Africa-United States joint curriculum development of a Master of Science degree in international infectious disease management at Makerere University

Africa-United States joint curriculum development of a Master of Science degree in international infectious disease management at Makerere University

Samuel Majalija^1,&, David Owiny Okello^1,2, Margaret Loy Khaitsa³, Douglas Freeman⁴, Abel Ekiri⁵, Marvin Ssemadaali⁶, John Baligwamunsi Kaneene⁷, John David Kabasa¹

¹College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda, ²Directorate of Research and Graduate Training, Makerere University, Kampala, Uganda, ³Department of Pathobiology and Population Medicine, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA, ⁴Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive Saskatoon, Saskatchewan, Canada, ⁵One Health Institute, School of Veterinary Medicine, University of California, Davis, California, USA, ⁶Department of Microbiological Sciences, North Dakota State University, Fargo, ND, USA, ⁷Center for Comparative Epidemiology Michigan State University, 736 Wilson Rd, Room A-109, East Lansing, MI, 48824, USA

^&Corresponding author
Samuel Majalija, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda

Introduction    

Africa has an estimated population of 224 million cattle and 447 million goats, with approximately 34 million equines and camels, yet malnutrition is rampant with rates as high as 35% or more in many countries [1]. More than 60% of these animals are resident in East and Central Africa (ECA), and livestock provides 36% of Africa´s Agricultural Gross domestic product (GDP) [1]. In ECA specifically, animal resources contribute up to 90% of the national GDP with Ethiopia, Somalia, Sudan, and Kenya sharing the upper percentile of 50-90% [1]. In Uganda, animal resources contribute more than 67% of the average household income. Beyond traditional livestock production, fisheries, and wildlife resources, present additional opportunities for food and economic security in ECA. However, despite this potential, ECA´s animal industry has remained largely subsistent informal and disconnected from the global market economy. Moreover, animal resources have been identified by several development partners, including The African Union (AU), Comprehensive Africa Agriculture Development Program (CAADIP); The United Nations Food and Agricultural Organization (FAO), and the New Partnership for Africa´s Development (NEPAD) as a strategic pathway for poverty eradication in Africa [1-3]. This calls for a Paradigm shift. Furthermore, there is realization in the United States (US) that global perspectives in agriculture are critical to the safety of US food and agricultural resources, and for global trade [3]. Trans-boundary infectious diseases and zoonoses, once thought to be limited by geographical demarcations, are now a constant threat to global animal and human health, trade, food security, and socio-economic wellbeing [3]. Many colleges and schools worldwide are training students to serve as professionals who will help in the improvement of animal health, public health and food security globally. Additionally, many institutions have embraced internationalization of higher education and a shift to a global context to meet the global needs as the way to go [4,5]. North Dakota State University (NDSU) in the US and Makerere University (Mak) in Uganda responded to this need by developing a joint Master of Science (MS) degree in International Infectious Disease Management (MS-IDM) in 2011. This was the first US-Africa trans-Atlantic degree addressing integrated disease management and international biosecurity. Initially, the program required completion of 30 credits with core courses offered jointly by both institutions as described earlier [6]. However, implementation of the program as a joint degree was difficult. Currently, Mak offers the MS-IDM as a dual degree with student exchange based on availability of funding.

