☰ Menu

8th Postgraduate Course for Training in Reproductive Medicine and Reproductive Biology

Africa and the Eastern Mediterranean Annual Technical Report 1997

W. Akande and H. Bathija
HRP - UNDP/UNFPA/WHO/World Bank Special Programme

REGIONAL STRATEGIES

The strategy for strengthening research capacity in reproductive health in the African and Eastern Mediterranean Regions, which was revised in the previous biennium, continues to focus on the strengthening of selected institutions and stimulation of interest in reproductive health in various countries.

The main elements of the strategy are as follows:

(i) development of subregional "Centres of Excellence" which are capable of assisting weaker centres, especially those in least developed countries (LDCs);

(ii) promotion of networks through "South-to-South" and "South-to-North" links;

(iii) improvement of research protocol development, research management and scientific writing;

(iv) promotion of intraregional training;

(v) stimulating interest in the LDCs, francophone Africa and the Eastern Mediterranean Region;

(vi) promoting resource mobilization for research capability strengthening activities in the region;

(vii) strengthening research skills in the social sciences; and

(viii) promoting "targeted" research on major reproductive health problems and the needs of LDCs.

For francophone Africa, additional strategies for increasing research capacity include: stimulating interest in research on reproductive health at country level; disseminating research findings in French; creating or rein forcing research networks among francophone African scientists and institutions; organizing regional conferences for francophone African countries; and improving the infrastructure for research by developing the human resources, strengthening libraries and promoting good management practices.

These strategies for francophone countries are being pursued in collaboration with other agencies, groups and institutions, such as the French National Institute of Health and Medical Research (INSERM) and the University of Geneva.

REGIONAL ACTIVITIES

Research

Research on female genital mutilation

Following a Protocol Design Workshop on Female Genital Mutilation (FGM) organized by the Programme and WHO’s Women’s Health Unit (WHD) in Abidjan, Côte d’Ivoire in December 1996, work commenced on the development of protocols for research on FGM in a number of areas as follows:

Clinical research

Clinical research is badly needed to fill existing in formation gaps on FGM and data in this area will assist WHO and countries to provide the necessary scientific evidence to support informed decision-making. In collaboration with WHD and the University of Manchester, Manchester, United Kingdom, the Programme undertook a systematic review of the sequelae of FGM measurable at childbirth, and prepared protocols for research on the obstetrical and sexual health consequences of FGM. During 1998, these protocols will be reviewed and refined at an investigators’ meeting of researchers from high prevalence areas of FGM. They will subsequently be submitted to the Programme’s Scientific and Ethical Review Group (SERG) for approval and it is hoped that a multicountry clinical study will commence in the second half of 1998 in selected countries, subject to availability of funds.

Sociocultural and behavioural research

A protocol for collecting and analysing data on the sociocultural aspects of FGM was prepared by the Department of Sociology/Anthropology, the University of Douala, Douala, Cameroon, with WHD. This protocol was reviewed internally by social scientists from the Programme’s Strategic Component on Social Science Research and other relevant programme areas in WHO. The protocol was also reviewed externally by researchers from the Karolinska Institute in Sweden and subsequently revised; it is currently being field tested in Cameroon. The protocol will be refined further in an investigators’ meeting of social scientists from high prevalence areas of FGM and will be submitted to SERG for approval during 1998. It is expected that the study will be ready for implementation in selected communities practising FGM towards the end of 1998. Such data will help WHO and others gain a sound understanding of the sociocultural, gender, economic and other factors perpetuating the practice of FGM in selected contexts. The results will also provide information on FGM that can be used to develop future prevention/intervention trials to prevent and eliminate FGM.

Operations research on improving reproductive health services for adolescents

During 1997, work with the francophone African coun tries included several events that were follow-up activities to the workshop held in December 1996 in Abidjan, Côte d’Ivoire, to develop a protocol on operations re search to evaluate and improve reproductive health services for adolescents. The project will take place in seven francophone sub-Saharan countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Guinea, Madagascar and Senegal. The proposed research will include a baseline sur vey to define the profile of the adolescent users of health services and the quality of services offered. It is expected that subsequently an intervention strategy will be developed for each country depending on the results of the baseline survey. This will address either the need for increasing information to adolescents or the modification of existing services to make them more youth-friendly. The intervention will be evaluated through a second survey. Although it is envisaged that the funding for each country project will be raised locally, the Programme is facilitating and coordinating this regional initiative. A special feature of the project is the active participation of youth representatives.

The following intercountry activities were held to develop various aspects of the protocol and to reach a consensus on the study methodology:

(i) A three-day workshop was held in April 1997 in Dakar, Senegal, with the coordinators of the project and the youth representatives of each country team to review the progress of the study preparations in each country; to further develop the study instruments; to define the role of the youth representatives in the teams; and to discuss strategies for raising funds for the study.

(ii) Two courses on epidemiological research methodology were organized in Conakry, Guinea, in September 1997. They lasted for one week and had several common sessions. The participants were principal investigators and coordinators or youth representatives of the study. The objectives of these courses were to strengthen the participants’ knowledge of the theory of research methodology and to agree on the research methodologies to be used in the study.

(iii) A one-week workshop on statistics and data process ing was organized in November 1997 in Pahou, Benin. The participants were statisticians, data programmers or principal investigators of the study from Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Guinea, Madagascar and Senegal. The objective of this workshop was to discuss and introduce a common system of data management and decide about a statistical strategy for the multicountry study. A detailed plan for the baseline survey of the study was developed during the workshop.

