Workshop report: building biostatistics capacity in Sub-saharan Africa-taking action

Workshop report: building biostatistics capacity in Sub-saharan Africa-taking action

 

Rhoderick Machekano^1,&, Taryn Young¹, Willie Conradie², Simbarashe Rusakaniko³, Lehana Thabane⁴

 

¹Centre for Evidence-based Health Care, Stellenbosch University, Stellenbosch, South Africa, ²Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa, ³Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe, ⁴Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

 

 

^&Corresponding author
Rhoderick Machekano, Centre for Evidence-based Health Care, Stellenbosch University, Stellenbosch, South Africa

 

 

 

 

The universal shortage of biostatisticians has been documented in many countries including the US [1] and Canada [2]. In particular, there remains a critical shortage of biostatistics expertise in the developing world including Sub Saharan Africa (SSA). This has resulted in an overreliance on inputs from biostatisticians sourced from economically developed countries or the pharmaceutical industry for writing competitive grants, leading the design of trials, executing statistical procedures, conducting advanced data analysis, publishing in high profile journals and teaching biostatistics at the postgraduate level. The few biostatisticians based at universities or research institutions in SSA are generally overburdened and unable to cope with the demand for their expertise. Furthermore, important emerging fields, such as genetic/genomic research, machine/statistical learning including systematic reviews for evidence sysnthesis and gudeline development, require the application of new statistical methods experience that is often lacking in Africa. Given the paradigm of Evidence Based Health Care that involves the review, synthesis and appraisal of evidence from various research studies to guide policy formulation and practice decisions, biostatistics is a core skill [3,4]. The need for capacity development in biostatistics in the SSA region has been recognized [5,6]. Good statistics departments do exist at SSA universities, however, they focus almost exclusively on training studentsfor careers in the business and financial sectors, as well as for careers at research and academic institutions, rather than for careers in the biomedical field. Those statistics departments offering teaching in biostatistics generally do not link up with health sciences faculties, which mean that students do not develop apractical understanding of the clinical context, or worse, never have the opportunity to fully appreciate the value of statistics in health and medical research. What is urgently required is a sustained response to the need for biostatistics strengthening in SSA. A cadre of professional/academic biostatisticians is needed to play a leadership role in developing the academic discipline of biostatistics, contribute to multidisciplinary, collaborative research in the health sciences and train the next generation of biostatisticians.

 

The National Institutes of Allergy and Infectious Diseases (NIAID) demonstrated interest in strengthening biostatistics capacity in SSA by sponsoring two workshops: one in 2009 in the Unites States and another in 2011 in Gaborone, Botswana[5]. Researchers from both the United States and SSA attended the workshop whose principal aim was to redefine the aproach to capacity building of this key area to research and development in Africa. Participants at the workshop noted that there were large gaps in biostatistics and appropriate data management skills, hence the need for project biostatisticians based at the same institution as researchers. But it was also noted that these few biostatiticians are only available to the project and not others who also have needs for such skills. This has resulted in a lack of experience sharing with the wider health research community. The workshop also noted that the project biostatisticians are either sponsored by the developed world or they are students from the same developed world who are gaining experience from SSA where there are rich resources of data. Just as with many other industries, capacity in SSA needs to be improved to provide value-added to the research data produced in the region. The workshops concluded that training programs aimed at building both long-term and short-term capacity were needed. The key recommendation from the workshops was that SSA universities should educate and retain in-country biostatisticians at both the masters and doctoral level. Based on the deliberations of these previous workshops, the focus ofthe workshop discussed in this paper, was to move the recommendations from the previous Gaborone workshop[5] into action and, importantly, to establish collaborations between biostatisticians in the region as well as share experiences in building biostatistics capacity. This report details the workshop activities.

 

 

Location and participants

 

From the 8-10 July 2014, the Biostatistics Unit, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, hosted the workshop Building Biostatistics Capacity in sub Saharan Africa: Taking Action in Cape Town, South Africa.Thisbrought together a group of experienced biostatisticians from the region (Table 1, Figure 1). Using the participant list of the NIH Botswana workshop, networks in South Africa and the Medical Education Partnership Iniative (MEPI) schools we specifically identified and invited biostatisticians working within the African region. Twenty nine participants representating Universities of KwaZulu Natal, Witwatersrand (WITS), Nairobi, Botswana, Zimbabwe, Ghana, Zambia, Kilimanjaro Christian Medical and Stellenbosch (with representation from South African Centre for Epidemiological Modelling and Analysis (SACEMA), Department of Statistics and Actuarial Science, and Faculty of Medicine and Health Sciences) as well as the Kenya Medical Research Institute (KEMRI) joined and others sent apologies and indicated that they are interested in continuing the conversations outside of the meeting.

 

Aim and objectives

 

The purpose of the workshop was to establish collaborations between biostatisticians in the region as well as to share experiences in building biostatistics capacity. Specific objectives of the workshop were to 1) discuss the structure of a Master's program in biostatistics 2) establish available human resources to facilitate such a program 3) discuss potential areas of collaboration in building biostatistics capacity 4) identify other potential biostatistics training models 5) learn and share experiences from colleagues involved in Biostatistics training 6) discuss other issues affecting biostatisticians within the region e.g. enhancing methodological research productivity, mentorship, and promoting the role of the biostatistician in collaborative research 7) discuss capacity building in meta-analysis and 8) discuss the potential for an Africa Center for Biostatistical Excellence and regional units. The focus was on building concensus and capacity across the region rather than concentrate expertise in one place.

 

Facilitators

 

Workshop facilitators brought a wealth of multidisciplinary experience. Facilitators included a professor in biostatistics, from Lesotho and now working at McMaster University; the head of the Department of Interdisciplinary Health Sciences at the Faculty of Medicine and Health Sciences, Stellenbosch University; the head of the Department of Statistics and Actuarial Science, Stellenbosch University; and staff from the Centre for Evidence-based Health Care and South African Cochrane Centre. Participants from regional universities shared their experiences in programmatic offering through formal presentations and discussion.

