First steps towards interprofessional health practice in Tanzania: an educational experiment in rural Bagamoyo district.

Health workers in Tanzania struggle to provide adequate health care for populations with high maternal, neonatal, and child mortality and high prevalence of communicable and non-communicable diseases. There are longstanding shortages of staff and resources. Universities are training more health professionals and revising curricula to be sure that staff have the specific skills needed to work in rural districts. This includes training people from different disciplines to work more effectively together. While teamwork is important in all settings, it is particularly critical in rural areas where there are few trained professionals. The health professional schools at Muhimbili University of Health and Allied Sciences (MUHAS) developed curricula that share common competencies to promote interprofessional cooperation. In this article, we describe a pilot program developed by MUHAS to train its professional students (dentists, doctors, environmental health officers, nurses, and pharmacists) to work collaboratively with each other and with other health staff at the district level. We describe the reactions of participants, and identify some considerations for taking such an exercise to scale for education.

Relation of low socioeconomic status to C-reactive protein in patients with coronary heart disease (from the heart and soul study).

Low socioeconomic status (SES) is associated with poor health outcomes in patients who have coronary heart disease (CHD). Inflammation is a potential mechanism by which low SES may lead to adverse cardiovascular outcomes, but it is not known whether low SES is associated with inflammation in patients who have CHD. We measured high-sensitivity C-reactive protein (CRP) levels in a cross-sectional study of 985 adults who had CHD. Income and education were determined by self-report. We used ordinal logistic regression to examine the association of income and education with CRP. Of the 985 participants, 390 had high CRP levels (>3 mg/dl). The proportion of participants who had high CRP levels ranged from 30% (103 of 340) in those who had a college degree to 51% (65 of 127) in those who had less than a high school degree (p<0.0001). The proportion of subjects who had a high CRP level ranged from 28% (52 of 183) in those who had annual income>or=$50,000 to 42% (199 of 974) in those who had an annual income<$20,000 (p<0.001). After adjustment for traditional cardiovascular risk factors and other potential confounding variables, lower income and education remained associated with higher CRP levels. In conclusion, low SES is associated with high CRP levels in patients who have CHD. This observation raises the possibility that inflammation may contribute to the adverse cardiovascular outcomes associated with low SES.