Research on reinforcement of the liaison between antenatal care and delivery care

Following the recommendation of the meeting held in 1994 with representatives of 13 francophone African countries in Yaoundé, Cameroon, to initiate a multicountry study on the quality of antenatal care, the Programme has facilitated a review of the current status of antenatal care in five francophone African countries: Benin, Burkina Faso, Cameroon, Côte d’Ivoire and Senegal. This assessment was done in 1996 through site visits, review of existing documentation and discussions with government officials, representatives of various international agencies and nongovernmental organizations (NGOs) in each country.

In 1997, the process was continued with the collaboration of a researcher from INSERM, Paris, France. It included first a survey of health professionals, decision-makers and community representatives in the same countries to understand which issues relating to antenatal care were considered by them the most important to carry out research on. Responses were received from about 100  persons and they indicated that most of the important problems related, at the community level, to the lack of information, education and communication concerning antenatal care and, at the service level, to the quality of services (content of care, interpersonal relationships between health personnel and clients).

A brainstorming workshop was held in April in Dakar, Senegal, where 13 participants (sociologists, gynaecologists, researchers, a nurse, a midwife, paediatricians and government representatives) developed the ideas further in order to proceed to protocol writing. The workshop was held in connection with the above-mentioned work-shop for the study dealing with reproductive health services for adolescents, since in both cases the proposal is to carry out operations research and, thus, the researchers of one study could share their experiences with those of the other study.

Subsequent to this workshop, a thorough literature review was carried out in collaboration with the African Network for Reproductive Health Research in Benin, Burkina Faso, Cameroon and Côte d’Ivoire. This revealed discrepancies between the percentages of pregnant women attending antenatal care and those having skilled assistance at delivery. This finding led to the suggestion that the new study should look at the possibilities of using antenatal care visits to prepare birth plans with women and explore the ways to assure skilled attendance at delivery. The current understanding on best strategies for reducing maternal mortality was also taken into consideration while preparing the protocol. In the light of the recent review of the success of various "safe motherhood" programmes within the past 10 years, the role of classical antenatal care is de-emphasized. It is difficult through antenatal care clinic visits to prevent or predict complications which lead to severe maternal morbidity or mortality, but a proper management of complications, when they arise, would be more effective. This understanding has led to the suggestion that the new study should look at the ways pregnant women, the community and health personnel perceive the complications and react to them and subsequently attempt to improve their methods of dealing with them appropriately.

The draft protocol developed so far suggests an approach where first a baseline survey will be carried out at community level to understand perceptions and experiences of both women and so-called key persons relating to pregnancy, antenatal care and obstetrical complications. At service level the survey will collect information about the current use of antenatal care, its content relating to how it prepares women for birth and its complications, its links with delivery care, and service providers’ perceptions on women’s needs.

The results of this first survey would then be discussed with all those involved at community and service levels in order to reach a consensus about the interventions to be implemented. Although the exact interventions will probably vary between countries, it has been agreed that some of them will address the content of care with the aim of assuring that, even if the woman has a limited number of antenatal visits, she will be able to benefit to the maximum from the procedures shown to be beneficial for pregnant women. The main emphasis in the interventions will be to strengthen the link between antenatal and delivery care and to use the antenatal care visits for making birth plans and providing skills and information on how to react to complications.

The interventions would be followed by another survey to evaluate their impact on variables such as frequency of use of services, satisfaction with services, rate of complications, rate of referrals, and pregnancy out-come.

Research training

Workshops and short courses

(i) A course on epidemiological research methodology was organized in Conakry, Guinea, in September 1997, for participants from seven countries (Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Guinea, Madagascar and Senegal). The faculty included scientists from Benin, Cameroon, Côte d’Ivoire and France. The objective of the course, which lasted for three weeks, was to help the participants to develop research protocols which would be scientifically sound and would address issues determined to be priorities for research in the subregion. Nine research protocols were developed on themes relating to men’s perception of contraception; adolescent reproductive health; medical and sociocultural aspects of female genital mutilation; antenatal care; "down-staging" method for diagnosis of cervical cancer.

(ii) The Programme collaborated with the Belgian Agency for Cooperation and Development and the School of Public Health of the Free University of Brussels (ULB) in holding a three-week workshop in May–June in Brussels for 10 persons from seven francophone countries (Algeria, Benin, Djibouti, Mali, Morocco, Senegal and Tunisia). The participants were people holding high-level posts relating to reproductive health (in ministries of health, or in university or other institutions training health professionals) and were selected by their governments. The faculty included ULB professors, WHO staff and one resource person each from Benin and Cameroon. The objectives were to plan the operationalization of the reproductive health concept at country level and to advocate for the necessity of reproductive health research. Since it was realized during the workshop that the time was too short to meet both objectives, the participants were asked to decide which objective they were most interested in achieving. In the end, all wanted to learn more about research. Consequently, two groups wanting to do a multicountry study were formed and outlines for three studies were developed related to the efficacy of the use of the partogram, to infertility and STDs in Maghrebian countries, and to the management of postpartum haemorrhage.

(iii) As a follow-up to the basic courses on statistics and management of reproductive health research data which had been conducted in 13 African countries between 1988 and 1994, the Clinical Trials and Informatics Support Unit of the Programme organized and conducted a regional training course on advanced statistical methods in Arusha, Tanzania. The course, which was jointly sponsored with the Commonwealth Health Secretariat, was attended by participants from 15 collaborating centres in Africa.

(iv) A Semenology Workshop was held in April 1997 at the Department of Obstetrics and Gynaecology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa, with the support of a grant from the Programme. There were 11 participants from six sub-Saharan countries (Benin, Kenya, South Africa, Uganda, Zambia and Zimbabwe). The Faculty included scientists from the Universities of Nairobi and Zimbabwe as well as the Stellenbosch University.

