Report 1 st Eastern Africa MicroResearch Forum Held at The College of Health Sciences, Mulago Hospital, Kampala Uganda March 25 26, 2013 Research presentations, networking, and scientific writing skills Invited Participants From Mbarara University of Science and Technology (MUST) and Healthy Child Uganda (HCU), Mbarara Uganda Makerere University (MU) and College of Health Sciences, Mulago Hospital (MH); Kampala, Uganda University of Nairobi (UoN) (and Kenya Medical training College (KMTC)); Nairobi Kenya Aga Khan University (AKU) and the Gertrude s Children s Hospital (GCH); Nairobi, Kenya Tanzanian Training Centre for International Health (TTCIH) and St Francis University College of Health and Allied Science (SFUCHAS); Ifakara, Tanzania 1
Objectives Opportunity for Presentations by MicroResearch projects leaders Opportunity for Networking to meet other MicroResearchers from East Africa with similar interests Scientific writing skills instruction to improve abstracts writing and response to grant reviews In put on Planning the next five years of MicroResearch Funding for the 1 st MicroResearch Forum International Development Research Centre (IDRC) Makerere University College of Health Sciences, Mulago Hospital Mbarara University of Science and Technology Healthy Child Uganda University of Nairobi Kampala Medical training College Aga Khan University Gertrude s Children s Hospital Tanzanian Training Centre for International Health IWK Health Centre Dalhousie University MicroResearch Personal donations: Noni MacDonald and Robert Bortolussi 2
Introduction and Background Poverty, hunger, illiteracy, maternal and child deaths have haunted the social landscape of under developed countries for generations. In 2000, the world took action by pledging to achieve eight Millennium Development Goals (MDGs) by 2015, including MDG #4: reduce under 5-year old mortality by two thirds; MDG #5 reduce maternal mortality by three quarters. These are huge tasks for developing countries as they bear 25% of the globe s disease burden with less than 1% of its healthcare professionals (HCP) and 2% of the research funds. International investment in research has made headway on MDGs by focusing on major problems like malaria, TB, and HIV. But the full value of these advances will never be realized until they are implemented in the community. This will require new strategies. Health Care Professionals (HCP) need skills and resources to find the best way to change local behavior and translate new discoveries into improved health. A new model for community based research was needed. MicroResearch is attempting to fill this role. Muhammad Yunus s microfinance concept has generated economic opportunities in developing nations by giving impoverished citizens access to capital to start new small businesses. Borrowing from microfinance principles, (train, coach and provide capital for small enterprise), MicroRresearch (MR), founded in 2008 by Jerome Kabakyenga, Dean of Medicine at MUST in Uganda, Noni MacDonald, former Dean of Medicine at Dalhousie University, and Robert Bortolussi, former VP Research at IWK Health Centre, provides training in grant proposal development, small grants to address health related community-based participatory research (CBPR) questions in a multidisciplinary manner (www.microresearch.ca) as well as training in community engagement and knowledge translation. MR s goals are to build CBPR capacity, foster a local culture of inquiry about health care needs and facilitate community engagement- all to improve maternal and child health outcomes. MicroResearch will soon be 5 years old with Mbarara University of Science and Technology (MUST) being the inaugural member (in 2008). MUST was soon joined by other Universities; Makerere University (in 2010) in Uganda; University of Nairobi (in 2011) and the Kenyan Medical Training College, Aga Khan University (Nairobi) and the Tanzanian Training Centre for International Health in Tanzania (in 2012). Since 2008, 11 training workshops have been held in these 5 East African Universities. More than 280 trainees formed 40 MicroResearch teams. Over 20 teams have submitted research proposals with more expected in May 2013 from the 2012 workshop participants. Given the number and range of projects, we believed the time had come for these MicroResearchers to present their findings and their proposal ideas to each other. The Forum also provided them with an opportunity to develop collaborative networks in key theme areas. Furthermore, since we are preparing to develop a strategic plan, the Forum provided us with an opportunity to listen to their thoughts on MicroResearch directions and goals through focus group discussion. Hence the rationale for the 1 st MicroResearch Forum. 3
