Nutrition training in medical and other health professional schools in West Africa: the need to improve current approaches and enhance training effectiveness

Figures & data

Table 1 Number of participating institutions and training programs assessed^a

		Number of training programs assessed
Country	Number of participating institutions	Medicine	Nursing	Midwifery	Nursing assistant
Benin	2	2	0	0	0
Burkina-Faso	6	2	6	4	10
Cote-d'Ivoire	1	0	1	1	0
Ghana	1	1	0	0	0
Guinea	6	0	4	5	0
Liberia	1	0	1	0	0
Mali	7	1	1	2	8
Mauritania	4	1	8	4	0
Niger	8	1	9	7	10
Nigeria	3	1	2	0	0
Senegal	9	2	8	7	7
Sierra-Leone	4	0	11	0	0
Total	52	11	51	30	35

^aFour countries in West Africa (Cape Verde, Guinea-Bissau, and The Gambia) were not included in our study.

Fig. 1 Characteristics of participating institutions^a (n=52).

^aNote that there were institutions offering more than one training program.

Table 2 Nutrition instruction year and contact time

			Medical programs (n=11)	Nursing programs (n=51)	Midwifery programs (n=30)	Nursing assistant programs (n=35)
Curriculum year^a (%)	First cycle only		9.1	84.3	86.6	77.1
	Second cycle only		63.6	2	6.3	22.9
	Throughout the curriculum		27.3	7.8	0	0
	Other patterns^b		0	5.9	7.1	0
Areas emphasized	Basic nutrition	Number of programs (%)	4 (36.4)	35 (68.6)	23 (76.7)	35 (100)
in the curriculum		Hours of contact^c	15.8±6.8	41.9±3.1	40.4±3.6	28.0±2.1
	Applied nutrition	Number of programs (%)	7 (63.8)	10 (19.6)	5 (16.7)	0
		Hours of contact^c	37.5±10.9	9.6±2.6	6.2±2.3	0
	Public health	Number of programs (%)	0	6 (11.8)	2 (6.6)	0
	nutrition	Hours of contact^c	3.6±2.4	5.0±1.7	2.9±1.3	0
Average hours of contact^c			56.9±5.7	56.4±4.0	48.3±3.3	28.0±2.1
Range (hours)			28–92	20–120	20–110	08–70

^aStudies for the doctoral programs consist generally of a first cycle (first 2 years or pre-clinical years), a second cycle (clinical years) followed by a third cycle (covering four semesters in the Francophone countries and the period of housemanship in Anglophone countries). Nursing and midwifery schools have two cycles (pre-clinical and clinical years).

^bThis includes courses taught during years 1 and 3 or years 2 and 3 for the nursing and midwifery programs or during year 3–7 for the medical programs.

^cValues are expressed as mean ± standard error.

Table 3 Characteristics of the nutrition training curricula of the health programs

Characteristic		Medical (n=11)	Nursing (n=51)	Midwifery (n=30)	Nursing assistant (n=35)
Distribution of nutrition	Dedicated nutrition courses	27	78	87	100
instruction throughout	Integrated with other courses	46	4	0	0
the curriculum (%)	Both patterns	27	18	13	0
Teaching format (%)	Didactic	88	100	100	100
	Problem-based learning	0	0	0	0
	Integrated system-based	12	0	0	0
Status of nutrition courses (%)	Required	100	100	100	100
Elective	0	0	0	0	0

Table 4 Core competencies and possible topics to be included in the curriculum of students in health professional schools

Status of nutrition course^a	Year in the curriculum^a	Focus area	Teaching method	Competencies and topics	Medical programs^b	Nursing and midwifery programs^b
		Basic nutrition	Didactic	Core competencies	Be able to understand the basic principles of human nutrition, assess the nutritional status of individuals and groups, and conduct dietary assessment
				Possible topics	Nutrition biochemistry Nutritional requirements Nutritional physiology Dietary and nutritional assessment Food composition Micronutrient deficiencies Infant and young child feeding
Integration of didactic, public health-oriented and applied nutrition courses throughout the curriculum	Throughout the curriculum, from pre-clinical to clinical years	Clinical nutrition	Integrated, system-based format	Core competencies	Be able to manage acute malnutrition using the national protocol, manage micronutrient deficiencies, and provide dietary and lifestyle advices for the management of obesity and diet-related chronic diseases	Be able to manage acute malnutrition using the national protocol, provide nursing care for the management of micronutrient deficiencies and diet-related chronic diseases
				Courses in which nutrition topics can be integrated	Pediatrics Endocrinology Clinical medicine	Pediatrics Clinical practices focused on acute disease management
					Multidisciplinary health care delivery Family medicine Preventive medicine Digestive system Cardiovascular disease	Clinical practices focused on chronic disease management Nursing care Dietetics Obstetrics and gynecology
		Public health nutrition	Problem-based learning and/or Integrated, system-based format	Core competencies	Be able to promote appropriate IYCF, prevent micronutrient deficiencies and diet-related chronic diseases through the application of public health principles; Be able to manage nutrition in emergencies
				Possible topics	Nutrition and health promotion Nutrition in emergencies Food and nutrition policies Community nutrition Food systems, nutrition and health

^aAdapted from Refs. 20, (22), and (25).

^bSome of the topics were derived from Ref. 1.

Leslie FC, Thomas S. Competent to care. Are all doctors competent in nutrition?. Proc Nutr Soc. 2009; 68: 296–9. [PubMed Abstract].

 Google Scholar

Ray S, Udumyan R, Rajput-Ray M, Thompson B, Lodge KM, Douglas P, etal. Evaluation of a novel nutrition education intervention for medical students from across England. BMJ Open. 2012; 2: e000417. [PubMed Abstract] [PubMed CentralFull Text].

 Google Scholar

Taren DL, Thomson CA, Koff NA, Gordon PR, Marian MJ, Bassford TL, etal. Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical–nutrition training. Am J Clin Nutr. 2001; 73: 1107–12. [PubMed Abstract].

 Google Scholar

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, etal. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013; 382: 427–51. [PubMed Abstract].

 Google Scholar