The MS-IDM degree was a framework/mechanism for addressing infectious diseases and food security needs of (ECA), a region with 70% of Africa´s livestock and a region that is exporting livestock live animals and meat and meat products regionally and internationally. According to the Africa Union- Inter-Africa Bureau for Animal Resources (AU-IBAR), ECA animal industry is currently grappling with a growing problem of Transboundary Animal Diseases (TADs) and Zoonoses [1]. This has paralyzed and crippled efforts to maintain sustainable animal and public health, food and nutrition security, production and trade leading to exacerbation of hunger and conflicts amidst deepening globalization pressure, population explosion, environmental and social stress [1]. Moreover, the globalization of trade and the reduction in transportation times have created new possibilities of disease spread that must be taken into consideration while scrutinizing the epidemiology of transboundary animal diseases [3]. ECA´s position in relation to the unique climate of the Great Lakes Region and Congo-Uganda Albertine-Ecosystem (the epicenter of dangerous disease pathogens), makes her most vulnerable to the high prevalence of infectious diseases of man and animals that are of global economic, public health and bio-security importance. These diseases kill large populations of animals and people, reducing production and productivity, and limiting market access and entry. According to the AU-IBAR, the 2007 Rift Valley Fever (RVF) outbreaks in North Eastern province of Kenya and later in Tanzania resulted in loss of human life in those countries, and the imposition of livestock and meat export ban from Ethiopia by the United Arab Emirates (UAE) for about 9 months [1]. ECA is a natural reservoir and regional epicentre for animal diseases of public health, biosecurity and economic significance. Yet, planning and management of disease control programs in ECA are ineffective and inefficient due to: a) paucity of data and information; b) under reporting, only 56% of African Union member states report to the AU-IBAR; c) transboundary animal diseases and zoonoses information is adhoc, inconsistent and not sufficiently linked to national and regional data base systems; and d) conventional educational, research and training models are not sufficiently designed for disease control and transformative development change [1]. In addition, educational programs and curricula in tertiary institutions are not sufficiently funded or founded on evidence-based learning, and are disconnected from communities. Also, there is growing vulnerability to climatic change and global diseases without sufficient capacity to mitigate or adapt. The African Higher Education Summit held in Dakar, Senegal (March 10-12, 2015) called for the following: African Universities harmonization of curricula, quality assurance, mobility of faculty, and joint and collaborative research and training against locally, regionally, and internationally agreed benchmarks of excellence [7]. Furthermore, higher education institutions were encouraged to embrace pedagogies that emphasize participation, creativity, invention, innovative citizenship and new technologies for teaching and learning [7,8]. The purpose of developing the MS-IDM degree was to develop a regional graduate program supported by regional governments that would standardize training and build local capacity leading to a coordinated effort in managing transboundary animal diseases and zoonoses in ECA.

Methods     

Mak and NDSU obtained funding from USDA-Higher Education Challenge grant and the United States Agency for International Development (USAID) through the CIMTRADZ project to develop the MS-IDM degree. The goal of the MS-IDM program was to: 1) provide opportunities for students in (ECA) to further their education, 2) develop capacity among students in ECA higher education institutions to manage transboundary animal diseases and zoonoses, and 3) foster lasting partnerships and collaborations between Mak and NDSU. Funding from USDA-HEC supported 4 graduate students (3 from the US and 1 from Ethiopia) through stipends, student training activities, including spending a summer semester at Mak, and research fellowships to complete the MS-IDM. Funding from USAID supported 10 MS-IDM students from Uganda and also awarded over 20 fellowships to graduate students to complete their respective MS programs. The specific objectives of the research grants and scholarships were to provide: 1) accelerated training of students from ECA in specific areas of expertise, 2) collaborative research and training in Transboundary Animal Diseases and Zoonoses, and 3) research resulting peer-reviewed scientific publications. Participating universities from ECA comprised CIMTRADZ partners described elsewhere. The faculty at partner institutions provided short-term trainings to MS-IDM students, including workshops at The Scientific Cultural Boma and conference in Uganda.

Results     

MS-IDM Curriculum Development

The accreditation process took about one year to complete and involved approval of the curriculum at the following levels of Makerere University: Department of - Biosecurity, Ecosystem and Veterinary Public Health; School of Biosecurity, Biotechnical and Laboratory Sciences; College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB) College Board; Makerere University Senate; and The Uganda National Council for Higher Education (UNCHE). The curriculum comprised 17 courses with a total minimum number of 30 credits, as summarized in Table 1. Additionally, students had to spend at least 1 semester at an international institution and complete research projects at Mak and the international institutions with joint mentorship of faculty at both institutions. Thirteen of the 14 MS-IDM courses are mandatory.

