Teaching and research in physiology in Sub-Saharan Africa: achievements and challenges

Features

Soga Sofola
University of Lagos, Nigeria

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https://doi.org/10.36866/pn.94.18

The history of teaching of physiology in Sub-Saharan Africa (SSA) is a fairly recent one, the earliest having been in the University of Cape Town (Republic of South Africa – RSA) in 1912, Pretoria (RSA) in 1943, Makerere (Uganda) in 1924, University College, Ibadan (Nigeria) in 1948, and Zimbabwe in 1952. There are about 168 Medical Schools in SSA with 26 in Nigeria and eight in the Republic of South Africa (Mullan et al. 2011).

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Teaching of physiology has traditionally been domiciled in medical schools with the majority using the traditional face-to-face method due largely to limited resources. One notable exception is the Republic of South Africa, which we in Nigeria refer to as a ‘European country located in Africa’. Our teaching methodology largely utilizes the white board and overhead/multimedia projectors. Many schools are beginning to incorporate some information and communications technology (ICT) components into their teaching, e.g. with use of videos, YouTube and electronic blackboard.

However, we can claim some achievements as several physiologists have been trained in SSA, despite limited resources, though many have ‘brain drained’ to developed countries. In addition, we have contributed to the training of many of the 145,000 doctors, as of 2011 (Mullan et al. 2011) as well as recording some modest achievements in training of PhDs that have helped to reinforce the system. The majority of faculty staff have obtained their PhD locally. Despite the constraints, many institutions are increasing student intake (Mullan et al. 2011). Many schools surveyed (personal questionnaire of 25 schools from 10 countries in geographical zones of west, central, east and southern African states) have student enrolment ranging from 20 to over 600 while the number of lecturers ranges between two and 18, to cope with a large workload, with over 50% having a PhD or MD degree. In the survey, post-graduate students enrolled for training in MSc/PhD programmes range from nil to about 30 while post-graduates produced cumulatively in the last 5 years range from nil to 20, per school, the larger numbers being from South Africa and the older universities in Nigeria.

The major constraint is funding. Most universities in SSA depend on government subsidies with little donor support. The issue is not helped by governments pegging tuition fees as well as poor staff salaries (Mullan et al. 2011). It is estimated that funding for tertiary education can be as low as $1000 per student in about 10% of countries (UNESCO, 2009), while the majority have per student funding in the range of $1800 to $4000 (Moyer, 2007). It is only recently that some universities have embarked on the use of Income Generating Units (IGUs) or charge high tuition fees so as to raise additional funds which can account for up to 56% in Uganda (UNESCO, 2009)

Other issues related to teaching challenges include but are not limited to the following:

• Limited number of PhD holders as lecturers. This is mainly due to low production rates, as a result of low number of supervisors/advisors.
• Low lecturer:student ratio and large classes, resulting in non-ideal lecture rooms and facilities as well as poor supervision during practical classes. An example of a large practical class with few teachers and limited equipment is shown in the above image. Recently, there have been efforts to acquire digital, teaching/practical platforms such as ADI PowerLab and WPI DataQ instruments, though very few are available (only about one or two pieces).
• Outdated and inadequate textbooks due to unaffordable costs, e.g. the cost of an imported textbook is about the monthly living allowance of an average student in Nigeria. There is now the alternative of locally authored textbooks, which are affordable, but not necessarily current in content.
• Limited ICT/internet facilities for lecturers to engage students in out-of-class teaching. This is because access is poor and expensive. Many universities cannot afford the cost of internet bandwidth and students and staff often have recourse to internet cafes, at high cost.
• Outdated curriculum: this is rampant in many SSA universities, due to lack of exposure of lecturers to foreign science and hence the inability to update their course contents. However, some universities are now reviewing their curricula and embracing such approaches as Problem Based Learning, e.g. Ibadan (Nigeria) and Sudan.
• Poor and erratic power supplies are prevalent in majority of countries which make running classes difficult, especially for long duration projects.

As for research, with the exception of South Africa, the output from the region is very low, in terms of publication in indexed journals. It has been estimated that SSA contributes less than 0.9% to global published work, with South Africa contributing over half of that (UNESCO, 2009). In a report covering the decade 1995–2004, the top three publishing countries, in terms of output of published works, indexed in PubMed, from medical schools in SSA, are South Africa (41.5%), Nigeria (16.1%) and Kenya (6.8%) (Hofman et al. 2009). An analysis of university rankings bears this out as the highest ranked university from SSA is University of Cape Town at 113. Only five African universities are in the world’s top 1000 (THE, 2013). This was not the case in the 1970s when some African universities featured among the topmost institutions in the world.

The obvious reason for the low research output is poor funding and thus fewer resources for acquiring appropriate equipment for research. There are hardly any grants for research except in South Africa and one or two other countries, e.g. Nigeria. where the Tertiary Education Trust Fund, which is contributed by the business community, is now being used to fund research grants and postgraduate training. The poor funding in SSA is reflected in the quality of articles, which lack mechanistic approaches with little or no cellular or subcellular mechanisms. This is in contrast to what appears in papers in journals from the developed world, e.g. The Journal of Physiology, where a considerable number of articles are largely biophysical, molecular and translational (Paterson et al. 2013).