Research training grants (RTGs)

During the year, two persons were studying outside their countries with Research Training Grants (RTGs) from the Programme. Their fields of study were biostatistics and reproductive endocrinology, respectively. In addition, five students from Tanzania, Uganda, Zambia and Zimbabwe were undertaking the Master’s Degree course (M.Sc.) in Reproductive Biology at the University of Nairobi, with University of Nairobi scholarships provided from grants by the Programme under the terms of a Memorandum of Understanding between the University of Nairobi and WHO (see below). Two new RTGs were approved in 1997: one to train in molecular biology and the second to study for a Diploma in Reproductive Biology and Medicine.

M.Sc. Course in Reproductive Biology, University of Nairobi

A Master’s Degree course (M.Sc.) in Reproductive Biology was commenced in October 1993 at the University of Nairobi with the assistance of the Programme. The initial intake into the course was seven students, of whom five were Kenyans and two non-Kenyans (one each from Cameroon and Uganda). A second set of six students (two Kenyans, two Tanzanians and two Ugandans) commenced the course in January 1996 and were completing their research work in 1997. A third set of five students have been admitted in 1997. They include two Kenyans and one student each from Tanzania, Zambia and Zimbabwe. Most of the students received University of Nairobi scholarships from grants provided by the Programme under the terms of a Memorandum of Understanding between the University of Nairobi and WHO. The results of two research projects by the students have already been presented in an international conference. They were on "Schistosoma mansoni—New Zealand rabbit model: effects on plasma testosterone" and "The effects of dieldrin on the reproductive system of the neonatal male rat".

Evaluation of research training

In collaboration with the WHO Regional Office for Africa, the Programme has since 1993, annually organized a regional course for francophone countries on epidemiological methods for reproductive health research. One national course was also organized in 1996. This year, an evaluation of the courses was done by mailing a questionnaire to the 78 persons who had been trained through these courses. A response rate of 77% was obtained. Since one of the main emphases of the course has been to develop a research protocol, the interest in the evaluation was to find out if this protocol had been finalized and implemented. Only one of the 58 individuals who responded had already completed the project developed during the course; in nine instances the project had been incorporated into another project; 13 had finalized the protocol and were waiting to receive funds; 23 were still working to improve the protocol; and five persons had never worked on their project after finishing the course. However, 95% of the respondents answered to have used the knowledge and skills acquired during the course in writing other research protocols, writing scientific articles, teaching students or in their clinical work. The results confirm the importance of continuing the training courses, but indicate the need to reorient the emphasis. The Programme has subsequently been in touch with other organizations and institutions providing similar types of training in the region to learn about their courses and their interest in collaboration to provide improved courses in research methodology. This process will continue in 1998. During 1997, a follow-up study was commenced of those who had received an RTG from the Programme between 1987 and 1996 in order to evaluate the impact of the Programme’s efforts to build up a critical mass of scientists involved in reproductive health research in the region. Seventy-five questionnaires were mailed to these grantees. It is expected that the responses will be processed and analysed during 1998.

Other intercountry activities

In the Eastern Mediterranean Region, an intercountry meeting on "Women’s and gender perspectives in reproductive health in the Eastern Mediterranean Region" was held in Casablanca, Morocco, from 10–13 November 1997, bringing together representatives of women’s groups, researchers, service providers and policy-makers from 10 countries of the region (Bahrain, Egypt, Jordan, Lebanon, Morocco, Oman, Palestine, Sudan, Syria, Tunisia). The meeting, which was held in collaboration with the WHO Regional Office, provided a forum for exchange of information and an opportunity to create a common understanding of what is meant by "Women’s perspectives" and "Gender approach" in reproductive health for the region. It also enabled the participants to identify ways of incorporating women’s perspectives in defining priorities in research and programmes and to identify possible joint actions at regional and/or national level. Further details of this activity are provided in the report on Women’s perspectives and gender issues.

COUNTRY ACTIVITIES

During 1997, collaboration with the Programme occurred in the following 16 countries of the African Region: Benin, Botswana, Burkina Faso, Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Kenya, Mozambique, Nigeria, Senegal, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. Collaboration also occurred in the following eight countries of the Eastern Mediterranean Region: Algeria, Egypt, Iran, Morocco, Pakistan, Saudi Arabia, Sudan and Tunisia. A total of 25 institutional grants and two RTGs were awarded. Five of the institutional grants were Long-term Institutional Development (LID) Grants.

AFRICAN REGION

BENIN

The Centre for Research in Human Reproduction and Demography (CERRHUD) of the Department of Obstetrics and Gynaecology, University of Benin, Cotonou, received LID Grant support between 1987 and 1996. A large part of the grant was used for training a team of scientists including demographers, a documentalist, a social scientist, a microbiologist, a statistician, and an endocrinologist. In 1997, the Centre benefited from a Resource Maintenance Grant (RMG).

Research

In 1997, the Centre had six ongoing research projects. Four of these projects were supported by international funding sources other than WHO. This is in continuation of the trend observed in 1995 and 1996. Three of the research projects related to fertility regulation, one to abortion and one to STDs. The Centre contributed to the conduct of the Demographic and Health Survey in Benin.

Capacity building

The staff served as faculty in the Programme-sponsored training activities at regional level during the year. Together with the Programme, the Centre organized a workshop on statistics and data management in French in Pahou, Benin, in November 1997.

