March 1982

Report of the

WORKSHOP FOR TEACHERS OF EPIDEMIOLOGY, KHARTOUM 23 January - 5 February 1982

Jointly sponsored by the

World Health Organization Regional Office for the Eastern Mediterranean

and the

UNDP~WORLD BANK~WHO Special Programme for Retiearc11 and TI-aining in Tropical Dioesees,

World Health Organization, Avenue Appia, Geneva, Switzerland

The views expressed i n t h i s r e p o r t do n o t n e c e s s a r i l y r e f l e c t t h e o f f i c i a l po l icy of t h e World Heal th Organizat ion, the United Nations Development Programme o r t h e World Bank.

TABLE OF C0N'ri:NTS

PAGE

I INTRODUCTION 1

11 PROCESS AND CONTENTS OF THE WORKSHOP 3

Principles of learning Group dynamics Identification of epidemiological responsibilities of various categories of health workers

Formulation of objectives Analysis of responsibilities Determinants of educational objectives Systems approach for curriculum planning Writing educational/learning objectives Planning student learning Design of units of instruction Evaluation A. Purpose and relationship to objectives B. Evaluation tools and criteria for selection Field training Epidemiological research and its relation to teaching Modelling in epidemiology

111 WORKSHOP OUTPUT 13

IV WORKSHOP EVALUATION 14

1. Pre- and Post-Workshop questionnaire 2. Evaluation questionnaire 3 . F i n a l comments by participants

V CONCLUSIONS AND RECOMMENDATIONS 16

ANNEX I OPENING ADDRESS DY PROFESSOR EL TAHER rADL

ANNEX I1 MESSAGE FROM D R A.H. TABA

ANNEX 111 OBJECTIVES OF TtlE WONCSHOP

ANNEX IV PROGRAMME

ANNEX V LIST O F PARTICIPANTS

I INTRODUCTION

I n t h e p resence of H.E. P r o f e s s o r A l i F a d l , M i n i s t e r of H e a l t h , P r o f e s s o r

E l Taher F a d l , A c t i n g Dean, F a c u l t y of Medicine , U n i v e r s i t y of Khartoum, inaugura ted

t h e Workshop on beha l f of t h e Vice -Chance l lo r , P r o f e s s o r Omer B e l e i l . I n h i s

Address (Annex I ) P r o f e s s o r E l Taher Fad1 welcomed t h e group of WHO s t a f f and t h e

p a r t i c i p a n t s and expres sed t h e g r e a t i n t e r e s t of t h e F a c u l t y of Medicine bo th i n

epidemiology and i n e d u c a t i o n a l p l ann ing . Dr R. Khan, WHO Programme Coord ina to r and

S p e c i a l R e p r e s e n t a t i v e , t h e n d e l i v e r e d a message from Dr A.H. Taba, WHO D i r e c t o r

f o r t h e E a s t e r n Med i t e r r anean Region (Annex 11) and expres sed h i s p e r s o n a l welcome

t o t h e whole group and wished them a s u c c e s s f u l workshop.

I n h i s message D r Taba reviewed n a t i o n a l and WHO e f f o r t s f o r t h e development

of e f f e c t i v e e p i d e m i o l o g i c a l s e r v i c e s i n Member S t a t e s 6f t h e Region and p inpo in ted

c o n s t r a i n t s and needs , p a r t i c u l a r l y w i t h r e s p e c t t o development of n e c e s s a r y manpower.

He i n d i c a t e d t h a t t h i s workshop had been o rgan ized t o s t r e n g t h e n n a t i o n a l c a p a b i l i t i e s

i n t e a c h i n g epidemiology through rev iewing c u r r e n t c o n c e p t s of epidemiology and of

p l a n n i n g t r a i n i n g programmes. T h i s was f e l t t o be gn e s s e n t i a l p r e l i m i n a r y s t e p

towards development of n a t i o n a l t r a i n i n g c o u r s e s f o r t h e d i f f e r e n t l e v e l s of h e a l t h

worke r s . He a l s o i n d i c a t e d t h e v a l u e of r e s e a r c h , bo th p e r s e and a s a u s e f u l

t e a c h i n g r e s o u r c e .

Dr Abdel Rahman E l Tom, Chairman of t h e N a t i o n a l P r e p a r a t o r y Committee, who

InLroduced Lhe s p d k r r s , dlsv addiessed t h e group and thanked t h e World H e a l t h

O r g a n i z a t i o n and t h e S p e c i a l Programme f o r Research and T r a i n i n g i n T r o p i c a l D i s e a s e s

(TDR) f o r t h e t r u s t bestowed on t h e F a c u l t y of Medicine and i t s E d u c a t i o n a l C e n t r e

t o conduct t h i s workshop.

A f t e r a s h o r t r e c e s s t h e r e g u l a r s e s s i o n s of t h e workshop s t a r t e d w i t h t h e

p r e t e s t . ParLicipants were handed a q u e s t i o n n a i r e which they answered i n tw-nty

minu tes . A f t e r t h i s , p a r t i c i p a n t s , c o n s u l t a n t s and f a c i l i t a t o r s met i n groups of

two and i n twenty minu tes t h e p a r t n e r s , guided by a check l i s t , c o l l e c t e d i n f o r m a t i o n

from each o t h e r on t h e i r p e r s o n a l and p r o f e s s i o n a l backgrounds and a l s o on t h e i r

e x p e c t a t i o n s from t h e workshop. Each one t h e n p r e s e n t e d h i s p a r t n e r t o t h e whole

group. I t became c l e a r t h a t , a l t h o u g h t h e p a r t i c i p a n t s had a wide r ange of e x p e r i e n c e

i n p u b l i c h e a l t h p r a c t i c e , t h e y a r e a l l engaged i n e p i d e m i o l o g i c a l work.

EM/HMD/457 E M / E P I D / ~ O EM/WKP.TCH.EPD/~ page 2

Most of t he ~ a r t i c i ~ a n t i e x p e c t a t i o n s from t h e workshop were focussed upon

- c q u i r i n g some knowledge of t h e p r i n c i p l e s and methods of e d u c a t i o n a l p l a n n i n g .

Other e x p e c t a t i o n s e x p r e s s e d inc luded s h a r i n g e x p e r i e n c e s w i t h c o l l e a g u e s from

o t h e r c o u n t r i e s and improving t h e i r unde r s t and ing and upda t ing t h e i r knowledge on

v a r i o u s a s p e c t s of epidemiology.

The o b j e c t i v e s of t h e workshop and t h e programme (Annex 111) were then

p r e s e n t e d t o t h e p a r t i c i p a n t s and t h e n e c e s s a r y c l a r i f i c a t i o n s made. P a r t i c i p a n t s

were a l s o b r l e f e d on che p rocedures Lu be Lulluwed rluri~lg L l l r wurkahup and what

i s expec ted of them.

O b j e c t i v e s

The workshop aims t o s t r e n g t h e n n a t i o n a l c a p a b i l i t i e s i n t e a c h i n g and r e s e a r c h

i n epidemi0:ogy. More s p e c i f i c a l l y , a t t h e end of t h i s workshop t h e p a r t i c i p a n L ~

a r e e x p e c t e d :

1. t o d e s c r i b e t h e r o l e s , r e s p o n s i b i l i t i e s and f u n c t i o n s of t h e v a r i o u s h e a l t h

pe r sonne l engaged i n epidemiology work, w i t h s p e c i a l emphasis on p r o f e s s i o n a l

e p i d e m i o l o g i s t s ;

2 . t o a c q u i r e a s y s t e m a t i c approach t o c u r r i c u l u m p l a n n i n g , which i n c l u d e s :

a ) f o r m u l a t i n g e d u c a t i o n a l o b j e c t i v e s

b ) s p e c i f y i n g c o u r s e c o n t e n t s

c ) d e s i g n i n g l e a r n i n g e x p e r i e n c e s

d ) d e s i g n i n g e v a l u a t i o n p r o c e d u r e s ;

3 . KO produce improved c o u r s e s I n ep idemiu lugy , uT which a~ least ulte w i l l be v C

use t o and s u b s e q u e n t l y used by each p a r t i c i p a n t ;

4 . t o i d e n t i f y t h e r o l e of e p i d e m i o l o g i c a l r e s e a r c h i n t e a c h i n g of epidemiology

and t o be b e t t e r a b l e t o p l a n and gu ide o t h e r s t o p l a n r e s e a r c h .

O r g a n i z a t i o n

The workshop was a t t e n d e d by 1 8 p a r t i c i p a n t s from seven c o u n t r i e s : Afghan i s t an

( I ) , Democrat ic Yemen ( I ) , Egypt ( 5 ) . I n d o n e s i a ( 1 1 , Kenya (21 , Sudan ( 7 ) and

S y r i a ( 1 ) . I n a d d i t i o n , f o u r o b s e r v e r s from Sudan a t t e n d e d t h e workshop ( ~ i s t n~

P a r t i c i p a n t s and S e c r e t a r i a t - Annex v ) .

Dr Abdel Rahman E l Tom, Chairman of t h e N a t i o n a l P r e p a r a t o r y Committee, was

a l s o nominated t o a c t a s Chairman. I t was dec ided t h a t p l e n a r y s e s s i o n s be c h a i r e d

i n r o t a t i o n and t h a t a Rappor teur f o r each d a y ' s s e s s i o n would be nominated.

Dr A. Abdel Salam was nominated Genera l Rappor t eu r .

Tlir Organiairig CummiLLee lrald d a i l y n l r rLir~gs tu e v a l u a t e t h e a c t i v i t i e s of t h e

day a s w e l l a s t o d i s c u s s forward p l a n n i n g f o r subsequen t s e s s i o n s .

