Awareness and perceptions of medical students and doctors regarding Tropical Medicine education and training in Europe: An international, online-based survey

BACKGROUND

Multifactorial health determinants and shifts in global patterns of disease increase the need for Tropical Medicine training across Europe. A survey of university and postgraduate opportunities in Europe was conducted to identify and analyse gaps.

METHOD

An online survey was circulated to medical students and doctors in Europe between April and June 2021. Significance tests and a thematic analysis of the data were conducted.

RESULTS

500 respondents (285 students and 215 doctors) from 27 countries were included. 17.2% of doctors were unsure whether postgraduate training in Tropical Medicine was available in their country. 20% of students and 10.7% of doctors said they were unsure whether they had been taught Tropical Medicine during university. 67.7% of students and 79.1% of doctors stated that the amount of Tropical Medicine training they encountered was or had been "not enough".

CONCLUSIONS

Respondents demonstrated great interest in Tropical Medicine. Their self-reported knowledge, awareness, and perceived competence were partly dependent on whether there is specific teaching accessible at the university. Postgraduate training options were available in some countries but not all respondents were aware of these. There is a pressing need for harmonized curricula and expanded postgraduate training to improve Tropical Medicine competencies across Europe.

Training and capacity building in medical statistics in Sub-Saharan Africa: Impact of the London School of Hygiene & Tropical Medicine MSc in Medical Statistics, 1969 to 2021

Since its inception in 1969, the MSc in medical statistics program has placed a high priority on training students from Africa. In this article, we review how the program has shaped, and in turn been shaped by, two substantial capacity building initiatives: (a) a fellowship program, funded by the UK Medical Research Council, and run through the International Statistical Epidemiology Group at the LSHTM, and (b) the Sub-Saharan capacity building in Biostatistics (SSACAB) initiative, administered through the Developing Excellence in Leadership, Training and Science in Africa (DELTAS) program of the African Academy of Sciences. We reflect on the impact of both initiatives, and the implications for future work in this area.

Scoping review of Neglected Tropical Disease Interventions and Health Promotion: A framework for successful NTD interventions as evidenced by the literature

Background

Neglected Tropical Diseases (NTDs) affect more than one billion people globally. A Public Library of Science (PLOS) journal dedicated to NTDs lists almost forty NTDs, while the WHO prioritises twenty NTDs. A person can be affected by more than one disease at the same time from a range of infectious and non-infectious agents. Many of these diseases are preventable, and could be eliminated with various public health, health promotion and medical interventions. This scoping review aims to determine the extent of the body of literature on NTD interventions and health promotion activities, and to provide an overview of their focus while providing recommendations for best practice going forward. This scoping review includes both the identification of relevant articles through the snowball method and an electronic database using key search terms. A two-phased screening process was used to assess the relevance of studies identified in the search–an initial screening review followed by data characterization using the Critical Appraisal Skills Program (CASP). Studies were eligible for inclusion if they broadly described the characteristics, methods, and approaches of (1) NTD interventions and/or (2) community health promotion.

Principal findings

90 articles met the CASP criteria partially or fully and then underwent a qualitative synthesis to be included in the review. 75 articles specifically focus on NTD interventions and approaches to their control, treatment, and elimination, while 15 focus specifically on health promotion and provide a grounding in health promotion theories and perspectives. 29 of the articles provided a global perspective to control, treatment, or elimination of NTDs through policy briefs or literature reviews. 19 of the articles focused on providing strategies for NTDs more generally while 12 addressed multiple NTDs or their interaction with other infectious diseases. Of the 20 NTDs categorized by the WHO and the expanded NTD list identified by PLOS NTDs, several NTDs did not appear in the database search on NTD interventions and health promotion, including yaws, fascioliasis, and chromoblastomycosis.

Conclusions

Based on the literature we have identified the four core components of best practices including programmatic interventions, multi sectoral and multi-level interventions, adopting a social and ecological model and clearly defining ‘community.’ NTD interventions tend to centre on mass drug administration (MDA), particularly because NTDs were branded as such based on their being amenable to MDA. However, there remains a need for intervention approaches that also include multiple strategies that inform a larger multi-disease and multi-sectoral programme. Many NTD strategies include a focus on WASH and should also incorporate the social and ecological determinants of NTDs, suggesting a preventative and systems approach to health, not just a treatment-based approach. Developing strong communities and incorporating social rehabilitation at the sublocation level (e.g. hospital) could benefit several NTDs and infectious diseases through a multi-disease, multi-sectoral, and multi-lateral approach. Finally, it is important the ‘community’ is clearly defined in each intervention, and that community members are included in intervention activities and viewed as assets to interventions.

Neglected Tropical Diseases (NTDs) affect more than one billion people globally. A person can be affected by more than one disease at the same time. Many of these diseases are preventable, and could be eliminated with various public health, health promotion and medical interventions. This scoping review aims to determine the extent of the body of literature on NTD interventions and health promotion activities, and to provide an overview of their focus while providing recommendations for best practice going forward. Through a database search and by identifying appropriate literature 75 articles were identified that specifically focus on NTD interventions and approaches to their control, treatment, and elimination, while 15 focus specifically on health promotion and provide a grounding in health promotion theories and perspectives. Based on the literature we have identified the four core components of best practices including programmatic interventions, multi sectoral and multi-level interventions, adopting a social and ecological model and clearly defining ‘community.’

