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Archive for "Learning/Training"



Education &Health Education &Learning/Training &Mentoring &Nigeria Bill Brieger | 29 Dec 2020

Prof Adetokunbo O Lucas, 1931-2020, Public Health and Tropical Disease Pioneer

Forty-five years ago, this week I arrived in Ibadan Nigeria to visit my MPH classmate, Joshua Adeniyi, and meet the faculty of the newly established African Regional Health Education Centre (ARHEC). A highlight of those meetings was seeing Prof Ade Lucas who as head of the Department of Preventive and Social Medicine (PSM), which housed ARHEC), had supported the partnership of the University of Ibadan, Federal Ministry of Health, and the World Health Organization that created ARHEC as the first Africa-based professional postgraduate training program in public health education. Prof Lucas had created a multidisciplinary environment where Public Health Education could thrive.

I was convinced to join the faculty of OSM and ARHEC, and by the time I returned in October 1976, Prof Lucas had taken up the directorship of The Special Program of Research and Training in Tropical Diseases (TDR), which was initially sponsored by WHO, the World Bank and UNDP. Fortunately, Prof Lucas continued to mentor the ARHEC faculty and by encouraging us to apply for TDR grants ensured that I was well on my way in building a career around social and behavioral interventions to control tropical diseases.

Unfortunately, Prof Lucas left us finally on 25 December 2020. Below are the postings of colleagues to commemorate his life. Idowu Olayinka of the Nigerian Academy of Science outlined some of the many accomplishments of Prof Lucas as follows:

  • He was an outstanding medical scientist.
  • Former Professor and Head Department of Preventive and Social Medicine at the University of Ibadan.
  • Founding Director, WHO Special Programme for Research and Training in Tropical Diseases.
  • Former Programme Chair, Carnegie Foundation.
  • Former Professor of International Health, Harvard University.
  • He was the first person ever to receive, in 1995, the highest academic honour of the University of Ibadan, Honorary Fellowship of UI, FUI.

The Provost of the College of Medicine, University of Ibadan, Prof Olayinka Omigbodun adds more to the list. “His achievements and accomplishments are too numerous to list here. These have been documented very well in many books, reports, and newspapers. He was the author of numerous books and articles in refereed public health journals. He was an author of many books including “A Short Textbook of Preventive Medicine for the Tropics”. Books have been written about him including his own autobiography (It Was the Best of Times: From Local to Global Health (2010,” and a biography “The Man: Adetokunbo Lucas” (2011).”

“A recipient of many honorary degrees from Emory University, Tulane University, and University of Ibadan he was also a recipient of academic honors from Harvard where he was a professor of Public health, he was bestowed with numerous awards including Prince Mahidol Award (1999), the Centenary Medal for Life-Time Achievements in Tropical Medicine (2007) and from the National Foundation for Infectious Diseases (NFID) (5 March 2013), to name a few.”

“There can be no question about Prof Lucas being a distinguished teacher of many students was who have become distinguished in their own rights. He was a global leader in Medical Research that has impacted many populations, especially in Africa. The footprints are notable and impactful.”

“When my children and grandchildren ask me who my best teachers while in the Medical School (or thereafter) were, I always list some top 10 teachers to those who imparted knowledge, affected my ambition to be “like them”, impressed me with statements and instructions that continued to ring in my ears till today, or demonstrated acts of exemplary kindness and character, indicated personal interest in my progress and success in life, and showed loving friendship to someone who was once their student or junior colleague. Professor Lucas was one of them.” The Provost refers people to a memorial website that has been created to share tributes, photographs and other memories.

Colleagues who worked with Professor Lucas in TDR or knew him because of TDR have shared their reflections. Jamie Guth said, “Prof Lucas was an amazing man. I felt privileged to have known him and experience the impact of what he started with TDR at WHO – now several generations of top scientists across Africa and many other countries finding solutions to infectious diseases.”

Jane Kayondo Frances Kengeya reacted with, “A giant has fallen. His legacy will live on through those he taught, mentored, influenced, supported and loved. Let’s celebrate his life and thank God that we had a chance to know him. May his soul Rest In eternal peace. May his family and close friends receive the grace to endure the loss.”