I1 PROCESS AND CONTENTS OF THE WORKSHOP

1. P r i n c i p l e s of L e a r n i n g

The o b j e c t i v e of t h i s S e c t i o n was t o i n t r o d u c e p a r t i c i p a n t s t o b a s i c p r i n c i p l e s

of l e a r n i n g by having them r e c a l l some memorable o c c a s i o n s i n t h e i r l l f e d u r i n g which

they have l e a r n e d something s i g n i f i c a n t which they s t i l l remember. They were t h e n

asked t o r e c o r d t h e s e e v e n t s i n w r i t i n g and t o g r a p h i c a l l y e x p r e s s them i n p i c t u r e s

on l a r g e f l i p c h a r t pape r . I n sma l l groups of 5 - 6 t h e p a r t i c i p a n t s ana lyzed t h e

f a c t o r s t h a t c o n t r i b u t e d t o t h e e v e n t ' s b e i n g a l e a r n i n g e x p e r i e n c e and l i s t e d them

on a f l i p c h a r t .

I n t h e p l e n a r y s e s s i o n each group p r e s e n t e d what they c o n s i d e r e d d e s i r a b l e

c h a r a c t e r i s t i c s of l e a r n i n g a c t i v i t i e s . These were d i s c u s s e d and a l i s t of u s e f u l

f a c t o r s t o be c o n s i d x e d i n d e s i g n i n g l e a r n i n g e x p e r i e n c e s was compi led. T h i s inc luded

f a c t o r s such a s : t h e l e a r n e r be ing p e r s o n a l l y invo lved and p a r t i c i p a t i n g , t h e

e x p e r i e n c e ' s immediate reward, t h e l e a r n e r be ing e m o t i o n a l l y i n v o l v e d , knowing i n

advance what he / she i s expec ted t o l e a r n and why i s i t r e l e v a n t f o r h i d h e r , e t c ..... Ark impur L d l i L , LuL u1isLdLrt1, u l j r c t i v e uf t h i s sess ion on learning p r i n c i p l e s

was t o p rov ide a n o p p o r t u n i t y f o r p a r t i c i p a n t s t o become b e t t e r a c q u a i n t e d i n s m a l l

i n f o r m a l g roups . T h i s o b j e c t i v e was w e l l ach ieved .

2 . s o u p dynamics

I n p l e n a r y , each p a r t i c i p a n t was r e q u e s t e d t o w r i t e a b r i e f s t a t e m e n t on t h e

d e f i n i t i o n and scope of epidemiology. Then i n f o u r s m a l l groups ( 4 - 5) t h e p a r t i -

c i p a n t s were t o d i s c u s s t h e i r d e f i n i t i o n s and r e c o r d on f l i p c h a r t s t h o s e which they

f e l t were most a p p r o p r i a t e t o r e p o r t back t o t h e p l e n a r y .

I n p l e n a r y , f l i p c h a r t s w i t h seven d i f f e r e n t d e f i n i t i o n s were d i s p l a y e d . T k

Moderator of t h e s e s s i o n then asked t h e whole group t o s e l e c t one of t h e s e s t a t e m e n t s

tuiilcli . i l l i)S them ag reed was t h e most a c c u r a t e o r a p p r o p r i a t e d e f i n i t i o n of epidci:li.:-

l o g y , and i t s s cope . He i n d i c a t e d t h a t t h e s e l e c t e d d e f i n i t i o n shou ld be by

consensus of t h e - n t i r e group. He a l s o asked them t o f e e l f r e e t o speak up i f they . I t ' i t f h.lt t t1i.y were be ing f o r c e d i n t o agreement and a l s o t o come i n any time they

w i s h p r l .

In t h e ensu ing hour most of t h e c l a s s i c a l forms of droup behavlour were

r u h i h l t r J I n an a t t e m p t t o fo l low t h e s e i n s t r u c t i o n s . Unknown t o t h e p a r t l c l p a n : , ,

two f L i c i l i t a t o r s were t a k i n g n o t e s on t h e types of behaviour d i s p l a y e d . A f t e r about

40 m ~ n u t e s and when enough o b s e r v a t i o n s were c o l l e c t e d , t h e Moderator of t h e s e s s i o n

in t errupted the rnelhe nnd i n f n r m ~ d thpm t h a t f a c i l i t a t o r s were o b s e r v i n g t h e i r i n t e r -

a c t i o n s . He then e x p l a i n e d t h e t y p e s of behav iour s which f a c i l i t a t e group p r o g r e s s ,

t h o s e which i n h i b i t p r o g r e s s and a l s o t h e ways of communication which a i d or ~ n l i ~ b l t

p r o g r e s s . The f a c i l i t a t o r s who had k e p t s c o r e t h e n r e p o r t e d on t h e i r o b s e r v a t i o n s

t o t h e p a r t i c i p a n t s a f t e r which they resumed t h e i r e f f o r t s t o a c h i e v e consensus .

Fo l lowing t h e i n t e r r u p t i o n and d i s c u s s i o n of t h e obse rved group behav iour , t he

p ~ l r t i c i p a n t s e f f e c t i v e l y went ahead t o a c h i e v e no t on ly a s a t i s f a c t o r y consensus ,

bu t a l s o a u s e f u l s t a t e m e n t on the d e f i n i t i o n and scope of epidemiology, which i s

sc~mmarized as follows:

"Epidemiology i s t he s t u d y of t h e d i s t r i b u t i o n / o c c u r r e n c e and d e t e r m i n a n t s or I r p . l l L h .~nd h e n l t h prohlems i n d ~ f i n e d p o p u l a t i o n s . ' I H e a l t h problems were c o ~ ~ g r ~ ( ?

t o ~ n c l u d e no t only-the e n t i r e r a n g e of e v e n t s t h a t l e a d t o i l l n e s s , d i s a b i l i t y or ---------- - cllh2-b_i!t a l s o measurab le a s p e c t s of h e a l t h such a s f e r t i l i t y and growth. Thev

f u r t h e r ag reed t h a t t h e o b j e c t i v e of t h e s e e p i d e m i o l o g ~ c a l s m d l e s I s L O prevenL

J l s r a s e and promote h e a l t h . The scope of epidemiology was c o n s i d e r e d t o have msnv

d imens ions , i n c l u d i n g a r ange of problems such a s ae t i o l o g i c a l i n v e s t i g a t i o n s ,

d i s e a s e c o n t r o l s t r a t e g i e s , h e a l t h s e r v i c e s p l a n n i n g , h e a l t h programme e v o l u t i o n s ,

e t c . and a r ange of d i s c i p l i n e s such a s c l i n i c a l med ic ine , e c o l o g y , b i o c h e m i s t r v ,

p a r a s i t o l o g y , s o c i o l o g y , e t c . . . a s w e l l a s s t a t i s t i c s .

T l ~ e same f a c i l i t a t o r s k e p t s c o r e s on t y p e s of group behaviour d u r i n g t h e

s e s s l o n f o l l o w i n g t h e i n t e r r u p t i o n and they r e p o r t e d t o t h e group about t h e i r grnup

b e h a v i o u r , which was much improved. Fo l lowing t h i s , t h e "Five s t a g e s of Grorip I . i v c "

were reviewed and i t was c l e a r t h a t t h e group had indeed evolved through t h e s e

s t n g c s i n t h e i r efforts t o a c h i e v e consensus

3. Identification of epidemiological responsibilities of various categories of health workers

The objectives of the session were to define roles, setting, responsibility and

the instructional situation, and to list the responsibilities for a selected role in

a specific setting.

In the plenary, an overview of the systematic approach to curriculum planning

was given outlining the three major phases:

Phase I : describing professional performance

Phase I1 : describing student competencies and

Phase 111 : plannlng srudenr learning.

The end results of these two weeks' efforts in the application of this approach

should be that each participant will produce an instructional unit that hefshe will

be using in their teaching programme.

The above terms were defined, discussed and examples given. The need for

precision and the importance of having responsibilities expressed, in terms of

action verbs and suitable size for analysis into skills, knowledge and attitudes

required, was emphasized.

Participants had previously indicated the level of training foe which they

wished to develop a teaching course and were divided into five groups as follows:

- 1 group for paramedical workers

- 2 groups for undergraduate medical students

- 1 group tor postgraduate students for Masters degree, and

- 1 group for short postgraduate courses for medical officers.

In the small g r n u p s , the r n l p s and settings for each group were outlined and

the major responsibilities for each were formulated. At least one of these responsi-

bilities was to be further analyzed to form the basis for the planned student learning

for the instruction unit to be developed.

4. Formulation of objectives

The purpose of this subject was to develop skills among participants in

formulating objectives.

Each participant was asked to think about the characteristics which should be

exhibited by a good epidemiologist. A comprehensive list was then assembled on a

fllp chart.

One of the identified characteristics, "community-oriented", was selected for

detailed analysis in small groups. The groups w e r e given t h e task of formulating t h c

speciflc observable behaviours (SOB) of an epidemiologist that would demonstrate that

he is community-oriented. In a plenary session the lists of specific behavioural

features of a community-oriented epidemiologist were refined to ensure that each

behavioural feature was observable and relevant to the General Instructional Objec

tive; the advantages of using "action" verbs were also discussed and emphasized.

5. Analysis of responsibilities

The analysis of professional responsibilities into the skill, knowledge and

attitude (SKA) components, was explained, together with illustrations. Each of the

f ~ v e worklng groups separately selected and analysed one of the professional

responsibilities they had previously listed into its SKA components. Group products

were then discussed and several points clarified.

