Mapping Africa's advanced public health education capacity: the AfriHealth project.

OBJECTIVE: Literature on human resources for health in Africa has focused on personal health services. Little is known about graduate public health education. This paper maps "advanced" public health education in Africa. Public health includes all professionals needed to manage and optimize health systems and the public's health. METHODS: Data were collected through questionnaires and personal visits to departments, institutes and schools of community medicine or public health. Simple descriptive statistics were used to analyse the data. FINDINGS: For more than 900 million people, there are fewer than 500 full-time staff, around two-thirds of whom are male. More men (89%) than women (72%) hold senior degrees. Over half (55%) of countries do not have any postgraduate public health programme. This shortage is most severe in lusophone and francophone Africa. The units offering public health programmes are small: 81% have less than 20 staff, and 62% less than 10. On the other hand, over 80% of Africans live in countries where at least one programme is available, and there are six larger schools with over 25 staff. Programmes are often narrowly focused on medical professionals, but "open" programmes are increasing in number. Public health education and research are not linked. CONCLUSION: Africa urgently needs a plan for developing its public health education capacity. Lack of critical mass seems a key gap to be addressed by strengthening subregional centres, each of which should provide programmes to surrounding countries. Research linked to public health education and to educational institutions needs to increase.

Malaria: a reemerging disease in Africa.

A recent upsurge of malaria in endemic-disease areas with explosive epidemics in many parts of Africa is probably caused by many factors, including rapidly spreading resistance to antimalarial drugs, climatic changes, and population movements. In Africa, malaria is caused by Plasmodium falciparum and is transmitted by Anopheles gambiae complex. Control efforts have been piecemeal and not coordinated. Strategies for control should have a solid research base both for developing antimalarial drugs and vaccines and for better understanding the pathogenesis, vector dynamics, epidemiology, and socioeconomic aspects of the disease. An international collaborative approach is needed to build appropriate research in a national context and to effectively translate research results into practical applications in the field. The Multilateral Initiative for Malaria in Africa can combine all of the above strategies to plan and coordinate partnerships, networking, and innovative approaches between African scientists and their Northern partners.

Pulmonary paragonimiasis in Cameroon.

Paragonimus africanus has been known to be endemic in the Bakossi area of Meme Division of Cameroon since it was first described in 1952. After a lapse of 25 years, exploratory work was undertaken in the area (but not in the same villages) to study the prevalence of the disease, to record the common presenting symptoms, to make a number of paraclinical examinations, to assess the beliefs and attitudes of the people towards the disease and the possible reasons for its persistent endemicity in that area and to carry out a therapeutic trial with Niclofolan (Bilevon). The disease was found to have a prevalence of 5% with a higher prevalence among those less than 20 years old. Boys were more affected than girls. The population did not appear to recognize the disease which they confused with tuberculosis. The disease was contracted by eating improperly cooked crabs, the intermediate host. The therapeutic trial with Bilevon given orally as a single dose was completely successful. This study showed that paragonimiasis must be considered seriously in the differential diagnosis of tuberculosis in this area and that a study on a much wider scale is required to establish the real extent of the disease.

A household study of illness prevalence and health care preferences in a rural district of Cameroon.

This report gives the results of a health interview survey using a recall interval of one month, in Rural Cameroon carried out between 5 November 1973 and 7 March 1974 on a random selection of 1886 families with 9362 individuals. The disease prevalence in the study area (a positive illness rate of 27.8 percent for a four-week recall period) is analysed by age, sex and treatment preference. People under the age of 15 years suffered predominantly from respiratory (20 percent), digestive (29 percent) and parasitic (12.5 percent) diseases for which Western treatment was preferred (average of 65 percent). In adults musculoskeletal, digestive diseases and generalized body pains were responsible for 63.0 percent of diseases in the age-group 45 and over. The treatment choice was partly Western (50 percent) and partly traditional (20 percent). Traditional treatment was generally preferred for seizures (65 percent) and mental illnesses (87 percent) except for children under four years who received 50.6 percent treatment for seizures from traditional sources and 49.4 percent from Western sources.