 

Programme

 

Over 3 days participants engaged to discuss and share experiences. Table 2 outlines the 3 day programme. It provided an opportunity to brainstorm biostatistics capacity development in Africa and how to enhance what is being done and establish and further collaborative links to work together. After considering the key role of biostatisticians in the design, conduct, analysis and reporting of research; the limited number of biostatisticians in the region and the paucity of masters programmes in the region, participants were very supportive of working together to increase and enhance the number of such programmes in the region. Time was spent on discussing the structure of a Master's program in biostatistics, lessons learnt from other similar programmes, the proposed competencies (Table 3), and collaboration in building biostatistics capacity. Graduates of these programmes should be empowered to play leading roles with respect to consulting, methodological research, management, entrepreneurship and mentorship in the field of Biostatistics.Another important related point was to improve the Biostatistics literacy among researchers, medical personnel, non-statisticians and the public through good teaching and dissemination. Underpinning all discussions and planning were the shared mission that itis now time for action and that by working together, both within country and across countries in the region, we will achieve much more. Role players from different institutions in the Cape Town area realised that collaboration between them to build Biostatistics capacity is of the outmost importance. It was also encouraging to observe that these institutions accepted the challenge to work together in structuring a jointly offered Masters Programme in Biostatistics and that the other participants in the workshop sanctioned this vision. A half-day session was spent on meta-analysis. It commenced with a presentation and discussion on Reducing waste in research: role of systematic reviews [7] followed by a presentation onUses and misuses of meta-analysis. We then reflected on current training initiatives in meta-analysis. These include formal training, mentoring, online tutorials, learning by doing reviews and meta-analysis, and peer review. In building capacity in meta-analysis, participants raised the need for collaboration, sharing expertise in the region, mentorship, linking authors of systematic reviews with Biostatisticians, training, resources and for getting involved in doing reviews.

 

Recommendations for action

 

To move key recommendations forward working groups were established. One is focusing on the structure and content of a MSc Biostatistics. This group is mapping existing programmes (experiences, structure), engaging with other stakeholders (academic institutions, research institutions, those who could not attend the workshop, etc.), and thinking through programmatic offering. Another group is working on the development of a concept paper for an Africa Centre for Biostatistics Excellence. The group also worked together to apply for a Wellcome Trust DELTAS grant which has consolidated the experience and enabled us to build confidence that we can make this happen.The two working groups hold monthly teleconferences to provide updates on their progress and discuss ways to foster collaborations and partnerships in biostatistical capacity across institutions in SSA region.

 

Evaluation

 

Participants liked the multidisciplinary approach and geographical distribution of workshop participants. They particularly liked the networking and sharing similar experiences, openness, opportunity for sharing ideas and having discussions, the rich interaction, and the chance to meet a range of people with similar interests. Some participants wanted their role to be more explictly clarfied prior to the workshop and wanted more content on meta-analysis. Table 4 summarises evaluation feedback. Overall the responses from participants' evaluation of the workshop suggests that participants rated the workshop as excellent and felt that the set objectives were met. Given that not all regional biostatisticians could join the workshop there is a need to continue the engagement on biostatistics capacity development.

 

 

By working together, and by supporting each other, regional institutions and biostatiaticians can address the need for biostatistics strengthening in Sub-Saharam Africa. "If you want to go fast, go alone. If you want to go far, go together. African Proverb"

 

 

Authors declare no competing interest.

 

 

All authors have read and agreed to the final version of this manuscript and have equally contributed to its content and to the management of the case.

 

 

The workshop was supported by Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) through US President's Emergency Plan for AIDS relief (PEPFAR) through HRSA under the terms of T84HA21652; Effective Health Care Research Consortium www.evidence4health.orgfunded through DFID; andInternational Research Training Planning Grant (1D71TW009758-01) funded through the National Institutes of Health (NIH) and Fogarty International Center (FIC). We would like to acknowledge the valuable contributions of the workshop participants resulting in this manuscript.

 

 

Table 1: workshop participants

Table 2: workshop outline

Table 3: defining Biostatistics competencies

Table 4: evaluation feedback (n=15)

Figure 1: geographic distribution of workshop participants (number) from the sub-saharan African region

 

 

1. DeMets DL, Stormo G, Boehnke M et al. Training of the next generation of biostatisticians: a call to action in the US. Stat Med. 2006; 25(20):3415-29. PubMed | Google Scholar


2. Thabane L, Wells G, Cook R et al. Canadian-led capacity-building in biostatistics and methodology in cardiovascular and diabetes trials: the CANNeCTIN Biostatistics and Methodological Innovation Working Group. Trials. 2011; 12:48. PubMed | Google Scholar


3. Frenk J, Chen L, Bhutta ZA et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Rev Peru Med Exp Salud Pública. 2011; 28(2):337-41. PubMed | Google Scholar


4. Dawes M, Summerskill W, Glasziou P et al. Sicily statement on evidence-based practice. BMC Med Educ. 2005; 5(1):1. PubMed | Google Scholar


5. Gezmu M, DeGruttola V, Dixon D et al. Strengthening biostatistics resources in sub-Saharan Africa: research collaborations through US partnerships. Stat Med. 2011; 30(7):695-708. PubMed | Google Scholar


6. Fegan G, Moulsdale M, Todd J. The potential of internet-based technologies for sharing data of public health importance. Bull World Health Organ. 2011; 89(2):82. PubMed | Google Scholar


7. Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Obstet Gynecol. 2009; 114(6):1341-5. PubMed | Google Scholar