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Salim Masoud N, Knopp S, Lenz N, Lweno O, Abdul Kibondo U, Mohamed A, Schindler T, Rothen J, Masimba J, S. Mohammed A, Althaus F, Abdulla S, Tanner M, Daubenberger C, Genton B. The impact of soil transmitted helminth on malaria clinical presentation and treatment outcome: A case control study among children in Bagamoyo district, coastal region of Tanzania. PLoS Negl Trop Dis 2024; 18:e0012412. [PMID: 39133750 PMCID: PMC11341094 DOI: 10.1371/journal.pntd.0012412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/22/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Parasitic infectious agents rarely occur in isolation. Epidemiological evidence is mostly lacking, and little is known on how the two common parasites Plasmodium and soil transmitted helminths (STH) interact. There are contradictory findings in different studies. Synergism, antagonism and neutral effect have been documented between Plasmodium and STH. This study investigated the impact of STH on clinical malaria presentation and treatment outcome. METHODS A matched case control study with a semi longitudinal follow up according to World Health Organization (WHO) antimalarial surveillance guideline was done among children aged 2 months to 9 years inclusively living in western rural areas of Bagamoyo, coastal region of Tanzania. Cases were children with uncomplicated and severe malaria enrolled from the health facilities while controls were children with asymptomatic Plasmodium parasitemia enrolled from the same community. RESULTS In simple conditional regression analysis there was a tendency for a protective effect of STH on the development of clinical malaria [OR = 0.6, 95% CI of 0.3-1.3] which was more marked for Enterobius vermicularis species [OR = 0.2, 95% CI of 0.0-0.9]. On the contrary, hookworm species tended to be associated with increased risk of clinical malaria [OR = 3.0, 95% CI of 0.9-9.5]. In multiple conditional regression analysis, the overall protective effect was lower for all helminth infection [OR = 0.8, 95% CI of 0.3-1.9] but remained significantly protective for E. vermicularis species [OR = 0.1, 95% CI of 0.0-1.0] and borderline significant for hookworm species [OR = 3.6, 95% CI of 0.9-14.3]. Using ordinal logistic regression which better reflects the progression of asymptomatic Plasmodium parasitemia to severe malaria, there was a 50% significant protective effect with overall helminths [OR = 0.5, 95% CI of 0.3-0.9]. On the contrary, hookworm species was highly predictive of uncomplicated and severe malaria [OR = 7.8, 95% (CI of 1.8-33.9) and 49.7 (95% CI of 1.9-1298.9) respectively]. Generally, children infected with STH had higher geometric mean time to first clearance of parasitemia. CONCLUSION The findings of a protective effect of E. vermicularis and an enhancing effect of hookworms may explain the contradictory results found in the literature about impact of helminths on clinical malaria. More insight should be gained on possible mechanisms for these opposite effects. These results should not deter at this stage deworming programs but rather foster implementation of integrated control program for these two common parasites.