OtherIn October, the Centre organized a special event for the traditional chiefs and kings of one geographical region of Benin to offer them an occasion to hear about the research results and reflect upon them with their populations for making decisions relating to reproductive health programming in their area. This innovative event was extremely well received and covered by the media. The conclusions and recommendations included, for instance, providing family life education to young people through schools. CAMEROON

The Centre for Human Reproduction Research at the Faculty of Medical and Biological Sciences of the University of Yaoundé has received LID Grant support between 1987 and 1996. In 1997, the Centre benefited from a Resource Maintenance Grant.

Research

In 1997, the Centre had 23 research projects. Eight of them were in the field of reproductive biology and eight on maternal and infant health, one on abortion, four on contraception, one on infertility and one on STDs. Funding for 12 of the projects came from national sources, for five projects from the LID Grant and for the remaining six projects from other international groups. The research themes included a rationalized approach to anaesthetic care in reproductive health, the cost of taking care of premature babies, effects of steroid contraception on liver function tests of hepatitis B carriers, and a comparative study of misoprostol and oxytocin in the induction of labour.

Capacity building

One member of the Centre served as faculty in the regional activities organized by the Programme.

CÔTE D’IVOIRE

Since 1995, the National Institute of Public Health in Abidjan has hosted the National Research Cellule on Reproductive Health, which was established in 1989 as part of The African Network on Research on Reproductive Health. There are 48 members of the Cellule, the majority of them representing clinical sciences, but they also include 16 social scientists. An application by the Cellule for a LID Grant is pending approval until the financial situation of the Programme improves. A pre-LID Grant in 1996 allowed the Cellule to prepare a document reviewing the research activities in reproductive health in Côte d’Ivoire. In 1997, the Cellule continued collaboration with the Programme by initiating a process to determine reproductive health research priorities.

Research

Four research projects were under way in 1997. Two of them dealt with maternal and infant health, one with abortion and one with reproductive health services.

Capacity building

During 1997, six members of the Research Cellule benefited from training workshops and courses offered by the Programme.

ETHIOPIA

The Department of Obstetrics and Gynaecology, University of Addis Ababa, was awarded a LID Grant from 1990 to 1994, a Resource Maintenance Grant in 1995 and a Small Grant since 1996 for library support.

Research

In 1997, a Reproductive Health Research Unit was established and a number of clinical studies initiated mostly in the field of maternal and infant health. Two of them are funded by the Ethiopian Science and Technology Commission.

Capacity building

No activity was reported in 1997.

KENYA

The four units collaborating with the Programme in Kenya constitute the National Centre for Research in Reproduction (NCRR). The units are: the Institute of Primate Research of the National Museums of Kenya; the Reproductive Biology Unit in the Department of Animal Physiology, also at the University of Nairobi; the Department of Obstetrics and Gynaecology, University of Nairobi; and the Reproductive Health Research Unit (RHRU) of the Kenya Medical Research Institute (KEMRI), which was the last to become a part of the NCRR.

The various units of the NCRR have continued to collaborate with the Programme after LID Grants to the original three units came to an end in 1989. The NCRR has proved to be a unique association which has provided opportunities for a comprehensive human reproduction training and research programme that has been of benefit not only to Kenyans but also to scientists from other parts of Africa. Within the various units involved in NCRR research, there are well-trained scientists in various disciplines, who are producing a steady flow of research results and are actively involved in human reproduction research training activities. The establishment of a Master’s Degree programme during 1993 in the University of Nairobi, under the auspices of the NCRR and with the financial support of the Programme, has undoubtedly widened the NCRR’s role as a regional training centre.

Institute of Primate Research of the National Museums of Kenya

The Programme’s institutional development support to the Institute dates back to 1979 when the Institute received its first LID Grant. Since then, it has received a grant every year. In 1997, it was a Small Grant to support animal and library facilities. The Institute has continued to collaborate actively with close to 100 international institutions in research and research training in 1997.

Research

During 1997, 20 research projects were ongoing; 11 of these were in the area of reproductive biology, five in contraception, one on maternal and infant health, one on infertility and two on STDs.

The reproductive biology projects included work on DNA typing of primate major histocompatibility complex (Mhc)-DQA1 locus by PCR and dot blot hybridization; cloning, sequencing and characterization of baboon sperm protein Sp 17; and studies on monkey fertilin ß. Other studies include those on the development of a primate IVF model for endangered primate species.

Capacity building

The Institute is currently offering research training to postgraduate students undertaking the M.Sc. course in Reproductive Biology which is supported by the Programme at the University of Nairobi. The Institute also conducted two training courses; one of them was on research supervision and the other on validation of hormonal assays for detection of early pregnancy in the baboon. In addition, 49 persons received individual training at the Institute during the year.

Reproductive Biology Unit, University of Nairobi

The Reproductive Biology Unit (RBU) of the Department of Animal Physiology, University of Nairobi, was established in 1979 by a group of collaborating scientists from various disciplines with a common interest in reproductive biology. The Programme supported the Unit from its inception because of its potential to identify animal models for research in reproduction. Institutional strengthening support ceased at the end of 1989, but since then the Unit has received an annual Small Grant for the purchase of journals and consumable laboratory supplies.

Research

Eight research projects were ongoing during 1997. They were all basic science research relating to issues such as the effects of heptachlor on reproduction in female and male rats, development of goat embryos, and non-genomic actions of steroid hormones.

Capacity building

The RBU is the focal point for the M.Sc. Degree course in Reproductive Biology which was developed by the NCRR and is supported by the Programme.