The Forum was held at the College of Health Sciences, Mulago Hospital at Makerere University, Kampala Uganda on March 25 and 26 2013. The 25 invited participants (Appendix 1) came to Kampala (Makerere University) from Mbarara Uganda, (MUST and Healthy Child Uganda), Nairobi Kenya (University of Nairobi, Kenyan Medical Training College, and Aga Khan University) and Ifakara Tanzania (Tanzanian Training Centre for International Health). Makerere University acted as host for the event. A range of past MicroResearch trainees and regional supporters were invited from all sites and regions. The only non-africa participants were Noni MacDonald and Bob Bortolussi. A representative from IDRC had been invited but was not able to attend. The Program The program for the two day Forum is shown in Appendix 2. Care and attention was taken in drafting the program to ensure opportunities for participants to meet, mingle and discuss their plans and goals. Few participants, other than Noni MacDonald and Bob Bortloussi, knew many of the other participants prior to this Forum. Day 1 The core of Day 1 involved presentations on 15 MicroResearch projects; a mixture of completed projects, some with publications, projects that are funded and underway, projects that have just received funding and projects in development. The presentations were selected to show the breadth of MicroResearch, to highlight opportunities for alternatives to MicroResearch funding as well as tenacity of MicroResearch teams. The MicroResearch presentations were grouped into three research themes; chronic disease, maternal and children s health and health system. The 15 projects, presenters and their MicroResearch teams are listed in Appendix 3. Every presentation led to questions, suggestions and praise. The quality and level of the projects was high and would have competed favorably at global health sessions at major international conferences. Many of those attending were surprised by the breadth covered by the selected projects. Links between different MicroResearch teams began to form. The last presentation on this day was a report on portions of an E mailed MicroResearch Survey of 60 MicroResearch Training graduates, and site and regional MicroResearch supporters and trainers from the five sites sent in February 2013. The response rate to the survey was high, 63% (43/68), and illustrated the interest in MicroResearch of those surveyed. Appendix 4 provides the power point presentation of the major findings. A full report including the analysis for themes for the SWOT analysis is being prepared. Day 2. Day 2 began with Focus Group Discussions. Two groups were formed; one predominately of MicroResearch program graduates and the other predominately of site and regional supporters/trainers of MicroResearch. The four questions posed to the Focus Groups were: 1. What should MicroResearch in Eastern Africa look like 5 years from now? 2. What tools and changes are needed to get there? 4
3. How will we know if we are there? 4. What gaps still need attention in fine-tuning MicroResearch processes and programs? The Focus Group Discussion sessions were recorded, will be transcribed and themes extracted. Following the Focus Group discussion, the participants from each group provided a brief report. (Summarized in Appendix 5) The last session of the day involved a scientific writing exercise. Two exercises were done by Workshop participants and invited local graduate students from Makerere University. The first exercise involved correcting the first draft of a mock abstract to find errors of omission and commission. This was done in small groups followed by large group review of the findings. All participants were sent a copy of the errors by email. The second exercise involved developing responses to review requests on a MicroResearch grant. Again this was done in groups with follow up in large group. Both exercises were well received with enthusiastic participation. Evaluation of the MicroResearch Forum. Twenty of the 24 participants completed an evaluation (Appendix 6) prior to the scientific writing session. Follow up and Recommendations: 1. Provide all participants, supporters and organizers with this report and post it on the MicroResearch website. 