6. Determinants of educational objectives

In the plenary session, the determinants (sources) of educational objectives,

which included personal experience, opinions of experts, programme directors,

politicians, trend-setters and pressure groups, community needs and Government and

private organizations, as well as statistical data were discussed with the

participants.

The need for verification of the educational objectives as illustr~ted by the

participants' Initial Mastery Description (IMD) to ascertain their relevance and

accuracy was stressed and the methods available for performance analysis were

summarlzed and discussed.

Participants were then told that, at this stage, it is useful to analyse per-

formance discrepancies, i.e. the mismatch between the IMD and the actual professional

performance. With the knowledge about the reasons for performance discrepancies,

relevant modifications in the IMD could then be carried out to produce the Final

Mastery Description (FMD) which then forms the basis for setting the educational

objectives.

Once t h i s t a s k i s completed, t h e nex t s t a g e i s t o d e s c r i b e r e q u i r e d

s t u d e n t s ' competencies ( t e r m i n a l , i n t e r m e d i a t e and e n t r y ) w i t h r e f e r e n c e t o t h e

FMD and c o n s i d e r i n g s u i t a b l e p r o g r e s s i o n of l e a r n i n g and t h e e v a l u a t i o n p rocedures

which w i l l be u t i l i z e d . T h i s s t a g e i s a l s o d e s c r i b e d a s t h e w r i t i n g of l e a r n i n g

( o r s p e c i f i c ) e d u c a t i o n a l o b j e c t i v e s .

7 . Systems approach f o r c u r r i c u l u m p l a n n i n g

Time was a l l o c a t e d t o r ev iew and sum up what had been cove red s o f a r i n t h e

c o n t e n t of t h e workshop. The i n s t r u c t o r l i n k e d a l l t h e t e a c h i n g l l e a r n i n g s e s s i o n s

which took p l a c e i n p l e n a r y and sma l l g roups , i n d i c a t i n g t o p a r t i c i p a n t s how and

why t h e i r c o n t e n t s c o n s t i t u t e d i n fact what is known by e d u c a t i o n a l i s t s as t h c

sys tems approach t o c u r r i c u l u m p lann ing w i t h t h e i n t e r r e l a t i o n s h i p of t h e t r i a d s :

E d u c a t i o n a l O b j e c t i v e s (GIO, SOB), I n s t r u c t i o n a l S t r a t e g i e s and E v a l u a t i o n . For

example, t h e s e s s i o n on p r i n c i p l e s of l e a r n i n g i n d i c a t e d t h e v a l u e of a c t i v e

p a r t i c i p a t i o n i n t h e l e a r n i n g p r o c e s s , whereas t h e s e s s i o n on group i n t e r a c t i o n

showed some of t h e p o s i t i v e behav iour s t o be a c q u i r e d t o f a c i l i t a t e t h e l e a r n i n g

p r o c e s s of t h e group i n r e a c h i n g i t s l e a r n i n g o b j e c t i v e s .

Evalr la t ion and i t s r e l e v a n c e t o e d u c a t i o n a l p l ann ing was t h e n d i s c u s s e d w i t h

t h e g roup . I t was i n d i c a t e d t o them t h a t e v a l u a t i o n p r o v i d e s f eedback t o t r a i n e e s

and l e a r n e r s a s w e l l . I n e v a l u a t i n g how much of t h e l e a r n i n g o b j e c t i v e s has been

a c h i e v e d , one can de te rmine whether p a r t i c i p a n t s have a c q u i r e d t h e s k i l l s , knowledge

and a t t i t u d e s they were supposed t o a c q u i r e ; a s a r e s u l t of t h e f eedback , t h e need

may a r l s e t o r e v i s e t h e c o n t e n t and /o r t h e t e c h n i q u e s of t h e i n s t r u c t i o n a l u n i t s .

Eornc p o a a i b l c cauaca of a n c g a t i v c evaluation cou ld bc:

- an u n s a t i s f a c t o r y e n t r y l e v e l of s t u d e n t s

- a poor d e f l n l t i o n of l e a r n i n g o b j e c t i v e s

- inadequate i n s t r u c t i o n a l u n i t s

- a l e v e l of l e a r n i n g o b j e c t i v e s which i s t o o h igh ( n o t a c h i e v a b l e by t h e s t u d e n t s )

- wrong methods of e v a l u a t i o n , ( e .g . e x t e r n a l examiners who a r e no t aware of t h e

c o u r s e o b j e c t i v e s , t e s t i n g o t h e r s e t s of s k i l l s , knowledge and a t t i t u d e s t h a n

t h o s e i n c l u d e d i n t h e l e a r n i n g o b j e c t i v e s ) .

Thus e v a l u a t i o n i s an i n s t r u c t i o n a l s t r a t e g y i n i t s e l f which i s a lways

c o n t r i b u t i n g t o any o r a l l of t h r e e t h i n g s : modifying l e a r n i n g o b j e c t i v e s , modifying

i n s t r u c t i o n a l u n i t s and p r o v i d i n g feedback t o l e a r n e r s and teachers.

8 . W r i t i n g e d u c a t i o n a l / l e a r n i n g o b j e c t i v e s

The s e s s i o n s t a r t e d w i t h a s m a l l t e s t aimed a t v e r i f y i n g t h e p a r t i c i p a n t s '

u n d e r s t a n d i n g of t h e types of l e a r n i n g o b j e c t i v e s : c q g n i t i v e , psychomotor and

a t t i t u d i n a l . T h i s 'was fo l lowed by a d e s c r i p t i o n and an a n a l y s i s of t h e concep t of

student's competence levels for a particular objective (terminal, intermediate,

e n t r y ) u s i n g a s a n i l l u s t r a t i o n one of t h e p r o f e s s i o n a l r e s p o n s i b i l i t i e s d e f i n e d by

p a t i c i p a n t s i n t h e i r group a s s ignmen t s . The s e s s i o n c o n s i d e r e d t h e q u e s t i o n s

of p r e r e q u i s i t e l e v e l s and p r e t e s t s and reviewed a g a i n t h e u s e of e v a l u a t i o n methods

t o p rov ide t h e n e c e s s a r y feedback t o l e a r n e r s and t e a c h e r s . I n t h e d i s c u s s i o n of

t h i s p a r t i c u l a r t o p i c i t became c l e a r t h a t t h e t e r m i n a l competence of a s t u d e n t was

r a r e l y ( i f e v e r ) t h e same as t h a t of a p r o f e s s i o n a l a c t u a l l y performing t h e t a s k i n

h i s a s s i g n e d r o l e and s e t t i n g .

9 . P l ann ing s t u d e ~ t l e a r n i n g

With i n p u t s from t h e p a r t i c i p a n t s , a l i s t of t e a c h i n g l l e a r n i n g methods was

e s t a b l i s h e d i n c l u d i n g l e c t u r e s , group d i s c u s s i o n s , s emina r s , i n d i v i d u a l a s s ignmen t s ,

e t c . An aptempt was t h e n made t o l i n k t h e s e methods of l e a r n i n g t o v a r i o u s educa-

t i o n a l o b j e c t i v e s th rough aq e x e r c i s e c a r r i e d o u t by t h e p a r t i c i p a n t s who were

i n v i t e d t o e v a l u a t e t e a c h i n g l l e a r n i n g methods i n terms of t h e p r i n c i p l e s of l e a r n i n g

reviewed f o u r days e a r l i e r i n t h e workshop.

The best scores were obtained by field practice, independent study projects,

seminars and t u t o r i a l s . The method which o b t a i n e d t h e lowes t s c o r e was t h e l e c t u r e

and y e t i t i s t h e most u t i l i z e d , presumably because ( i ) i t can convey a g r e a t d e a l

of knowledge i n a v e r y s h o r t t ime , ( i i ) i t d e a l s s i m u l ~ a n e o u s l y w i t h a l a r g e

group of s t u d e n t s i n a s h o r t t ime , and ( i i i ) i t i s conven ien t and cheap t o o r g a n i z e .

Var ious ways of improving l e c t u r e s were d i s c u s s e d : t h e u s e of a u d i u - v i s u a l a i d s ,

w e l l focussed o b j e c t i v e s , t h e i n t e r s p e r s i n g of q u e s t i o n s / a n s w e r s s e s s i o n s i n t h e

l e c t u r e , and t h e involvement of s t u d e n t s . I t was r ecogn ized t h a t a s t u d e n t who i s

e m o t i o n a l l y invo lved and who wants t o l e a r n something w i l l l e a r n from a l e c t u r e -

even a bad ly s t r u c t u r e d one.

The need f o r u s i n g a v a r i e t y of methods of i n s t r u c t i o n was emphasized. An

a t t e m p t was t h e n made by t h e p a r t i c i p a n t s t o e s t a b l i s h a r e l a t i o n s h i p between v a r i o u s

methods of learning and the three types of iearning objectives (cognitive,

psychomotor, and attitudinal), grading each method in terms of its effectiveness.

In the second half of the day, discussions resumed around students' learning

with a rcvicw of instructional functions. These are intended to provide a frame

of reference ( s e t t i n g the behaviours t o be learned), provide a reason to learn

(initiate motivation), shape students' attitudes, transmit information, demonstrate

behaviours, allow students to practise behaviours, and provide feedback on student

progress. This plenary session was followed by work In small groups on he develop-

ment of instructional units.

A genera l rev i ew and asoessment of the a c t i v i t i e n of the week was conducted in

plenary at the end of the day.

