Sub-Sahara Africa Consortium for Advanced Biostatistics training

Sub-Sahara Africa Consortium for Advanced Biostatistics training (SSACAB I)

Impact Story of SSACAB: Training and research in advanced biostatistics methods

The Sub-Sahara Africa Consortium for Advanced Biostatistics training (SSACAB) has brought together African and Northern academic/research institutions to enhance and strengthen biostatistical skills among researchers in the African region.

The below provide a summary of the four objectives for SSACAB summarized under these areas:

To develop, strengthen and implement high quality biostatistics Master’s curricula at lead and partner institutions
To provide PhD training to sharpen expertise, skills and develop African leaders in biostatistical research
To build sustainable local and international network of biostatisticians within each country through outreach, mentoring and skills transfer
Integrate meeting with International Biometrics Society (IBS) through the Sub-Saharan Africa Network (SUSAN) and National Statistical Societies

Local and International Networks

SSACAB has created a biostatistical network to nurture researchers with advanced skills and expertise. SSACAB has been supporting the development of a network of biostatisticians to deliver statistical courses and workshops for biomedical researchers and create the framework for improved biostatistical skills among health researchers and academics in nine African countries (South Africa, Namibia, Tanzania, Kenya, Uganda, Democratic Republic of Congo, Malawi, Ghana and Zambia).

More recently, SSACAB leadership has participated in strengthening biostatistics resources in the following countries:

The Gambia – NIH funded a workshop to bring together biostatisticians in West Africa to brainstorm how to enhance biostatistics skills and research in West Africa considering that SSACAB was concentrated in the East, Central and Southern Africa.
DRC – a similar workshop was conducted to also bring together francophone countries. In both cases, SSACAB was used as a model for strengthening biostatistics and supporting research.

After these meetings. UAC, Benin became part of SSACAB and is also running postgraduate programmes. develop biostats capacity in the country; currently running an MSc and looking to support research – Both meetings supported via NIH through Dr Misrak Gezmu

The consortium has grown into a cross-cutting biostatistics support structure for other SSACAB consortia. It has provided training workshops, data analysis sessions and joint supervision of students who need advanced statistical support within consortia supported under SFA. Some of the SSACAB staff and fellows are part of and linked to the statistical societies and networks both locally and internationally.

These partnerships involve the following:

The South African Statistical Association (SASA), the Sub- Saharan Africa Network (SUSAN) of the International Biometric Society (IBS) and others. Through such interactions during scientific meetings and conferences organized by such societies we share research findings with policymakers and stakeholders.
The lead institution site was registered with Royal Statistical Society, and this is of great value as the RSS’s responsibility is to develop and maintain standards in educational qualifications for those who wish to follow a career in statistics and allied disciplines. The accreditation is set to become important in benchmarking for higher education programmes including commercial training institutions.
In some institutions, (e.g., KCMUCo) staff from the Ministry of Health (MoH policy makers) and research institutions have been invited to teach. This has fostered collaboration by creating a harmonious working environment. KCMUCo members of staff have been involved in supervision for PhDs students from the MoH to help them analyze their data to guide decision making. PhD graduates from KCMUCo have managed to prepare some policy briefs related to their research and shared with the MoH to influence policy and practice.

Scientific Quality

SSACAB has contributed to building a critical mass of f researchers within the Africa region. It has strengthened and implemented high quality biostatistics Masters’ and PhD training at the lead & partner Institutions:

Developed five new programmes and strengthened four existing and
Graduated 121 Masters’ and 25 PhD fellows, supervised within the consortium.
Training and research have led to 60 publications on HIV/AIDS, TB, malaria, Non-Communicable Diseases (NCDs) and emerging infectious diseases among others in high impact and open-access journals according to the sponsor’s publication policy. The papers applied advanced biostatistical analysis methods such as repeated measures analysis, spatial analysis, transition modelling, stochastic and deterministic modelling, ssurvival and Bayesian analysis. Some of the publications and their impact will be highlighted

Examples of research project publications are as follows:

“Difference in HIV prevalence by testing venue: results from population level survey in Uganda, AIDS Care”

The paper found out that there was higher HIV prevalence among individuals who tested in a health facility compared to those tested in a community setting and this contributed to the call for reviewing of the Uganda Health Management Information System (HMIS) data to inform scaling up of HIV testing interventions.