2. Send participants follow up of the scientific writing exercises a) noting omissions and commissions on the abstract and b) suggested format for responses to grant and manuscript feedback. 3. Provide participants with the Focus Group discussions, and invite additional comments. 4. Consider incorporating the scientific writing exercises into the MicroResearch Workshop course. 5. Use the Survey and the Focus Groups discussions to provide background information for participants in the upcoming MicroResearch Strategic Planning meeting later in 2013 Including discussion on: Funding for on site MicroReasearch coordinators at each University, Refinements to MicroResearch Curriculum, Revision of the Website to facilitate discussion, Annual Forum Meetings. 5
6. Encourage development of a MicroResearch Consortium with collaboration among Eastern Africa Universities and work with the Consortium to write a Grand Challenge Canada grant application for 2013. 7. Explore potential for an online International Journal of MicroResearch 8. Explore potential for greater MicroResearch Canadian and African obstetric collaboration, leading to a formal relationship with the Society of Obstetricians and Gynecologists of Canada similar to the relationship with the Canadian Paediatric Society. 6
Appendix 1. Participants at the 1 st MicroResearch Forum Participant Affiliation email Atwiine Barnabas MUST atwiine78@gmail.com Basil Tibanyendera MUST/HCU basiltiba@yahoo.com Benson Estambale U of Nairobi; Jaramogi Oginga Odinga University of Science and Technology bestambale@uonbi.ac.ke Boniphace Jullu TTCIH jullub@gmail.com Conrad Wanyama Gertrude Children s Hospital relwancon@gmail.com, cwanyama@gerties.org Eric Wobudeya Makerere University ewobudeya@gmail.com Fred Mochache U of Nairobi fredmosem@yahoo.com Mose Hellen Kariuki U of Nairobi hellen.kariuki@uonbi.ac.ke Isha Grant Kadic Health Centre isha52ke@yahoo.com Jennifer Oyieke U of Nairobi jenniferoyieke@yahoo.com Jerome MUST/HCU jkabakyenga@gmail.com Kabakyenga Josaphat Byamugisha Makerere University jbyamugisha@chs.mak.ac.ug, byamugisha2001@yahoo.com Juliet Birungi Makerere University jlietmb@yahoo.com Justine Marvyn Makerere University mkamuchaki@gmail.com Kamuchaki Kenneth Juma Aga Khan University Kenneth.juma@aku.edu Leah Chebet Bii U of Nairobi/ KMTC leah_chebet@yahoo.com Mary Samantha HCU samantham500@gmail.com Mohamoud Merali Aga Khan University mohamoud.merali@aku.edu Nelson Sewankam Makerere University sewankam@infocom.co.ug Noni MacDonald Dalhousie University Noni.MacDonald@Dal.ca Robert Bortolussi Dalhousie University Bob.Bortolussi@iwk.nshealth.ca Sarah Kiguli Makerere University skwalube@yahoo.co.uk Scholastic Ashaba MUST /HCU scholaashaba@yahoo.com Senga Pemba TTCIH pemba7@gmail.com, pemba@healthtrainingifakara.org Teddy Kyomuhangi HCU hcupm@yahoo.co.uk Zabron Abel TTCIH zabron76@gmail.com 7
Appendix 2. 1 st MicroResearch Forum Program Sunday March 24, 2013, 20:00 h [Abba Hotel] Meet & Greet (light meal provided) Monday March 25[Board Room, College of Health Sciences, Mulago Hospital] 9:00 Launch of Meeting: Registration, Opening Ceremony and Group Photo Introduction to MicroResearch Forum [RB] Theme 1 Presentations: Chronic Disease Research 10:30 Tea Break Theme 2 Presentations: Maternal and Child Health Research 12:00 Lunch (Served on site with Networking Opportunity) Theme 3: Health Systems Research Networking Introduction [RB] 15:00 Tea Break with your network group MicroResearch Needs Assessment Survey Report [NM and RB] 18:30 Supper The Lawns, plot 34 Impala Ave, Kololo Tuesday March 26 [Board Room, College of Health Sciences, Mulago Hospital] 9:00 Introduction to Focus Groups [NM] Focus Group Discussion Reports from Focus Groups Distribution of Certificates of attendance and Final Group Photo 12:00 Lunch (served on site with Networking Opportunity) Scientific Writing Skills lecture and Workshop [RB and NM] 15:00 Close of Forum, Certificates and departure for Airport 8