Mohamnadou Jabur Cham, observed that, “His contributions to the RCS within TDR were not only impressively significant but indeed phenomenal. An envious legacy especially for young scientists from disadvantaged countries. Adieu Prof. till we meet again.”

We trust that the legacy of Professor Ade Lucas will live on in the many people he has taught and mentored and the many careers he has helped launch in public health, preventive medicine and tropical disease control.

Diagnosis &Learning/Training &Microscopy Bill Brieger | 22 Nov 2019

Intensive Malaria Microscopy Training in Rwanda

Noella Umulisa, Veneranda Umubyeyi, Tharcisse Munyaneza, Ruzindana Emmanuel, Aline Uwimana, Stephen Mutwiwa, and Aimable Mbituyumuremyi presented “Assessment of Competence of Participants Before and After 6-day Intensive Malaria Microscopy Training in Rwanda” at the 68th Annual Meeting of the American Society of Tropical Medicines and Hygiene. (Affiliations: Maternal and Child Survival Program/Jhpiego, Malaria and Other Parasitic Diseases Division [Mal & OPDD], National Reference Laboratory, Rwanda Biomedical Centre [RBC]). Their findings are shared below.

WHO recommends prompt malaria diagnosis either by microscopy or malaria rapid diagnostic test (RDT) in all patients with suspected malaria before treatment is administered. Light Microscopy remains the mainstay of malaria diagnosis, allows the identification of different malaria-causing parasites (P. falciparum, P. vivax, P. malariae and P. ovale). It is estimated that a diagnostic test with 95% sensitivity and 95% specificity requiring minimal infrastructure would avert more than 100,000 deaths and about 400 million unnecessary treatments. Frequent delays occur since conventional microscopy methods are labour intensive, require skilled manpower and time

Sufficient training of laboratory staff is paramount for the correct microscopy diagnosis of malaria. In Rwanda, P. falciparum is by far the most common contributing 97-99% of the parasite population, followed by P. ovale with 0.5-2% and followed by P. malariae 0.5–1% as mono-infection.

Rwanda has 8 referral hospitals, 4 provincial hospitals, 36 district hospitals, 504 health centers, 818 health posts and 30,000 CHWs able to perform malaria diagnostics. Each of these health facilities has a laboratory able to perform malaria microscopy with at least 1 trained lab technician and 1 functioning microscope.

In May 2018, the Rwanda Biomedical Center and partners trained 1 lab technician per health center from 6 poor performing districts in malaria microscopy. The main objective was to evaluate the performance of laboratory technicians in detecting and quantifying malaria parasites from 75 health facilities within 6 districts in Rwanda. Information was collected at two points in time.

In Month 1 there were a Pre-Test for Theoretical and practical evaluation, a Practical session, Slides preparation practice, and detection of parasite’s density and species. This was followed by the Post-Test, again a Theoretical and practical evaluation

In Month 4 Post training follow up was conducted with 35 randomly selected trained lab technicians after 4 months. Observation of technicians’ Conduct visual inspection and maneuvers used in routine malaria diagnosis was done. Their ability to Detect parasites on a standardized pre-validated slide panel of five slides was determined. during this 4 Months Post-Training Species Detection Performance, P. Falciparum was identified correctly more often than P. ovale or P. malariae.

The attached charts show the results of training. During the training 75 technicians from 75 health centers in 6 districts were trained from May 28th–June 18th, 2018. 53% of the trained lab technicians were female and 47% male.

Correct Parasite Density was slightly higher just after training. Classic training improved the performance of lab technicians in parasite’s density from 53% to 87% immediately after training.

After 4 months of training, P. falciparum and P. ovalae were correctly detected by 93% and 79% of lab technicians, respectively. Also, after 4 months of training, P. malariae was detected only by 68% of evaluated lab technicians. Training: Sensitivity (99%) and specificity (85%) remain high. Performance of lab technicians assessed using standardized pre-validated slide panel as gold standard after >4 months

Trainings of lab technicians improves performance on malaria parasites density and species detection. P. falciparum is the most well detected species followed by P. ovale . The detection rate for P. malariae was the lowest, this can be explained by the fact is not often seen in Rwanda. Participants had high sensitivity and specificity in the detection of malaria parasites.

