Background

Neurological diseases especially stroke are projected to be one of the leading causes of morbidity and mortality worldwide. However, neurology research and training has been relatively neglected in Uganda. There is lack of good quality on the epidemiology of neurological diseases and clinical outcomes and few on site expert in neurology. Most of the research on neurological diseases in Uganda was done before 1980 and a little or no research has been conducted in the last 30 years. This therefore translates into low levels of awareness in the communities, delayed diagnoses, poorer outcomes and sub-optimal primary care. This award therefore is to expand our highly successful research collaborations in infectious diseases to include neurology, with the goal of designing a program that will substantially improve the capacity for research and training in Uganda and to address the critical shortage of leaders in neurology. The MEPI-neurology program is integrated into two major medical schools in Uganda namely, Makerere University College of Health (MakCHS) and Post graduate Medical Education, Uganda Martyrs University to ensure its sustainability. These medical Schools are collaborating with Case Western Reserve University to provide short term fellowship programs for Ugandan neurology residents and faculty. It’s anticipated that by the end of this program, a critical mass of personnel will have been trained and the research environment for neurology will have been improved hence an increase in publications and improved retention of trained faculty.

Objectives

Build Capacity for neurology research and training among medical students, residents and faculty in the field of neurological diseases.

Determine the magnitude of the neurology disease in Uganda and distribution of traditional and emerging neurology risk factors in order to formulate appropriate strategies for prevention, early detection, treatment and control. The survey will provide a baseline epidemiological data on neurology prevalence and risk factors hence facilitate research trainings.

MEPI-NEUROLOGY Year 3 Report

For the past three years, MEPI-Neurology linked award have expanded our highly successful research collaborations in infectious diseases to include Neurology, with the goal of substantially improving the capacity for research and training in Uganda and to address the critical shortage of leaders in Neurology. The specific aims include;

  • Building Capacity for neurological diseases and stroke research and training among medical students, residents and faculty in order to promote leadership, independent research and clinical careers in the field of neurology in Uganda.
  • To determine the magnitude of the neurological disorders and stroke problem in Uganda and the distribution of traditional and emerging risk factors in order to formulate appropriate strategies for prevention, early detection , treatment and control.

 We have continued to use the community based education, research and service (COBERS) sites to support training medical students in Neurology risk assessment and primary care. In addition, master’s degree programs for residents and short term fellowships and PhD training for young faculty are provided to develop clinical and research careers in Neurology.

Capacity Building.

  • We are currently supporting 10 Masters Students over the 3 years of the program, four (4) of whom have successfully completed and graduated.  The project also supports 2 PhD students who are fully registered and are progressing well.  
  • In addition to Yr.1 Cohort, 2 graduates were appointed faculty at Makerere University and all graduates have remained in-country.
Residents

10 residents with research focused in neurological disorders and stroke have been enrolled and  trained – (6-Internal medicine, 1 Psychiatry, 3-pediatric and child health.) 4 residents completed and graduated with Master’s degrees (2- Internal Medicine, 1-pediatrics and 1-pyschiatry, in January 2015. 3 trainees have completed and will be graduating next year 2016, 2 received their approval letters and have started on their research and 1 presented to the Institutional review board and will soon get her ethical approval to carry out her research.

With the no cost extension, we have taken on 2 more trainees from the department of pediatrics and Psychiatry.

PhD Students

2 PhD students have been and continuing to be supported and both have been appointed faculty in the department of Medicine and pediatrics.

Train faculty in non-degree neurology fellowships

To date, the program has supported 5 non-degree fellowship trainings, including for 4 young faculty members from Makerere’s College of Health Sciences and Nsambya Post Graduate Medical School at CWRU, Johns Hopkins, and Yale University.

Retention

For the 4 residents who graduated, 2 have been retained at Makerere University and 2 are working at Nsambya Hospital, our collaborating partner institution.

All the 2 PhD fellows have also been appointed faculty in the department of Medicine and pediatrics.

COBERS - Neurology risk assessments and on-site training

In preparation to the community based education Internships, over 350 undergraduate students have been given over-view lectures and oriented on neurology risk assessments, formulation of appropriate diagnostic and care for patients with stoke risk before their COBERS rotation.  

This has helped the students in identifying the risk factors and conducting appropriate referrals in their respective communities.

During  the community based education research and service (COBERS) visits, a series of onsite training and mentoring have been performed for the undergraduate students, health workers and medical officers from the community.

This has increased neurology understanding, clinical training and mentorship of students and health workers from different communities in the country. These training are facilitated by the staff from the neurology unit and PhD fellows. This also;

  • Strengthens the need to train a health care worker in a context in he/she can work.

At COBER’s, the students present different neurology cases from the community and go through neurological clinical examination with the neurology team.

 Students during COBERS at Kalisizo Hospital.

