we go againsorting out the tools
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Notice how high up the mounting point is
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The fully mounted and spread net
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Were this in the bedroom, I would fold it up like
this, and leave it hung there
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Developing and implementing appropriate health
communication messages for home management of
fevers, Dangme West, Ghana(Uncomplicated malaria
and Pneumonia)
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TOWARDS MALARIA ELIMINATION AN INTEGRATED
COMMUNITY-BASED APPROACH TO MALARIA CONTROL
(Rwanda)

• Entomological approach (reduction of malaria
  bearing mosquitos)
• Medical approach (prompt diagnosis and treatment)
• Economic approach (Feasible and sustainable
  programme activities)
• Behavioural approach (community-based approach,
  communication and enhancement of preventive
  behaviours like bednet use, help seeking,
  removing of mosquito breeding places.

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Relevance for developing country Does it work?

• Is capacity building sustainable?
• Do graduates remain working in their own country?
• Does the research and work of graduates
  contribute to the health of people?

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Sustainability example
Department of Health Promotion Research and
Development, Medical Research Council SA
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Example of translation into practice
Results of research on war traumas of female
students at Ahfad University in Sudan (Started 2
years ago)(Alia Badri)

• Development of a trauma counselling centra at
  Ahfad university
• Preparations for a Master in trauma counselling
  for the region

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Relevance for Maastricht University/CAPHRI

• Testing of theories and methods in different
  socio-cultural contexts
• Opportunities for international comparison
• Publication and dissertation output
• Enhance HE/HP image of MU capacity
• Expand network and international position
  Maastricht University

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Continuation of capacity building?
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Thank you