Another publication revolved around the “Secular trends in the prevalence of Female Genital Mutilation/Cuttings among girls: a systematic analysis”

The paper found that there was evidence of huge and significant decline in the prevalence of FGM/C among children across countries and regions and it also appreciated the need to sustain comprehensive intervention efforts and further targeted efforts in countries and regions still showing high prevalence of FGM/C among children, where the practice is still pervasive within Africa and Middle East countries. The impact of this publication was key on reinforcing messages on FGM within the African and Middle East context for the policy makers. Another publication on FGM came from the Northumbria University has facilitated policy engagements efforts to eliminate Female Genital Mutilation/Cutting & which is now a Sustainable Development Goal (SDG 5.3). The research impacted on internal policies & practices of UNFPA, UNICEF, & the Population Council and writing of a book. The Female Genital Mutilation (FGM) around the world book is now used as a training resource & has received global media attention (BBC world service, coverage in newspapers, websites, radio stations & TV news) reaching an audience of over 17 million people.

trend of exclusive breastfeeding over 12 years period (2002-2014) among women in Moshi, Tanzania.

The paper found that in Tanzania, while establishing trends of EBF at a national level is commendable, efforts to establish the trend in the smaller geographical areas were needed to provide a true picture that may otherwise be masked, and which is necessary to guide localized interventions. The paper was impactful for the policy makers as it helped them to understand the need in exploring breastfeeding interventions for women of different socioeconomic and health status.

The issues that were addressed in the publications show SSACAB’s commitment and contribution to the wider global public health response.

SSACAB has conducted some workshops and short courses that have targeted researchers and students locally and externally from various research institutions and centers. The trainings and academic support are as follows:

The University of KwaZulu-Natal’s (UKZN) School of Mathematics, Statistics and Computer Science workshops and short courses in Data Science and Machine Learning (date recently when I went to KZN)
Multilevel modelling workshop, 2017: by Prof Manda, Biostatistics Unit, SA MRC.
Monitoring and evaluation course, 2018: Jointly run by UKZN and Harvard Department of Biostatistics, School of Public Health. This was led by a SSACAB PhD fellow, Ms Jesca Batidzirai.
University of Zambia (UNZA) and Kilimanjaro Christian Medical University College (KCMUCo) have run short courses in Biostatistics and scientific writing to meet the demand from the health programs and research institutions.
The University of the Witwatersrand (Wits) has established a fully-fledged biostatistical support service for its Faculty of Health Sciences postgraduate (now extended to undergraduate) students, research entities and staff. This valuable service is led by SSACAB fellows as part of their experiential learning and professional growth.

As part of collaborations, Central Africa’s regional training workshops in advanced statistics techniques were organized as a ground-breaking and innovative initiative. The training brought together researchers from the Francophone Central African region (Democratic Republic of Congo, Cameroun, Chad, and Gabon) working in academia, government ministries, National Statistics Offices to benefit from the latest developments in the field of applied statistics.

Joint training in the region

SSACAB has also facilitated the sharing of academic staff and the teaching of MSc courses across partner institutions between the consortium institutions. This has created a huge impact in terms of training biostatisticians and joint supervision for research projects at postgraduate level.

UKZN SMSCS contributed to teaching at the KCMUCo; Wits contributed to teaching at Universities of Namibia, Malawi, KCMUCo and Makerere; University of Zambia contributed to MSc teaching at University of Stellenbosch.

Our South-South partners worked with Northern partners (Northumbria and LSHTM) to develop these new programmes at Universities of Makerere, Stellenbosch, Namibia and Zambia.

