Challenges Facing Surgical Training in the Great Lakes Region in Sub-Saharan Africa: a Review Article

Background: There is a severe shortage of health workers in sub-Saharan Africa yet this subcontinent experiences a significant proportion of the world’s disease burden. This shortage is further reflected in the lack of personnel for surgical sub specialities such as orthopaedics, paediatrics, neurology and urology to mention but a few.Objective: This review therefore sought to summarize the current literature on the state of surgical training in sub Saharan Africa, discuss the  challenges faced and the possible ways to overcome these challengesMethods: We performed online searches of electronic databases i.e. PUBMED, MEDLINE and African Journals online that feature many African Journals not index by the ‘regular’ databases.Results: The searches returned 88 articles and 24 of which were included in the review, we present results focused on; training capacity and methods, scope of practice, technology and surgery, and low research capacity and output.Conclusion: The future of surgical training in Africa will depend on the ability of the leadership to create or and adopt innovative educational technologies, recruit and retain trainers and attract trainees on one hand and on the other, the growth of demand for quality surgical care in the great lakes regions. For those that have excelled in training need to build on those successes and share their stories.Keywords: Surgical Training, challenges, sub- Saharan Afric

Diagnostic accuracy of the Tzanakis score for acute appendicitis in a resource-limited setting: A tertiary hospital-based survey

Background: The management of acute appendicitis remains challenging with high peri-operative morbidity and mortality due diagnostic delay or high negative appendicetomy rates due to aggressive surgical approaches. CT scan is accurate for pre-operative diagnosis but not available or affordable in all settings. There remains a need for an affordable yet accurate tool for diagnosing acute appendicitis in the resource limited setting. Methods: To determine the diagnostic accuracy of Tzanakis score in the preoperative evaluation of patients with acute appendicitis, we conducted a descriptive cross-sectional study at Mulago Hospital in Kampala, Uganda. Eligible consenting patients diagnosed with acute appendicitis consecutively underwent Tzanakis scoring and appendicectomy. Appencieal samples were sent for histological examination. Sensitivity, specificity, positive predictive value, negative predictive values, and diagnostic accuracy of the Tzanakis scoring system were calculated, relative to histological examination. Results: We enrolled 160 participants of mean age 30.4 years with male:female ratio of 2:1. The Tzanakis score had sensitivity of100% (95% CI 98-100), positive predictive value 97 % (95% CI 95-99), specificity of 64% (95% CI 31-89), negative predictive value of 100%, and overall diagnostic accuracy of 98% with 3% negative appendectomy rate. Conclusions: The Tzanakis score is found to be a sensitive and specific tool that should be considered for preoperative diagnosis of acute appendicitis in resource limited settings. Keywords: appendicitis; appendicectomy; acute abdomen; diagnosis; Tzanakis score; Uganda

Problem based learning: tutors’ views 5 years after implementation at a sub-Saharan University

Background: Curriculum evaluation is key to continuous assurance of quality of education.Objectives: To assess the teachers’ perceptions on how well student teaching and learning activities were conducted at an institution that had practiced PBL for five years.Methods: A cross sectional descriptive study. 150 teachers from 23 departments at the College of Health Sciences participated in the study. A 25 item self-administered questionnaire was used to collect data. Activities evaluated included; students assessment, self-directed learning, feedback and clinical exposure. Data were entered in epi data and analysed using SPSS. Ethical approval was obtained.Results: The participants’ average teaching experience was eight years. The PBL/COBES approach mostly achieved the aim of producing self-directed and lifelong learners. Half of the teaching staff actively provided regular feedback about the learning and teaching activities they were involved in. Early clinical exposure was widely accepted as a highly rewarding appropriate teaching and learning strategy. COBES activities were well organized although involvement of College staff was low.Conclusion: PBL/COBES program was successfully executed and had high acceptance among Faculty. The biggest challenge was getting all staff to provide regular feedback. Self institutional curriculum review can be done cheaply and quickly to provide feedback for continual curriculum improvement.Key words: Problem Based Learning, Evaluation, Curriculum, Universit

Cross-breeding cattle for milk production in the tropics: achievements, challenges and opportunities

This paper reviews experiences with cross-breeding for milk production in the tropics. Data were compiled from 23 different studies evaluating the performance of different grades of cross-bred animals as well as local breeds. Relative performance of indigenous breeds compared with different grades of cross-breeds was calculated for three climatic zones. Traits considered were milk yield per lactation, age at first calving, services per conception, lifetime milk yield and total number of lactations completed. At 50 percent Bos taurus blood, lactation milk yields were 2.6, 2.4 and 2.2 times higher than those of local cattle in the highland, tropical wet and dry, and semi-arid climatic zones, respectively; lactation lengths increased by 1.2, 1.2 and 1.9 months in the above-mentioned climatic zones, respectively; there was a reduction in calving interval by 0.8 times and in age at first calving by 0.9 times. Similarly, cross-breds with 50 percent B. taurus genes had 1.8 times higher lifetime milk yields and a 1.2 times higher number of total lactations. Although cross-breeding faces a number of challenges such as better infrastructure, higher demand for health care, there are many advantages of using it. These are higher production per animal, higher income for the families and provision of high-value food. It is therefore likely to continue to be an important livestock improvement tool in the tropics in the future, where farmers can provide sufficient management for maintaining animals with higher input requirements and access to the milk market can be secured

Student and tutor perception of a new problem based learning curriculum at Faculty of Medicine, Makerere University

