Challenges in training the ideal Doctor for Africa: lessons learned from Zimbabwe.

BACKGROUND: Limited competencies among doctors and reduced numbers from medical migration in Africa could be corrected through innovative curricula and retention of trained manpower. The University of Zimbabwe Medical School simultaneously decided to increase the quality and quantity of doctors to address shortages. AIMS: To evaluate the outcome of innovative medical education at the University of Zimbabwe Medical School. METHOD: A structured questionnaire was administered to a broad group of staff and student representatives. In addition, a desk review of academic documents and policies and procedures was carried out. RESULTS: Early patient contact and community attachment which were introduced to the traditional curriculum remained but other teaching methodologies were not sustained with traditional didactic training still taking centre stage with limited staff development and retention. Whilst the annual student enrolment increased from less than 80 to 200 per year the vacancy rate of academic staff increased to 50%. CONCLUSION: Innovative curricula were partially implemented. The annual student intake increased but the staff complement declined. There is an urgent need to monitor and evaluate outcomes of medical education in Africa to arrest further decline in the quality of health care services.

Prevalence of noncommunicable diseases in Zimbabwe: results from analysis of data from the National Central Registry and Urban Survey.

The disease burden from noncommunicable diseases (NCDs) in Africa is rapidly increasing based on projections from a limited number of reports. In the absence of national health surveys in Zimbabwe, all data nationally generated between 1990 and 1997 were analyzed. From 1990 to 1997, prevalence rates (expressed per 100,000 people) of hypertension increased from 1000 to 4000, rates of diabetes increased from 150 to 550, and rates of cerebrovascular accidents (CVA) increased from 5 to 15. The case fatality rate (CFR) for CVA decreased substantially during the period of study, implying improved case management of the disease, while the CFR for most other diseases did not change significantly throughout the study period. The observation of increased prevalence of some NCDs during the study period was corroborated by findings from a blood pressure survey subsequently conducted in an urban environment of Zimbabwe, which revealed a hypertension (blood pressure > or =140/90 mm Hg) prevalence of 35% in women and 24% in men. In spite of the limitations of the centrally generated hospital-based data, its analysis is still valuable. Countries are therefore encouraged to utilize this easily accessible resource for policy formulation and resource mobilization.

Emerging non-communicable disease epidemic in Africa: preventive measures from the WHO Regional Office for Africa.

The World Health Organization Regional Office for Africa (WHO AFRO) commissioned a study to compile and analyze published reports on non-communicable diseases (NCDs) in Africa to build evidence on the burden of NCDs in the region. Anecdotally, little information or literature was available on this subject. The objective of the study was to establish the status of NCDs in Africa by using published sources of information. A literature search was done through MEDLINE/PubMed and Google to identify studies that reported on prevalence rates of NCD risk factors. The study confirmed that information on NCDs in Africa was lacking. The prevalence of hypertension was found to be rapidly increasing, from 3% in rural areas to > 30% in some urban settings. In some populations, hypertension prevalence rates were higher in women than in men while the opposite was true in others. Most people with hypertension were not aware of their condition, and of those who were on treatment, < 20% had optimal control. The prevalence of diabetes mirrored that of hypertension, from < 1% in some rural areas to > 20% in some selected populations and racial groupings in urban settings. The predominant type was type 2 diabetes, which accounted for > 80% of all cases in some reports and tended to present later in life. The prevalence of tobacco smoking also varied across the continent, from < 1% in rural women to 50% in some urban men. Recent studies based on analysis of hospital-based information have documented NCD trends that were similar to prevalence data generated from national risk factor surveys. NCD risk factors such as hypertension and diabetes are increasing in Africa.

Determinants of health insurance ownership among South African women.

BACKGROUND: Studies conducted in developed countries using economic models show that individual- and household- level variables are important determinants of health insurance ownership. There is however a dearth of such studies in sub-Saharan Africa. The objective of this study was to examine the relationship between health insurance ownership and the demographic, economic and educational characteristics of South African women. METHODS: The analysis was based on data from a cross-sectional national household sample derived from the South African Health Inequalities Survey (SANHIS). The study subjects consisted of 3,489 women, aged between 16 and 64 years. It was a non-interventional, qualitative response econometric study. The outcome measure was the probability of a respondent's ownership of a health insurance policy. RESULTS: The chi2 test for goodness of fit indicated satisfactory prediction of the estimated logit model. The coefficients of the covariates for area of residence, income, education, environment rating, age, smoking and marital status were positive, and all statistically significant at p < or = 0.05. Women who had standard 10 education and above (secondary), high incomes and lived in affluent provinces and permanent accommodations, had a higher likelihood of being insured. CONCLUSION: Poverty reduction programmes aimed at increasing women's incomes in poor provinces; improving living environment (e.g. potable water supplies, sanitation, electricity and housing) for women in urban informal settlements; enhancing women's access to education; reducing unemployment among women; and increasing effective coverage of family planning services, will empower South African women to reach a higher standard of living and in doing so increase their economic access to health insurance policies and the associated health services.