10. Design of units of instruction

After a further two hours of continued working in small groups on designing

students' level of competence, particularly the intermediate competence or check

points, feedback was then obtained when the groups presented their work in plenary.

This was followed by critical and constructive discussion. The products were of

high quality in terms of model understanding and epidemiological contents.

Continuing on the plenary, Designing Instructional Activities was introduced

to the participants who were reminded of the resources now available and needed

for this task, namely, the Mastery Description ot the protessional, studenr encry,

intermediate and cerminal competencies, evaluative purposes and procedures, instruc-

tional functions, instructional methods and media. Additional guidelines for

designing instructional activities plus a worked-out example, were presented to the

class. The participants were then given the assignment to design instructional

a c t i v i t i e s .

Simulation exercises as a method of instruction were introduced to the groups

with the objective of familiarizing them with their use.

Two simulation exercises, "Investigation of an outbreak of virus hepatitis" and

"Investigation of an outbreak of gastro-intestinal illness", were used for this

purpose. The mechanism of the exercises was explained to the groups and participants

in small groups of 5 and 4 went through the steps of the exercise. This was

followed by a discussion in plenary during which each group explained the rationale

behind their choice and defended it.

. I \ . , ~ i t ~ ~ t l o n - - -

1'111 p u s ~ , , n d r r l a t ~ o n s h i p t o o b l e c t i v e s - - -- - -- - - - -- - -- -- - - -- -

I ~ P p a r t l c l p a n t s , i n p a n e l , r e c a p i t u l a t e d what had a l r e a d y been cove red i n

L I I I ~ I L U ~ L I ~ I p l a n n i n g . They t h e n f e l t t h a t e v a l u a t i o n was t h e n e x t l o g i c a l s t e p t o

i i ~ l l o r j . Thev a l s o f e l t t h a t t h i s shou ld be t a c k l e d under t h r e e i t e m s namely: why,

1.h 1 1 1nc1 hnrs t o p v a l u a t e .

111 I * r ? l n - s t o r m i n g Enchion , partioipnnto cxprcoocd and r c c o r d c d thc functions

~ n d pu rposes of e v a l u a t i o n . These i n c l u d e d t h o s e d u r i n g t h e c o n t e n t of t r a i n i n g

I n c o u r s e ( f o r m a t i v e / d i a g n o s t i c ) and t h o s e a t t h e end of t r a i n i n g (summative/

( r t l t \ i r l g ) . The ~ s s e n t i a l c h a r a c t e r i s t i c s of t h e two t y p e s were t h e n d i s c u s s e d and

'1 slilnmarv hand-out distributed.

1.vd l11,iL Lon oF sLudent competence , o b j e c t i v e s , s k i l l s , knowledge and a t t i t u d e s

b i:, r e v ~ p w e d when t h e s r ib j ec t of what t o e v a l u a t e was d i s c u s s e d .

l h e methods of e v a l u a t i o n , namely e s s a y s , m u l t l p l e c h o i c e q u e s t i o n s , o r a l

c , i r n ~ n.1 t I ons , sim111,lt i on e x e r c i s e s , p r a c t i c a l / c l i n i c ; l l and o b s e r v a t i o n s , were l i s t e d

I v Lhe p a r t l c l p a n t s . Then each participant was asked t o r a t e t h e e f f e c t i v e n e s s

Ll~c e methods i n r e l a t i o n t o o b j e c t i v e s . The r e s u l t s o b t a i n e d were p r e s e n t e d

and a r e a s of c o n t r o v e r s y o r d i sag reemen t d i s c u s s e d . It was c l e a r t h a t t h e e s s a y

-rid cr l ~1 m e t l i o d \ had t h e p o o r e s t r a t i n g w h i l e t h e p r a c t i c a l , u s i n g check l i s t s ,

I 1 1 I nr -i , i l e s <inJ s imul : i t ion , bad t h e h i g h e s t s c o r e .

i \ i i I ~ ! d i ~ o r ~ .-- t o o l s and c r l t e r l a f o r selection - - - - - -

Ihc q u a l l t l e s ol a good e v a l u a t ~ o n t o o l were e l l c i t e d f rom t h e p a r t i c i p a n t s

I I I ~ L l s t e d on a i l i p c h a r t . These l n c l u d e d i t e m s such a s c l e a r i n s t r u c t i o n s ,

f l c ~ d o r n L r o m n m b ~ g u i t ~ e s , q d d r e s s l n g s y l l a b u s and t e s t l n g a l l o b j e c t i v e s . The

iivc ,I 1131 1 ;ood r e l a x e d a tmosphere f o r t h e examina t ion w i t h a s u i t a b l e environment

i t I These clua l l t l e s were t h e n a g g r e g a t e d under objectivity, t e a s l b l l l t y ,

r t i L i i i ~ \ I I \ a n d v 11 ~ ( l i t y and a hand-out summarizing t h e s e c h a r a c t e r i s t i c s was t h e n

r l ~ c t r l b l l t e d t o t h e p a r t l c l p a n t s .

P a r t l c l p a n t s t h e n met l n groups and o u t l i n e d t h e a d v a n t a g e s and d i s a d v a n t a g e s

1 <In* i !11c rnctkiuds of t .v. i l r l ,3t inn. i i ~ i n g t h e c r i t e r i a of a good examina t ion i n

r c l ~ i l 1r)n t r , ~ ~ J ~ C ~ I V C S ni ld 3ny o t h e r criteria. The groups t h e n p r e s e n t e d t h e

171 o i l ~ z c t r t c x t I I V 1 7 1 1.n 11 whcrc a livclv discusalon followed.

EM/HMD/457 EM/EPID/~O EM/WKP.TCH.EPD/~ page 11

Befo re d i s c u s s i n g t h e advan tages and d i s a d v a n t a g e s of t h e e s s a y method,

p a r t i c i p a n t s were g iven a n example of a n e s s a y answer t o a s p e c i f i c q u e s t i o n and

were asked t o s c o r e i t on t h e b a s i s of 100 w i t h 50 a s p a s s i n g mark. The s c o r e s

v a r i e d from 0 t o 85 w i t h most of t h e s c o r i n g be ing under 50. The tremendous

v a r i a t i o n of t h e s c o r e s a roused c o n s i d e r a b l e d i s c u s s i o n on t h e e s s a y examina t ion

a s a n e v a l u a t i o n t o o l , and t h e need f o r a s c o r i n g key was brought o u t by t h e

p a r t i c i p a n t s a s a s o l u t i o n t o improve t h e o b j e c t i v i t y of t h e t o o l .

Fo l lowing t h i s , p a r t i c i p a n t s were i n t r o d u c e d t o t h e s u b j e c t of "Planning f o r

Eva lua t ion" and examples of what i s r e q u i r e d f o r e v a l u a t i o n a t e n t r y , format ive ,

summative and p o s t - t r a i n i n g s t a g e s , were g iven .

1 2 . F i e l d t r a i n i n g

The p a r t i c i p a n t s were d i v i d e d i n t o two groups i n o r d e r t o f a c i l i t a t e t h e i r

f i e l d v i s i t s t o t h e newly des igned Community-Based Family H e a l t h P r o j e c t b e i n g

developed j o i n t l y by t h e Department of Community H e a l t h , F a c u l t y of Medicine ,

Khartoum U n i v e r s i t y , t h e M i n i s t r y of H e a l t h and USAID. The p r o j e c t emphasizes

community involvement and o r g a n i z a t i o n of bo th f i x e d c e n t r e s and mobi le teams f o r

p r o v i s i o n of immunizat ion, o r a l r e h y d r a t i o n , f a m i l y p l ann ing , n u t r i t i o n and

housetiold/community s a n i t a t i o n p r a c t i c e s . C o n s i d e r a b l e en thus ia sm on t h e p a r t

of t h e h e a l t h team w i t h e v i d e n t s t r o n g suppor t from t h e community was n o t i c e d

d u r i n g t h e v i s i t . I t i s premature t o judge t h e end r e s u l t s of t h e programme i n

terms of changes i n t h e h e a l t h s t a t u s of t h e p o p u l a t i o n , b u t p r e l i m i n a r y i n d i c a t i o n s

a r e f a v o u r a b l e .

On t h e f o l l o w i n g day , t h e p a r t i c i p a n t s met t o r ev iew t h e f i e l d v i s i t and t o

d i s c u s s t h e r o l e of f i e l d t r a i n i n g i n t h e i r t e a c h i n g programmes a t home, w i t h

emphasis on approaches t o e v a l u a t i o n of f i e l d t r a i n i n g .

The g e n e r a l i m p r e s s i o n was t h a t t h e Community-Based Family H e a l t h P r o j e c t i s

a v e r y good p r o j e c t , u t i l i z i n g a v a i l a b l e r e s o u r c e s w e l l . The s t a f f i nvo lved i n i t

a r e v e r y e f f i c i e n t . I l l i t e r a c y d i d n o t s t a n d a s a b a r r i e r t o t r a i n i n g v i l l a g e

midwives; a c l e v e r r e c o r d i n g sys tem u s i n g d i f f e r e n t c o l o u r e d c a r d s and s p e c i a l marks

was d e v i s e d t o e n a b l e i l l i t e r a t e h e a l t h worke r s t o keep t r a c k of whom they were

s e e i n g and what t h e i r c o n d i t i o n was.

Ques t ions were r a i s e d abou t t h e e x t e d t o t community p a r t i c i p a t i o n and t h e

e x t e n t t o which t h e p r o j e c t c o u l d be p r a c t i s e d e l sewhere i n Sudan. It was f e l t

t h a t t h e p r o j e c t shou ld i n c l u d e more i n p u t from t h e M i n i s t r y o i H e a l t h s t a f f a t

h i g h e r l e v e l s and t h a t c l e a r e v a l u a t i o n s t r a t e g i e s shou ld be developed f o r i t .