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Affiliation(s)
- Nahya Salim Masoud
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
- Department of Pediatrics and Child Health, Muhimbili University Health and Allied Sciences (MUHAS), Dar es Salaam, United Republic of Tanzania
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Stefanie Knopp
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nicole Lenz
- Food Microbial Systems, Risk Assessment and Mitigation Group, Agroscope, Bern, Switzerland
| | - Omar Lweno
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Ummi Abdul Kibondo
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Ali Mohamed
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Tobias Schindler
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
- University of Basel, Basel, Switzerland
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Julian Rothen
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
- University of Basel, Basel, Switzerland
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - John Masimba
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Alisa S. Mohammed
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Fabrice Althaus
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Health Unit, International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - Salim Abdulla
- Bagamoyo Research and Training Centre, Ifakara Health Institute, Bagamoyo, United Republic of Tanzania
| | - Marcel Tanner
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Claudia Daubenberger
- University of Basel, Basel, Switzerland
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Blaise Genton
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
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Kitema GF, Laidlaw A, O'Carroll V, Sagahutu JB, Blaikie A. The status and outcomes of interprofessional health education in sub-Saharan Africa: A systematic review. J Interprof Care 2024; 38:133-155. [PMID: 36739570 DOI: 10.1080/13561820.2023.2168631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/07/2023] [Indexed: 02/06/2023]
Abstract
The increasing burden of chronic diseases, and shortage of health care workers especially in Low and Middle Income countries (LMICs) requires greater collaborative working between health professions. There is a growing body of evidence that interprofessional education (IPE) and interprofessional continuous education (IPCE) can improve collaborative practice thus strengthening health care delivery in low resource settings. The World Health Organization (WHO) promotes this educational strategy in these regions as part of wider programs to improve health care. The purpose of this systematic review was to summarize IPE and IPCE activities in sub-Saharan Africa (SSA) and its outcomes; including practice, service and patient outcomes. Standard guidelines for conducting and reporting systematic reviews were followed. The online databases searched included MEDLINE, Embase, Education Resources Information Centre (ERIC), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Science Direct. The Kirkpatrick model was used to classify IPE outcomes reported from literature. Following full text screening, 41 articles were selected for data extraction. It was found that IPE/IPCE is still a relatively new concept in SSA with 93% of studies published after 2012. Furthermore, IPE is concentrated predominantly in undergraduate institutions and mainly implemented to improve collaborative practice and address important public health concerns. Positive reaction and outcomes of IPE/IPCE were reported in terms of change of attitude and perception toward collaborative practice as well as knowledge and skills acquisition. Few studies in SSA sought to understand and measure the outcomes of IPE/IPCE relating to health care practice. More work in this important potential outcome of IPE/IPCE is recommended.
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Affiliation(s)
| | - Anita Laidlaw
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, UK
| | | | - Jean Baptiste Sagahutu
- School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Andrew Blaikie
- School of Medicine, University of St-Andrews, Scotland, UK
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Tarimo CN, Kapanda GE, Muiruri C, Kulanga AT, Lisasi E, Mteta KA, Kessi E, Mogella D, Venance M, Rogers T, Mimano L, Bartlett J. Building Clinical Clerkships Capacity in a Resource-limited Setting: The Case of the Kilimanjaro Christian Medical University College in Tanzania. Ann Glob Health 2018; 84:129-138. [PMID: 30873784 PMCID: PMC6748287 DOI: 10.29024/aogh.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The shortage of medical doctors in sub-Saharan Africa (SSA) has resulted in increased enrolment in medical schools, which has not been matched with increased faculty size or physical infrastructure. This process has led to overcrowding and possibly reduced quality of training. To reduce overcrowding at its teaching hospital, the Kilimanjaro Christian Medical University College introduced eight-week peripheral clerkship rotations in 2012. We explore students' perceptions and attitudes towards peripheral hospital placements. METHOD The clerkship rotations were conducted in eight hospitals operating in the northern Tanzania, after evaluating each hospitals' capabilities and establishing the optimum number of students per hospital. Paper-based surveys were conducted after student rotations from 2014 to 2016. RESULTS Overall student satisfaction was moderate (strength of consensus measure (sCns), 77%). The three cohorts exhibited improving trends over three years with respect to satisfaction with clinical skills and attitude towards placements. student-preceptor interaction was rated highly (sCns 81-84%). The first cohort students expressed concerns about limited laboratory support, and poor access to Internet and learning resources. Specific interventions were undertaken to address these concerns. CONCLUSIONS Student experiences in peripheral rotations were positive with adequate satisfaction levels. Opportunities exist for medical schools in SSA to enhance clinical training and relieve overcrowding through peripheral clerkship rotations.
