Health Promotion capacity building through PhD training in developing countries

1. Health Promotion capacity building through PhD training in developing countries CAPHRI April 3, 2012

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

3. 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 Rational and how it started

4. 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

5. 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

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

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

8. Sudan 5 Ghana 1 Kenya5 Nigeria 2 Tanzania 2 Mozambique 0 Zimbabwe 1 South Africa 8 Health Promotion: Collaborative sites in Africa Djibouti 1 Rwanda 1

9. 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, trauma’s) Health services organization and use

10. 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

11. Developing countries dissertation completed and in progress Dissertations completed 15 Dissertations in progress 17 (Dutch Master students 20-25)

12. Example Malaria (3 PhDs)

13. Africa 3.0 Asia China Central & S.America 2.0 Annual Deaths from Malaria (millions) N.America & Europe 1.0 0.1 1900 1930 1950 1970 1990 2000 (R.Carter,1999) The malaria problem • Mosquito-borne parasitic disease • 300-500 million cases annually • >1 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

14. 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.

15. The study location N W E To Busia S • rural area • 200km2 N.E. of L. Victoria • population ~60,000 • 96% Luo ethnic group • perennial malaria transmission Siaya KEMRI Equator Bondo Kisumu ASEMBO Lake Victoria KENYA Kisumu

16. Homestead: close range

18. Gambia 23% Burkina Faso 14% Ghana 18% coastal Kenya 29% Lengeler C, et al., 1998. Effect of insecticide-treated bednets on malaria

19. 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 Study objectives

20. Socio-behavioral studies

21. Minimal (<5%) 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 Formative evaluative research

22. 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 Malaria knowledge including care seeking

23. 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 Adherence study

24. A section oftrainees

25. Tools of the trade: mat, net, twine

26. The pre-training and evaluation interviews

27. Okay, let’s see you sort out the tools

28. This is how I want it spread out

29. Net too high up…checking where we went wrong

30. Here we go again…sorting out the tools

31. Notice how high up the mounting point is

32. The fully mounted and spread net

33. Were this in the bedroom, I would fold it up like this, and leave it hung there

34. Developing and implementing appropriate health communication messages for home management of fevers, Dangme West, Ghana(Uncomplicated malaria and Pneumonia)

35. Entomological approach (reduction of malaria bearing mosquito’s) 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. TOWARDS MALARIA ELIMINATION: AN INTEGRATED COMMUNITY-BASED APPROACH TO MALARIA CONTROL (Rwanda)

36. 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?

37. Sustainability: example Department of Health Promotion Research and Development, Medical Research Council SA

38. Example of translation into practice Results of research on war trauma’s 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

39. 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

40. Continuation of capacity building?

41. Thank you