MS-IDM Curriculum structure

The program is structured in 2 academic years of 4 semesters undertaken under Plan A or Plan B. Students that take Plan A option are required to take at least 30 credits of course work and 2 semesters of full-time research leading to a dissertation. Students on Plan B are required to take 45 credits of course work and 1 semester of full-time project work leading to a project report.

Student research and graduation rate

All MS-IDM students that were enrolled in the inaugural class graduated on time and advanced their careers to various professional development opportunities, including: joining medical school, enrolling into Ph. D programs and employment with State Departments of Health and Human Services. The students from Uganda were employed by COVAB as Assistant Lecturers or were given responsibility as Program Managers at Africa Institute for Strategic Resource Services (AFRISA), a public private partnership responsible for offering training to various stakeholders in various agricultural value chains. Table 2 summarizes abstracts of research conducted by students enrolled into the MS-IDM program at Mak and NDSU as part of the requirements for their graduation. Table 3 shows a sample of MS-IDM graduates and where they currently are.

Outcomes and impacts of grants awarded to fellows and MS-IDM students: Students were extremely successful in completing their degrees and several published their research in peer review journals, attended joint symposia and conferences, wrote joint grant submissions and awards and made career advancements. Also, student interactions with faculty from various higher education institutions resulted into joint mentorship and exposure to other additional faculty and their research facilities.

Personal testimonies of the MS-IDM inaugural Class - June, 2012

The inaugural class of MS-IDM comprised of 8 students; Rahel Gemedda (Ethiopia), Robert Mugabi (Uganda), Michael Muleme (Uganda), Timothy Miller (USA), Emma Jellsion (USA), Annet Kyomuhangi (Uganda), Herbert Mukiibi (Uganda), and Lee Kiedrowski (USA). All 8 students enrolled at NDSU but had to complete a semester (summer 2012) at (Mak) where they completed up to 3 core courses. Each of these students wrote personal testimonies on how the MS-IDM training had impacted their lives and what they hoped to accomplish in the future. The testimonies exhibited dedication, ambition, and personal character of the highest levels. The CIMTRADZ partners are honored to have participated in each student´s individual growth, personally and academically. Below are some key quotes from their testimonies:

Emma Jellison: “I can truly say that this program has influenced my life in such an incredible way and opened doors for me that may not have been there previously. I will be starting medical school this fall at the University of North Dakota and can say that I will be better prepared than my colleagues at a multitude of levels - from communication, to holistic thinking, to the relationships between human medicine, public health, and vet medicine, to public/private partnerships, to governmental organizations, to major global issues like climate change and food security, and many more. This opportunity has really enabled me to become a leader during a critical time when we, as young professionals, are poised to impact future generations.”

Timothy Miller: “This unique program uses the "One Health" concept while appreciating the collapse in time and space due to international trade and travel. During my time in Uganda, I conducted research on zoonotic bovine tuberculosis focusing on the prevalence of the African 2 Clonal Complex spoligotype pattern, which is geographically associated with the horn of Africa. Through the IDM program, I was able to get an internship this summer at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA to conduct research on Whooping Cough. I plan to join the Navy Medical Corps for Infectious Disease and Tropical Medicine after medical school.”

Robert Mugabi: “The program, given its international nature in infectious disease management, has exposed me to how diseases are handled in the two worlds (developing and developed). These exposures are hard to quantify but they have equipped me to handle diseases at an international level keeping in mind the fact that some emerging diseases are trans-boundary. Although the impact of this program may be invisible now, to me it´s a rare and long-term achievement. I have socially interacted with a lot people from different backgrounds and nationalities, made a couple friends, which has improved my social life as a person.”

Rahel Gemedda: “Through the master´s program, I got a chance to make educational trips in USA and Uganda. Overall, the educational opportunity I got was a life changing opportunity that empowered me with knowledge and experience on infectious disease management and the dynamics in developed and developing countries. The courses made me ready for the growing human resource demand on infectious disease.”