Gender Inclusiveness

SSACAB has shown its gender inclusivity by growing the pool of women scientists through MSc and PhD level training. Some of our female fellows (Women in Science) Dr Susan Gachau (Kenya) and Dr Zvifadzo Matsena-Zingoni (Zimbabwe) conducted research that is world class during their PhD studies. Their work used advanced biostatistical methods on routine data to inform policy and practice (use of clinic data on children and analysis of HIV data from Zimbabwe respectively).

It is evident that SSACAB has greatly contributed to building a critical mass of the scientific quality of researchers within the Africa region.

Research Leadership

Through collaboration and co-supervision, SSACAB has been building a critical mass of African Research leaders in Biostatistics which have succeeded in various capacities. The alumni have continued to co-supervise thereby growing into the next generation of biostatistics leaders. SSACAB has built a career pathway from Masters’ to PhD and to postdoctoral training as shown in examples below:

Kennedy Mwai (Kenyan) and Glory Chidumwa (Zimbabwean) pursued their PhDs at KWTRP and Wits University respectively and Kamunkhwala Gausi (Malawian) further on studied at the University of Cape Town
Dr Omololu Aluko and Dr Zvifadzo Zingoni went on to do her post-doc at Stellenbosch University.

As an example, we identified two fellows by the names of Dr. Zvifadzo Matsena Zingoni and Dr Lawrence Lubyayi who clearly have demonstrated leadership credentials built from within SSACAB. During their fellowship with SSACAB, Dr Zvifadzo worked at the National Institute of Health Research (NIHR) under the Ministry of Health and Child Care, in Zimbabwe as a principal research technologist in Chiredzi and her role was mainly field, and laboratory based. While Dr Lawrence worked as a Statistician with the Medical Research Council / Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Unit. He was exposed to a wealth of experience from academic institutions and practical grounding in research execution with real-life studies in Uganda. Their leadership skills within research are evident as they have also testified the research leadership impact SSACAB has provided. See annexure A and Annexure B for testimonies.

SSACAB has also created a stepping-stone for additional funding for biostatistics training through:

GSK funding
NIH D43 Interdisciplinary Malaria Research training in Malawi and
Global Fund support for Ministries of Health through advanced data analytics.

Research Management, Culture, and Infrastructure

SSACAB has provided infrastructural & human resources to support partner institutions, information technology/equipment (laptops, computers, software), finance training, project management & biostatistics human resources for postgraduate teaching. The consortium has provided support for equipment and supplies to facilitate the research activities at partner institutions, and this has led to increased research output and teaching for both students and teachers at several partner institutions. This has been impactful in the overall contribution of setting up of the fellowships, logistics of the research projects and use of tools for data analysis.

The consortium SSACAB, is governed by an Executive Committee and led by the Programme Director, Professors Tobias Chirwa (Wits), and co-directors Jim Todd (LSHTM) and Eustasius Musenge (Wits), Samson Kinyanjui (KWTRP), Ngianga-Bakwin Kandala (Warwick University) and Henry Mwambi (UKZN). The Exec is supported by the Principal Investigators from each partner institution, the Programme Manager (Wits) and the Technical Advisory Group (TAG). The consortium has created governance policies and finance management structures through the Lead Institution – Wits University for effective development of the consortium and its associated partners, research support staff and fellows. The grant management structure created by the Lead Institution has supported the governance and finance management of Partner Institutions according to Wellcome Trust policies.

The consortium grants are managed in line with the Good financial grant practice (GFGP) that major funders look for when granting funding. The lead institution is certified and compliant with the GFGP guidelines. These requirements run across four practice areas of financial management, human resources, procurement and governance. The secretariat has provided training on good financial training with the GFGP for the partner institutions finance administrators to ensure all partners manage their sub award grants in an internationally recognized way.