Appendix 3: Forum Project Presentations Theme 1: Chronic Disease Research Cervical Cancer Turning a threat into opportunities. Presenter: Kenneth Juma (AKUH) Team: Rose Kamwena (AKUH), Patricia Okiro (AKUH), Frank Mwendwa (AKUH), Ann N. Wanyoike (AKUH), Moraa Bisase (GU), Monica Komen, (GU), Coach: Anthony Otley (Dalhousie University), Efficacy of glutamine supplementation on the outcome of children admitted with persistent diarrhea. Presenter: Justine Marvyn Kamuchaki (MU) Team: Sarah Kiguli (MU), Bob Bortolussi (Dalhousie University), Eric Wobudeya (MU) The MicroResearch Clubfoot project in Kenya: The Journey Presenter: Hellen Kariuki (U of N) Team: Mary Anziani (Kenya Medical Research Institute (KEMRI)), Martin Kollmann (CBM and U of N), Danson Kereri Mwangi (Institute of Primate research, Kenya(IPR), Susan Ndinguri (Kijabe Hospital ), Mwaniki John Njeru (KEMRI), Coach: Theresa McElroy (BC Womens and Children s Hospital, University of British Columbia) Theme 2: Maternal and Children Health Research Perinatal death audits in rural Uganda. Presenter: Isha Grant (KHC) Team: Deogratias Manube (MU), Sarah Kiguli (MU), Bob Bortolussi (Dalhousie University) Knowledge and practices of women regarding prevention of mother to child transmission of HIV (PMTCT) in rural southwest Uganda. Presenter: Atwiine Barnabas (MUST/HCU) Team: Aloysius Rukundo (MUST), Julius Mugisha Sebikali (MUST), David Mutibwa (MUST), Dickson Tumusiime (MUST), Robert Turyamureeba (MUST), Lillian Birungi (MUST), Coaches: Basil Tibanyendera (MUST), Walter Schlech (Dalhousie University), Noni MacDonald (Dalhousie University) Assessing tools and practices at antenatal clinic for optimization of the health of pregnant mothers in Kilombero District Presenter: Boniface Jullu (TTCIH, SFUCHAS) Team: Jacquiline Liseki (SFUCHAS), Benjamin Ngoso, Ramadhan Abdul (TTCIH), Benjamin Ngosos (TTCIH), Kija Nghabi ( Ifakara Health Institute), Coach: John LeBlanc (Dalhousie University) Use of mobile phones to improve the antenatal care attendance of pregnant women in Semiurban of South Eastern Tanzania. Presenter: Zabron Abel (TTCIH) Team: Meshack Lubeleje (SFUCHAS), Peter Paciens (TTCIH), Fassil Gebregziabher (SFUCHAS), Aza Lyimo (SFUCHAS), Sally Mtenga (TTCIH), Coach: Bob Bortolussi (Dalhousie University) Pilot Project: Impact of In Service training of midwives on partogram use. Presenter: Jennifer Oyieke (UoN) Team: Elizabeth Dimba (UoN), Faith Okalebo (UoN), Regina Mutave (UoN), Jane Ong Ang O (KEMRI), Alice Yugi (Assoc for the Physically Disabled in Kenya), Maria Kiio (IPR), Coach: Heather Scott (Dalhousie University) 9
Determinants of Maternal Health Care Utilisation by Adolescents in Informal Settlements of Nairobi. Presenter: Fred Mochache Mose (UoN) Team: Elijah Okall (Kijabe Hospital), Jane Achieng Acholla (KMTC), Jeremiah Munyao Muli (KMTC), Peter Mwangi Kirigwi (KMTC), Lucy Wangari Mwangi (UoN), John Kariri Mukui (KMTC), Coaches: Margo Lane (University of Manitoba), Roberta Woodgate (University of Manitoba) Theme 3: Health Systems Research To understand the Attitudes and Perceptions of the patient need for counseling by Family Physicians at the out patient Primary Care Centre at the Aga Khan University Hospital. Presenter: Mohamoud Merali (AKUH) Team: Peninah Chege (GCH), Ednah Ojee (AKUH), Peter A. Obonyo (GUH), Eunita Kagasi (GUH), Safina Kulola Dhadho (GUH), Bernard Otieno Oduor (AKUH), Coach: Elizabeth Cummings (Dalhousie University) Healthy Child Uganda Survey on knowledge, Attitude and Behaviour of Village Health Team (VHTs) towards their work in south west Uganda. Presenter: Scholastic Ashaba (MUST/HCU) Team: Godfrey Zari Rukundo (MUST), Data Santorino (MUST/HCU), Moses Ntaro (MUST/HCU), Florence Beinempaka (MUST), Katushabe Syson (MUST), Coach: John LeBlanc (Dalhousie University) Acceptability and utilization of motorcycle ambulance in Mbarara and Bushenyi districts. Presenter: Teddy Kyomuhangi (MUST/HCU) Team: Healthy Child Uganda Investigating the role of income generating activities to help in motivation and retention of Village Health Teams in the Kinoni health sub district in South west Uganda. Presenter: Mary Samantha (MUST) Team: Katuruba David (HCU/MUST), Apuulison Friday (MUST), Mahoro Christine (MUST/HCU), Nakide Gladys (MUST), Asiimwe John Baptist (MUST), Coach: Shawna O Hearn (Dalhousie University) Assessment of activities and impact of Community Owned Resource Persons (CORPs) on families and communities in Healthy Child Uganda Bwizibwera Project Area. Presenter: Basil Tibanyendera (MUST) Team: Milton A Wesuta (MUST), Fortunate Atwiine (MUST), Esther Beebwa (MUST), Francis Mugabi, Stephens Twesigye, Stephens Twesigye (MUST) Coach: Noni MacDonald Hepatitis B vaccination and influencing factors among healthcare students at Kenya Medical Training College, Kenya Leah Chebet Bii (KMTC) Team: Anne Njeri Maina (UoN), Billy Oduor Nyanga (UoN), Peris Jelagat Kipchumba (KMTC), Peter Muiruri Guchu (KMTC), Kipkoech Geoffry Korir (KMTC), Coach: Elaine Mills (formerly McGill University) 10