These i s s u e s were d i s c u s s e d and p o i n t s c l a r i f i e d .

P a r t i c i p a n t s then p r e s e n t e d f i e l d t r a i n i n g a c t i v i t i e s i n t h e i r c o u n t r i e s ,

with r e s p e c t t o c n t e g o r i e ~ of personnel t r a i n e d , type of t r a i n i n g , Pime a l l o c a t e d ,

c o n s t r a i n t s and methods of e v a l u a t i o n .

13. Q j d ~ m i o l o g i c a l r e s e a r c h and i t s r e l a t i o n t o t e a c h i n 4

One day was devo ted t o c o n s i d e r i n g e p i d e m i o l o g i c a l r e s e a r c h , e s p e c i a l l y i n

r e l a t i o n t o t e a c h i n g . A f t e r a b r i e f i n t r o d u c t i o n , f o u r r e s e a r c h p r o t o c o l s * were

d e s c r i b e d t o t h e whole group by t h e r e s e a r c h workers invo lved . Then t h e workshop

d i v i d e d i n t o f o u r sma l l g roups , each of which ana lysed one of t h e p r o t o c o l s i n

d e t a i l , c o n s i d e r i n g f i r s t t h e s u i t a b i l i t y and r e l e v a n c e of p r o j e c t d e s i g n and t h e n

t h e s k i l l s , knowledge and a t t i t u d e s n e c e s s a r y t o d e s i g n and implement t h e s t u d i e s

on t h e p a r t of t h e v a r i o u s s t a f f concerned. S i n c e do ing f i e l d r e s e a r c h was a

profess iona.1 r e s p o n s i b i l i t y of t hose f o r whom t h e group were p r e p a r i n g c o u r s e s , t h i s

s e s s i o n c o u l d be viewed a s a type of performance a n a l y s i s .

The s m a l l groups r e p o r t e d back i n p l e n a r y s e s s i o n , which was honoured by t h e

p resence of H .E . The M t ~ i s t e r of H e a l t h . Dur ing two h o u r s ' d i s c u s s i o n t h e p a r t i -

c l p a n t s showed deep under s t and ing of r e s e a r c h methodology and of t h e s k i l l s r e q u i r e d '

~n rcscnrch d c s i g n and p r o t o c o l w r i t i n g .

Fol lowing t h e d i s c u s s i o n , two s p e c i a l WHO programmes were p r e s e n t e d and

d i s c u s s e d : t h a t on T r o p i c a l D i sease Resea rch and t h a t f o r C o n t r o l of D ia r rhoea1

D i s e a s e s . The f i r s t was concerned w i t h r e s e a r c h i n t r o p i c a l d i s e a s e s and i n

s t r e n g t h e n i n g r e s e a r c h c a p a b i l i t i e s i n endemic c o u n t r i e s , w h i l e t h e second embraced

b o t h research and c o n t r o l a s p c c t s . Both programme s t r u c t u r e and the r e l e v a n c e t o

p a r t i c i p a n t s wer.e o u t l i n e d .

1 4 . Model l ing i n epidemiology

I n a n a f t e r n o o n s e s s i o n a c o n c e p t u a l s t r u c t u r e f o r t e a c h i n g t h e epidemiology

of m a l a r i a , based on t h e MacDonald Ep idemio log ica l Model, was p u t forward f o r

* a . M o r t a l i t y s t u d y of young c h i l d r e n i n Sudan b . P reva lence s t u d y of l e p r o s y i n Nuba Mountains c . C a s e - c o n t r o l s t u d y of p r e - e c l a m p t i c toxaemia i n Khartoum d . Foca l m o l l u s c i c i d i n g i n s c h i s t o s o m i a s i s c o n t r o l i n Gez i r a v i l l a g e s

~ M / H M l I / l r 5 7

EM/EPID/~O EM/WKP.TCH.EPD/7 page 13

discussion. It was new to many participants and also served to illustrate the

concept of a "model", exercises on vector life tables, and computer simulation

exercises.

I11 WORKSH3P OUTPUT

The major activity of the workshop was the development of instructional

units carried out in small groups as outlined above in Section 11. The following

are the titleo of the inotructionol unite:

GrouqA - Course title: Paramedical course in epidemiology - Instructional unit: The conduct of communicable ---- disease surveillance

Group2 - Course title: Introduction to epidemiology for medical students -- -------- Instructional unit: Organization and supervision of ---------- immunization for children required by the national

immunization programme.

Group C.l - Course title: Prevention and control of communicable diseases - (for medical students)

Instructional unit: The diagnosis of infectious

diseases

- Course title: Life style intervention for control and prevention - of schistosomiasis (for medical students)

Instructional unit: Practise health education

Group D - Course title Refresher course in epidemiology (for medical - -- - - - - officers of health)

Instructional unit: Planning and evaluation of - - - - - -- - present situation in respect of acute diarrhoea1

diseases

G r m - Course title: Master in Community Medicine (for postgradute - medical doctors)

Instructional unit: Conduct of an epidemiological -------- survey.

E M / H M D / ~ ~ ~ EM/EPID/~O EM/WKP.TCH.EPD/~ page 14

Copies of these instructional units will be available on request from the

WHO Office for the Eastern Mediterranean Region or from the Special Programme f o r

Research and Training in Tropical Diseases, World Health Organization, 1.211 Geneva 27,

Switzerland, after I April 1982.

L V WORKSHOP EVALUATION

Guided by the quality and comprehensiveness of the instructional units pre-

p r ~ d by the participants d u r i n g the wurkshup , it became evident that they have

acquired the systematic approach to c~rrriculum planning with its four main areas,

namely formulating educational objectives, specifying course contents, designing

Learning experiences and designing evaluation procedures.

Workshop evaluatio,~ was made through three msin approaches:

Pre- and Post-Workshop Questionnaire, Evaluation Questionnaire and final

verbatim comnents .

1. Pre- and Post-Workshop Questionnaire

A multiple choice questionnaire with twenty questions covering four main

fields, namely: definitions and objectives; educational planning and course

design; epidemiological principles; and epidemiological research, were prepared

and administered at the beginning of the workshop and repeated at its end.

The results of the pre- and post-tests were analysed along two parameters,

namely by comparing participants' achievements before and after and by comparing

knowledge about these four specific fields before and after the workahnp. Two

participants from Sudan missed either the pre- or post-evaluation and were therefore

excluded.

Analysing the total average score for individual participants, twelve

participants showed definite improvement; four had the same score in the pre- and

post-tests while two had a slightly lower score in the post-test.

Analysing pre- and post-tests for each field separately, there was an evident

general trend of improvement in all four fields. However, the degree of improvement

was not the same in all of them. Improvement was most evident in the area of

educational planning and course design, followed hy research, definitions and

objectives and then aspects related to epidemiological principles. This is d m p l y

E M / H M D / ~ ~ ~ EM/EPID/~O EM/WKP.TCH.EPD/~ page 1 5

a r e f l e c t i o n of t h e i n p u t s made d u r i n g t h i s workshop, where t h e main s t r e s s was on

e d u c a t i o n a l p l ann ing and c o u r s e d e s i g n . Aspec t s r e l a t e d t o e p i d e m i o l o g i c a l

p r i n c i p l e s were no t ammg t h e main o b j e c t i v e s of t h e workshop.

2 . E v a l u a t i o n Q u e s t i o n n a i r e - - - - - - - - - - - - - - A d e t a i l e d q u e s t i o n n a i r e was p repa red t o cove r a l l a s p e c t s r e l a t e d t o t h e

workshop. I t was des igned i n such a way a s t o o b t a i n s p e c i f i c comments from t h e

p d r L i c i y d r ~ L s . I L wda decidrd t u lrlake it alnunyrnouo so that participants ftlt frcc

t o e x p r e s s t h e i r v i ews .

R e p l i e s were o b t a i n e d from a l l t h e twznty p a r t i c i p a n t s and t h e f o l l o w i n g

a r e t h e main r e s u l t s o b t a i n e d :

a ) A l l t h e p a r t i c i p a n t s c o n s i d e r e d t h a t t h e o b j e c t i v e s o r t h e workshop were

a t t a i n e d . 85% of them i n d i c a t e d t h a t t h e o b j e c t i v e s were a t t a i n e d f u l l y o r even

more than e x p e c t e d ; t h e r ema in ing 15% ment ioned t h a t t h e y were o n l y p a r t l y ach ieved .

The l a t t e r group f e l t t h a t t h e workshop shou ld have cove red more f u l l y a s p e c t s

r e l a t e d t o e p i d e m i o l o g i c a l p r i n c i p l e s , modern t r e n d s ' a n d dynamics.

b) The o v e r a l l e v a l u a t i o n of t h e workshop was graded a s " e x c e l l e n t " of "good" by

90% of t h e p a r t i c i p s n t s ; 10% graded i t a s " f a i r " .

C ) The workshop s e t t i n g was graded " e x c e l l e n t " o r "good" by 85% o t t h e p a r t i c i p a n t s

and " f a i r " by 15%.

d ) Nineteen o u t of t h e twenty p a r t i c i p a n t s i n d i c a t e d t h a t t hey were g iven

s u f f i c i e n t o p p o r t u n i t y t o speak, a s k q u e s t i o n s o r a i r t h e i r v iews. They f e l t t h a t

t h e i r p a r t i c i p a t i o n was on t h e whole " e x c e l l e n t to good".

e ) Only two p a r t i c i p a n t s mentioned t h a t t hey had some communication problems;

one of them was due t o be ing unab le t o e x p r e s s h i s views i n E n g l i s h and t h e o t h e r

f e l t t h a t b r i e f i n g i n some t o p i c s and i n d i v i d u a l work had no t a lways been c l e a r .

