Selection strategies to ensure that members of underserved communities can pursue medical careers can be effective in achieving a fair and equitable representation of underserved communities within the student body. Such strategies may contribute to a diverse medical student body with strong intentions to work with underserved populations.

ObjectivesTo assess HIV and syphilis prevalence, HIV-related behaviours and testing for HIV in female sex workers (FSW) in Sudan.DesignBio-behavioural surveys using respondent-driven sampling were carried out among FSW in the capital cities of 14 states in Sudan in 2011–2012. HIV and syphilis testing was done by rapid tests.Results4220 FSW aged 15–49 years were recruited. The median age of recruited women varied from 21 to 28 years per site. The highest HIV prevalence was measured at two sites in the eastern zone (5.0% and 7.7%), while in the other zones it ranged from 0% to 1.5%. Syphilis prevalence ranged from 1.5% in the northern zone to 8.9% in the eastern zone. Ever having been tested for HIV was reported by 4.4%–23.9% of FSW across all sites. Condom use at last sex with a client varied from 4.7% to 55.1%, while consistent condom use with clients in the month preceding the surveys was reported by 0.7%–24.5% of FSW. The highest reporting of ever injecting drugs was measured at a site in the western zone (5.0%).ConclusionsThe surveys’ findings indicate that the highest burden of HIV in FSW is in the eastern states of the country. Condom use and HIV testing data demonstrate the need for HIV interventions that should focus on HIV testing and risk reduction strategies that include stronger condom promotion programmes in FSW and their clients.

BackgroundUnderstanding the impact of selection and medical education on practice intentions and eventual practice is an essential component of training a fit-for-purpose health workforce distributed according to population need. Existing evidence comes largely from high-income settings and neglects contextual factors. This paper describes the practice intentions of entry and exit cohorts of medical students across low and high income settings and the correlation of student characteristics with these intentions.MethodsThe Training for Health Equity Network (THEnet) Graduate Outcome Study (GOS) is an international prospective cohort study tracking learners throughout training and ten years into practice as part of the longitudinal impact assessment described in THEnet’s Evaluation Framework. THEnet is an international community of practice of twelve medical schools with a social accountability mandate. Data presented here include cross-sectional entry and exit data obtained from different cohorts of medical students involving eight medical schools in six countries and five continents. Binary logistic regression was used to create adjusted odds ratios for associations with practice intent.ResultsFindings from 3346 learners from eight THEnet medical schools in 6 countries collected between 2012 and 2016 are presented. A high proportion of study respondents at these schools come from rural and disadvantaged backgrounds and these respondents are more likely than others to express an intention to work in underserved locations after graduation at both entry and exit from medical school. After adjusting for confounding factors, rural and low income background and regional location of medical school were the most important predictors of intent to practice in a rural location. For schools in the Philippines and Africa, intention to emigrate was more likely for respondents from high income and urban backgrounds.ConclusionsThese findings, from a diverse range of schools with social accountability mandates in different settings, provide preliminary evidence for the selection and training of a medical workforce motivated to meet the needs of underserved populations. These respondents are being followed longitudinally to determine the degree to which these intentions translate into actual practice.

A socially accountable medical school is one that directs its education, research and service activities towards addressing the priority health concerns of the community it serves and verifying its impact on the community. This study aimed to assess the social accountability of the University of Gezira faculty of medicine in Sudan. We reviewed the literature, faculty documents and reports and used both the World Health Organization social accountability grid and the conceptualization-production-usability model as frameworks for analysis. In most of the domains and phases of the social accountability grid, the faculty's educational programme was found to be well-planned and well-implemented, demonstrating an impact on the community and active participation in health-system development in the local area. The University of Gezira faculty of medicine is socially responsible and responsive and is on the way to becoming fully socially accountable in certain aspects.

A total of 647 eligible subjects participated in the study. Two week incidence of diarrhoeal rates were estimated by a community survey some four months before and again four months after provision of the LifeStrawY. In addition counts were kept of people attending at the community clinic with diarrhoea. Compliance rates were good with 86.5% of people saying they always used it and only 3.7% saying they had never used it. In a before implementation survey 15.3% of participants reported diarrhoea in the previous 2 weeks compared with only 2.3% in a survey after implementation. Similarly 58 people presented to the clinic as a new case of diarrhoea in the four months before compared with only six in the four months after implementation. When compared with diarrhoeal attendances at the regional hospital, this was a statistically significant decline in attendances ( p , 0.0001). The LifeStrawY is likely to find a role as an adjunct to water quality interventions aimed at the home. However, more research is needed to assess the long-term impact and uptake of these devices before their definitive value can be assessed.