European Course in Tropical Epidemiology (ECTE)

A short history by Bo Eriksson and Christian Lengeler (December 2012)

Updated by Luis Cuevas 2013.

¨The first meeting on the European Course in Tropical Epidemiology took place in 1980 in Antwerp with Rudi Peeters, Willy Eylenbosh, Alex Muller, Axel Kroeger (just moving from London to Heidelberg) and Rudi Sloff (Amsterdam). The idea for this course came from London (Patrick Vaughan and Axel Kroeger), Antwerp and Amsterdam. The first technical meeting to discuss the contents of the course was held in 1981 in Heidelberg with the addition of Rolf Korte (GTZ) and Uwe Brinkmann (Hamburg).

The first course took place in Hamburg from August 22nd to September 3rd, 1982 and was organised by Uwe Brinkmann. The founder team members were lecturers together with David Robinson from Liverpool, Tom Marshall from London and Hayé Nordbeck, from Amsterdam. Hayé organised the second course in Amsterdam (1983) and Rudi Peeters the third in Antwerp (1984). The 1985 course was run in Heidelberg, 1986 in London and 1987 in Barcelona. Contributors to the course increased over the time, with Richard Hayes of the London School of Hygiene and Tropical Medicine, Dick Morrow at WHO, Ken Newell in Liverpool, Manuel Corachan from Barcelona, and others joining the faculty. Each course had about 40 participants and 10-15 lecturers. The course also became a meeting point for the lecturers and a mechanis to share experiences and teaching materials. There was always an evaluation meeting after the course, usually at the institution where the course had been run. Some of these evaluation meetings were hosted by the DSE in Berlin.

The idea of the course was to create a short training for European medical doctors who worked or planned to work in tropical countries, or who had an interest in the epidemiology of tropical diseases and at the same time strengthen the ties among epidemiologists at European Institutes of Tropical Medicine. The principle was that the two-week course should be organised at different places each year and involve staff from most of the participating institutions. The participants should pay a fee to cover travel expenses and living cost of lecturers. No remuneration was given to the lecturerss until very recently. The course should also have a curriculum of basic epidemiology and statistics with a focus on tropical diseases.

In 1988 the course was organised by the Nordic School of Public Health in Goteborg. This course included for the first time participants from outside Europe, which has been the case ever since. The following course in Liverpool (1989) had a participant from Czechoslovakia who then became the organiser in Prague in 1992. This was the first and so far only course in the former Eastern Europe. In-between there were courses in Berlin (1990), hosted by the DSE, and Antwerp (1991). The course went back to Göteborg in 1993 and to Barcelona in 1994. The Swiss Tropical Institute was the organiser in 1995. The next courses took place in London (1996) and Heidelberg (1997). The Tropical Institute of Lisboa organised the course at Estoril on Atlantic coast in 1998. In 1999 the course was run again in Liverpool. The discussion about having the course in Italy had been going on over many years and in 2000 the course was organised in Verona. In 2001 the course returned to the Swiss Tropical Institute in Basel. Since then the course took place again in Antwerp, Göteborg, London, Verona, Liverpool, Berlin and Barcelona. In 2013, the course was held for the first time in Denmark.

A reasonable estimate is that about 700 persons have taken the course over the years. The numbers of participants were somewhat lower during the late 1990s, but numbers increased in recent years, maybe thanks to an efficient website. However most participants indicate they decide to attend because another person has recommended the course. Many nationalities and organisations have been represented. Normally a course will see participants from 10-15 countries and over 20 nationalities, with staff from International Organisations such as the Global Funds, UNICEF, WHO, GAVI and non-governmental organisations suchas as MSF and Oxfam. The participants come from all over the world. The course is held in English. It is difficult to estimate the number of staff or resource persons that have been involved over the years. A conservative guess is 80-90 staff. Some lecturers have been involved in a long sequence of courses, while others participated only in a few. There are no hard rules of who is invited the next year, but a good guide is a good evaluation of the lecturer by the participants! However the ethos of developing good lecturers in epidemiology and statistics is reflected in lecturers finding older staff sitting along the benches and providing positive feedback for the next year.

The group of organising institutions has changed over the years mainly through including new informal members. Some institutions have not taken part for a long time. The course was, and is, intended to be basic. The objectives and contents have not changed much over the years. A major change occurred in the 1990’s through the wide availability of personal computers. Sessions on computer software, databases and Internet have become regular part of the course. Over time, the course was extended from two to two-and-a-half weeks and in Basel in 2007 the course became a three week course. Time constraint has always be cited as one of the major limitations by both participants and lecturers and this was a popular change.

The main topics that have been included with slightly different emphasis in different years are:

The statistics content has developed from a rather traditional set of basic statistical methods, not clearly specific to epidemiology, to the study of risk, incidence and prevalence, relative risk and odds ratios. The consequence has also been the introduction of somewhat more complicated analysis methods like regression.

An integral part of the course has always been a major group work on a specific topic, usually the design of a study, either descriptive or interventional.

The course has sometimes had a formal examination, sometimes not and currently students are not formally assessed.

The initial course was at times run in other languages. A French-speaking course lasting three weeks was run for some years, independently of the English course but with a liaison person. A Latin-American Course was organized by a group of colleagues from Argentina, Peru, Ecuador, Guatemala, Germany (Axel Kroeger) and PAHO. The Latin-American Workshop for Applied Epidemiology (TLEA) was first organized in Peru in 1989 and in the following years in Paraguay, Mexico, Colombia, Uruguay, Ecuador and Guatemala. In 1998 and 1999 this course was replaced by the "Latin-American Workshop on Health Sector Reforms" (TLARES) which still had some elements of the epidemiology course. An Asian Course was organized by Fred Merkle from GTZ. There were three courses in Thailand. Two Spanish speaking courses also took place in Madrid initiated by Heidelberg (Carmen Perez Samaniego and Axel Kroeger). Currently only the English course is active.