Attendee's awareness about preventive chemotherapy neglected tropical diseases (PC-NTD) control during the first world neglected tropical diseases day in Ekiti State, Nigeria

BACKGROUND

The need to control Neglected Tropical Diseases (NTDs) and sustain progress towards elimination through mass administration of medicines requires substantial communal participation. This study, therefore, assessed the knowledge and perception of attendees' regarding NTDs and its control activities during the inaugural World NTD day event in Ekiti State, Nigeria.

METHODOLOGY

A cross-sectional study involving the administration of pretested semi-structured questionnaires to consenting attendees at the Inaugural World NTD day event was conducted on the 30th January, 2020. The questionnaire collected data on attendee's demography, knowledge and awareness about NTDs and its control in Nigeria. Quantitative data were analysed using descriptive statistics in SPSS. 20.0 software and expressed as frequencies and percentages. However, qualitative data to support quantitative analysis were obtained using open-ended questionnaires and analysed thematically.

PRINCIPAL FINDINGS/CONCLUSION

A total of 309 attendees comprising 167 (54.0%) females, and 142 (46.0%) males participated in this study. By age groupings, majority 206 (66.7%) were within 15-25 years. 167 (54.8%) of the attendees have not heard about NTDs before, whereas 77(35.0%) have heard about NTDs through the advertisement of the event. 181(63.3%) were aware of ongoing NTD control programs in schools and communities. Also, 246 (83.4%) of them have not taken or do not know anyone that has taken drugs donated in schools or communities. The number of attendees 41(13.3%) who incorrectly classified malaria as NTDs is higher than those who recognized onchocerciasis 36 (11.7%) and worm infections 34(11.0%) as NTDs (p>0.05). This study has shown that awareness and knowledge about NTDs control activities in Ekiti State is low, thus justifying the event as an awareness day for addressing NTDs. Public enlightment and regular promotional activities such as media engagement will raise the public appreciation and participation in NTDs control activities.

Scientific Representations at the UPR School of Tropical Medicine. IV: Special Technical Studies

The essay examines the scientific representations that unfolded and evolved at the University of Puerto Rico School of Tropical Medicine (STM) under the auspices of Columbia University (1926-1949). This article on the STM's scientific endeavors is the fourth in a historical serial collection about the images and evolution of sciences at the institution and it portrays the diagrammatic representations of special technical research aspects and studies (i.e., personnel, epidemiology, methodology, animal studies, biology, field studies, treatment and immunology, and chemotherapy agents). The essay focuses on the emerged scientific representations and on the nature and evolution of sciences at the School, and has been divided into four sections: a) images of science, b) evolution during the first two eras, c) the third and last era unfolding, and d) special technical studies. In this paper the scientific representations have been brought about mainly through the analyses of research publications in external and local venues. The analysis of the STM's scientific evolution has been organized in three distinct historical stages: 1926-31, 1932-40, and 1941-49. These representations open an exploration pathway for a better understanding of the intricate interrelationships between the techné and the episteme horizons of tropical medical science in Puerto Rico.

Preparing nurses for fieldwork in tropical nursing

Due to factors related to increasing globalization, geopolitical conflicts, and climate change, tropical nursing is increasingly important. This article offers an overview of the Diploma in Tropical Nursing program and explores the challenges facing nurses who serve patients in tropical settings with limited resources.

Scientific Representations at the UPR School of Tropical Medicine. III: The Evolution of Science, the Last Era (1941-1949)

The essay examines the scientific representations that unfolded and evolved at the University of Puerto Rico School of Tropical Medicine (STM) under the auspices of Columbia University (1926-1949). It focuses on the emerged scientific representations and on the nature and evolution of sciences at the School, and has been divided into four sections: images of science, evolution during the first two eras (1926-31 and 1932-40), the unfolding last era (1941-49), and special technical studies. This article on the STM's scientific endeavors is the third in this historical serial collection about the images and evolution of sciences at the institution, and portrays the events and processes of the last scientific era. It analyzes the faculty's principal investigations, development of research programs, and concomitant scientific productivity and research outcomes. The scientific representations have been brought forth through the analyses of different sources: academic and research reports, and publications in external and local venues. The analysis of the STM's scientific evolution has been organized in three distinct chronological stages, while also considering other time evolving models (e.g., historical moments). The main themes of the collection are the scientific images and knowledge exemplars: the emergence of a tradition. An analytical framework of research schemas, exemplars of knowledge, and epistemes proved useful and constructive. These studies on the history of science allow for the postulation of an 'enriched thesis' on the different kinds of paradigmatic diseases of tropical medicine in Puerto Rico during the 20th Century, and enable further substantiation of the tropical obliviousness thesis.