Department of Obstetrics and Gynaecology, University of Nairobi

The Programme’s institutional support to the Department of Obstetrics and Gynaecology commenced in 1979 and was phased out in 1989 at the expiration of the second LID Grant. Since then, Small Grants have been given to maintain library resources and purchase laboratory supplies. This Department is a good example of how the Programme’s long-term support has enabled an institution to develop to a stage where it is now capable of attracting funds from elsewhere to continue its research efforts successfully.

Research

There were 16 ongoing research projects, six of which were supported by the Programme.

Capacity building

An epidemiology workshop for participants from Ethiopia, Kenya, South Africa, Uganda, Zambia and Zimbabwe was held with a grant from the Programme. A few staff members attended an andrology workshop in South Africa.

Kenya Medical Research Institute (KEMRI)

During 1997, the Institute received a Small Grant for laboratory supplies and journal subscriptions.

Research

The main research focus of the Reproductive Health Research Unit (RHRU) of KEMRI is on the adaptation and introduction, as well as long-term surveillance, of contraceptive technology in Kenya. There were four projects under way in 1997: one on early diagnosis and treatment of cervical cancer, one on vertical transmission of HIV-1 infection, one on prevention and management of STD/HIV among street children in Nairobi, and one on semen quality.

Capacity building

No activities were reported in 1997.

MOZAMBIQUE

The Department of Obstetrics and Gynaecology, National University of Maputo, Maputo, has received a LID Grant since 1989.

Research

During 1997, the Centre’s published work relating to induction of labour by misopristol was quoted in some well known textbooks. The ongoing projects dealt with neonatal morbidity, intrauterine adhesions, psychological aspects of adolescent pregnancies, and the role of men in the decision to use contraception.

The Department has continued to collaborate with a number of international institutions and agencies, notably the Swedish Agency for Research Cooperation with Developing Countries (SAREC), Stockholm, Sweden; The Population Council, New York, NY, USA, and the Gulbenkian Foundation, Lisbon, Portugal.

Capacity building

A research methodology course has been introduced in 1997 as a mandatory part of the specialization training in the Department. The Centre reports that results from the research carried out in the Department have had a strong impact on the way obstetrics and gynaecology is practiced in the country.

NIGERIA

The Programme’s collaboration with Nigeria commenced in 1972 with the joint designation of the Departments of Chemical Pathology and of Obstetrics and Gynaecology at the University of Ibadan as a WHO Collaborating Centre for Research in Human Reproduction. Since then, collaboration has been extended to other institutions in the country.

Department of Obstetrics and Gynaecology, University of Ibadan, Ibadan

The Programme’s long-term support to the Department ceased in 1986 but Small Grants for library facilities and laboratory support continue to be given.

Research

The majority of research projects are clinical and epidemiological with increasing input from social science methodologies. There were four projects ongoing: one on introduction of the emergency contraceptive pill, one on contraceptive efficacy of two oral dosage regimens of gossypol acetate, one on contraceptive method switch and one on abortion in urban areas.

Capacity building

The Centre organized three courses on reproductive endocrinology, on reproductive biology and on family planning training for nurses.

University of Benin, Benin City

The Department of Obstetrics and Gynaecology of the University of Benin, Benin City, was awarded a LID Grant from 1989 to 1993, during which period the laboratory and other research facilities of the Department were strengthened and a number of staff trained in laboratory, clinical and nursing research. In 1997, the Department received a Small Grant for laboratory supplies and journal subscriptions.

Research

During 1997, the main research theme was a community-based study on determinants of infertility in rural and urban areas in Nigeria.

Capacity building

During 1997, one scientist from the Department was undertaking an M.Sc. course in Reproductive Epidemiology at the London School of Hygiene and Tropical Medicine, with an RTG awarded by the Programme.

Ogun State University, Sagamu

In 1997, the Centre received a Small Grant for laboratory supplies and journal subscriptions.

Research

There were four ongoing studies, all of them supported by Strategic Programme Components. The prospective randomized, multicentre study to compare the Yuzpe regimen with levonorgestrel in emergency contraception continued in 1997. The other studies were on comparative effectiveness of non-latex and standard latex condoms in preventing pregnancy, on determination of reference ranges of reproductive hormones, and the randomized trial of misoprostol and oxytocics in the management of the third stage of labour.

Capacity building

A workshop was organized on reducing postpartum haemorrhage in maternity services.

SENEGAL

The Department of Obstetrics and Gynaecology at Le Dantec Hospital, University of Dakar, Dakar, has collaborated with the Programme in various projects since 1981. In November 1996, the International Centre for Training and Research in Reproductive Health (CEFOREP), which is attached to the Department, started to function as an NGO at national level.

Due to its financial difficulties, the Programme was not able to approve a LID Grant to the Department for the period 1996–2000, but a Small Grant was awarded to support its documentation centre and journal subscriptions for 1996 and 1997.

In April 1997, the Department hosted regional work-shops on protocol development for the studies on reproductive health services for adolescents and on improving antenatal care (see p. 182)

SOUTH AFRICA

Since 1992, there have been a number of initiatives within the field of reproductive health which have brought South African researchers and policy-makers together with their counterparts from other African countries. In 1993, a report was produced for the Programme by a consultant from Baragwanath Hospital, Johannesburg, detailing research interests and projects of the major university departments and other research institutions. This was presented to the Programme and discussed with staff of the different Strategic Programme Components. Following the readmission of South Africa to WHO in May 1994, the Programme has started to expand its links with South African researchers and institutions. In 1997, the Programme’s Strategic Component of Social Science Research organized a research training workshop in Durban to finalize the protocol for a multicountry study on "Family planning and sexual behaviour in the era of HIV/STDs".