 

In addition to Capacity building in Neurology, we conducted and carried out Epilepsy Video-conferencing in 2013 with Case Western Reserve University Neurology Institute. 120 medical students, both undergraduates and graduate attended and discussed various issues of management with an epileptologist as shown below;-

Community sensitizations and support.

  • Neurology Awareness Campaigns. To date, Makerere neurology faculty has held 4 neurology and stroke awareness campaigns to sensitize and increase community knowledge of neurological disorders and management skills. From these campaigns, a total of 170 community health care workers and 90 district medical workers have been oriented and sensitized.
  • Through successful neurology awareness, it has raised the acceptability of neurology diseases to the public, educating people on neurological disorders, prevention and to increase control over their health.
  • Awareness activities have helped to increase the professional and public knowledge on the severity and costs of neurological disorders and emphasize the need to provide neurological care at all levels.
Partnerships

Makerere University college of Health csience has been involved with quiet a number of collaborators. In this case we opted to engage with Case western Reserve University (CWRU) which had a highly and mutually beneficial collaboration with Makerere Universty.

We opted to expand our collaboaration with this team with a focus in Neurology to ensure capacity building of the two local institutions in Neurology skills ; Makerere University and Nsambya school of Medicine.

  • Through this partnership, we have had an opportunity for the medical students , residents and post graduates to learn from experts to develop necessary skills  in neurology,research , care and diseasse prevention in Uganda.
  • For the 3 year’s Program, the neurology team from CWRU have visited the College and have participated in the site visits for the COBERS and interacted with the site supervisors, students , health workers and also participated in the neurology trainings of students at Makerere University college of Health Sciences and Nsambya School of Medicine.
  • Through collaboration, it provided an opportunity for both institutions , students and the neurology team to learn from each other with different neurological skills and research techniques as well as expriece in neurology care in rural settings.

Through this, students learn to work in rural communities and it helps them understand the socio-economic determinants of health, hence capacity building.

A large scale community epidemiology survey
  • Neurology Survey. A study  to determine the prevalence of neurological disorders in Urban and rural population in Uganda and also assess the knowledge and attitudes to perceptions of neurological disorders and associated major risk factors in subjects with neurological disorders  was completed  with over 3,000 participants in year 2 and also analyzed 200 blood samples.
  • This survey provided baseline neurology data on prevalence and risk factors and will facilitate research training. Data from this survey is being analyzed. A manuscript is under development, and several other scientific drafts are in-progress.
  • Publications. The program published 2 peer-reviewed research articles in major international journals. Four additional articles have been submitted to journals for review.
  • To date, 20 trainees have undergone an EMG skills transfer workshop which been instrumental in improving research and training infrastructure using the procured equipment.
Conclusion

MEPI-Neurology has improved in-country neurology expertise and better knowledge of the epidemiology of neurological disease and is to assist the Ministry of Health to establish effective policies for the treatment and control of neurological diseases and will improve outcomes.

Students during COBERS at Kalisizo Hospital, 2015

Dr. Ddumba Edward carrying out assessment of students during the COBER’S site at Masaka Regional referral hospital, 2014

Video-conferencing with CWRU Neurology Institute, Epilepsy center, 2013 with graduate and undergraduate medical students Davis lecture theatre.

Prof. Elly Katabira carrying out the training of health practitioners at Masaka Regional Referral Hospital, 2014

Dr. Edward Ddumba during the health worker’s training, 2014

Student led discussion regarding their neurology research activities and presenting their research findings to the team. Dr. George Akabwai presenting his results in 2014.

(In the Middle) “The Mepi-Neuro program has broadened my understanding of paediatric neurology. I have been able to develop more skills in treating children with neurological disorders. Most importantly, I have begun my career in neurological research.”Dr. Deogratias Munube

“I was honoured to have been part of MEPI - Neurology 2013-2014 as l was offered an opportunity to develop my post graduate research project as well as improving my skills and knowledge in field of Neurology through regular mentorship meetings. Thank you Case Western and Makerere University for this great opportunity.  Dr. Mugwano Isaac”

Sudden Death in Epilepsy (SUDEP) presentation by Prof. Samden Lhatoo with post graduate students October 2014, Mulago Senior Common room

Neurology epidemiology survey, study staff measuring the blood pressure of a study participant December 2014

The team from Case Western University visited the COBERS  in July 2015.-Prof Devereux ,Prof.Martha kalisizo team and Neurology team from Makerere  university College of Health sciences.

COBERS site visit and students’ training at Kalisizo Hospital, July 2015. Sitting front row (Prof. Martha Sajatovic, Dr. Angelina Kakooza, Dr. Edward Ddumba, Dr. Michael Devereux, Prof Elly Katabira and Dr. Douglas Flagg) Standing behind medical students and hospital staff after a neurology session.

Prof. Elly Katabira during the community visit  , July 2015