I t i s ' o be no ted t h a t t h e p a r t i c i p a n t who had sone problem i n e x p r e s s i n g h imse l f

i n E n g l i s h was g i v e n t h e o p p o r t u n i t y t o speak i n h i s n a t i v e language (Arabic)

whenever he wished t o i n t e r v e n e .

f ) The d u r a t i o n of t h e workshop was c o n s i d e r e d t o be t o o s h o r t f o r t h e s e t

o b j e c t i v e s by 60% of t h e p a r t i c i p a n t s , adequa te by 30% and t o o long by 10%.

g ) Many p d r L i ~ i p d n L a C e l t t h a t t h e programme w a s rather congested and that aftcr-

noon s e s s i o n s and "homework" shou ld have been r educed .

EM/HMD/L57 EM/EP1D/70 EM/WKP .TCH. EPD/~ page 16

h) All participants except one were satisfied with their individual or group

product for systematic course design. They also indicated that they intend to

use the instructional unit they have designed and also other units designed in

the w,>rkshop in their own departments . i) All participants felt that similar workshops should be run agaln. The

categories of participants mentioned for similar workshops included: teachers of

epidemiology, public health administrators and epidemiologists/research workers.

3. Final comments by participznts

Participants in a final whip-around expressed their general satisfaction with

the workshop. In addition to repeating many of the items entered in the evaluation

sheet, they added that the workshop had given them a chance to meet with fellow

epidemiologists from neighbouring countries and exchange views on several aspects

related to epidemiological problems and services. They acknowledged the excellent

arrangements made by the hosting institute and by the organizers of the course.

V CONCLUSIONS AND RECOMMENDATIONS

The Workshop,

Having completed a successful Workshop for Teachers of Epidemiology with the

objective of strengthening national capabilities in teaching and research in

eprdemiology w l t h p a r t i c u l a r emphasis on rlexrelnping a systernqtir approach to

c~irriculum design:

Noting the recommendations of the Workshop on the Teaching of Epidemiolosy,

Mqnila, 1980, and the International Epidemiological Association (IEA)/World Health

Organization Workshop on Postgraduate Epidemiological Training in Developing

Countr i ee , Edinburgh, 1981.

Recognizing the serious deficiencies in the quantity and quality of

epidemiological manpower in developing countries whichare largely due to the lack

ot wall-defined career structures for epidemiological manpower and to the lack of

adequate training programmes for epidemiological personnel particularly with practical

field training:

ENDl39SES the general recommendations of the Manila and IEA Workshops, and:

~ ~ / H M n / 4 5 7 EM/EPID/~O EM/WKP.TCH .EPD/7 page 17

SPECIFICALLY RECOMMENDS:

1. That fo l low-up workghops o r t h e i r e q u i v a l e n t on s y s t e m a t i c c u r r i c u l u m d e s i g n

be implemented by a l l p a r t i c i p a n t s t o complete and f i e l d - t e s t t h e e p i d e m i o l o g i c a l

c o u r s e s w i t h emphasis on f i e l d t r a i n i n g ;

2 . That when t h e e p i d e m i o l o g i c a l c o u r s e s developed a t t h i s workshop a r e f u l l y

p r e p a r e d , WHO/TDR be r e q u e s t e d t o c o n s i d e r a p p r o p r i a t e suppor t f o r t h e i r implementa-

tion:

3. Tha t f u r t h e r r e g i o n a l workshops s i m i l a r t o t h i s one be conducted f o r

p a r t i c i p a n t s from o t h e r c o u n t r i e s unab le t o a t t e n d t h i s workshop. The s e p a r a t i o n

of such workshops i n terms of c a t e g o r y of p e r s o n n e l , e . g . p o s t - g r a d u a t e , under-

g r a d u a t e , pa ramed ica l , e t c . cou ld enhance t h e e f f i c i e n c y of t h e workshops;

4 , That s h o r t , i n t e n s i v e workshops, s i m i l a r i n s p i r i t , b u t d i r e c t e d towards

e p i d e m i o l o g i c a l r e s e a r c h d e s i g n and methodology, be developed by WHO/TDR;

5. That workshops of e p i d e m i o l o g i c a l c o n t e n t be des igned and convened t o deve lop

and d i s s e m i n a t e s u i t a b l e t e a c h i n g m a t e r i a l s and methods; and

6 . Tha t t h e exchange of v i s i t i ~ g e p i d e m i o l o g i s t s between and w i t h i n c o u n t r i e s and

WHO Regions be planned and i n i t i a t e d wherever p o s s i b l e w i t h a view t o enhancing

e p i d e m i o l o g i c a l r e s e a r c h , t e a c h i n g and t r a i n i n g , and exchange of s e r v i c e e x p e r i e n c e .

EM/HMD/457 EM/EPID/70 EM/WKP.TCH .EPD/? Annex I

ANNEX I

OPENING ADDRESS

BY

PROFESSOR EL TAHER FADL

ACTING DEAN, FACULTY OF MEDICINE,

UNLVERSITY OF KHARTOUM

Your Exce l l ency M i n i s t e r of H e a l t h

Ex Vice -Chance l lo r , U n i v e r s i t y of Khartoum

S e c r e t a r y Genera l , Counc i l f o r Higher Educa t ion

D r Ra f ique Khan, WHO Programme Coord ina to r and S p e c i a l R e p r e s e n t a t i v e , Khartoum

Dr M.H. Wahdan, WHO Reg iona l A d v i s e r , Ep idemio log ica l S u r v e i l l a n c e of Communicable

D i s e a s e s and S e c r e t a r y of t h e Workshop

Dr R.H. Morrou, Medical O f f i c e r , P a r a s i t i c D i s e a s e s , WHO Geneva, WHO Advi se r s and

C o n s u l t a n t s

P r e s i d e n t , Sudan D o c t o r s ' Union

Cucoto and Participants

Col leagues :

It giveo me great pleasure to welcome you cordially and warmly t o t h i s c o u n t r y

and t h i s F a c u l t y which i s now 55 y e a r s o l d and i s one of t h e o l d e s t Medical Schools

i n A f r i c a , second on ly t o Kasr E l E i n i , C a i r o . I thank you f o r a c c e p t i n g t h e

i n v i t a t i o n t o t h e Sudan f o r t h e purpose of t h e workshop. We a r e r e a l l y delighted chac

you were a b l e t o come. I t i s n i c e t o s e e f r i e n d s coming from A f g h a n i s t a n , Democratic

Yemen, Egypt , I n d o n e s i a , Kenya and S y r i a . Thanks a l s o t o t h e World H e a l t h O r g a n i z a t i o n

f o r nominat ing our c o u n t r y t o h o s t t h i s workshop f o r t e a c h e r s of epidemiology and t o

t h e WHO S e c r e t a r i a t Dr Wahdan, Dr Morrow, P r o f e s s o r Brad ley , P r o f e s s o r L a v o i p i e r r e ,

Dr Lo and t o Mrs C a r t o u d i s Dbmi t r io , Mrs Hadid and Mrs A u s t i n .

Our F a c u l t y has been g r e a t l y i n t e r e s t e d i n t h e two a r e a s of t h e work: t h e s u b j e c t

m a t t e r of Epidemiology and E d u c a t i o n a l P lann ing . We have a l s p been promot ing t h e

E M / H M D / ~ ~ ~ EM/EP1D/70 EM/WKP.TCH.EPD/~ Annex I page ii

i n t e g r a t e d , i n t e r d e p a r t m e n t a l and d i s c i p l i n a r y t e a c h i n g of epidemiology and o t h e r

s u b j e c t s which we a r e c o n t i n u o u s l y t r y i n g t o improve. I am s u r e t h i s workshop w i l l

h e l p us t o do s o . Once a g a i n thank you f o r your good w i l l and p l e a s e c o n s i d e r

y o u r s e l v e s a t hove. I am s u r e you w i l l f e e l f r e e t o make f u l l u se of our humble

f a c i l i t i e s .

Thanking you a g a i n ; on beha l f of t h e Vice-Chancel lor i t g i v e s me g r e a t p l e a s u r e

t o d e c l a r e t h i s wsrkshop open.

EM/HMD/457 E M / E P I D / ~ O EM/W .TCH. E P D / ~ Annex I1 page i

ANNEX I1

MESSAGE FROM DR A . H . TABA UImCTOR

WHO EASTERN MEDITERRANEAN REGION

t o t h e

WORKSHOP FOR TEACHERS OF EPIDEMIOLOGY

Khartoum, 23 January - 5 February 1982

Your Excel lency, dear Colleagues,

It g ives me g r e a t p leasure t o send t h i s message of welcome t o you

on t h e occasion of t h e opening of t h e F i r s t Workshop f o r Teachers of

Epidemiology. I wish t o extend my personal thanks and those of t h e World

Health Organizat ion and the Spec ia l Programme f o r Research and Training

i n Troplca l Dlseases (TDR) t o t h e Min is t ry of Heal th of Sudan, and t h e

Univers i ty of Khartoum, f o r hos t ing t h i s Workshop and f o r providing t h e

necessary e x p e r t i s e and f a c i l i t i e s .