Continuous capacity building for lab staff is needed to ensure accurate malaria laboratory diagnosis for appropriate treatment. Malaria microscopy diagnosis quality control/assurance activities from central and district level to health center level should be strengthen for continuous capacity building of lab technicians

Acknowledgements: This poster was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Cooperative Agreement AID-OAA-A-14-00028. The contents are the responsibility of the Maternal and Child Survival Program and do not necessarily reflect the views of USAID or the United States Government.

Capacity Building &Human Resources &Learning/Training &Research Bill Brieger | 19 Apr 2018

MIM – Fostering the next generation of malaria researchers in Africa – gaps and emerging opportunities

Dr Olumide Ogundahunsi of the of the Unicef-UNDP-World Bank-WHO Tropical Disease Research Program (best known as TDR) helped organize a symposium on the history and future goals of the Multilateral Initiative for Malaria (MIM) at the current MIM Conference. He describes the symposium, efforts to launch a MIM Society, and related issues below.

Dakar is hosting the 7th Multilateral Initiative for Malaria (MIM) Pan Africa Malaria Conference 21 years after the first such gathering of malaria researchers in the city in 1997. At that time Northern research and development organizations including NIH/Fogarty, WHO/TDR, Wellcome Trust, SIDA and others sought to take measure of the malaria research experience and needs of African scientists and scientific institutions. It was challenging at that time to find strong and representative core of malaria researchers across the continent. Arising from that first conference was the development of MIM and a plan for building the capacity of African researchers through a series of malaria research grants that included both postgraduate training as well as support for applying the acquired skills in undertaking malaria research.

Dr John Reeder, Director of TDR and Prof Fred Binka

Between 1997 and 2007 MIM supported Fifty six (56) research capacity strengthening (RCS) grants through the Special programme for research and training in Tropical diseases (TDR) for an aggregate amount of $12.9 million from 1997 to 2007.  The grants responded to basic gaps in capacity, research tools/commodities/supplies and communication. The latter reflected a major need for researchers to connect with the global malaria research community to learn and share.

These grants under the aegis of the MIM/TDR task force on Malaria RCS addressed the following broad research themes: Pathogenesis and Immunology of Malaria, malaria vector control (including insecticide resistance), Chemotherapy and antimalarial drug resistance, research and development of new tools from natural products, and research to facilitate malaria control interventions. At the Symposium Representatives of the 56 MIM grantees from West, Central, East and Southern Africa shared experiences during and after completion of their MIM grant. These included –

  • Professor Francine Ntoumi, Malaria immunology and pathogenesis research capacity in Central Africa, University Marien Ngouabi, Brazzaville, Republic of Congo
  • Professor Lizette Koekemoer, Malaria vector research capacity in Africa, University of the Witwatersrand, Johannesburg, South Africa
  • Professor Abdoulaye Djimde, Malaria treatment and antimalarial drug resistance in West Africa., Univerity of Bamako, Bamako, Mali
  • Professor Wilfred Mbacham, Malaria treatment and antimalarial drug resistance in Central Africa, Univeristy of Younde 1, Younde, Cameroon
  • Professor Kwadwo Koram, Malaria epidemiology research capacity for elimination and control in Africa, Noguchi Memorial Institute for Medical Research and University of Ghana,  Accra, Ghana

These speakers demonstrate MIM’s and their own specific achievements in following areas:

  • -Capacity built with infrastructure, technology transfer, skill acquisition and graduate students and postdocs trained (including their current status/subsequent contribution to malaria research and (or) control)
  • -Resources/other grants leveraged
  • -Collaborations established and sustained
  • -Contributions to national and regional malaria research capacity, control and elimination.

MIM ‘alumni’ speaking at the Symposium

Since that time those receiving the MIM RCS were able to benefit from further TDR and other malaria research grants and in the process have themselves helped develop new generations of malaria scientists in the universities and institutes where they work. MIM has continued to address the original research gaps. The holding of six subsequent Pan-African conferences.  Grants were also provided for establishing satellite communications systems at three institutions where grantees were based.

