AMERICAN UNIVERSITY OF ARMENIA &
NATIONAL INSTITUTE OF HEALTH, YEREVAN
MAY 13 - 17 & JUNE 19 - 23, 2002
ALEXANDER LAZARYAN, MD MPH
Malaria Training Program in Armenia in 2002 became possible through the sponsorship and support of the Fogarty International Center, US. I want to acknowledge particularly Dr. Dale Morse for his constant supervision, guidance and support.
The National Institute of Health (NIH) of Armenia has generously contributed to the project providing a space and some equipment for the training along with the professor staff for lecturing.
I am also very grateful to the American University of Armenia (AUA) for the overall support throughout the whole program. I am also very thankful to the CDC, US for its contribution, particularly to Dr. Gail Stennies - our guest speaker, and Dr. Monica Parise for her comments and support during my stay at the CDC in 2001. Special thanks to Dr. Jorgen Kurtzhals, Denmark, for his lecturing and expertise, and to Dr. Susan McMarlin from the AUA for lecturing on "Ethics in Biomedical Research".
The courses were launched for the health care professionals involved in antimalarial activities in the country. The training courses taught participants how to apply the improved malaria case management in their own facilities. It also provided them with guidelines of local malaria surveillance and prevention measures. Additionally, course participants from various regions had an opportunity of sharing their experience with each other and building up the capacity for future networking.
Both courses were organized at the National Institute of Health (NIH, Armenia). They were very similar in terms of planning and conducting the workshops. However, the second course had more participants from the malarious regions and districts. There were also no foreign speakers for the second course. Those "guest lecture" topics were presented by local malariologists/ID specialists, and they were also partially covered by the course director Dr. Lazaryan.
The training course participants represented a variety of central and regional hospitals, labs and public health institutions, including those located in Yerevan, Ararat Marz, Ijevan, Artsakh, Zangezur etc. Out of
Fig1. All participant by workplace
45 course participants, 12 were from the military hospitals, 12 from local Centers for Disease Control, 3 from Republic Center for Disease Control, 10 from infectious disease clinics, 6 from the National Institute of Health (Fig1).
The specialty distribution was as follows: 16 parasitologists, 11 ID specialists (infectionists), 2
Fig2. All partcipant by speciality
entomologists, 4 epidemiologists, 4 lab physicians, 4 general practitioners (Fig2).
List of Participants (First, Last Name)
1. Levon Tumasyan
2. Manik Meimaryan
3. Varduhi Galstyan
4. Heghine Hovsepyan
5. Zohrab Tadevosyan
6. Sargis Nushikyan
7. Lusine Khlghatyan
8. Vardan Arzakanyan
9. Armen Hairapetyan
10. Galina Sayan
11. Hrant Aslanyan
12. Arusyak Muradyan
13. Lusine Atoyan
14. Zoya Aghababyan
15. Anahit Mkrtchyan
16. Armine Kostanyan
17. Naira Melkonyan
18. Yelena Khachaturyan
19. Zhora Sahakyan
20. Zaruhi Beglaryan
21. Haroout Tchamjyan
22. Aghavni Gevorgyan
23. Anna Ohanyan
24. Anna Gasparyan
25. Zaruhi Manukyan
26. Marine Sargsyan
27. Lena Israelyan
28. Inga Avagyan
29. Vera Haroutyunyan
30. Sasun Orbelyan
31. Vahagn Javadyan
32. Hripsime Lalayan
33. Aghun Gochunyan
34. Varduhi Yesayan
35. Mariam Ghukasyan
36. Susanna Sarukhanyan
37. Yeghsan Melikyan
38. Amalia Simonyan
39. Kristine Hakobyan
40. Sona Ajvazyan
41. Svetlana Sargsyan
42. Irina Markosyan
43. Nona Ohanyan
44. Siranush Varsanyan
45. Mariam Sargsyan
Both local and international malaria experts contributed to the training program. Local lecturers were invited from the leading teaching hospitals as well as from the research departments of the Armenian NIH. Guest lectures included Dr. Gail Stennies from the Division of Parasitic Diseases at CDC, US and Dr. Jorgen Kurtzhals from the Department of Clinical Microbiology at the Copenhagen University Hospital. Foreign speakers introduced cut-edge knowledge on various malaria issues. They were particularly highly rated by the course participants.
The preparation of course materials started long before the beginning of the training program. The malaria Question-Answer Manual was prepared by Alex Lazaryan and reviewed by Dr. Monica Parise from CDC. Guest lecturers were contacted and asked to submit their Power Point presentations in advance. In that way all the presentations for the courses were finally available not only in printed out forms but also being translated into Armenian (both printouts and .ppt slides). Special course manuals (course packs) were created for the participants and they included all teaching materials necessary for the training course.
The Malaria Team, in conjunction with the technical staff from the AUA, established a computer network system in the PC auditorium at the National Institute of Health, where the lectures were held. It enabled the participants to have an ongoing presentation on their PC screens, and it was also very helpful in demonstrating photomicrograph slides of malaria blood smears.