Scientific Representations at the UPR School of Tropical Medicine. II: The Evolution of Science, the First Two Eras (1926-31, 1932-1940)

The essay examines the scientific representations that unfolded and manifested at the University of Puerto Rico School of Tropical Medicine (STM) under the auspices of Columbia University (1926-1949). It focuses on the emerged scientific representations and on the kind of science practiced at the School, and has been divided into four sections: images of science, evolution during the first two eras (1926-31 and 1932-40), the unfolding third and last era (1941-49), and special technical studies. This article on the STM's scientific endeavors is the second in this historical serial collection about the images and evolution of sciences at the institution, and portrays the events and processes of the first two scientific eras. It reviews the faculty's principal investigations, development of research programs, and concomitant scientific productivity and research outcomes. The following historical sources were considered: academic and research reports, and publications in external and local venues. On findings, bacteriological investigations and studies on mycology and dermatological fungal infections characterized research during the first era. Parasitology became the hegemonic science of tropical medicine during the second scientific era, in conjunction with important studies on nutrition and streptococcal bacteriological infections. Variations of an earlier tropical medicine discourse of 'abundance of material for study' were: the socioeconomic toll of tropical diseases and a biopower exertion of induced recruitment of medical bodies. And public health field-community studies became a critical research approach at-end of periods. The evolution of science in the last and third era will be the main subject of the next article.

Scientific Representations at the UPR School of Tropical Medicine. I: Images of Science

The essay examines the scientific representations that prevailed at the University of Puerto Rico School of Tropical Medicine (STM) under the auspices of Columbia University (1926-1949). This article on the STM's scientific endeavors is the first in a historical serial collection about the images and evolution of sciences at the institution. It reviews faculty's principal investigations (by disciplines and research problems), development of research programs, and concomitant scientific productivity and research outcomes. The essay focuses on the emerged scientific representations and the nature of sciences, and has been divided into four sections: 1) images of science, 2) the evolution of science in the first two eras (1926-40), 3) the third and last era unfolding (1941-49), and 4) special studies. This first paper focuses on the scientific images that emerged from an examination of communities' interactions, networks, and academic and foundational documents. The scientific representations have been brought about through the analyses of different sources: academic and research reports, and publications in external and local venues. The most significant findings of this representational inquiry are: the idea of an academic tropical center in the tropics had a shared colonial-metropolis image; the community of common, but unequal, scientific citizens became an integrated epistemological community; interdisciplinary cooperation was the School's research dictum; and an image of a mature science and school of tropical medicine emerged. The richness and varieties of the practices and outcomes of science at the STM are analytically viewed as research schemas, exemplars of knowledge (paradigms), and epistemological fields (epistemes).

Global action for training in malaria elimination

The Rethinking Malaria Leadership Forum, held at Harvard Business School in February 2017 with collaboration of the Barcelona Institute for Global Health and the Swiss Tropical and Public Health Institute, identified this training gap as a high priority for both analysis and action. The gap in human resource training for malaria elimination needs to be addressed in order to assure continued progress. This paper identifies major gaps in skills and human resources, suggests institutions that can assist in filling the training gaps, and proposes global actions to implement expanded training for malaria elimination in endemic countries.

Tracking the career development of scientists in low- and middle-income countries trained through TDR's research capacity strengthening programmes: Learning from monitoring and impact evaluation

The Special Programme for Research and Training in Tropical Diseases (TDR) co-sponsored by UNICEF, UNDP, World Bank and WHO has been supporting research capacity strengthening in low- and middle-income countries for over 40 years. In order to assess and continuously optimize its capacity strengthening approaches, an evaluation of the influence of TDR training grants on research career development was undertaken. The assessment was part of a larger evaluation conducted by the European Science Foundation. A comprehensive survey questionnaire was developed and sent to a group of 117 trainees supported by TDR who had completed their degree (masters or PhD) between 2000 and 2012; of these, seventy seven (77) responded. Most of the respondents (80%) rated TDR support as a very important factor that influenced their professional career achievements. The “brain drain” phenomenon towards high-income countries was particularly low amongst TDR grantees: the rate of return to their region of origin upon completion of their degree was 96%. A vast majority of respondents are still working in research (89%), with 81% of respondents having participated in multidisciplinary research activities; women engaged in multidisciplinary collaboration to a higher extent than men. However, only a minority of all have engaged in intersectoral collaboration, an aspect that would require further study. The post-degree career choices made by the respondents were strongly influenced by academic considerations. At the time of the survey, 92% of all respondents hold full-time positions, mainly in the public sector. Almost 25% of the respondents reported that they had influenced policy and practice changes. Some of the challenges and opportunities faced by trainees at various stages of their research career have been identified. Modalities to overcome these will require further investigation. The survey evidenced how TDR’s research capacity grant programmes made a difference on researchers’ career development and on south-south collaborations, by strengthening and localizing research capacity in lower income regions, and also showed there is more that needs to be done. The factors involved, challenges and lessons learnt may help donors and policy makers improve their future interventions with regard to designing capacity strengthening programmes and setting funding priorities.

The Special Programme for Research and Training in Tropical Diseases (TDR) co-sponsored by UNICEF, UNDP, World Bank and WHO has been providing training grants to strengthen research capacity in low- and middle-income countries for over 40 years. In order to assess to what extent TDR’s grants made a difference on the career development of these grantees, a survey tool was developed and implemented in collaboration with the European Science Foundation. The survey was answered by 77 individual trainees who completed their degree (masters or PhD) with support from TDR between 2000 and 2012. The study provided valuable information on factors involved in the career development of the trainees and influencing the local retention of the capacity that has been built, to prevent “brain drain”. Encouraging aspects, such as a 96% of the capacity being retained locally, a 92% full-time employment rate at the time of the survey, or 89% of the respondents still working in research showed the positive influence of TDR’s capacity strengthening grants on researchers’ career development. This was in line with 80% of the respondents rating TDR’s support as “very important”. The challenges, lessons learnt and further opportunities identified may be helpful to donors and policy-makers when designing research capacity programmes, fostering south-south collaboration, and setting funding priorities.