Reproductive Health Research Unit, Baragwanath Hospital, Soweto

Collaboration between the Programme and the Reproductive Health Research Unit (RHRU), Baragwanath Hospital, Soweto, has steadily increased since 1993.

Research

In 1997, there were nine research projects under way; three of them were supported by the Programme. Most of them were in the field of contraception including acceptability of non-latex condoms, reasons for discontinuation of depot medroxyprogesterone acetate and norethisterone enantate, and female condom reuse. The Unit continued research projects with a focus on men and their involvement in reproductive health.

Capacity building

In July 1997, the Unit held a course on Reproductive Health Research Methods which was attended by participants from the entire southern African region. It was such a success that it will now be run annually. Staff development and research training have been a high priority for the Unit, and almost all the staff have received training either internally or elsewhere.

Other

The Unit continued to provide major support to the National Department of Health, Directorate of Maternal, Child and Woman’s Health and the AIDS Directorate. It also supported the provincial health departments.

UGANDA

The Department of Obstetrics and Gynaecology of Makerere University, which is based in the Mulago Hospital at Kampala, has a LID Grant since 1989.

Research

There were six projects ongoing in 1997: one on reproductive biology (testicular function in HIV-infected men) and five on maternal and infant health, including various trials of determining efficacy of certain drugs (zidovudine and 3TC or Nevirapine) for prevention of HIV infection. The project on infertility had three components: "Etiological factors of infertility in Uganda", "Hormonal profiles of infertile women" and "Contribution of male infertility". The data analysis of this project was started in 1997.

Capacity building

A course on research methodology, clinical epidemiology and elementary statistics was organized for post-graduate students in obstetrics and gynaecology. Twelve of them were from Uganda and four from other countries. In April, the Department organized, with funding from Sida/SAREC, the Reproductive Health Conference for East, Central and Southern Africa, with about 145 participants. Individual training in laboratory techniques was provided to two persons.

ZAMBIA

The Department of Obstetrics and Gynaecology of the University of Zambia, based in the Teaching Hospital in Lusaka, was designated as a WHO Collaborating Centre for Research in Human Reproduction in 1973. Institution strengthening support included a LID Grant in 1987 which ceased in 1991. Since then, the Department has received Small Grants to support library facilities and the purchase of consumable laboratory supplies.

Research

There were about 20 ongoing projects including several theses in the Departments of Post Basic Nursing and Community Medicine. In partnership with the University of Alabama, Birmingham, AL, USA, the Department of Obstetrics and Gynaecology, together with the Department of Paediatrics, received a HIVNET contract for studies on perinatal transmission of HIV infection. The Strategic Component of Surveillance and Evaluation has selected the Centre to participate in a multicountry study on hormonal effects in HIV-positive women. Preparations for the study started in 1997.

Capacity building

No activities were reported for 1997.

ZIMBABWE

The Department of Obstetrics and Gynaecology of the University of Zimbabwe in Harare has received a LID Grant since 1988.

Research

There were 13 ongoing projects in the fields of reproductive biology, contraception, infertility, abortion and STDs. Two of them were supported by the LID Grant.

Capacity building

The Department hosted a Programme-supported course on strengthening communication skills of scientists and policy-makers.

OTHER COUNTRIES IN AFRICA

During 1997, the Programme’s Strategic Component on Social Science Research supported research projects in Botswana, Ghana and Togo. The project in Botswana addresses sexual behaviour and risk of HIV infection among adolescent females. The main objective of the study is to identify the relationship between sexual behaviour and risk of STD/HIV infection among adolescent females in different settings of Botswana, to make related policy recommendations and design information programmes for the prevention of STDs and unwanted pregnancy. In Ghana, an exploratory study into the sexual behaviour of Ghanaian prostitutes with their clients and partners and "free women" and their partners was undertaken at the Institute of African Studies at the University of Ghana, Legon. At the University of Benin, Lome, Togo, the Strategic Component supported a research project on "Fertility transition in rural Africa: the example of south-east Togo."

EASTERN MEDITERRANEAN REGION

EGYPT

Department of Obstetrics and Gynaecology, University of Alexandria, Alexandria

The Department of Obstetrics and Gynaecology, University of Alexandria, Alexandria, was one of the earliest institutions which collaborated with the Programme. It was designated a WHO Collaborating Centre for Research in Human Reproduction in 1972. The Programme’s core institutional support to the Centre ceased in 1980 when it was considered to have gone through the "strengthening" phase, but other forms of support continue to be given to maintain library and laboratory facilities.

The Centre continues to collaborate actively with different organizations within the country. In particular, it interacts closely with the National Family Planning Programme including participation in planning and supervision of activities of governmental committees on family planning. The Centre also interacts closely with the Egyptian Fertility Care Society and the Egyptian Society of Clinical Chemists.

Research

A total of 77 research projects were ongoing in 1997. Twenty-four of them related to infertility, 42 to maternal and infant health and 11 to contraception.

Capacity building

The Centre organized 24 training courses, workshops and seminars which were attended by about 1900 persons who were researchers, clinicians and nurses from Egypt, other Arab countries and some African countries.

The Egyptian Fertility Care Society

The Egyptian Fertility Care Society (EFCS) was founded in 1974 as an affiliate of the Egyptian Medical Association with a mandate to promote maternal and child health through the promotion of fertility management and family health care. The EFCS research network includes all University and Ministry of Health teaching hospitals which carry out multicentric research that addresses the needs of the National Family Planning Programme. Priorities for research undertaken by the EFCS are set in consultation with the national research and service-delivery institutions and are revised on a five-yearly basis.