Michael Muleme: “The IDM program has one unique component, the integration of research and policy. As part of my courses in the IDM program, I participated in the Global policy course on animal health and food security, organized by Washington State University, University of Minnesota, University of California Davis & North Dakota State University at Washington DC. Also, I attended the veterinary day at CDC (Centers for Disease Control and Prevention). With this training and networking, my dream is to integrate research and community development to improve livelihoods in developing countries.”

Herbert Mukiibi: “The creative projects, one in Africa and another in the USA, have contributed to my skills in that now I can comfortably go in the Laboratory and identify any microbe, including the infectious and the noninfectious ones, using the most modern diagnostics; PCR, ELISA, Western Blot, Northern Blot among others. This knowledge is very relevant in developing countries where the Neglected Tropical Diseases are prevalent.”

Lee Kiedrowski: “Through my experiences in this program I have learned of all the many career Paths, I could take. I could enter the workforce or continue my education. I could work internationally or stay domestic. I could do field or laboratory research. The options under these career paths are endless. As of now, I can state with absolute certainty, this master´s program has changed my life forever. My career path will forever be altered. I have made connections with so many unique individuals during my time in the program that I am certain I will utilize them in the course of my career.”

Annet Kyomuhangi: “Since joining IDM, I have seen my aspirations evolve; from being very specific to integration of other science fields. It has been that connecting link between my molecular biology focus and other fields in science, such as public health and international health policy. In a nutshell; IDM has not only opened doors for great opportunities to serve, it has also given me a solid foundation onto which I can grasp and sail into the world of science with confidence and focus.”

Challenges experienced during implementation of MS-IDM degree

Mak and NDSU experienced difficulty in establishing timely and effective communication resulting in a slight difference in the title of the degree approved at each institution. NDSU approved a Master of Science degree and a Graduate Certificate in International Infectious Disease Management while Makerere University approved a Master of Science degree in International Infectious Disease Management and Biosecurity. Both institutions agreed that it was important for partners to establish clear and consistent communication channels to keep all partners up to date on the status of degree approval process and potential challenges. The partners worked best when they met regularly, whether over the phone or in person. Additionally, there was difficulty in the transfer of credits from Mak to NDSU for students that took courses at Mak. Furthermore, financial constraints were a limitation to many students that were interested in enrolling into the MS-IDM program. After the end of CIMTRADZ, subsequent students enrolling in the MS-IDM program were supported by their employers. Due to the wider appeal of the program in the region, student enrollments have been steady including students from neighboring countries such as Ethiopia, Somalia and Rwanda. Participation in mentorship of students by international faculty significantly reduced after the CIMTRADZ project ended. However, additional opportunities for international faculty to engage in student mentorship have been provided through programs such as The Carnegie African Diaspora Fellowship Program that supported CIMTRADZ partners Dr. John B. Kaneene (Michigan State University), Dr. Florence Wakoko (Columbus State University) and Dr. Khaitsa (Mississippi State University) in 2014, Dr. Wilson Rumbeiha (Iowa State University, 2016), Dr. Patrick Pithua (University of Missouri, 2017), and Dr. Wakoko and Dr. Khaitsa (in 2017); and The Fulbright Fellowship Program (Dr. Patrick Pithua, University of Missouri, 2017); and International summer research and training (Dr. Khaitsa and Dr. Wills, Mississippi State University). Makerere University is participating in several other workforce development programs, such as Emerging Pandemic Threats Program funded by USAID. Also, other cheaper and sustainable avenues for joint faculty engagement are being explored, including distance education.