Developing and implementing a global emergency medicine course: Lessons learned from Rwanda

BACKGROUND

There is a growing demand by medical trainees for meaningful, short-term global emergency medicine (EM) experiences. EM programs in high-income countries (HICs) have forged opportunities for their trainees to access this experience in low-and middle-income countries (LMICs). However, few programs in LMICs have created and managed such courses. As more LMICs establish EM programs, these settings are ideal for developing courses beneficial for all participants. We describe our experience of creating and implementing a short-term global EM course in Rwanda.

OBJECTIVES

The objectives of this study were to (1) provide EM trainees from HICs with an opportunity to observe global clinical practice and to learn from local experts, (2) provide EM trainees from an LMIC with an opportunity to share their expert knowledge and skills with HIC trainees, (3) create a sustainable model for a short-term global EM course in an LMIC context.

METHODS

A global EM curriculum and course were developed in Rwanda, entitled EM in the Tropics Emergency Medicine in the Tropics (EMIT). The following topics were covered: EM systems development, public health, trauma/triage, pediatrics, disaster management, and tropical EM. A one-and two-week course program was created and implemented.

RESULTS

EMIT participants rotated through pediatric and adult EDs, Intensive Care Unit, trauma surgery, internal medicine, emergency medical services, and ultrasound training. Activities included bedside teaching, case presentations, ultrasound practice, group lectures, simulation and skills workshops, and a rotation to a district hospital. A total of 11 participants attended: six for both weeks and five for 1 week. The course raised $5000 USD, which was dedicated in full to sponsoring local EM residents to attend international conferences.

DISCUSSION

The EMIT course in Rwanda achieved its objectives of teaching and learning between all participants. Benefits of this in-person experience for both visiting and local participants are clear in clinical, intercultural, and professional ways.

CONCLUSION

Our experience of developing and implementing EMIT in Rwanda demonstrates that EM programs in LMICs can provide short-term global EM courses that are not only beneficial to all participants, but also logistically and financially sustainable.

[(INTRODUCTION OF RESEARCH RESULTS INTO THE TRAINING OF PHYSICIANS IN THE SPECIALTY OF PARASITOLOGY)]

The paper presents the results of theoretical and practical studies into parasitology, which were conducted at the E.I.Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases and then used for the training of specialists with higher medical education at the Department of Tropical Medicine and Parasitic Diseases, I.M.Sechenov First Moscow State Medical University. The need to develop professional skills is related to the increasing learning require- ments due to socioeconomic conditions and the epidemiological situation in the country.

The Sole Provider: Preparation for Deployment to a Medically Austere Theater

The combat focus of the US Military over the past 15 years has primarily centered on the Iraq and Afghanistan areas of operation (AOs). Thus, much human and financial capital has been dedicated to the creation of a robust medical infrastructure to support those operations. However, Special Operation Forces (SOF) are often called upon to deploy in much more medically austere AOs. SOF medical providers operating in such environments face significant challenges due to the diversity of medical threats, extremely limited access to medical resupply, a material shortage of casualty evacuation platforms, lack of medical facilities, and limited access to higher-level care providers. This article highlights the challenges faced during a recent Special Forces deployment to such an austere environment. Many of these challenges can be mitigated with a specific approach to premission training and preparation.

The Educational Legacy of the UPR School of Tropical Medicine: Curricula, Faculty, Students (1926-1949)

This essay discusses the educational evolution of the University of Puerto Rico-School of Tropical Medicine (UPR-STM) under the auspices of Columbia University. It takes a closer look to what was taught, who taught it and who were the students benefitting from the educational, learning and advanced research activities. It highlights some characteristics of the educational environment that aimed to harvest a well-trained group of scientists, academicians, and practitioners. It examines the characteristics of the faculty and graduates and their role in the teaching and dissemination of knowledge in tropical medicine and closely related fields. The curricula was characterized for its flexibility to accommodate the students' clinical and research interests. With the advent of the 1940s the School started offering public health professionals degrees in addition to the former research-based training. This brought tensions associated to professionalization, the diversification of purposes, the expansion without sufficient resources, and the opening to different levels of students. Maintaining a cadre of well-trained prestigious faculty was always a struggle. Strategies such as visiting professors and joint and ad-honorem appointments were used. Agreements with universities around the world, philanthropic institutions, professional associations, and with different branches of the local and federal government supplemented the resources of the School. In return, the School offered an environment committed to educational standards, networking and a wealth of data for study and discovery.

Marvels and Shadows: Science and Education at the University of Puerto Rico School of Tropical Medicine under the Auspices of Columbia University: An Introduction

This essay introduces a series of five historical articles on the scientific and educational contributions of the University of Puerto Rico School of Tropical Medicine (STM), under the auspices of Columbia University (1926-1949), to the fields of tropical medicine and public health. The articles will appear in several consecutive issues, and will address various themes as follows: 1) historical antecedents of the STM, particularly institutional precedents; 2) the educational legacy of the STM; 3) a history of the STM scientific journal ("The Puerto Rico Journal of Public Health and Tropical Medicine"); 4) the scientific practices and representations that prevailed at the institution; and, 5) a brief sociocultural history of malaria in Puerto Rico, mainly from the perspective of the STM's scientific and public health activities. The authors have systematically and comprehensively studied a wide variety of documents from different sources based on multiple archives in Puerto Rico, the United States and England. The authors treat the fluid meanings of the examined historical encounters from a research perspective that privilege complex reciprocal interactions, multiple adaptations and elaborate sociocultural constructs present in a collaborative exemplar of the modernity of medical science in a neocolonial tropical context.