During r e c e n t y e a r s , n a t i o n a l h e a l t h a u t h o r i t i e s and WHO have been

t r y i n g t o develop n a t i o n a l epidemiological s u r v e i l l a n c e a c t i v i t i e s . How-

e v e r , a s you a r e w e l l aware, t h i s e s s e n t i a l s e r v i c e i s s t i l l i n need of

improvement i n many p a r t s of t h e world. The main problem facing t h e

development of e f f e c t i v e epidemiological s u r v e i l l a n c e a c t i v i t i e s is t h e

c r i t i c a l shor tage of t r a i n e d personnel a t a l l l e v e l s . This i n t u r n i s ,

a t l e a s t i n p a r t , due t o l imi ted i n t e r e s t on t h e p a r t of medical graduates

i n t h i s important d i s c i p l i n e .

The problem,as we a l l know, i s a complex one and is c l o s e l y l inked

with the l imi ted incen t ives i n publ ic h e a l t h work when compared wi th those

o f t e r e d t o r c l i n i c a l work. A s a consequence i t i s d i f f i c u l t t o motivate

EM/HMD/457 EM/EPID/~O EM/WKP.TCH. E P D / ~ Annex I1 page i i

physicians t o t ake up epidemiology o r publ ic h e a l t h a s a c a r e e r . We know

t h a t e f f e c t i v e a c t i o n i n t h i s r e s p e c t l i e s with the governments concerned,

and I am happy t o s e e t h a t t h e p a r t i c i p a t i o n i n t h i s Workshop i n d i c a t e s a

d i s t i n c t t r a n d iuwards more emphasis on, and recognition o i epidemiology

a s a n e s s e n t i a l p a r t of h e a l t h s e r v i c e s development.

However, you, a s t eachers of epidemiology have t h e r e s p o n s i b i l i t y of

ensuring t h a t g radua tes rece ive enough epidemiological i n s t r u c t i o n , and a l s o

t o make decision-making o f f i c i a l s aware of the value of the epidemiological

c o n t r i b u t i o n t o appropr ia te h e a l t h planning.

I need not s t r e s s t h e r o l e of epidemiology and t h e a p p l i c a t i o n of

epidemiological s u r v e i l l a n c e methodology f o r t h e success of h e a l t h programmes

These methods provide a s c i e n t i f i c b a s i s f o r planning, o rgan iz ing , monitoring - and conducting h e a l t h programmes. The a p p l i c a t i o n of appropr ia te epidemiol-

o g i c a l methodologies p resen ts a major input i n our e f f o r t s towards achieving '

Lhe g l o b a l goa l of "HealCh f o r All by t h e Year 2000".

Up t i l l now, e f f o r t s of Member S t a t e s of t h i s Region and those of WHO i n

t r y i n g t o develop epidemiological manpower have focussed on :

(1) Teaching of epldemlology a t medlcal schools , and i n genera l a s p a r t of

prevent ive and s o c i a l medicine courses f o r non-medical h e a l t h p rofess iona ls .

( 2 ) Postgraduate t r a i n i n g leading t o t h e Diploma o r Mas te r ' s Degree i n

Publ ic Heal th i n Epidemiology, both i n t h e U n i v e r s i t i e s of t h e Region and

abroad. WHO has a l s o organized a s u b s t a n t i a l number of r e g i o n a l and i n t e r -

reg iona l t r a i n i n g courses i n epidemiology i n which many physicians from t h i s

Region have p a r t i c i p a t e d .

IK i s f e l t t h a t t h e p resen t a c t i v i t i e s of t r a i n i n g i n epidemiology

should be f u r t h e r s t imula ted i n view of t h e small number of personnel t r a i n e d

EM/HMD/457 E M / E P I D / ~ o EM/WKP.TCH .EPD/7 Annex I1 page iii

as compared to actual needs. It is also felt that, although epidemiological

principles are common to all countries, insofar as they relate to scientific

methods, the practice of epidemiology can vary a great deal from one country

to another due to differences in health conditions in the environment, and

in the comprehensiveness and quality of medical services. Furthermore, the

accepted role of the epidemiologist in planning and implementation of health

programmes is differently understood.

With all these aspects in mind, together with the fact that training is

most effective when given in circumstances which are the same as, or very

similar to, those in which the trainee will eventually work, it was decided

to develop regional training of teachers in epidemiology to encourage national

training courses for the different levels of health workers required under

local conditions.

As a preliminary step towards achieving this goal, it was decided to

organize this Workshop in order to strengthen national capabilities in

teaching epidemiology, through the review of current concepts and scope of

epidemiology applicable to local conditions, planning of teaching programmes

of epidemiology including their design and content, and teaching methods

and means of their evaluation.

It is also planned that this Workshop will deal with epidemiological

research both in general and also particularly with regard to the six tropical

diseases covered by the Special Programme for Research and Training in

Tropical Diseases. Research in fact is an extremely useful teaching resource,

particularly as students can be involved with research work carried out in

their own communities.

EM/HMD/457

EM/EPID/~O EM/WKP.TCH.EPD/~ Annex I1 page iv

As an outcome of this Workshop, I will look forward to receiving news

of your plans for organizing national training courses in epidemiology for

national health workers. WHO would be glad to collaborate, should this be

required, and within the limitations of our budgetary and other resources

in the implementation of such courses.

In conclusion, I wish to thank the Sudanese authorities for hosting

this Workshop and for providing their well known excellent expertise and

iacilities.

I wish you all a pleasant stay in Khartoum, and sincerely hope that

you will find the Workshop a useful exercise.

EM/HMD/&~~ . E M / E P I D / ~ O

EM/WKP.TCH.EPD/~ Annex 111

ANNEX 111

OBJECTIVES OF THE WORKSHOP

The workshop a ims t o s t r e n g t h e n n a t i o n a l c a p a b i l i t i e s i n t e a c h i n g and

r e s e a r c h i n ep idemio logy . More s p e c i f i c a l l y , a t t h e end of t h i s Workshop t h e

p a r t i c i p a n t s a r e e x p e c t e d :

1. t o d e s c r i b e t h e r o l e s , r e s p o n s i b i l i t i e s and f u n c t i o n s of t h e v a r i o u s h e a l t h

personnel in epidemiology, with special emphasis on professinnal ~ p i d e m i n l n e i c t c ;

2 . t o a c q u i r e a s y s t e m a t i c app roach t o c u r r i c u l u m p l a n n i n g , which w i l l :

( a ) f o r m u l a t e e d u c a t i o n a l o b j e c t i v e s

( b ) s p e c i f y c o u r s e c o n t e n t s

( c ) d e s i g n l e a r n i n g e x p e r i e n c e s

( d ) d e s i g n e v a l u a t i o n p r o c e d u r e s ;

3 . t o produce improved c o u r s e s i n ep idemio logy , of which a t l e a s t one w i l l be of

u s e t o and s u b s e q u e n t l y used by each p a r t i c i p a n t ;

4. t o i d e n t i f y t h e r o l e of e p i d e m i o l o g i c a l r e s e a r c h i n t e a c h i n g of epidemiology

and t o be b e t t e r a b l e t o p l a n and gu ide o t h e r s t o p l a n r e s e a r c h .

EM!WKP.TCH.EPD/~ Annex IV p?ge i

R e g i s t r a t i o n ( F a c u l t y of Medic ine , Conference Hall)

- Opening S e s s i o n , p l e n a r y (Baghdadi H a l l )

- Inaugural e d d r e a s nn b e h a l f nf Prnfessnr Omer B e l e i l , V ice -Chance l lo r , U n i v e r s i t y of Khartoum, Khartoum, by P r o f e s s o r E l Toher F a d l , A c t i n g Dsan, k a c u l t y O F Med ic ine , U n i v e r s i t y of Khartoum, Khartoum

- PIessage lrom D r A . H . Taba , WHO D i r e c t o r f o r t h e E a s t e r n Med i t e r r anean Kegion

- I n t r o d u c t on

- Opinion q u e s t i o n n a i r e

- I n d i v i d u a l i n t e r v i e w s and i n t r u d u c t i o n 01- p a r t i c i p : ~ n t s

O b j e c t i v e s of t h e workshop

T e a c h i n g and practice of e l > i d p m i n l npy in home s e t t i n g resentat at ions by p ~ r t l c i p a n t s )

S:ill?jr% _2_lt_l:tn1!ary 1982

t ) 8 . 0 ( 1 - i O . O O - P r i n c i p l e s of l e a r n i n g

I 1 1.0;\ - 10 30 RECESS

, I 30 - 1 3 . 0 0 - Group dynamics

- l d e n t i f i c a t i o n of e p i d e m i o l o g i c a l r e s p o n s i - h i l i t l e s of v a r i o u s c a t e g o r i e s of h e a l t h worke r s

<: (20 ninul-ex b reak a t 1 7 . 4 8 )

page i i

Monday, 25 J a n u a r y 1982 - - - - - - - -- - - - - - - - - - - - - 08.01 - 10 .03

11.00 - 11.30

i1.30 - 1 4 . 0 0

Wednesday, 27 J a n u a r y 1982

Thursday, 28 J a n u a r y 1982

f ~ 8 . 0 f i - lo.oo

LEARNING OBJECTIVES

- Formula t ion of o b j e c t i v e s

RECESS

- C l a s s i f i c a t i o n of o b j e c t i v e s

- A n a l y s i s of r e s p o n s i b i l i t i e s + (15 m i n u t e s b r e a k nt noon)

