Governance and assessment in a widely distributed medical education program in Australia.

The learning objectives, curriculum content, and assessment standards for distributed medical education programs must be aligned across the health care systems and community contexts in which their students train. In this article, the authors describe their experiences at Monash University implementing a distributed medical education program at metropolitan, regional, and rural Australian sites and an offshore Malaysian site, using four different implementation models. Standardizing learning objectives, curriculum content, and assessment standards across all sites while allowing for site-specific implementation models created challenges for educational alignment.

Where is the evidence that rural exposure increases uptake of rural medical practice?

Australian Government initiatives to address medical workforce shortages in rural Australia include increasing the intake of students of rural background and increasing exposure to rural medicine during training. Rural-orientated medical training programs in the USA that selectively admit students from rural backgrounds and who intend to practise as family practitioners have demonstrated success in increasing uptake of practice in rural/underserved areas. However, in examining the specific contribution of rural exposure towards increasing uptake of rural practice, the evidence is inconclusive, largely due to the failure to adjust for these critical independent predictors of rural practice.

Maternal recall of exclusive breast feeding duration.

Background: Both the pattern and duration of breast feeding are important determinants of health outcomes. In vertical HIV transmission research, reliable documentation of early breast feeding practices is important in order to correctly attribute postnatal transmission to feeding pattern.

Aims: To validate methods of collecting data on the duration of exclusive breast feeding (EBF) in an area of South Africa with a high HIV prevalence rate.

New approaches to spatially analyse primary health care usage patterns in rural South Africa.

Objective: To develop indices to quantitatively assess and understand the spatial usage patterns of health facilities in the Hlabisa district of South Africa.

Methodology: We mapped and interviewed more than 23 000 homesteads (approximately 200 000 people) in Hlabisa district, South Africa and spatially analysed their modal primary health usage patterns using a geographical information system. We generated contour maps of health service use and quantified the relationship between clinic catchments and distance-defined catchments using inclusion and exclusion error.

HIV heterogeneity and proximity of homestead to roads in rural South Africa: an exploration using a geographical information system.

objective To describe heterogeneity of HIV prevalence among pregnant women in Hlabisa health district, South Africa and to correlate this with proximity of homestead to roads. methods HIV prevalence measured through anonymous surveillance among pregnant women and stratified by local village clinic. Polygons were created around each clinic, assuming women attend the clinic nearest their home.

Practical skills and valued community outcomes: the next step in community-based education.

Objectives: Community-based medical education (CBE) has clear value. However, there are aspects of CBE where improvement is possible. First, communities do not generally receive valued outcomes in exchange for participation in the CBE process.

Hepatitis B infection in black children from residential care facilities in KwaZulu-Natal. Implications for adoption and foster care.

Objectives: A study was undertaken to assess the prevalence of hepatitis B infection in selected residential child care facilities in Natal.

Design: All residents at three facilities in the Durban and Pietermaritzburg areas of KwaZulu-Natal were tested for markers of hepatitis B infection as part of a broader health status assessment.

Results: One hundred and ninety-five children between the ages of 3 and 194 months (78 +/- 47) were studied.

Community-based survey versus sentinel site sampling in determining the nutritional status of rural children. Implications for nutritional surveillance and the development of nutritional programmes.

A study of the anthropometric status of under-5-year-olds was conducted in the Nqutu district of KwaZulu by means of a representative community-based sample and concurrent samples from primary health care clinics, preschools and primary schools. The first objective of this exercise was to determine the extent of acute nutritional stress in the district as an indication of the appropriateness of food relief efforts in the region. The absence of wasting and the high prevalence of stunting (37.

The use of COSAS in the analysis of vaccination coverage in urban, peri-urban and rural populations in the Edendale/Vulindlela district of KwaZulu.

A repeat vaccination coverage survey has been conducted in the Edendale/Vulindlela district of KwaZulu. The survey data were processed using the Coverage Survey Analysis System (COSAS) developed by the World Health Organisation (WHO) through its Expanded Programme on Immunisation (EPI). A modified random cluster sampling method was used to select 281 children between the ages of 12 and 23 months.

A community paediatric information system--a tool for measles surveillance in a fragmented health ward.

A community paediatric geographical information system using hospital-based inpatient data was created to monitor longitudinal child health trends, to define paediatric priorities and to generate research ideas and interventions in a large and very fragmented health ward. This epidemiological tool has been used to describe measles admission trends over a 4-year period (1987-1990), which included a severe measles epidemic. The examination of these trends in progressively finer geographical categories has identified a number of areas with a particularly high incidence of measles and has provided useful guidelines for subsequent community-based research.

Vaccination--coverage of under-fives, validity of records, and the impact of mass campaigns in the Edendale/Vulindlela district of KwaZulu.

Recent epidemics of poliomyelitis and measles in the Edendale/Vulindlela district of KwaZulu spurred an investigation into the causes of vaccination failure. Vaccination coverage achieved by routine clinic services and by two mass campaigns was assessed. The validity of routine clinic vaccination records was also determined.

Primary health care nurse training in Kwazulu. An evaluation of diagnostic flow charts versus a conventional training method.

Diagnostic flow charts have been adapted for the training of primary health care (PHC) nurses in a rural area of South Africa. We designed a randomized controlled trial to assess whether nurses' clinical competence differed if they were trained using flow charts or using conventional patient-centered teaching. Although clinical competence improved during the training programme, this improvement did not differ significantly according to which of the two training methods was used.