However, efforts are being made to play ‘catch up’. For example, our laboratory has been studying the effects of high salt diet on vascular mechanisms, using rat aortic rings. Our earlier results were later confirmed using the pressurized mesenteric artery preparation (Sofola et al. 2002) during the author’s appointment as a British Heart Foundation Fellow at Leeds University. However, on return to Nigeria, such facilities were not available but we are still publishing using the ring preparation (Oloyo et al. 2012) although we have recently acquired digital recorders for research work with better results (unpublished). The image above shows our old faithful, the Model 7D Grass polygraph, which we are currently using. Our subsequent studies, however, have been carried out investigating the role of the renal epithelial sodium channel (ENaC) in normotensive and hypertensive Nigerians (S. O. Elias, PhD thesis, Lagos, 2012) while collaborating with foreign laboratories for DNA sequencing and identification of genetic mutations. We hope that this foray will open new grounds and attract more graduate students to genetic and molecular aspects of physiology as well as allow us to establish some laboratory space for such research.

Other challenges relating to research include:

• Heavy teaching load, mentioned earlier, with too many students and too few teachers and hence little or no time for research work.
• Outdated equipment and little availability of reagents and consumables for research projects due to very low budgets, which is very prominent in most universities in SSA with the possible exception of South Africa. This is compounded by low currency exchange rates in most of our countries as a result of devaluation, as well as political instability.
• Low PhD production, also exacerbated by in-breeding due to inability to send our students for exposure to foreign laboratories due to funding constraints.
• Lack of, or limited access to, journals, which is worsened by high costs as well as low access to free e-journals (except mostly back issues from Highwire Press–Stanford and Hinari). Availability of full text of current issues in PubMed apparently is less than 20%.
• Brain drain from SSA, as a large percentage, about 20–30%, of graduates are lost from the profession, with about 30% leaving the continent for better pay and better access to research facilities while others go to the ministry or the private sector (Mullan et al. 2011).

Appeal for Support

This brings up the point of how we in SSA (except perhaps South Africa) can leverage on the superb research facilities, more like those in the developed countries. It will also need to involve the exposure of our staff to research at cellular and subcellular levels including cell signalling as well as translational research in line with current trends.

Thus, an appeal is being made to the IUPS to come to the aid of SSA. As the way forward, some suggestions are:

• Provision of sabbaticals for nationals of SSA to laboratories in the developed countries where they can acquire requisite skills that are in demand.
• Provision of laboratory space for research training/mentoring and skills acquisition by our younger colleagues in order to increase their research capabilities.
• Initiation of technology transfer workshops by experts from the IUPS or its affiliates, from the developed world. In 1980, the IUPS organized such a workshop in Lagos, supervised by Profs Otto Hutter, Lawrence Smaje and John Patrick. This attracted lecturers from the West African subregion. In addition staff from institutions in SSA can go to developed countries for a duration of 6–12 months for hands on experience, on more frequent arrangements. A few of these initiatives exist which are limited or not widespread and more will be required.
• A mechanism for equipment transfer through donation of ‘surplus to requirement’ but useful equipment to universities in SSA. For example, establishing a ‘warehouse’ system in the IUPS and affiliates, for donation of equipment and transfer of such to interested laboratories in SSA.
• Funding/grants to be made available to identified research-active laboratories, doing some good work, so as to scale up their researches. This can be tagged on to the Association of African Physiological Sciences (AAPS), which can then initiate South–South research collaboration to increase the internal pool of active African researchers.

The theme of these and other suggestions is to give assistance to SSA physiologists to boost teaching and research capabilities and thereby improve on the present dismal situation. This should also serve to arrest the brain drain and make competent and willing researchers remain in their country and contribute meaningfully to global scientific enterprise.

In conclusion, it is hoped that this article will make us in Sub-Saharan Africa more visible on the world map of scientific enterprise in the subject of physiology.

References

Hofman KJ, Kanyengo CW, Rapp BA & Kotzin S (2009). Mapping the health research landscape in Sub-Saharan Africa: a study of trends in biomedical publications. J Med Lib Assoc 97, 41–44.

Moyer EJ (2007). An educated view of universities research in Africa. Research Africa 20, 20.

Mullan F, Frehywot S, Omaswa F, Buch E, Chen C, Greysen SR et al. (2011). Medical schools in sub-Saharan Africa. Lancet 377, 1113–1121.

Oloyo AK, Nair RR, Anigbogu CN & Sofola OA (2012). Relaxation response of abdominal aorta to androgens in orchidectomized Sprague-Dawley rats fed a high salt diet. Can J Physiol Pharmacol 90, 1647–1651.

Paterson DJ, Huxley C, Schnelle C & Howells S (2013). The Journal of Physiology Annual Report 2012–13. A year of progress. J Physiol 591, 593–599.

Sofola OA, Knill A, Hainsworth R & Drinkhill MJ (2002). Alteration of endothelial vasodilatory function in pressurized mesenteric arteries of Sprague-Dawley rats fed a high salt diet. J Physiol 543, 255–260.

THE (2013). World ranking of universities – 2012–13. www.timeshighereducation.co.uk/world-university-rankings/2012-13/worldranking

UNESCO (2009). Financing tertiary education in Africa, synthesis report. www.unesco.org/education/WCHE.2009/synthese170609.pdf