- Teach ing t h e epidemiology of m a l a r i a

- Dete rminan t s of e d u c a t i o n a l o b j e c t i v e s

- Systems approach t o c u r r i c u l u m p l a n n i n g

RECESS

- W r i t i n g o b j e c t i v e s

EPIDEMIOLOGIC RESEARCH AND ITS RELATION TO TEACHING

- 1 n t r o d . d c t i o n o t p r o j e c t s

- A n a l y s i s of p r o j e c t s

* ( 3 0 minu te s r e c e s s a t 10 .00)

RECESS

- D i s c u s s i o n of r e s u l t of a n a l y s i s

- The S p e c i a l Programme of Resea rch i n T r o p i c a l D i s e a s e s

- D i a r r h o e a 1 D i s e a s e s C o n t r o l Programme

PLANNING STUDENT LEARN1 NG

- I n s t r u c t i o n a l methods c u r r e n t l y used and r e l a t i o n t o o b j e c t i v e s

RECESS

- S e l e c t i o n of a p p r o p r i a t e methods

;: (15 minu te s b r e a k a t noon)

E M / K M D / ~ ~ ~ EM/EPID/~O EM/WKP.TCH.EPD/~ Annex IV page iii

Saturday, 30 January 1982 ----

08.00 - 09.00

13.30 - 14.00 Mends, 1 February 1982 -

FIELD VISIT

Tuesday, 2-Eebruery 1982 -- 08.00 - 09.30

09.30 - 10.00

- Group work on Project Assignment No. 7 (continued)

- Plenary, feedback (presentations on project assignments up to No. 7 )

RECESS

- Introduction to Project Assignment No. 9

- S i m ~ i l n t i o n exercises - Investigation of outbreaks

- Group work on Project Assignment No. 9

EVALUATION

- Purpose of evaluation and its relationship to objectives

RECESS

- Evaluation tools, criteria for selection

* (15 minutes break at 13.00)

- Introduction of Project Assignment No. 8

- Evaluation of field training

- Other field training experiences (Presentation by participants)

- Group work on Project Assignments numbers 8 and 9

- Presentation and discussion of units

- Introduction to presentation

- Preparation for presentation

E M / H M D / ~ ~ ~ EM/EPID/~O EM/WKP.TCH. E P D / ~ Annex IV page iv

1.7.30 - 18.nn

Thursday, 4 February 1982 ------ 08.30 - 10.30

10.30 - 11.00

11.03 - 13.00

FRIDAY, 5 F e b _ ~ u _ ~ ~ y 1982

FIELD VISIT

- Group work presentation

* (30 minutes break at 10.30)

- Group work for recomnendations

RECESS

- Post-test

- Workshop evaluation questionnaire

- Workshop evaluation (continued )

RECESS

- Closing session

E M / H M D / ~ ~ ~ EM/EPID/~D EM/WKP.TCH. EPD/7 Annex V page i

ANNEX V

LIST OF PARTICIPANTS -

DEMOCRATIC REPUBLIC OF AFGHANISTAN Dr S . Saga r V i c e - P r e s i d e n t Department of P r e v e n t i v e Medic ine Ministry of I leal th Kabul -

PEOPLE'S DEMOCRATIC REP'JBLIC OF YEMEN D r A . Basaha i Direc tor of Preventive Madic i~ l t . M i n i s t r y of H e a l t h A*

EGYPT Dr Mohamed Abdel F a t t a h Abda l l ah Chairman Department of Epidemiology F a c u l t y of Medic ine A s s i u t U n i v e r s i t y A s s i u t

*Sr Mohamed Sobhi Abdel Rehim D i r e c t o r T e c h n i c a l H e a l t h I n s t i t u t e Embaba C a i r o - Dr Mohamed Takk i Abbas Gaafar A s s i s t a n t P r o f e s s o r P u b l i c H e a l t h Department Faculty of Medicine A l e x a n d r i a U n i v e r s i t y A lexandr i a -- D r Mohamed Sayed Morsy Shaffri A s s i s t a n t P r o f e s s o r of Epidemiology F a c u l t y of Medicine Al Azhar U n i v e r s i t y C a i r o - Dr Samir Mohamed K a b i l L e c t u r e r i n C l i n i c a l T r o p i c a l Medicine F a c u l t y of Medic ine U n i v e r s i t y of Banha Banha

* Did n o t a t t e n d

E M / H M D / ~ ~ ~

EM/EPID/~O EM/wKP.TCH.EPD/~ Annex V page ii

EGYPT (cont'd)

INDONESIA

KENYA

SUDAN

Dr Adel Abdel Ghafiar T I \ I ! I

Assistant Professor o l 1'11171 I I 1 1 , I I I 1

Faculty of Medicine U n i v e r s i t y o f Mansoura

Mansoura

Dr Bambang Sutrisna Lecturer i n E p i d c m i o l o g v

Faculty of Public Health University of Indonesia Jakarta

Dr P.R. Kenya Senior Research ~ E f ~ c e r / ~ ~ ~ d e n - o l Medical Research Centre Nairobi

Dr (MKS) M. Were Senior Lecturer Department of Community Heal L i i

University of Nairobi Nairobi

Dr Mohamed Ibrahim A 1 Tmnm Director-General Preventive Health Services Ministry of Health Khar t oum

Dr ASdel Malik Abdalla Abdel I i c l I

Faculty of Medicine U n i v e r s i t y of K h n r t n~~ rn

Khartoum

Dr Attia Taha Zein El Abdeen L e c t u r o r Faculty of Medicine University of Gezira Wad Medani

Dr Hyder Abu Ahmed Ministry of Health Khartoum

Dr Kamal Kheir Allai FacuLty of Medicine Department of Cornmuni! ,, ? k g i i c i . U n i v e r s i t y of Khar t c > ~ ! r n

Khartoum

SUDAN ( c o n t ' d )

SYRIA

HOST COUNTRY OBSERVERS

D r V.H. Wahdan

D r R.H. Morrow

Prof . D. Bradley

EM/HMD/457 EM/EPID/~O EM~KP.TcH.EPD/~ Annex V

D r Mansour Mohamed Mansour Facu l ty of Medicine Univers i ty of Khartoum Khartoum

D r Omer Tameem Epidemiologist Min is t ry of Heal th Khartoum

Dr A l i I. B e i l i Deputy Di rec tor Rural Wealth and Primary Hea l th Care Min is t ry of Health Khartoum

D r Amal M. Adnan Community Physician Minis t ry of Health Khartoum

D r Mohamed B-Kassas Di rec tor Prevent ive Medicine Department Damascus Health D i r e c t o r a t e Ministry of Heal th Damascus --------- D r Osman Modawi Senior Gynaecologis t Ministry of Health . . Khartoum

D r Muzamil Hassan Lecturer Facul ty of Medicine Univers i ty of Gezira Wad Medani

WHO SECRETARIAT

Regional Adviser , Epidemiological WHO Regional Off i c e f o r Surve i l l ance of Communicable the E a s t e r n Mediterranean Diseases, Secre ta ry of t h e Workshop

Medical O f f i c e r , P a r a s i t i c Diseases WHO C e n t r a l O f f i c e , Programme, WHO Geneva Geneva, Switzer land

Consul tant

Prof . G. Lavoip ie r re Consul tant

Professor of Tropica l Hygiene and Di rec tor Ross T n s t i t ~ l t e of Tropi- cal Hygiene, London School of Hygiene and Tropica l Medicine, London, UK

Medical Research O f f i c e r , V i c t o r i a Heal th Commi- s s i o n , 555 C o l l i n s S t . , Me1 hnnrne 3000,Australia

EM/HMD/457 EM/EPID/~O EM/wKP.TCH.EPD/~ Annex V page i v

D r Eddy K.C. Lo Consul tant

D r Abdel Rahman Temporary Adviser E l Tom

D r Abdel Aal Abda l l a Temporary Adviser Osman

D r B. Hamad Temporary Adviser

D r Abdel Rahman Temporary Adviser Abdel Salam

D r M.Y. Sukkar

D r Mohamed Ibrahim A l i Omer

Conference Serv ices

Mrs C . Cartoudis- DBm6tr i o

Mrs M.T. Hadid

Temporary Adviser

Temporary Adviser

Conference O f f i c e r

S e c r e t a r y

A s s i s t a n t Di rec tor of Heal th Serv ices (Epi- demiology) Ministry of Health , Kuala Lumpur , Malaysia

Pro tessor of CommuniEy Medicine and Head Department of Community Medicine, Facu l ty of Medicine, UniverslEy of Khartoum , Khartoum , Sudan

Pro tessor of surgery , Facu l ty of Medicine, Univers i ty of Khartoum, Khartoum, Sudan

Dean, Facu l ty of Medicine, Univers i ty of Gezira , Wad Medani, Sudan

D i r e c t o r , Centre f o r Educat ional Development f o r Health Profess ion<, Facu l ty of Medicine, , Univers i ty of Khartoum, Khartoum, Sudan #

Dean, Graduate c o l l e g e , Univers i ty of Khartoum, Khartoum, Sudan

D i r e c t o r , Post-graduate Medical S tud ies Board, Facu l ty of Medicine, U n i v e r s i t y of Khartoum, Khartoum, Sudan

WHO Regional Off ice f o r the Eas te rn Mediterran- ean

WHO Regional Off ice f o r the Eas te rn Mediterran- ean

:ia t i o n n l P r e p a r s i o r y Committee --

WHO C e n t r a l O f f i c e , Geneva. S w i t z e r l a n d

D r Abdel Rahman E l Tom, P r o f e s s o r of C~~mmuni ty Medic ine and Head, Department of Community Medicine, F a c u l t y of Med ic ine , Khartoum U n i v e r s i t y , Khartoum, Sudan