Discussion     

Zoonotic diseases are very common, both in the US and around the globe [9]. Scientists estimate that more than 6 out of every 10 known infectious disease in people are spread from animals, and 3 out of every 4 new or emerging infectious disease in people are spread from animals [9]. At least 70% of the known human and animal pathogens affecting production, public health, global trade, and security reside in sub-Saharan Africa and, in particular, the ECA region [1]. This region has, therefore, been described as a hot spot of global pandemics. Additionally, the ECA region, particularly the greater horn of Africa, frequently experiences food insecurity [1]. Throughout the region there is a concurrent increasing demand for livestock products from the growing population. Concerns over population growth, climate change, conflict, and declining productivity of the natural resource base present very real challenges for food security and conflict in the region and globally. The Greater Horn of Africa comprising Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan, Uganda and Tanzania has 6 of its members engaged in the Africa - U.S. Integrated Disease Management (AFRUS-IDM) network and CIMTRADZ project [10]. This region is also home to the world´s largest concentration of traditional pastoralists, among the world´s most marginalized and harsh societies. These pastoralists utilize the vast, dry rangelands, where extensive grazing of livestock provides the only viable means of agricultural production. Their livelihoods, however, are threatened by the region´s rapidly growing human population, diminishing resources and increasing environmental degradation. In pursuit of their livelihoods, pastoralists move their livestock over wide areas of the dry and semi-arid lands, thereby enhancing disease spread. The rivers and pastures and trade in ECA are transboundary, thus posing a real risk to spread of transboundary animal diseases and zoonoses. The scale, range, and complexity of these modern challenges to health security call for new and broader approaches to student training, including standardization and harmonization of regional curricula. The MS-IDM degree provides a mechanism for higher education institutions in ECA to harmonize training for scientists to manage transboundary animal diseases and zoonoses in the region. This approach in training is in accordance with the recommendations of the African Union (AU) and the sub-regional groupings to develop a continental higher education system that enhances student mobility and comparison among higher education institutions in Africa [7]. This framework is also in accord with Regional University Mediated Partnerships Enhancing Livelihoods and Health in Africa (RUMPELHA) [11] that aims at harmonizing credentials and setting up continent-wide and sub-regional quality assurance mechanisms. The MS-IDM program provides a pathway to realizing the “Africa Higher Education Agenda, 2063” that was so well articulated at The African Higher Education Summit held in Dakar, Senegal in March, 2015 [7]. Additionally, many higher education institutions from developed countries have realized the benefits of partnering with institutions from low developing countries with the goal of preparing their students to gain competencies in global, international and intercultural experiences and development [12,13]. This trend is driven by the global interconnectedness, including the scourge of emerging and re-emerging infectious diseases which have no respect for geographical borders [12]. Therefore, the MS-IDM program provided opportunities for students from NDSU to gain experience in international training at Mak, including cultural exposure.

Conclusion     

The MS-IDM degree provided opportunities for human capacity development to manage transboundary animal diseases and zoonoses in ECA. In spite of the challenges experienced, both Mak and NDSU learnt valuable lessons in developing twinning programs between institutions in the developing and developed countries or under different education systems. These lessons will inform future similar collaborative endeavors in internationalization of curricula in higher education.

Competing interests     

The authors declare no competing interest.

Authors´ contributions     

The primary author (Samuel Majalija) served as The Program Director, MS-IDM at Makerere University; Dr. Khaitsa (CIMTRADZ Partnership Director & MS-IDM Program Director at North Dakota State University, and Dr. Ekiri (CIMTRADZ Project Manager) at North Dakota State University. All authors mentored MS-IDM students, contributed to writing the article, reviewed several drafts, and approved the version to be published. Additionally, all authors participated in the CIMTRADZ project and played a significant role in its implementation. All authors have read and agreed to the final version of this manuscript.

Acknowledgments     

The authors wish to acknowledge faculty and administrators from several institutions that participated in the planning and development of the MS-IDM degree, particularly North Dakota State University, and Makerere University. Similarly, the authors are grateful to all CIMTRADZ partners that participated in the training and mentorship of MS-IDM graduate students. Funding for developing the MS-IDM degree and support for four MS-IDM students from North Dakota State University was provided by USDA-Higher Education Challenge grant. Funding for the training of students from Makerere University (10 MS-IDM and several fellowships awardees) was provided by USAID through Higher Education for Development (HED).

Tables     

Table 1: summary of Master of Science, International Infectious Disease Management (MS-IDM) degree Curriculum

Table 2: abstracts of Master of Science, International Infectious Disease Management (MS-IDM) degree awardees

Table 3: sample of previous students of Master of Science degree in International Infectious Disease Management (MS-IDM) and Current Career Status

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