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Affiliation(s)
| | | | - Charles Muiruri
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US
| | - Ahaz T Kulanga
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - Esther Lisasi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,University of Cape Town, ZA
| | - Kien A Mteta
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Moshi, TZ
| | - Egbert Kessi
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | | | - Maro Venance
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Temu Rogers
- Kilimanjaro Christian Medical University College, Moshi, TZ.,Kilimanjaro Christian Medical Centre Medical, TZ
| | - Lucy Mimano
- Kilimanjaro Christian Medical University College, Moshi, TZ
| | - John Bartlett
- Kilimanjaro Christian Medical, Centre Medical Education Partnership Initiative, Durham, North Carolina, US.,Medicine, Global Health, and Nursing, Duke University, US
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Owusu Y, Medakkar P, Akinnawo EM, Stewart-Pyne A, Ashu EE, Hammond R, Plata J, Pierre K, Farag E. Emigration of skilled healthcare workers from developing countries: can team-based healthcare practice fill the gaps in maternal, newborn and child healthcare delivery? Int J MCH AIDS 2017; 6:130-138. [PMID: 29367888 PMCID: PMC5777387 DOI: 10.21106/ijma.204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND INTRODUCTION Emigration of healthcare workers from developing countries is on the rise and there is an urgent need for policies that increase access to and continuity of healthcare. In this commentary, we highlight some of the negative impacts of emigration on maternal and child health and discuss whether team-based healthcare delivery could possibly mitigate the shortfall of maternal and child health professionals in developing countries. METHODOLOGY We cross-examine the availability of supporting structures to implement team-based maternal and child healthcare delivery in developing countries. We briefly discuss three key supporting structures: culture of sharing, telecommunication, and inter-professional education. Supporting structures are examined at system, organizational and individual levels. We argue that the culture of sharing, limited barriers to inter-professional education and increasing access to telecommunication will be advantageous to implementing team-based healthcare delivery in developing countries. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS Although most developing countries may have notable supporting structures to implement team-based healthcare delivery, the effectiveness of such models in terms of cost, time and infrastructure in resource limited settings is still to be evaluated. Hence, we call on usual stakeholders, government, regulatory colleges and professional associations in countries with longstanding emigration of maternal and child healthcare workers to invest in establishing comprehensive models needed to guide the development, implementation and evaluation of team-based maternal and child healthcare delivery.
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Affiliation(s)
- Yaw Owusu
- Registered Nurses' Association of Ontario, 158 Pearl St., Toronto, Ontario, CANADA M5H-1L3
| | - Prerana Medakkar
- York University, 158 St. George Street, Toronto, ON, M5S 2V8 CANADA
| | - Elizabeth M Akinnawo
- GlaxoSmithKline, 7333 Mississauga Road North, Mississauga, Ontario, L5N 6L4, CANADA
| | - Althea Stewart-Pyne
- Registered Nurses' Association of Ontario, 158 Pearl St., Toronto, Ontario, CANADA M5H-1L3
| | - Eta E Ashu
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., PO Box 234, Riverdale, Maryland 20738, USA
| | - Rodney Hammond
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
| | - Jesus Plata
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
| | - Kimberly Pierre
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
| | - Ehsan Farag
- Department of Public Health, Montclair State University, 1 Normal Avenue, University Hall Room 4162, Montclair NJ 07043, USA
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Loukanova S, Prytherch H, Blank A, Duysburgh E, Tomson G, Gustafsson LL, Sié A, Williams J, Leshabari M, Haefeli WE, Sauerborn R, Fonn S. Nesting doctoral students in collaborative North-South partnerships for health systems research. Glob Health Action 2014; 7:24070. [PMID: 25030216 PMCID: PMC4101456 DOI: 10.3402/gha.v7.24070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The European Union (EU) supports North-South Partnerships and collaborative research projects through its Framework Programmes and Horizon 2020. There is limited research on how such projects can be harnessed to provide a structured platform for doctoral level studies as a way of strengthening health system research capacity in sub-Saharan Africa (SSA). OBJECTIVE The aim of this study was to explore the challenges of, and facilitating factors for, 'nesting' doctoral students in North-South collaborative research projects. The term nesting refers to the embedding of the processes of recruiting, supervising, and coordinating doctoral students in the overall research plan and processes. DESIGN This cross-sectional qualitative study was undertaken by the EU-funded QUALMAT Project. A questionnaire was implemented with doctoral students, supervisors, and country