Participants in this process who attended the current conference (MIM2018) were able to help achieve on of the objectives of the symposium that is “highlighting the importance of continuous investment in training and monitoring of young African scientists.” The symposium also articulated the unmet and emerging gaps in research capacity of particular relevance to malaria control and elimination.

Visiting the TDR booth to discuss MIM experiences and research opportunities

MIM started and continues as a partnership among Northern and African research organizations with a rotating secretariat. For the past 10 years the MIM secretariat has been based in Africa, and most recently in Cameroon in the Biotechnology Centre of the University of Yaoundé.

Going forward the MIM is evolving into the MIM Society, a broad-based society which will focus among others on organizing regular MIM conferences, promoting research capacity strengthening and foster and unite the different initiative on the continent and worldwide. The MIM society will also invigorate the young African scientist to emerge as outstanding researchers and leaders with ground breaking innovation in science and its applications to development.

The MIM Society will be a global non-profit organization whose mission is to unite all human resources, young and experienced, working on malaria (from researchers over implementers, teachers, producers, funders, policy makers) to strengthen and sustain the capacity of malaria affected countries and to be an umbrella organization for all malaria related initiatives. The MIM Society through its members will guarantee capacity building goals for malaria researchers set by MIM 20 years ago will be carried forward for another 20 years and more.

Diagnosis &Health Workers &Learning/Training Bill Brieger | 05 Nov 2017

Performance assessment of laboratory technicians on Malaria Microscopy in 5 high endemic districts of Rwanda

Parasitological diagnosis plays an increasing role in malaria control and elimination. Noella Umulisa, Angelique Mugirente, Tharcisse Munyaneza, Aniceth Rucogoza, Aline Uwimana, Beata Mukarugwiro, Stephen Mutwiwa, Aimable and Mbituyumuremyi of the
Maternal and Child Survival Program, Jhpiego, the National Reference Laboratory, Rwanda Biomedical Centre (RBC), and the Malaria and Other Parasitic Diseases Division (Mal & OPDD) in Rwanda will present their experiences building the capacity of lab technicians during Session 47 at the American Society of Tropical Medicine and Hygiene Annual Meeting on 6 November 2017.  Their abstract is found below.

Accurate malaria diagnostics help to establish the true prevalence of each Plasmodium species and can ensure appropriate treatment. Light microscopy is the gold standard for malaria diagnosis and sufficient training of laboratory staff is paramount for the correct microscopy diagnosis of malaria. In Rwanda each of about 400 health centers has a laboratory able to perform malaria microscopy, at least 2 trained lab technicians and 1 to 2 functioning microscopes.

The objective of the study is to evaluate the performance of laboratory technicians in detecting and quantifying malaria parasites in 81 health centers from 5 highly endemic districts (Huye, Nyanza, Ngoma, Kirehe, Kayonza, Gatsibo). In October 2015 the Rwanda Biomedical Center and partners trained 1 lab technician per health center from these districts in malaria microscopy.

The training emphasized determining parasite density and detection of malaria species. From August to September 2016 a follow-up assessment was conducted. Of the 81 technicians trained, 30 were randomly chosen and assessed at their health facilities.

A standardized pre-validated slide panel of 5 slides was distributed, a comprehensive checklist used to collect information and conduct visual inspection and maneuvers used in routine malaria diagnosis. During the training a significant increase was found between pre and post tests with median scores improving from 47% to 85%.

As part of the assessment 150 lab tech-prepared slides were analyzed to evaluate the quality of thick and thin blood smears. There was a significant increase in quality of both blood smear types. The sensitivity and specificity of participants in detection of malaria parasites were 100% and 86% respectively, while species identification and parasite quantification accuracy were 79% and 75% respectively.

The findings of this assessment support the need for continuous capacity building for laboratory staff to ensure accurate malaria diagnosis for appropriate treatment and suggest that District hospitals may benefit from conducting regular malaria microscopy diagnosis quality control/assurance activities at health center laboratories.