Appendix 4. Preliminary Report of 2013 MicroResearch Survey 11
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Appendix 5 Draft Summary of Forum Focus Group Discussion Group 1 1. What should MR in Eastern Africa look like 5 years from now? MR across the region will become a MR Consortium. MR will be a network for writing proposals. The first proposal to be written is to Grand Challenge Canada in September 2013 Each site /university will develop templates for the university and for departments in terms of key performance indicators for MR. MR concepts will be incorporated into present course and tailored to fit new ones. Eastern Africa MR Consortium will be recognized as world leaders in MR. 2. What tools and changes are needed to get there? Develop clear definitions and framework with targets and key performance indicators. There must be strong ownership of MR at each site and across the region i.e. work strongly together. A preliminary leadership group is proposed for the consortium. Must ensure that MR is credible, and quality is assured across the consortium. Development of a work plan with time frame and deliverables is key. 3. How will we know if we are there? The Eastern African MR Consortium is recognized internationally as leaders in MR with other countries locally and in other parts of the world sending people to be trained in MR. An International Journal on MR that is in PubMed will be in place. Regular MR forums will be held. The MR Consortium will be seen as a resource for MR teams to access expertise across the networks e.g. need a psychiatrist on the team or as a resource, the consortium can connect the Team to the local expert. The MR Consortium will have a plan in place and working that ensures sustainability for MR in the region. They will work locally as well as internationally. 4. What gaps still need attention in fine tuning MR processes and programs? The current MR Training Course should charge a fee set by each site Each site needs a MR Coordinator to write applications as well as support the program Need to develop more local trainers and have them work across the 5 sites. Group 2 1. What should MR in Eastern Africa look like 5 years from now? MR will have on sight infrastructure facilities including mentors, coaches, local solution finders and a coordinator who will keep all trainees informed. Goals for the infrastructure will include: o Support: with adequate tools to achieve this and a process for evaluation o Networking: with tools and evaluation o Training: with tools and evaluation Expansion: o A secretariat will develop links with government policy makers o MR training principles will be incorporated into faculty training programs o An annual Forum will be held with each theme decided in region o Training will be enhanced by a domino effect, (trainee training others) o Over next 5 years MR will remain focused in East Africa (not Eastern Africa) 2. What tools and changes are needed to get there? We will need a Roadmap to achieve goals and objectives. 15
Need Champions at each university to coordinate each group. Need a database with info on research projects, researchers etc to facilitate networking. Need local coordinator to facilitate team meetings and communication. Website needs to be improved: o Individual page for each university o Improved electronic discussion process o Link to University web page for IRB, finance management page 3. How will we know if we are there? There will be champions at each university. MR will be a leader in community health research and have close links to Health Policy makers. Local expert team will be available at each university: o IRB navigator (imbedded in the IRB and in MR) o Financial management expertise 4. What gaps still need attention in