One Health in sub-Saharan African medical curricula: a cross-sectional, mixed-methods study

Introduction: the One Health approach addresses human, animal, and ecosystem health. While important, there is little published information describing One Health training in medical education, particularly in sub-Saharan Africa. This study aimed to explore One Health topics and competencies integrated into sub-Saharan African medical curricula, how they are integrated, and the benefits and barriers to integration.



Methods: in this cross-sectional, mixed methods study, purposive and snowball sampling were used to sample one Dean, administrator, or faculty member per identified medical education institution with self-reported knowledge about their institution's medical curriculum. Quantitative and qualitative data were collected using an online QualtricsXM survey and semi-structured interviews. Descriptive statistics and thematic analysis were used for data analysis.



Results: sixty-one participants from 27 sub-Saharan African countries completed the survey. Among these participants, 23 also completed a semi-structured interview. The most commonly reported One Health topics and competencies integrated into medical curricula were epidemiology (n=56, 93.3%) and ethics and values (n=40, 66.7%). Interviewees linked zoonotic/vector-borne diseases, collaboration, and research with One Health. The most commonly cited benefit of One Health was "holistic patient care" (n=14, 48.3%). "Not enough time" (n=23, 53.3%) and "lack of faculty knowledge" (n=16, 88.9%) were the most common barriers to integrating One Health.



Conclusion: there are gaps in One Health integration into sub-Saharan African medical curricula. There are imminent needs to train medical teaching staff and future medical doctors to provide holistic, equity-focused care using One Health approaches.