The consortium’s governance structures are of great importance as they have stood out in developing excellence in biostatistics leadership, training and science in Africa. It is appreciated to say that the consortium has been noted as one of the best ways of managing biostatistics consortiums whereby training unites expertise to deliver research excellence. This has been noted in a publication that the Consortium published Developing excellence in biostatistics leadership, training and science in Africa: How the Sub-Saharan Africa Consortium for Advanced Biostatistics (SSACAB) training unites expertise to deliver excellence - PMC (nih.gov). The structure of how the consortium is run, can be used as a template for future biostatistics consortiums within SSA.

Scientific Citizenship

SSACAB’s impact on scientific citizenship has been profound, as the programme has actively fostered a culture of collaboration, community engagement and policy influence among African researchers. The programme has supported numerous community outreach activities that were aimed at raising awareness about important health issues and promoting public understanding of scientific research. These activities helped bridge the gap between researchers and the communities they serve, fostering a sense of trust and collaboration that is essential for effective public health interventions.

We highlight below some of the partnerships supporting outreach:

Stellenbosch University’s Epidemiology & Biostatistics Division has a dedicated Centre for Evidence Based Health Care division for engaging policy makers on evidence synthesis & knowledge translation strategies to inform policy, guidelines & media reporting.
KCMCo & NIMR engage with Tanzania Ministry of Health for inputs on statistical methods for routine data.
Workshops with National AIDS Control Programme to analyse HIV service data, including access to antiretroviral therapy & viral load suppression.
SSACAB MSc Fellows have led some of these sessions & worked on data as M&E officers &data analysts.
University Medical Center Utrecht’s Julius Center has showcased science communication with policy makers on their website (www.globalhealth.eu) & in news items & letters.

UNIMA conducts outreach activities to High schools to promote study of biostatistics; Increase biostatistical capacity in Government Ministries e.g. Global fund grant;

GlaxoSmithKline fellowships, DELTAS Africa collaborative funding (iDEAL, MARCAD).

Public Engagement in Science (PES)

SSACAB has also become an expert at sharing information on Public Engagement in Science (PES) and ensuring all the fellows' research includes engaging the public in science communication to communities. As one of the goals of science communication include informing non-experts about scientific findings, raising the public awareness of and interest in science, influencing people's attitudes and behaviours, informing public policy, and engaging with diverse communities to address societal problems. An example of the above is that of when the lead institute hosted a dynamic Public Engagement with Science Biostatistics session at the Wits School of Public Health, alongside a valuable career guidance initiative (raising the public awareness of and interest in science). The primary objective of the event was to spotlight biostatistics as a compelling career path, paving the way for the emergence of future African Biostatistics Research Leaders across MSc, PhD, and Postdoctoral levels (see annexure C for the public engagement event’s poster). The event was well attended by leaners from local schools, alongside BSc students, graciously supported by the Wits School of Public Health and Epidemiology and Biostatistics Division dedicated staff members.

In summary, one of the most profound impacts of SSACAB is the establishment of Postgraduate studies in biostatistics as an independent statistical discipline that was previously not considered worthy of pursuing up to a PhD level in the region. In the past, SSA had a periphery of biostatisticians as far as they analyze health sciences data, without undergoing master’s or PhD training in biostatistics. What SACCAB has done is to define postgraduate biostatistics training with minimum required standards to ensure high quality is maintained. The University of Malawi has produced its first homegrown Ph.D. in Biostatistics with the support of SACCAB. Its PhD program in biostatistics is attracting many postgraduate students.

Conclusion

In conclusion, SSACAB has made significant contributions towards science quality, research leadership, Research Management, Culture and Infrastructure and scientific citizenship in public health research and academia, in the Sub-Saharan Africa region. The programme’s achievements highlight that strengthened biostatistics training not only has direct application to solve real life problems in medicine and public health but also shapes African biostatistics research leaders. The impact stories of researchers like Dr Zvifadzo Matsena Zingoni and Dr Lawrence Lubyayi illustrate the profound and lasting benefits of this programme, highlighting its potential to shape the future of health research and policy on the continent.