The announcement for the malaria training course was disseminated to all major health care institutions throughout the country. Local Centers for Disease Control in the malarious regions were notified to send their personnel candidates to participate in the program. In many circumstances the Malaria Team personally met with the Chief Physicians of hospitals to explain the main goals of the program and who may benefit from it. As a result of those efforts, a number of military physicians from the remote areas of Azerbaijan bordering regions (Zangezur, Artsakh etc.) received an invitation to participate. Military medical officials at the level of Central Military Hospital in Yerevan demonstrated a great interest in the program and in the opportunity to train their heath care personnel in contemporary malaria management issues. All announcements were delivered and posted by mid April, 2002. Preliminary registration was complete by the end of April 2002, and the course participants were selected based on their submitted applications. All of them were notified to be present at the opening ceremony of the program at the Small Auditorium of the American University of Armenia. The final in person registration of all course participants took place right before the opening ceremony at the AUA.
During the first day of the course registration, all participants were supplied with the participants' course manual. The latter included course agenda, lectures, malaria question-answer manual etc.
Local health officials from the Ministry of Health, NIH, Infectious Disease Hospitals and also from the American University of Armenia were present at the opening ceremony.
Prior to the beginning of the course, malaria pre-test was handed in to all registered participants. Tests were graded and kept for the final course evaluation purposes.
Lectures and practical sessions were held according to the course agenda. The participants started out being not very actively involved in the discussion at the beginning of the course. However, after a few sessions, discussions of clinical experiences began over the coffee breaks. We urged the participants to contribute during the lectures rather than during breaks. This led to lively discussions that fully utilized the experience of many participants. The idea of having a lecture, followed by involving discussion, turned to be very successful.
Because of the presence of foreign experts, many lectures focused on Western (high tech facilities) and African (poor endemic) malaria situation. Although this might have been considered a weakness, it appeared that participants were able to extract the important messages pertinent to the Armenian malaria situation. This became possible due to extensive dialog between the lecturers and the participants.
By the end of the course, malaria post-test was completed by every participant. This time the correct answers were explained and thoroughly discussed. On-site grading and analysis of individual performance was performed by malaria team, and the results were presented at the closing ceremony.
All course participants were granted the certificate (see Sample in Supplemental Materials) signed by the course director, CDC representative and the Deputy Minister of Health of Armenia.
Evaluation of the individual performance of the course participants was based on the assessment of pre- and post-tests. Tests consisted of multiple choice type questions, including a couple of cases with blood film photomicrographs. Maximum available test score was 22. Participants' scores were grouped into 4 groups. Statistical difference was assessed by paired t-test for each course. Both cohorts of participants
Fig3. Course 1. Pre & post -test performance
Fig4. Course 2. Pre & post -test performance
had a mean baseline score (pre-test) of about 12 (out of 22). On the post-test the 1st cohort significantly improved the mean score up to 16, and the 2nd cohort - up to 17, p-values < 0.0001 (see Fig3-4).
Special evaluation form was designed for the participants to rate the lecture topics and lecturers (see Sample in Supplemental Materials). Overall, all participants deemed the courses to be very helpful and enriching. Many participants suggested putting all teaching materials on the World Web for the continuous medical education purposes. We received acknowledgements for successful organization or malaria training program on behalf of both the participants and the Ministry of Health.
Today, Armenia is not a high-risk malaria country. However, risk is high in many neighboring countries such as Turkey, Iran, Azerbaijan etc. Moreover, each year more and more Armenians travel abroad. Thus, imported malaria is likely to become increasingly important, even if efforts to contain the present outbreak result in complete eradication of malaria in Armenia. It is necessary to maintain a high awareness and knowledge about malaria among Armenian health care workers - at least - among infectious disease consultants and others with special interest.
Overall the courses were quite successful, not least due to the collaborative efforts between the organizers, as well as the international and local partners.
Based on the training program evaluation, there are a number of suggestions and recommendations, which might be beneficial to take into account during the future training initiatives.
- Each participant should have a nameplate on his/her desk particularly during the discussion. This introduction would allow lecturers and participants to get to know one another better and it may promote better interaction. Even if a participant is shy about asking a question in front of the group, he/she may be comfortable approaching someone alone, especially if they know they have a particular background or work in a region that is of interest to them.
- Smaller groups for the smear staining and reading (5-6 people) would be more effective. Perhaps that could be an activity that could be conducted simultaneously for 2-3 groups. If equipment or supervisory limitations preclude that option, then the lab sessions can be run twice at minimum or more. Although that may require giving a lecture twice since some participants will be in the practical session while others - in lecture.
- For the smear reading lab sessions, it would be better to have a teaching microscope(s) which would allow for 2 or more people to read the slide at the same time.
- Participants should be encouraged to bring interesting and challenging cases from their workplace to present for discussion.
© 2002. Malaria in Armenia.
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