The EFCS has been in receipt of a LID Grant since 1992. The Grant was renewed for a period of five years from 1997.

Research

During 1997, the Society completed several large-scale research projects, including "Unmet needs in contraception and reproductive health care in Egypt", and "Clinic-based investigations of the typology and self-reporting of female genital mutilation in Egypt". The Society was awarded grants to do secondary analysis of the DHS data on "Fertility patterns in migrant populations in Egypt" and "Determinants of maternal service utilization by pregnant women in Egypt".

Capacity building

With the support of the Programme, the Society organized a workshop on scientific writing, which was attended by members of Departments of Obstetrics and Gynaecology from all medical schools in Egypt.

ISLAMIC REPUBLIC OF IRAN

The National Research Centre for Reproductive Health, which is under the Deputy Minister of Health and Medical Education, has the following objectives:

(i) to conduct research to assess the acceptability, effectiveness, and side-effects of different methods of contraception;

(ii) to conduct research on mother and child health care and reproductive health of teenage girls;

(iii) to conduct research on sexually transmitted diseases (STDs);

(iv) to conduct research on infertility;

(v) to develop research guidelines on genital and breast cancers;

(vi) to conduct research on the knowledge, attitudes and practices (KAP) of both men and women relating to various contraceptive methods;

(vii) to undertake reproductive health training programmes for health personnel.

In 1997, the Centre received a Small Grant for library support.

Research

There were eight projects, all of them funded from international sources other than WHO. Three of them were on contraception (KAP of health personnel on contraceptive methods, efficacy of Norplant, comparison of tubal ligation with a Filshie clip and bipolar electrocoagulation of Fallopian tubes), two on maternal and infant health, and one each on unwanted pregnancy, postmenopausal complications, and on prevalence of primary infertility.

Capacity building

A report writing workshop was held for 30 members of six provincial research committees.

PAKISTAN

The National Research Institute of Fertility Control (NRIFC) in Karachi was established in 1962 to carry out research that would be useful to the Government in deciding on the introduction of contraceptive methods in Pakistan. The Institute was designated a WHO Collaborating Centre for Research in Human Reproduction in 1976 and has since participated in a number of multicentre studies. It received a Small Grant in 1997 for library resources and laboratory supplies.

Research

The ongoing research projects were in the areas of contraception, maternal/infant health and contraceptive quality control.

Capacity building

No activity was reported in 1997.

SUDAN

The Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, has received a LID Grant since 1989.

Research

There were four research projects ongoing during 1997. One of these was in the area of maternal/child health, two on contraception and one on reproductive biology. The titles were, respectively: "Screening of Rubella antibodies among pregnant Sudanese women", "Effect of Marvelon on lipid metabolism in Sudanese women", "Contraceptive awareness and usage among educated women", and "Age at menarche and relation to physical growth".

Capacity building

One computer course and two research methodology courses were organized; altogether 74 persons attended. Four seminars and symposia were held on assisted reproduction, hypertensive disorders of pregnancy, infertility and on the menopause. There were 281 participants in these events.

TUNISIA

The Centre for Research in Human Reproduction, Tunis

The Centre is a large government clinic providing services for family planning and the management of infertility. It is a national reference centre for the scientific evaluation of contraceptive methods in use in the country, as well as new methods prior to them being introduced in the country. Over a period of some 20 years, the Centre has received substantial support from the Programme for capacity building in endocrinological research. It was in receipt of a LID Grant from 1987 to 1991 and has, since 1994, received annually a Small Grant to support library and laboratory services. In 1997, a Resource Maintenance Grant was awarded to the Centre.

Research

There were four research projects ongoing in 1997. One of them was on reproductive biology, one on abortion, one on STDs and one on contraception. The funding for half the projects came from national sources. One of the major interests of the Centre is to continue the ongoing study on cervical cancer screening on a nationwide scale.

Capacity building

A national research methodology course was held in November–December for 24 participants. Other seminars on reproductive health were held for 78 persons and a workshop to initiate a Maghrebian research network had 19 participants from Algeria, Morocco and Tunisia.

Other

In 1997, the Centre reoriented its activities to research on all aspects of reproductive health and initiated a process to evaluate reproductive health needs in Tunisia. A national seminar on reproductive health priorities with 71 participants representing the Government, reproductive health service providers, NGOs and the media was held in February 1997.

Tunisian Endocrine Society, Tunis

The journal Revue Maghrébine d’endocrinologie-diabète et de reproduction, launched in 1995 with a financial contribution from the Programme and edited by the Tunisian Endocrine Society, was published twice during 1997. The purpose of the journal is to disseminate important research results relevant to the African region, in French. French translation of articles from the Programme’s newsletter Progress in reproductive health research has been incorporated.

OTHER COUNTRIES IN THE EASTERN MEDITERRANEAN REGION

The Programme is actively exploring mechanisms of expanding its collaboration to other countries in the Eastern Mediterranean Region. In this regard, one collaborative research project on evaluation of a new model of antenatal care is currently ongoing in the Kingdom of Saudi Arabia (Jeddah and Riyadh). Moreover, Algerian and Moroccan researchers are part of the network being initiated by the Tunisian centre (see above).

It is hoped that a framework will soon be in place enabling more countries of the Region to collaborate with the Programme through the establishment of a reproductive health research network.

FUTURE ACTIVITIES

Future activities will be concentrated on the implementation of the regional research initiatives which were commenced during 1996 and continued in 1997. National and subregional reproductive health research networks would be developed and existing ones strengthened. Emphasis would be placed on strengthening research skills in the social sciences and epidemiology. In addition, more intraregional training programmes would be promoted to make research training cost-effective and the development of regional "Centres of Excellence", capable of assisting Centres in the least developed countries (LDCs) would be encouraged.

