Future career plans of Malawian medical students: a cross-sectional survey.

BACKGROUND: Malawi has one of the lowest physician densities in the world, at 1.1 doctors per 100,000 population. Undergraduate training of doctors at the national medical school has increased considerably in recent years with donor support. However, qualified doctors continue to leave the public sector in order to work or train abroad. We explored the postgraduate plans of current medical students, and the extent to which this is influenced by their background. METHODS: A self-administered questionnaire was developed after discussion with students and senior staff. This included questions on background characteristics, education before medical school, and future career plans. This was distributed to all medical and premedical students on campus over 1 week and collected by an independent researcher. One reminder visit was made to each class. Chi-squared tests were performed to investigate the relationship of student characteristics with future career plans. RESULTS: One hundred and forty-nine students completed the questionnaire out of a student body of 312, a response rate of 48%. When questioned on their plans for after graduation, 49.0% of students plan to stay in Malawi. However, 38.9% plan to leave Malawi immediately. Medical students who completed a 'premedical' foundation year at the medical school were significantly more likely to have immediate plans to stay in Malawi compared to those who completed A-levels, an advanced school-leaving qualification (P = 0.037). Current premedical students were slightly more likely to have immediate plans to work or train in Malawi compared to medical students (P = 0.049). However, a trend test across all the years was not significant. When asked about future plans, nearly half of students intend to work or train outside Malawi. CONCLUSIONS: The majority of respondents plan to leave Malawi in the future. The effectiveness of the substantial upscaling of medical education in Malawi may be diminished unless more medical students plan to work in Malawi after graduation

The mechanism of the selective inotropic and hypotensive effects of triterpenoids of plant origin.

Thesis (Ph.D.)--University of KwaZulu-Natal, 2004.Abstract available in PDF file

Characterizing the impact of sustained sulfadoxine/pyrimethamine use upon the Plasmodium falciparum population in Malawi

Background Malawi experienced prolonged use of sulfadoxine/pyrimethamine (SP) as the front-line anti-malarial drug, with early replacement of chloroquine and delayed introduction of artemisinin-based combination therapy. Extended use of SP, and its continued application in pregnancy is impacting the genomic variation of the Plasmodium falciparum population. Methods Whole genome sequence data of P. falciparum isolates covering 2 years of transmission within Malawi, alongside global datasets, were used. More than 745,000 SNPs were identified, and differences in allele frequencies between countries assessed, as well as genetic regions under positive selection determined. Results Positive selection signals were identified within dhps, dhfr and gch1, all components of the parasite folate pathway associated with SP resistance. Sitting predominantly on a dhfr triple mutation background, a novel copy number increase of ~twofold was identified in the gch1 promoter. This copy number was almost fixed (96.8% frequency) in Malawi samples, but found at less than 45% frequency in other African populations, and distinct from a whole gene duplication previously reported in Southeast Asian parasites. Conclusions SP resistance selection pressures have been retained in the Malawian population, with known resistance dhfr mutations at fixation, complemented by a novel gch1 promoter duplication. The effects of the duplication on the fitness costs of SP variants and resistance need to be elucidated

Medical schools in sub-Saharan Africa

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85361/1/MedicalSchoolsinSubSaharaAfrica.pd

Future career plans of Malawian medical students: a cross-sectional survey

Abstract Background Malawi has one of the lowest physician densities in the world, at 1.1 doctors per 100,000 population. Undergraduate training of doctors at the national medical school has increased considerably in recent years with donor support. However, qualified doctors continue to leave the public sector in order to work or train abroad. We explored the postgraduate plans of current medical students, and the extent to which this is influenced by their background. Methods A self-administered questionnaire was developed after discussion with students and senior staff. This included questions on background characteristics, education before medical school, and future career plans. This was distributed to all medical and premedical students on campus over 1 week and collected by an independent researcher. One reminder visit was made to each class. Chi-squared tests were performed to investigate the relationship of student characteristics with future career plans. Results One hundred and forty-nine students completed the questionnaire out of a student body of 312, a response rate of 48%. When questioned on their plans for after graduation, 49.0% of students plan to stay in Malawi. However, 38.9% plan to leave Malawi immediately. Medical students who completed a ‘premedical’ foundation year at the medical school were significantly more likely to have immediate plans to stay in Malawi compared to those who completed A-levels, an advanced school-leaving qualification (P = 0.037). Current premedical students were slightly more likely to have immediate plans to work or train in Malawi compared to medical students (P = 0.049). However, a trend test across all the years was not significant. When asked about future plans, nearly half of students intend to work or train outside Malawi. Conclusions The majority of respondents plan to leave Malawi in the future. The effectiveness of the substantial upscaling of medical education in Malawi may be diminished unless more medical students plan to work in Malawi after graduation.</p

The collaboration between the Bute Medical School, University of St Andrews, UK and the College of Medicine (COM) Blantyre, Malawi in the development of a new undergraduate medical curriculum for Malawi.

St Andrews collaboration with College of Medicine (COM) is to assist the College with its ongoing curricular reform of the undergraduate medical programme. This is driven by the Malawian need to significantly increase the number of medical students in training. The Bute Medical School (BMS) has recently undergone a major curriculum review and redesign for similar reasons of capacity building and modernization and so is able to offer advice based on its own relevant experience This has resulted in the implementation of a new curriculum in Malawi in January 2009 where material is now delivered in integrated courses/modules and clinical relevance and context is provided from the start by a series of patient cases, guided study and clinical visits and lectures. Learning objectives are provided to allow the students to focus their learning appropriately. The students are presented with an introductory foundations phase preparing them for a systems-based focus for the remainder of the pre-clinical stage of the programme. The content of the systems-based stage is presented in a recognised cycle of Normal Structure, followed by Normal Function, Abnormal Function and finally by Treatment. Assessment of the curriculum is by an integrated series of assessments that are valid, reliable and match the learning objectives specified