‘Far from the views of decision-makers’: podoconiosis instruction at medical schools across endemic countries in Africa

Abstract

Background Podoconiosis is a neglected tropical disease that causes significant physical, emotional and financial suffering, especially among impoverished rural farmers. Sufficient physician training is integral to optimizing patient outcomes through timely diagnosis and appropriate management. Therefore we sought to characterize podoconiosis instruction offered to medical students in endemic African countries. Methods We invited faculty from 170 medical schools in all podoconiosis-endemic African countries to provide information about podoconiosis inclusion in medical curricula. Surveys were available in French and English and captured podoconiosis knowledge, quantity/quality of instruction, ranking of importance relative to other diseases and barriers for improvement. Respondents voluntarily shared responses online or by telephone. Results Study participants provided information about curricula at 97 medical schools across 14 countries. In total, 42.6% of schools across nine countries offered podoconiosis-specific instruction; most respondents felt that the quality (60.4%) and quantity (61.5%) of instruction was insufficient. Common barriers to sufficient training included exclusion from government curricula, prioritization according to caseload and scarce epidemiological data. Conclusions Our study demonstrates widespread neglect in podoconiosis training for physicians in endemic countries. Government support is needed to ensure curricula match the needs of health workers practicing in rural, low-income regions.

Stakeholder perspectives on an integrated package of care for lower limb disorders caused by podoconiosis, lymphatic filariasis or leprosy: A qualitative study

“…This is similar to a recent Rwandan study which demonstrated poor knowledge around podoconiosis as well as minimal clinical experience in treating affected persons [26]; this was compounded by shortages of supplies and drugs as in our study. Another recent study which explored the inclusion of podoconiosis in medical undergraduate studies across all endemic countries in Africa found there was insufficient specific teaching on podoconiosis [27], mirroring our respondents, along with earlier Ethiopiaspecific reports [28] of high levels of misconceptions among health care professionals. Education interventions targeted to healthcare workers in endemic areas should be a component of any planned intervention to aid success.…”

Podoconiosis instruction at nursing schools in Kenya, Rwanda, and Uganda

“…Our findings align with previous studies from Rwanda and Ethiopia demonstrating that health workers lacked the specific knowledge to effectively treat and care for podoconiosis patients [ 19 – 21 , 34 ]. Similar misperceptions on disease cause and management were documented among medical faculty in endemic Sub-Saharan countries [ 23 ]. Altogether, this highlights a shared need for podoconiosis education for nurses and physicians to accelerate early detection, reduce patient stigma, improve prevention, and optimize patient outcomes.…”

“…Survey questions were initially developed by this team to assess podoconiosis instruction at African medical schools and were modified for nursing schools [ 23 ]. The survey tool was developed in English, pre-tested on 14 nursing tutors and lecturers in East Africa, and adapted as necessary.…”

“…Other studies in Ethiopia revealed that patients often discontinued treatment due to lack of adequate information on effectiveness or fear of being stigmatized by health workers [ 19 , 21 , 22 ]. An evaluation of podoconiosis education in medical schools found that only 27 out of 63 (42.9%) of medical programs in endemic East African countries included podoconiosis content in their curricula [ 23 ].…”

Solving the Puzzle of Global Health Inequity: Completing the Picture Piece by Piece by Piece

“…The value of a seamless interchange between research and education has been demonstrated regarding the serious but neglected tropical disease, podoconiosis (a type of tropical lymphoedema). Research has identified important gaps in knowledge by health workers as well as insufficiencies in medical school training (Bayisenge et al, 2020 ; Fowler et al, 2020 ). Importantly, new knowledge has been generated regarding the demographic profile of podoconiosis patients (Bikorimana et al, 2020 ), which could inform the development of programs of training and instruction to ensure that training is based on evidence that is current and high-quality thereby helping to reduce inequities in service provision for under-represented diseases.…”