Learning/Training &Malaria in Pregnancy &Partnership &Strategy Bill Brieger | 05 Feb 2014

Jhpiego at 40 – commitment to malaria prevention and control in Burkina Faso

Jhpiego 40th Anniversary celebration in Ouagadougou with First Lady, US Ambassador, Minister for Health and Jhpiego's President and Vice President

Jhpiego 40th Anniversary celebration in Ouagadougou with First Lady, US Ambassador, Minister for Health and Jhpiego’s President and Vice President

Jhpiego was founded in 1973 to provide technical assistance to countries where the risk of maternal mortality and morbidity was quite high.  While focusing on local capacity building from the start, Jhpiego’s model for technical assistance has evolved.  Burkina Faso first benefitted in 1983 by having health staff attend intensive training at Johns Hopkins Hospital.  Subsequently Jhpiego’s work moved to the field, and some of the early trainees became staff on the ground.

Jhpiego established an office in Ouagadougou in 1996, and one of the earliest projects focused on malaria in pregnancy as part of USAID’s flagship program “Maternal and Neonatal Health” (MNH).  It was during that time that Jhpiego collaborated with partners like CDC to do some of the early testing of the intermittent preventive treatment of malaria in pregnancy (IPTp) in West Africa.  The results of this life-saving intervention were published in the American Journal of Tropical Medicine and Hygiene.

Jhpiego continued to provide technical assistance on malaria in pregnancy interventions and capacity building to the Ministry of Health (MOH) in Burkina Faso through the MNH project and into its successor, USAID’s ACCESS project. Jhpiego worked with partners to update malaria guidelines, training materials, supervisory tools and job aids during this period.

Cover Page Directives finalisées du 23 5 2013In 2009 USAID presented the Maternal and Child Health Integrated Project (MCHIP) with the opportunity to carry out an integrated package of malaria care and prevention strengthening with the MOH and particularly the National Malaria Control Program (NMCP). Over a period of three years Jhpiego, the lead organization in MCHIP, working with together with partners from the NMCP and MOH, was able to accomplish among others the following:

  • Updating Malaria policy and guidelines
  • Updating Malaria supervisory tools and training of supervisors
  • Updating In-service training materials on malaria and training of health facility staff
  • Developing a Strategic communications plan and strategy for malaria
  • Forming of curriculum update committee on malaria at national training schools for primary health staff
  • Training of US Peace Corps Volunteers to support malaria activities in their communities
  • Building the capacity and organizational strengthening for the NMCP itself
  • Conducting a situation analysis of rapid diagnostic test acceptance and use
  • Undertaking a health systems analysis of the strengths and bottlenecks of malaria program implementation in Burkina Faso

Jhpiego 40th Malaria BoothLast week, the Burkina Faso office of Jhpiego hosted the organization’s African Malaria Technical Update Workshop with staff from 15 countries participating. Today Jhpiego is taking its 40th Anniversary celebrations to Ouagadougou.  Jhpiego will express appreciation to local partners in the fight against malaria and threats to maternal and child health.

Jhpiego has been committed on the ground in Burkina Faso to building national capacity for controlling malaria specifically for over 15 years. The recent award by USAID of its bilateral program “Improving Malaria Care” to Jhpiego last October cements Jhpiego’s commitment to the country and to reducing malaria for another five years.

Corruption &Learning/Training Bill Brieger | 26 Dec 2010

Global Fund – timely oversight or trigger happy

In the past year the Global Fund to fight AIDS, TB and Malaria (GFATM) has suspended grants in Mauritania, The Philippines, Zambia, and Mali. In fact one grant to Mali was terminated. Efforts to identify high risk grants are underway.
Some are saying that the Office of the Inspector General (OIG) of GFATM is finally showing some teeth, while others worry that actions to suspend and terminate will harm the very persons that the Global Fund was set up to help. At the recent 22nd GFATM Board Meeting the Executive Director provided the following comments based on OIG work:

  • Based on recent OIG findings in a number of countries, activities involving cash transfers for training events and associated costs, including per diems, travel, meal and expense payments, are in many cases posing a high risk of misuse
  • The OIG has identified five countries where measures to protect Global Fund-financed drug shipments from theft need to be implemented
  • The Secretariat and OIG agree that LFAs have not been sufficiently focused on the identification of fraud risks and actual fraud in Global Fund-financed programs, and may not currently have the capacity to address these risks

Prior to the recent Board meeting, one wonders whether the communication between the Secretariat, the Executive Director and the Office of the Inspector General were clear and efficient. A 6th December 2010 memo entitled “Joint communication on Inspector General matters” mentioned that, “The Inspector General and the Executive Director of the Global Fund have initiated sincere effort towards collaboration to follow up on recent findings by the Inspector General as well as to take steps to permanently strengthen grant oversight.”