The Historical Antecedents of the UPR School of Tropical Medicine

This article deals with the historical antecedents of the University of Puerto Rico (UPR) School of Tropical Medicine (STM) under the auspices of Columbia University. It presents a general view of the social, institutional and conceptual factors that were correlated with the establishment of the STM. The authors start by examining the historical continuities and discontinuities present during the imperial transitions between Spanish colonial and U.S. military medicine at the turn of the 20th century. The clarification of these changes is important for the proper understanding of the emergence of tropical medicine in Puerto Rico, marked by the identification of the biological determinant of the so called "peasants' anemia." The essay focuses on two institutional precursor events: the Puerto Rico Anemia Commissions (1904-1908) and the Institute of Tropical Medicine and Hygiene (1912-1914). Their nature and work paved the way for the establishment of the STM. The notions of tropical medicine and diseases are considered as historical concepts. The support of the Rockefeller Foundation to several significant public health activities in Puerto Rico is also examined. Finally, the social and health conditions which prevailed at the time of the creation of the STM have been summarized. In general, the article provides a sense of historical context deemed essential to understand the emergence and evolution of the STM.

Research Capacity Strengthening in Low and Middle Income Countries - An Evaluation of the WHO/TDR Career Development Fellowship Programme

Between August 2012 and April 2013 the Career Development Fellowship programme of the Special Programme for Research and Training in Tropical Diseases (World Health Organization) underwent an external evaluation to assess its past performance and determine recommendations for future programme development and continuous performance improvement. The programme provides a year-long training experience for qualified researchers from low and middle income countries at pharmaceutical companies or product development partnerships. Independent evaluators from the Swiss Tropical and Public Health Institute and the Barcelona Institute for Global Health used a results-based methodology to review the programme. Data were gathered through document review, surveys, and interviews with a range of programme participants. The final evaluation report found the Career Development Fellowship to be relevant to organizers’ and programme objectives, efficient in its operations, and effective in its training scheme, which was found to address needs and gaps for both fellows and their home institutions. Evaluators found that the programme has the potential for impact and sustainability beyond the programme period, especially with the successful reintegration of fellows into their home institutions, through which newly-developed skills can be shared at the institutional level. Recommendations included the development of a scheme to support the re-integration of fellows into their home institutions post-fellowship and to seek partnerships to facilitate the scaling-up of the programme. The impact of the Professional Membership Scheme, an online professional development tool launched through the programme, beyond the scope of the Career Development Fellowship programme itself to other applications, has been identified as a positive unintended outcome. The results of this evaluation may be of interest for other efforts in the field of research capacity strengthening in LMICs or, generally, to other professional development schemes of a similar structure.

The asymmetry of research training between high and low and middle income countries (LMICs) and the resulting need for research capacity strengthening (RCS) in under-resourced regions has long been established. In 1999, the World Health Organization (WHO), through the Special Programme for Research and Training in Tropical Diseases (TDR), launched the Career Development Fellowship (CDF) programme, in which LMICs’ candidates spend one year in a pharmaceutical company to be trained in product development and clinical research and then return to their home institution. Between August 2012 and April 2013, the programme underwent an independent external evaluation from the perspectives of relevance, effectiveness, efficiency, and impact, and sustainability. In addition to analysis of data and documentation, programme managers, current and former fellows, home and host institutions participated in the evaluation through surveys and interviews. In the current article, the external evaluators, along with CDF programme managers, discuss the results of the evaluation in the broader context of individual and institutional RCS, underlining CDF successes, including transmitting essential skills and networks, and addressing the challenge and fundamental importance of integrating fellows, home and host institutions into an on-going relationship that solidifies and amplifies the benefits of the one-year experience.

Extent of Integration of Priority Interventions into General Health Systems: A Case Study of Neglected Tropical Diseases Programme in the Western Region of Ghana

BACKGROUND

The global health system has a large arsenal of interventions, medical products and technologies to address current global health challenges. However, identifying the most effective and efficient strategies to deliver these resources to where they are most needed has been a challenge. Targeted and integrated interventions have been the main delivery strategies. However, the health system discourse increasingly favours integrated strategies in the context of functionally merging targeted interventions with multifunctional health care delivery systems with a focus on strengthening country health systems to deliver needed interventions. Neglected Tropical Diseases (NTD) have been identified to promote and perpetuate poverty hence there has been global effort to combat these diseases. The Neglected Tropical Diseases Programme (NTDP) in Ghana has a national programme team and office, however, it depends on the multifunctional health delivery system at the regional and district level to implement interventions. The NTDP seeks further health system integration to accelerate achievement of coverage targets. The study estimated the extent of integration of the NTDP at the national, regional and district levels to provide evidence to guide further integration.