principal investigators (PIs), and content analysis was undertaken. RESULTS Completed questionnaires were received from nine doctoral students, six supervisors, and three country PIs (86% responses rate). The doctoral students from SSA described high expectations about the input they would receive (administrative support, equipment, training, supervision). This contrasted with the expectations of the supervisors for proactivity and self-management on the part of the students. The rationale for candidate selection, and understandings of the purpose of the doctoral students in the project were areas of considerable divergence. There were some challenges associated with the use of the country PIs as co-supervisors. Doctoral student progress was at times impeded by delays in the release of funding instalments from the EU. The paper provides a checklist of essential requirements and a set of recommendations for effective nesting of doctoral students in joint North-South projects. CONCLUSION There are considerable challenges to the effective nesting of doctoral students within major collaborative research projects. However, ways can be found to overcome them. The nesting process ultimately helped the institutions involved in this example to take better advantage of the opportunities that collaborative projects offer to foster North-South partnerships as a contribution to the strengthening of local research capacity.
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Affiliation(s)
- Svetla Loukanova
- Department of Public Health, University of Heidelberg, Heidelberg, Germany;
| | - Helen Prytherch
- Department of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, Internal Medicine Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Els Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Göran Tomson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden; Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Melkizedeck Leshabari
- Department of Behavioral Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Internal Medicine Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Sauerborn
- Department of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Sharon Fonn
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Teaching and educational scholarship in Tanzania: faculty initiative to improve performance of health professions' students. J Public Health Policy 2013; 33 Suppl 1:S150-70. [PMID: 23254841 DOI: 10.1057/jphp.2012.45] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Well-educated and competent health professionals influence the health system in which they work to improve health outcomes, through clinical care and community interventions, and by raising standards of practice and supervision. To prepare these individuals, training institutions must ensure that their faculty members, who design and deliver education, are effective teachers. We describe the experience of the Muhimbili University of Health and Allied Sciences (MUHAS) in encouraging improvements in the teaching capacity of its faculty and postgraduate students triggered by a major institutional transition to competency-based education. We employed a multi-stage process that started by identifying the teaching and learning needs and challenges of MUHAS students and faculty. Collaborating with the University of California San Francisco (UCSF), MUHAS responded to these needs by introducing faculty to competency-based curricula and later to strategies for long term continuing improvement. We demonstrate that teaching faculty members are keen for local institutional support to enable them to enhance their skills as educators, and that they have been able to sustain a program of faculty development for their peers.
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Partnering on education for health: Muhimbili University of Health and Allied Sciences and the University of California San Francisco. J Public Health Policy 2013; 33 Suppl 1:S13-22. [PMID: 23254839 DOI: 10.1057/jphp.2012.40] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In 2005, Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania and the University of California San Francisco (UCSF) in the United States joined to form a partnership across all the schools in our institutions. Although our goal is to address the health workforce crisis in Tanzania, we have gained much as institutions. We review the work undertaken and point out how this education partnership differs from many research collaborations. Important characteristics include: (i) activities grew out of MUHAS's institutional needs, but also benefit UCSF; (ii) working across professions changed the discourse from 'medical education' to 'health professions education'; (iii) challenged by gaps in our respective health-care systems, both institutions chose a new focus, interprofessional team work; (iv) despite being so differently resourced, MUHAS and UCSF seek strategies to address growing class sizes; and (v) we involved a wider range of people - faculty, administrators, students, and residents - at both institutions than is usually the case with research. This partnership has convinced us to exhort other academic leaders in the health arena to seek opportunities together to enlighten and enliven our educational enterprises.
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