Background: The Makerere University Faculty of Medicine started the implementation of the Problem Based Learning/Community Based Education and Service curriculum for incoming students in the academic year 2003/2004. It undertook an intense preparatory period of 2 years before implementation, which included sensitizing, and training tutors to take their new role. Objectives: To evaluate student and tutor perception of the New PBL Curriculum at the Faculty of Medicine and to evaluate tutors perception of how well the students were doing.Methods: The study was at the end of the first semester, after seventeen weeks of the new curricula implementation. A 19-item questionnaire was self-administered by the students. An open discussion led by one of the investigators followed that questionnaire filling session. A 5-point likert scale was used to rate the different aspects. A different questionnaire was administered to the 35 academic staff that had tutored the twenty tutorial groups of eight to ten students each. The data collected from the two questionnaires was analyzed using SSPS software. The Faculty Research Committee approved the study.Results: Out of 180 students, 135 students filled in the questionnaire. In addition 25 tutors out of 35 filled in their questionnaire. The tutors’ facilitation of the tutorials was rated highly by the students. Students’ rated their (students’) participation in the tutorial process as excellent. The students rated access to learning resources as inadequate and they were anxious as to whether they were learning enough. On the other hand the tutors were satisfied with the depth and scope of the discussions by the students. The majority of the tutors thought it was the right move to introduce PBL. They were however concerned about sustainability of the novel educational reform (PBL).Conclusion: The students perceived the new method as acceptable. They expressed anxiety and uncertainly as to whether they were learning enough. And whereas the students were not sure they were learning enough, the tutors were satisfied with the depth of knowledge exhibited by the students. To sustain the reform tutors’ concerns and fears ought to be addressed

The Burden of Hand Injuries at a Tertiary Hospital in Sub-Saharan Africa

Background. Hand injuries are common worldwide and lead to heavy financial losses in terms of treatment, job loss, and time off duty. There is paucity of data on hand injuries in sub-Saharan Africa. The aim of this study was to determine the burden and early outcomes of hand injuries at a tertiary hospital. Method. A descriptive prospective study. Eligible patients were recruited over 5 months and followed up for four weeks. Pain, nerve function, and gross functions of the hand were assessed. Results. In total 138 patients were enrolled out of 2940 trauma patients. Of these, 122 patients returned for follow-up. The majority of the patients were males (83%). Mean age was 26.7 years (SD 12.8). The commonest places of injury occurrence were the workplace (36%), home (28%), and on the road (traffic crushes) (23%). Machines (21.3%) were the commonest agent of injuries; others were knives (10%) and broken glass (10%). Sixty-three (51%) patients still had pain at one month. Conclusions. Hand injuries accounted for 4.7% of all trauma patients. Road traffic crushes and machines were the commonest causes of hand injuries. Men in their 20s were mostly involved. Sensitization for prevention strategies at the workplace may be helpful

Is a PhD a necessary requirement for lecturers in a`Medical School? Report of a survey

Background: Makerere University introduced a new policy1 on the minimum qualification for appointment to a lecturer teaching position and eligibility for subsequent promotions. The highlight of the policy is a requirement for a PhD or equivalent as the minimum qualification necessary for appointment to a lecturer position and above.As a result of this policy fewer and fewer members have shown interest or indeed joined the Faculty of Medicine teaching staff roll.Objectives: This study set out to investigate the perception of the faculty and the impact of the policy on staffing.Methods: Literature review, oral and a questionnaire interviews were used to gather data. Participants included current members of teaching staff (of biomedical sciences and clinical disciplines) postgraduate students and visiting overseas academic staff and adjunct staff employed by the Ministry of Health at teaching hospitals.Data collected was analyzed and summarized in tabular form.Results: A PhD or equivalent is required as a minimum qualification to join academic positions at lecturer level and above at Faculty of Medicine and subsequent promotion to higher positions. There was a significant lag in promotions and recruitment in the Faculty of Medicine compared to counterparts employed by the Uganda Ministry of Health at the teaching hospitals. Participants expressed strong views that a PhD or equivalent should not be a minimum requirement nor should it be a prerequisite for promotions though it should be encouraged. Policy documents from other universities did not require a PhD or equivalent qualifications as a minimum requirement for appointment to the academic ranks of those institutions.Conclusion: Whereas it is desirable for the academic staff to acquire a PhD, it should not be a mandatory requirement. The policy was not in the best interest of the Faculty of Medicine and may not be for other medical schools to impose that requirement for appointment or promotion.University policy makers should consider schools of medicine as an exception to the policy requiring a PhD or equivalent as minimum requirement for teaching at a Medical School

Oesophageal cancer management guidelines for Uganda

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Key Aspects of Health Policy Development to Improve Surgical Services in Uganda

Recently, surgical services have been gaining greater attention as an integral part of public health in low-income countries due to the significant volume and burden of surgical conditions, growing evidence of the cost-effectiveness of surgical intervention, and global disparities in surgical care. Nonetheless, there has been limited discussion of the key aspects of health policy related to surgical services in low-income countries. Uganda, like other low-income sub-Saharan African countries, bears a heavy burden of surgical conditions with low surgical output in health facilities and significant unmet need for surgical care. To address this lack of adequate surgical services in Uganda, a diverse group of local stakeholders met in Kampala, Uganda, in May 2008 to develop a roadmap of key policy actions that would improve surgical services at the national level. The group identified a list of health policy priorities to improve surgical services in Uganda. The priorities were classified into three areas: (1) human resources, (2) health systems, and (3) research and advocacy. This article is a critical discussion of these health policy priorities with references to recent literature. This was the first such multidisciplinary meeting in Uganda with a focus on surgical services and its output may have relevance to health policy development in other low-income countries planning to improve delivery of surgical services