METHODOLOGY/PRINCIPAL FINDINGS

The research design was a descriptive case study that interviewed key persons involved in the programme at the three levels of the health system as well as extensive document review. Integration was assessed on two planes-across health system functions-stewardship and governance, financing, planning, service delivery, monitoring and evaluation and demand generation; and across three administrative levels of the health system-national, regional and district. A composite measure of integration designated Cumulative Integration Index (CII) with a range of 0.00-1.00 was used to estimate extent of integration at the three levels of the health system. Service delivery was most integrated while financing and planning were least integrated. Extent of integration was partial at all levels of the health system with a CII of 0.48-0.68; however it was higher at the district compared to the national and regional levels.

CONCLUSIONS/SIGNIFICANCE

To ensure further integration of the NTDP, planning and finance management activities must be decentralized to involve regional and district levels of the health system. The study provides an empirical measure of extent of integration and indicators to guide further integration.

Travel and Adventure Medicine Resources

Given the ever-changing nature of travel medicine, practitioners who provide pretravel and posttravel care are obligatorily students for the duration of their professional careers. A large variety of resources are available for medical practitioners. Providers should join at least one travel or tropical medicine professional association, attend its annual meeting, and read its journal. The largest general travel medicine association is the International Society of Travel Medicine.

[What place and what future for the pathology of infectious and tropical diseases in France?]

The management of tissues and cellular samples by the pathologists in the infectious and tropical diseases pathology field in 2014 needs a strong knowledge of both morphological and molecular domains which includes the good control: (i) of the taxonomy of infectious and tropical diseases pathology leading to the pathogens identification and (ii) of the ancillary methods which can be used in fixed samples in order to detect or better identify these pathogens. There is a recent paradox in France concerning the frequency of infectious diseases to be diagnosed in pathology laboratories and the progressive loss of pathologist's expertise in this domain. Different reasons could explain this statement including the omnipresence of the tumour lesions to be managed in a pathology laboratory as well as the recent constraints associated with the different biomarkers that are mandatory to be detected by immunohistochemistry and/or by molecular biology. Even if the microbiologists play a pivotal role for identifying the different pathogens as well as for the assessment of their sensitivity to the anti-microbial drugs, a large number of infectious diseases can be diagnosed only on fixed tissue and/or cells by the pathologists. The purpose of this review is to describe the current and future issues of infectious and tropical diseases diagnoses in pathology laboratories, in particular in France.

Midwifery in Somaliland

During the civil war in Somaliland (1982-1991), health facilities were devastated and many healthcare workers were killed or became refugees. Since then the country has struggled to rebuild hospitals and health centres and increase the number of healthcare professionals. Many non government officers from a variety of countries are assisting throughout the country. In 2011 I accepted a post establishing the first BSc in midwifery in Hargeisa, the capital of Somaliland. I was employed by Tropical Health Education Trust (THET) in conjunction with Edna Adan University hospital. The students were to be nurse-midwives; the hope was that they would go on to become the movers and shakers in Somaliland. Little did I know how big the challenge would be.

[Training in tropical medicine in France]

Tropical medicine was a key element of the medical structures provided by France to our former colonies and, later; to countries within the scope of our international cooperation. hI recent decades, France has drastically reduced its bilateral commitments to countries in the tropics, and especially in sub-Saharan Africa. At the same time, the teaching of tropical medicine, which was highly regarded even beyond our borders, has lost a good deal of its expertise. Initially available in a few large French centers, and ensured by teachers with extensive field experience, training in tropical medicine is now offered in many universities. However; their programs and educational objectives, focusing mainly on infectious and parasitic diseases, no longer meet the healthcare priorities of southern countries, which are facing an epidemiological transition and the rise of non communicable diseases. Few teachers now have recognized expertise in tropical medicine. These changes have had negative consequences for research programs in tropical medicine and for the image of French assistance to developing countries. In this context, the followving perspectives should be considered: 1) training in tropical medicine should be enhanced by the creation of a national diploma recognized by international bodies. 2) The creation of a doctoral course in tropical medicine is a prerequisite for achieving this goal, and the future diploma must include a significant research component. 3) Teaching in tropical medicine must become more practical and be ensured by teachers with extensive field experience. 4) Training in tropical medicine should be part of a bilateral relationship with countries in the tropics, each party contributing its expertise while respecting that of its partners. 5) Training in tropical medicine should be backed uip by high-level scientific research based on enhanced synergy of our current networks (Institute for Research and Development, Network of overseas Pasteur Institutes, universities, etc.). 6) Teaching of tropical medicine should be coordinated by a supra-university structure whose mission is to ensure coherence. 7) Success in all these objectives will require strong political commitment. This is the only way to restore the enviable position which France occupied in the recent past.

Presidential addresses of the Royal Society of Tropical Medicine and Hygiene: 1907-2013

Presidents have been required to give an inaugural address on commencing office at the Royal Society of Tropical Medicine and Hygiene (RSTMH) since its foundation in 1907. All presidential addresses were identified, sourced and assembled into an annotated bibliography. The majority of presidential addresses have been published in Transactions of the Royal Society of Tropical Medicine and Hygiene. Unpublished and in some cases ‘lost’ contributions have now been sourced where possible and archived at the RSTMH. This unique, rich and rewarding archive provides a vista into the development of the RSTMH and the discipline of tropical medicine. The archive is freely available to all.