The memo concluded that, “The Global Fund, by nature of its mandate, sometimes has to work with entities with weak programmatic and financial capacity, and to operate in environments where there may be a paucity of financial controls and lack of oversight systems. The Global Fund’s risk management systems are constantly improving. Recently discovered fraud has made the Secretariat determined to redouble its efforts to improve these systems.”

In some cases of suspended grants the Global Fund is looking for alternative Principal Recipients to manage the funds or find alternatives to ensure services to those in need do not cease to be served.  The concern about the Local Fund Agents is valid since the Global Fund, unlike other international agencies, does not have country offices or provide technical assistance.

Several years ago I worked with a team in Nigeria to design and deliver adolescent and youth peer education on reproductive health through community based organizations (CBOs). The initial effort focused on how to organize and train peer educators and the technical aspects of reproductive health. Eventually it became obvious when one CBO leader was using her personal bank account to keep project funds that the local CBOs needed as much technical assistance in establishing and maintaining proper financial and accounting procedures as they did in organizing peer based reproductive health education.

The Global Fund operates in a scale thousands of times larger that our small peer education projects, but the basic principle remains. Don’t condemn local organizations for poor financial performance if you did not try to help them develop better financial and accountability procedures in the first place.

Currently 22% of grants are considered to be poor performers. Too much is at stake in reaching 2015 and beyond to simply say to poor performers, “sorry, your funds are suspended.”

Learning/Training &Monitoring Bill Brieger | 24 Apr 2009

eLearning – prepare yourself to count malaria out

In order to count malaria out we need to learn as much as possible about the design and management of malaria control programs, especially setting up a functional monitoring and evaluation (M&E) system from which health workers, program managers and policy makers can learn and then plan improvements.

intro-w-logo-sm.jpgUSAID’s Global Health eLearning Center is a great free online resource for agency staff and health team members to learn about maternal and child health issues, including malaria. Registration is free, and the format does not require much bandwidth, so should be more accessible to learners in developing countries.  As of World Malaria Day – 25 April 2009 – the 29th course will be added to the curriculum, that is a six-module learning activity on malaria in pregnancy (MIP) developed by Jhpiego.  This compliments the existing general malaria course available on the site.

Global Health eLearning was originally designed to help update the knowledge of USAID health, population and nutrition staff. The website now has over 30,000 registered learners, and 80% of those are not directly affiliated with USAID. This means that the courses are filling a continuing education need for a wide variety of people.  Eventually there may be up to 50 courses, which may be organized into focused learning packages.

Another useful free eLearning site is he Open Course Ware (OCW) program of the Johns Hopkins Bloomberg School of Public Health. Lecture materials from approximately 80 of the School’s courses is available consisting of slides, handouts and other resources.  The course on Malariology

Presents issues related to malaria as a major public health problem. Emphasizes the biology of malaria parasites and factors affecting their transmission to humans by anopheline vectors. Topics include host-parasite-vector relationships; diagnostics; parasite biology; vector biology; epidemiology; host immunity; risk factors associated with infection, human behavior, chemotherapy, and drug resistances; anti-vector measures; vaccine development; and management and policy issues.

Jhpiego has a Malaria in Pregnancy Resource Package (MRP) online.  The MRP contains all the materials needed to conduct training on malaria in pregnancy including a facilitator’s guide, sample slides, a brief tutorial, job aids and other reference documents. The training materials emphasize the M&E component of MIP service delivery.

Another key online learning resource is the Roll Back Malaria Toolbox. One can download a number of reference materials for planning and implementing M&E components to all aspects of malaria control services.

There is no excuse not to keep up-to-date on malaria control with all the free eLearning materials available online. Please share with us additional sources and links that foster eLearning on malaria.