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

Health Education and Promotion

Health Promotion capacity building Health Promotion capacity building through PhD training in developing through PhD training in developing

countriescountries

CAPHRI April 3, 2012


ContentContent

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


Rational and how it started 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


Basic assumptions and ways of workingBasic 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


SupervisionSupervision 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


Supervisory teamSupervisory team

Mostly 2 Dutch supervisors (depending on expertise from UM or different)

Always one supervisor from developing country


Strategies in supervisionStrategies in supervision

Candidate prepares proposal (in cooperation with supervisors)

Provisional publication plan Time planning for publications Attitudes towards authorship

Health Education and PromotionHealth Promotion: Collaborative Health Promotion: Collaborative sites in Africasites in Africa

South Africa 8

Kenya 5

Mozambique 0

Zimbabwe 1

Tanzania 2

Sudan 5

Ghana 1Nigeria 2

Rwanda 1

Djibouti 1


Research topics and health problemsResearch 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


Research fundingResearch 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


Developing countries dissertation Developing countries dissertation completed and in progresscompleted and in progress

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


Example Malaria (3 PhDs) Example Malaria (3 PhDs)


0.1

1.0

3.0

2.0

China

N.America & Europe

Africa

Ann

ual D

eath

s fr

om M

alar

ia (

mill

ions

)

(R.Carter,1999)

Central & S.America

Asia

1900 1930 1950 1970 1990 2000

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

The malaria problemThe malaria problem

Health Education and PromotionInsecticide-treated bednets (ITNs) for malaria Insecticide-treated bednets (ITNs) for malaria controlcontrol

Alaii JA,

Kenya Medical Research Institute,

Centers for Disease Control and Prevention, Atlanta, GA.

CAPHRI, Maastricht University, NL.


• rural area• 200km2 N.E. of L. Victoria• population ~60,000• 96% Luo ethnic group

• perennial malaria transmission

KEMRI

Kisumu

KENYA

Lake Victoria

Equator

N

EW

S

To Busia

Siaya

Bondo KisumuASEMBO

The study locationThe study location

Health Education and PromotionHomestead: close rangeHomestead: close range


Health Education and Promotion Effect of insecticide-treated bednets on malariaEffect of insecticide-treated bednets on malaria

Lengeler C, et al., 1998.

Gambia23%

Ghana18%

Burkina Faso14%

coastal Kenya 29%

Health Education and PromotionStudy objectivesStudy 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


Socio-behavioral studiesSocio-behavioral studies

S lee pinga rran gem e n ts*

Im p lem enta tionspot-checks***

P a rticip ato rym on itoring *

Form ative eva luative(D iffusion of

Innovations Theory)

P re- a nd po st-ITNK A P B **

H ealth edu ca tioncove ra ge **

A ssessing know ledge(Theory of

P lanned Behaviour)

Q uarte rly pre-d awnspot-checks**

E lic ita tionin terv ie ws*

C h ild sk illtra in ing ***

A dherence proper(Socia l C ognitive Theory,

S tages of C hange)


• 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

Health Education and PromotionMalaria knowledge including care seekingMalaria 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

Health Education and PromotionAdherence studyAdherence 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

Health Education and PromotionA section ofA section of traineestrainees

Health Education and PromotionTools of the trade: mat, net, twineTools of the trade: mat, net, twine

Health Education and PromotionThe pre-training and evaluation interviewsThe pre-training and evaluation interviews

Health Education and PromotionOkay, let’s see you sort out the toolsOkay, let’s see you sort out the tools

Health Education and PromotionThis is how I want it spread outThis is how I want it spread out

Health Education and PromotionNet too high up…checking where we went wrongNet too high up…checking where we went wrong

Health Education and PromotionHere we go again…sorting out the toolsHere we go again…sorting out the tools

Health Education and PromotionNotice how high up the mounting point isNotice how high up the mounting point is

Health Education and PromotionThe fully mounted and spread netThe fully mounted and spread net


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


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

Health Education and PromotionTOWARDS MALARIA ELIMINATION: AN TOWARDS MALARIA ELIMINATION: AN INTEGRATED COMMUNITY-BASED APPROACH INTEGRATED COMMUNITY-BASED APPROACH

TO MALARIA CONTROL (Rwanda)TO MALARIA CONTROL (Rwanda)

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.


Relevance for developing country: Does Relevance for developing country: Does it work?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?


Sustainability: exampleSustainability: example

Department of Health Promotion Research and Development, Medical Research Council SA


Example of translation into practiceExample 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


Relevance for Maastricht Relevance for Maastricht University/CAPHRIUniversity/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


Continuation of capacity building?Continuation of capacity building?


Thank you

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

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