Tulane University School of Public Health and Tropical Medicine 100th anniversary. Introduction. From hygiene and tropical medicine to global health

The author reviews the history of the Tulane School of Public Health and Tropical Medicine. In 1912, Dr. Creighton Wellman published a groundbreaking paper entitled "The New Orleans School of Tropical Medicine and Hygiene," outlining a clear plan for a new independent school of public health. He became the founding dean of the Tulane School of Hygiene and Tropical Medicine. Dr. Wellman had spent 9 years practicing medicine in Angola and graduated from the London School of Tropical Medicine before launching a career in tropical medicine in the United States. Tulane already had a formal course of hygiene established as early as 1881. The founding of Tulane School of Hygiene and Tropical Medicine was made possible by a gift from Samuel Zemurray, who would become the president of the United Fruit Company. In January of 1914, Dr. Wellman abruptly left New Orleans to live in Brazil. The school lost its independence in 1919 and again became part of the School of Medicine until 1967. The school initiated by Dr. Wellman is the foundation on which today's Tulane School of Public Health and Tropical Medicine is built.

Global health training starts at home: a unique US-based global health clinical elective for residents

BACKGROUND

Many physicians planning to work in global health lack adequate formal training. Globalized cities create opportunities to integrate global health training into residency programs, preparing clinicians for less supported experiences abroad.

AIM

To develop a clinical elective to advance residents' knowledge and skills in global health and fieldwork abroad.

METHODS

Two-week comprehensive elective was offered to PGY2 combined medicine-pediatrics residents. We incorporated clinical exposures and global health topics. Global health experts were involved as teachers and preceptors. Clinical exposure included: tropical medicine with laboratory sessions; travel medicine; tuberculosis; immigrant and continuity; and human rights clinics. Didactic components and supplemental readings included socio-political issues, global public health, and health challenges of populations from developing regions. We assessed resident satisfaction using questionnaires and focus groups.

RESULTS

Residents reported usefulness and relevance of sessions and topics as (4) very good (scale: (1) poor to (5) excellent), and quality of sessions and teaching as very good to excellent (4.2). Residents' baseline knowledge and understanding of global health issues improved by around 50%.

CONCLUSION

Our experience supports the feasibility and usefulness of clinical and didactic training in global health issues at home. A multidisciplinary approach, collaboration with academic and non-academic institutions, experienced faculty, and departmental commitment are vital.

[International collaboration of the E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine: assistance for public health in the Republic of Guinea]

Within the framework of international collaboration, the E.I. Martsinovsky Institute of Medical Parasitology and Tropical Medicine (IMPTM), I.M. Sechenov First Moscow State Medical University, assisted the Public Health System of the Republic of Guinea in detecting, diagnosing, studying, and preventing tropical infections of viral, bacterial, and parasitic etiologies, and in training national scientific manpower. The work was under way in the Soviet-Guinea Research Microbiology and Virology Laboratory, USSR Ministry of Health, in the Republic of Guinea (now the Pasteur Institute in Guinea (PIG)) in 1978-1991. The circulation of pathogens of a number of tropical infections, the fauna of vectors and carriers of transmissible infections, and their involvement of the circulation of pathogens of these diseases were found in this period. Consultative-and-methodological and medical assistance was given; national higher- and middle-level brainpower trained. It is expedient to restore scientific ties between the IMPTM and the PIG.

[The rehabilitation cares at the lepers]

Leprosy elimination (<1/100 000) is almost reached all around the world, although, but disabled people are still a lot, and they need rehabilitation as soon as possible. The different lesions (neurological, dermatologic and joint) must be treated in order to protect from handicap. Physical rehabilitation medicine can help with a global and polyvalent coverage. Therapeutic education and reinsertion are an important part.

Knowledge and interests of Romanian medical students in parasitology, tropical and travel medicine

As travel has become easier and faster, the rate of tropical infections across the world is expected to increase; more students working abroad are going to encounter these diseases more often. Disorders of parasitic etiology play an important role in travel and tropical medicine. The aim of our study was to assess the preclinical students' knowledge regarding parasitic diseases, tropical and travel medicine in the broad context of their professional background. A total of 346 Romanian medical students completed a 13-item questionnaire on the above-mentioned topics. In order to allow for complex evaluation, the questionnaire also included items related to their extracurricular training as well as their future perspectives. The majority of the students (97.7%) declared they had prior knowledge (before studying parasitology) of malaria. Most of the responders (90.2%) knew that a journey in (sub)tropical regions requires adequate prophylactic measures. About a quarter of those interviewed (26.4%) would agree to practice tropical medicine after graduation. They were mainly interested in helping people from underdeveloped countries regardless of remuneration (52.7%). The majority of students (59.8%) wished to practice clinical medicine. It has been observed that fewer than 5% of the questioned students had ever read a scientific paper or book in the field of tropical medicine. English was the most commonly spoken foreign language (92.8%), and 99.1% of students had at least intermediate computer skills. Finally, 71.6% of students would choose to practice the specialty of travel medicine if it were available in Romania. The implementation of appropriate measures towards the globalization of medical teaching in Romanian universities should represent an important issue in this new millennium, in which borders between various nations are starting to fade; otherwise the next generations of physicians will lose the chance to gain wider experiences and share the international influences on health.

