Health Education and Promotion
Health Promotion capacity building through PhD
training in developing countries
CAPHRI April 3, 2012
Health Education and Promotion
Content
 Rational,
background and assumptions
 Supervision
 Research topics
 Funding an scholarships
 A sample of a research theme
 Relevance: does it work?
 Continuation?
Health Education and Promotion
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
Health Education and Promotion
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

Health Education and Promotion
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

Health Education and Promotion
Supervisory team
 Mostly
2 Dutch supervisors (depending on
expertise from UM or different)
 Always one supervisor from developing
country
Health Education and Promotion
Strategies in supervision
 Candidate
prepares proposal (in cooperation with supervisors)
 Provisional publication plan
 Time planning for publications
 Attitudes towards authorship
Health Education and
Promotion
Health
Promotion:
Collaborative sites in
Africa
Sudan 5
Djibouti 1
Rwanda 1
Ghana 1
Nigeria 2
Kenya 5
Tanzania 2
Mozambique 0
Zimbabwe 1
South Africa 8
Health Education and Promotion
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

Health Education and Promotion
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

Health Education and Promotion
Developing countries dissertation
completed and in progress
 Dissertations completed
15
Dissertations in progress 17
 (Dutch Master students 20-25)

Health Education and Promotion
Example Malaria (3 PhDs)
Health Education and Promotion
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
Annual Deaths from Malaria (millions)

Africa
Asia
3.0
China
Central &
S.America
N.America &
Europe
2.0
1.0
0.1
1900
1930
1950
1970
1990
2000
(R.Carter,1999)
Insecticide-treated bednets (ITNs) for malaria
control
Health Education and Promotion
Alaii JA,
Kenya Medical Research Institute,
Centers for Disease Control and Prevention, Atlanta, GA.
CAPHRI, Maastricht University, NL.
The study location
Health Education and Promotion
N
•
•
•
•
rural area
200km2 N.E. of L. Victoria
population ~60,000
96% Luo ethnic group
• perennial malaria transmission
W
To Busia
E
S
Siaya
KEMRI
Bondo
Equator
Kisumu
ASEMBO
Lake Victoria
KENYA
Kisumu
Health Education and Promotion
Homestead: close range
Health Education and Promotion
Effect of insecticide-treated bednets on malaria
Health Education and Promotion
Gambia
23%
Burkina Faso
14%
Ghana
18%
coastal Kenya
29%
Lengeler C, et al., 1998.
Study objectives
Health Education and Promotion







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
Health Education and Promotion
Socio-behavioral studies
Formative evaluative
Assessing knowledge
Adherence proper
(Diffusion of
Innovations Theory)
(Theory of
Planned Behaviour)
(Social Cognitive Theory,
Stages of Change)
Sleeping
arrangements*
Pre- and post-ITN
KAPB**
Quarterly pre-dawn
spot-checks**
Implementation
spot-checks***
Health education
coverage**
Elicitation
interviews*
Participatory
monitoring*
Child skill
training***
Health Education and Promotion
Formative evaluative research
•
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
Malaria knowledge including care seeking
Health Education and Promotion

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
Adherence
study
Health Education and Promotion
 Social factors affecting bednet
use pose major challenge
(sleeping arrangements, family hierarchy systems)
 Mothers sometimes not at
 Mothers to
 “Older”
home to put child to bed
tired to hang nets after work
children (6-12) were not involved in bednet mounting
Health Education and Promotion
A section of trainees
Health Education and Promotion
Tools of the trade: mat, net, twine
Education and Promotion
The Health
pre-training
and evaluation interviews
Okay, let’s see you sort out the tools
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This is how I want it spread out
Health Education and Promotion
Health Education
Promotion
Net too
high andup…checking
where we went wrong
Health Education and Promotion
Here we go again…sorting out the tools
Health Education
Promotion
Notice
howandhigh
up the mounting point is
Education
and Promotion and spread net
TheHealth
fully
mounted
Health Education and Promotion
Were this in the bedroom, I would fold it up like this,
and leave it hung there
Health Education and Promotion
Developing and implementing
appropriate health communication
messages for home management of
fevers, Dangme West, Ghana
(Uncomplicated malaria and Pneumonia)
TOWARDS
MALARIA ELIMINATION: AN
Health
Education and Promotion
INTEGRATED COMMUNITY-BASED APPROACH
TO MALARIA CONTROL (Rwanda)
 Entomological
mosquito’s)
approach (reduction of malaria bearing
 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.
Health Education and Promotion
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?
Health Education and Promotion
Sustainability: example
Department of Health Promotion Research and Development, Medical
Research Council SA
Health Education and Promotion
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
Health Education and Promotion
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

Health Education and Promotion
Continuation of capacity building?
Health Education and Promotion
Thank you