Nicotinamide: A Way to Prevent Fetal Alcohol Syndrome?

Background: This paper describes the socio-economic profile of medical students in the 1998/99 academic year at the Universidade Eduardo Mondlane (UEM) Medical Faculty in Maputo. It aims to identify their social and geographical origins in addition to their expectations and difficulties regarding their education and professional future. Methods: The data were collected through a questionnaire administered to all medical students at the faculty. Results: Although most medical students were from outside Maputo City and Maputo Province, expectations of getting into medical school were already associated with a migration from the periphery to the capital city, even before entering medical education. This lays the basis for the concentration of physicians in the capital city once their term of compulsory rural employment as junior doctors is completed. The decision to become a doctor was taken at an early age. Close relatives, or family friends seem to have been an especially important variable in encouraging, reinforcing and promoting the desire to be a doctor. The academic performance of medical students was dismal. This seems to be related to several difficulties such as lack of library facilities, inadequate financial support, as well as poor high school preparation. Only one fifth of the students reported receiving financial support from the Mozambican government to subsidize their medical studies. Conclusion: Medical students seem to know that they will be needed in the public sector, and that this represents an opportunity to contribute to the public's welfare. Nevertheless, their expectations are, already as medical students, to combine their public sector practice with private medical work in order to improve their earnings. Published: 19 April 2007 Human Resources for Health 2007, 5:11 doi:10.1186/1478-4491-5-11 Received: 19 August 2004 Accepted: 19 April 2007 This article is available from: http://www.human-resources-health.com/content/5/1/11 © 2007 Sousa et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Page 1 of 7 (page number not for citation purposes) Human Resources for Health 2007, 5:11 http://www.human-resources-health.com/content/5/1/11 Background Mozambique, previously a Portuguese colony, became independent in 1975 and had a single party political system until 1994, when the first multi-party elections were held. Mozambique is classified as a low human development country and the poverty index is the highest in the Southern African Development Community (SADC) region [1,2]. Since the peace agreement signed by Resistência Nacional Moçambicana (RENAMO) and Frente de Libertação de Moçambique (FRELIMO) in 1992, Mozambique has embarked on a major economic restructuring process, changing from a centrally planned to a market economy [3]. A new constitution was introduced in 1990, opening the way for the peace process and for a multi-party election in 1994. A plethora of new laws and regulations have been issued since then, legalizing or liberalizing economic activities including health services that previously were under absolute state control [2]. Following the civil war, the health services have gone through a period of rapid expansion but the access to health care is still poor [4]. In 1999, of a total of 406 Medical doctors holding clinical posts, there were 204 foreigners. Of 298 specialist medical doctors, 173 were concentrated in Maputo city (responsible for over 34% of the national Gross Domestic Product [1]) where it is easier to develop private medical practice. According to Vio, many of the national doctors work part-time in the private sector [5]. Currently, the Mozambican health system is a mixed economy of public and private sector players. The public healthcare sector actually involves eight Ministries, but it is dominated by the services provided by the Ministry of Health [4], the main provider of health care services in the country which remains highly dependent upon external financial support [5]. In Mozambique medical students are trained in two faculties, the Maputo based, public sector Medical Faculty of the University Eduardo Mondlane and the private sector Faculty of Medicine in Beira, integrated into the Catholic University. There is talk of a third Faculty in Nampula. The Beira Faculty of Medicine is a recently established institution, functioning since 2001. The principal provider of undergraduate medical training has been the Faculty of Medicine in Maputo. Its output has been erratic (see Figure 1). Medical education has tried to keep up with the changes in the health care system. Established in 1963 in the colonial period, it has, since independence, trained doctors to meet to some extent the needs of a then exclusively public sector socialist health care system, partially free at the point of delivery. More recently, the Medical School has tried to adapt its medical syllabus to accommodate a more nuanced and realistic vision of a Mozambican society with a multitude and diversity of health care sectors [2]. The training curriculum introduced after independence remained unchanged up to 1982. In 1985, the teaching of several ideological subjects (Marxism-Leninism, and Political Economy) was dropped. The course duration was increased from six to seven years. New subjects were introNumber of graduates of the Maputo Medical SchoolUEM Figur 1 Number of graduates of the Maputo Medical SchoolUEM. Source: Medical Faculty of Maputo 0 5 10 15 20 25 30 35 40 45 5