South-to-North, cross-disciplinary training in global health practice: ten years of lessons learned from an infectious disease field course in Jamaica

Global commerce, travel, and emerging and resurging infectious diseases have increased awareness of global health threats and opportunities for collaborative and service learning. We review course materials, knowledge archives, data management archives, and student evaluations for the first 10 years of an intensive summer field course in infectious disease epidemiology and surveillance offered in Jamaica. We have trained 300 students from 28 countries through collaboration between the University of the West Indies and U.S. partner universities. Participants were primarily graduate students in public health, but also included health professionals with terminal degrees, and public health nurses and inspectors. Strong institutional synergies, committed faculty, an emphasis on scientific and cultural competencies, and use of team-based field research projects culminate in a unique training environment that provides participants with career-developing experiences. We share lessons learned over the past decade, and conclude that South-to-North leadership is critical in shaping transdisciplinary, cross-cultural, global health practice.

The "other diseases" of the Millennium Development Goals: rhetoric and reality of free drug distribution to cure the poor's parasites

The sixth MDG aims 'to combat HIV/AIDS, TB, malaria and other diseases'. The residual category of 'other diseases' has become the focus of intense interest, partly because it has provided an opportunity to increase resources for the control of the mostly parasitic 'neglected tropical diseases' (NTDs). Intense lobbying has secured large amounts of funding from donors, as well as generous donations of medicines from the major drug companies. A massive programme is now underway to treat the parasites of the poor in Africa via integrated vertical interventions of mass drug administration in endemic areas. The approach has been hailed as remarkably effective, with claims that there is now a real prospect of complete control and, for some NTDs, even elimination. However, a closer look at evaluation and research data reveals that much less is known about what is being achieved than is suggested. Competition between implementing organisations is leading to potentially counterproductive exaggerations about treatment coverage. Detailed local-level research in Uganda and Tanzania shows that actual rates of drug take-up among target populations are often lower than is necessary to effectively control the diseases, and that methods of drug distribution may even lead to active resistance to treatment. If current trends are not corrected, declining rates of NTD infection will not be sustained. Much more rigorous and effective monitoring is essential.

Health risks encountered by Dutch medical students during an elective in the tropics and the quality and comprehensiveness of pre-and post-travel care

BACKGROUND

Clinical and research electives abroad offer medical students many unique experiences. However, participating in an unfamiliar health-care setting combined with limited medical experience may place students at risk of illness. To improve pre-and post-travel care, we assessed the health risks and the quality and comprehensiveness of pre-and post-travel care in a cohort of Dutch medical students returning form an elective abroad.

METHODS

All medical students who had performed an elective in the tropics between July 2006 and December 2008 were sent an informative email asking them to complete a web-based questionnaire.

RESULTS

180 of 242 (74%) students completed the questionnaire. Regarding the risk of bloodborne viral infection: 67% of all students and 32% of junior students engaged in procedures that constitute a risk of exposure to bloodborne viral infection, often in countries with high HIV prevalence rates. None of nine students who experienced possible or certain mucosal or percutaneous exposure to potentially infectious body fluids reported the exposure at the time it occurred and none used PEP. Regarding other health risks: 8 of 40 (20%) students stopped using mefloquine due to adverse effects. This left a sizeable proportion unprotected in countries that are hyperendemic for malaria. Post-travel screening for schistosomiasis, tuberculosis (tuberculin skin test) and carriage of methicillin-resistant Staphylococcus aureus (MRSA) encompassed approximately half of all students who should have been screened.

CONCLUSIONS

Based on the results of this study we have adopted an integral set of measures to reduce the health risks associated with an elective abroad. The pre and post-travel consult has been centralized and standardized as well as the distribution of PEP. In addition we have developed a mandatory module on Global Health for all medical students planning an elective abroad.

Global Health Education: a cross-sectional study among German medical students to identify needs, deficits and potential benefits (Part 1 of 2: Mobility patterns & educational needs and demands)

BACKGROUND

In recent years, education and training in global health has been the subject of recurring debate in many countries. However, in Germany, there has been no analysis of the educational needs or demands of medical students, or the educational deficits or potential benefits involved in global health education. Our purpose is to analyse international health elective patterns of medical students enrolled at German universities and assess whether or how they prepare for their electives abroad. We examine the exposure of medical students enrolled at German universities to training courses in tropical medicine or global health and assess students' perceived needs and demands for education in global health.

METHODS

Cross-sectional study among medical students in Germany including all 36 medical schools during the second half of the year 2007. All registered medical students were eligible to participate in the study. Recruitment occurred via electronic mailing-lists of students' unions. We developed a web-based, semi-structured questionnaire to capture students' international mobility patterns, preparation before electives, destination countries, exposure to and demand for global health learning opportunities.

RESULTS

1126 online-replies were received and analysed from all registered medical students in Germany (N = 78.067). 33.0% of all respondents (370/1126) declared at least one international health elective and of these, 36.0% (133/370) completed their electives in developing countries. 36.0% (131/363) did not prepare specifically at all, 59.0% (214/363) prepared either by self-study or declared a participation in specific preparation programmes. 87.8% of 5th and 6th year students had never participated in a global health course and 72.6% (209/288) had not completed a course in tropical medicine. 94.0% (861/916) endorsed the idea of introducing global health into medical education.

CONCLUSION

Students in our sample are highly mobile during their studies. International health electives are common, also in developing countries. Formal preparation beyond self-study is virtually non-existent amongst our sample and the participation rate in courses of tropical medicine or global health is appallingly low. We have identified unmet perceived needs and the demand for more learning opportunities in global health in our sample, urging for reforms to adjust curricula to a globalising world.