fine tuning MR processes and programs? We need Champions in Eastern Africa. We need to set 5 year and interim targets, with continuous evaluation and monitoring and reports based on set targets. We need an evaluation process to assess success and chart changes using Quality Assurance Teams for specific items: o Number workshops and people completing workshop o Quality of workshop o Retention of team members and recruitment of new team members o Number of proposals submitted and completed o Papers and reports published o o Amount of money partnered to MR by NGOs and others Number policies influenced (self reported and those that are also documented in policy background publication) Need to develop a Dashboard to allow university comparisons, e.g. IRB time, project completion time etc. Universities may then share ideas for changes Additional comments: MicroResearch should stay focused on maternal child health at present time I hope that the MicroResearch approach will have been tilted towards action research in order to realize its tangible impact in the communities. I also hope that the MicroResearch will have been registered in the relevant national organs for due accreditation and official national recognition. This is significant for purposes of attaining political will and support wherever and whenever necessary. Need to consider more involvement of the teaching hospital leadership as well as the university leadership in MicroResearch 16
Appendix 6 Evaluation Summary Completed Forms: 20 of 24 (excludes Bob Bortolussi and Noni MacDonald). Forms were collected before the scientific writing exercise because of time constraints, but comments on the scientific writing exercise were collected 1. Please rate the MR Forum in terms of meeting your expectations. Excellent 17 Satisfactory 3 Unsatisfactory 0 Poor 0 2. The MR Forum travel arrangements, accommodation and facilities, were comfortable and appropriate. Strongly Agree 5 (one comment: but hotel too far to venue ) Agree 6 Disagree 2 (comment: disorganized airport pickup) Strongly Disagree 2 Undecided 1 Not Applicable 3 (local participants) 3. The number of participants at the MR Forum were Too many 0 Just about right 20 Too few 0 Undecided 0 4. What did you like best about the MR Forum? (Note: some noted >1) Scientific presentations (13 responses) taught me a lot diversity, basic but important issues very good ideas discussed nature of mixture was fantastic ownership of project ideas by presenters resilience of the MR teams looking beyond MR for funding Networking (8 responses) interaction with those from other universities, disciplines sharing ideas and talking Focus Groups (5 responses) open discussions interaction junior and senior faculty excitement about learning usefulness of different projects in the 3 countries 5. What did you like least about the MR Forum? None: 9 Logistics: 8 o accommodation, closer to venue 17
o venue (more washrooms ) Presentations: 2 o some presenters did not follow MR teaching font size, # slides, need to strengthen Time: 1 o few hours needed for site seeing, shopping 6. What, if any, improvements would you suggest for the next MR Forum? Venue: Arrange accommodation closer to venue 5 Arrange venue away from work site for locals 1 Travel: Send ticket and insurance earlier 1 Send travel information earlier (e.g. 2 weeks) 1 Earlier flights to allow rest before meeting 1 Other: better organized, proper logistics 1 Add time for sightseeing and shopping 1 Comments: Keep it up Keep format Have joint moderators for sessions Keep presentation sharp to 10 min with 4 min for discussion, (and correct) slide numbers, font size Bring new /university people on board to learn about what MR is about More training in research methodology; data management and analysis Perhaps time for discussion on MR supervision and guidance at individual level 7. Comments on Scientific Writing Exercise (18 participants) Abstract Learned a lot, really helped emphasize what had learned in MR training (10 ) Was fun to work in groups and exercise was fun format Incorporate abstract exercise into MR course (5) Send out answers to abstract writing exercises (10) Responding to grant review comments Totally new and helpful experience (8) Learned a lot Will try to apply this with future grant reviews (3) Also think how might be added to MT training (10) 18