Annex 1

REGIONAL ADVISORY PANEL FOR AFRICA AND THE EASTERN MEDITERRANEAN IN 1997

Members

  • H. Ba’aqel, King Khalid National Guard Hospital, Jeddah, Saudi Arabia
  • S. Bergström, Karolinska Institute, Stockholm, Sweden
  • R. Boukhris, Centre for Studies and Research in Human Reproduction, Tunis, Tunisia
  • *C. Effiom, Ministry of Social Affairs, Yaoundé, Cameroon
  • P. Hiza (Chairman), Muhimbili Medical Centre, Dar-es-Salaam,Tanzania
  • *G. Lindmark, University of Uppsala, Uppsala, Sweden
  • J. McIntyre, University of Witwatersrand, Soweto, South Africa
  • J. Moodley, University of Natal, Congella, South Africa
  • B. Nasah, P.O. Box 360, Buea, Cameroon
  • H. Okoth-Ogendo, University of Nairobi, Nairobi, Kenya
  • B. Osotimehin, University College Hospital, Ibadan, Nigeria
  • M. Shaaban, University of Assiut, Assiut, Egypt
  • M. Djuhari Wirakartakusumah, University of Indonesia, Jakarta, Indonesia

Collaborating agencies

  • Family Health International
  • The Population Council
  • INSERM
  • Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa

*Denotes woman

Annex 2

SCIENTISTS COLLABORATING WITH THE PROGRAMME IN THE REGIONS IN 1997

African Region

  • Y. Ahmed, Department of Obstetrics and Gynaecology, University of Zambia, Lusaka, Zambia
  • E. Alihonou, Centre of Research in Human Reproduction and Demography, National University of Benin, Cotonou, Benin
  • O.A. Ashiru, College of Medicine, University of Lagos, Lagos, Nigeria
  • *M. Ba, Faculty of Medicine and Pharmacy, University of Dakar, Dakar, Senegal
  • M.D. Balde, University Hospital of Donka, Conakry, Guinea
  • C.S. Bambra, Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
  • A.M. Bugalho, Department of Obstetrics and Gynaecology, Maputo Central Hospital, Maputo, Mozambique
  • T. Chipato, Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
  • O.A. Dada, College of Health Sciences, Ogun State University, Sagamu, Nigeria
  • F. Diadhiou, Faculty of Medicine and Pharmacy, University of Dakar, Dakar, Senegal
  • F. Giwa-Osagie, College of Medicine, University of Lagos, Lagos, Nigeria
  • D. Gondo, Department of Obstetrics and Gynaecology, University Hospital of Cocody, Abidjan, Côte d’Ivoire
  • A. Gossa, University of Addis Ababa, Addis Ababa, Ethiopia
  • *L. Kanhonou, Centre of Research in Human Reproduction and Demography, National University of Benin, Cotonou, Benin
  • J.G. Karanja, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
  • J. Kasule, Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
  • *C. Kigondu, Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
  • K.A. Kouame, University of Cocody, Abidjan, Côte d’Ivoire
  • R. Leke, Department of Obstetrics and Gynaecology, Faculty of Medicine and Biological Sciences, Yaoundé, Cameroon
  • M. Mbivzo, Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe
  • R. Mbu, Department of Obstetrics and Gynaecology, Faculty of Medicine and Biological Sciences, Yaoundé, Cameroon
  • *F. Mirembe, Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
  • F.A. Mmiro, Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
  • D. Oduor-Okelo, Reproductive Biology Unit, University of Nairobi, Nairobi, Kenya
  • A.O. Ojengbede, Department of Obstetrics and Gynaecology, University of Ibadan, Ibadan, Nigeria
  • A.A.E. Orhue, Department of Obstetrics and Gynaecology, University of Benin, Benin City, Nigeria
  • D. Rasaon, Department of Gynaecology and Obstetrics, University of Antananarivo, Antananarivo, Madagascar
  • *A. Sangare, National Research Cellule of Reproductive Health, National Institute of Public Health, Abidjan, Côte d’Ivoire
  • N.C. Sikazwe, Department of Obstetrics and Gynaecology, University of Zambia, Lusaka, Zambia
  • G.S. Traore, Ministry of Health, Ouagadougou, Burkina Faso
  • E.O. Wango, Reproductive Biology Unit, University of Nairobi, Nairobi, Kenya
  • *C. Welffens-Ekra, University Hospital Centre of Yopugan, Abidjan, Côte d’Ivoire

Eastern Mediterranean Region

  • *R.K. Ali, National Research Institute of Fertility Control, Karachi, Pakistan
  • *E. Barouti, National Research Centre in Family Planning, Ministry of Health and Medical Education, Teheran, Iran
  • A.S. Gerais, Department of Obstetrics and Gynaecology, University of Khartoum, Khartoum, Sudan
  • *R. Hamzaoui, Research Centre for Human Reproduction, Tunis, Tunisia
  • E.O. Hassan, The Egyptian Fertility Care Society, Cairo, Egypt
  • W. Sadek, Department of Obstetrics and Gynaecology, Shatby Maternity Hospital, Alexandria, Egypt
  • S. Said, Department of Obstetrics and Gynaecology, Shatby Maternity Hospital, Alexandria, Egypt
  • M. Shaaban, Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
  • M. Shahab, Department of Biological Sciences, Quaid-i-Azam, Islamabad, Pakistan

*Denotes woman