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Regional scale-up of an Emergency Triage Assessment and Treatment (ETAT) training programme from a referral hospital to primary care health centres in Guatemala
  1. Rupa Kapoor1,2,
  2. Maria Antonieta Sandoval3,
  3. Leslie Avendaño3,
  4. Andrea T Cruz1,
  5. Miguel A Soto3,
  6. Elizabeth A Camp1,
  7. Heather L Crouse1
  1. 1Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
  2. 2Division of Emergency Medicine, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
  3. 3Department of Pediatrics, Hospital Nacional Pedro Bethancourt, La Antigua, Guatemala
  1. Correspondence to Dr Rupa Kapoor, Division of Emergency Medicine, Children's Hospital of the King's Daughters, 601 Children's Lane, Norfolk, VA 23507, USA; rupa.kapoor{at}


Objective Emergency Triage Assessment and Treatment (ETAT) was developed by the WHO to teach paediatric assessment, triage and initial management to healthcare workers (HCWs) in resource-limited hospital-based settings. This study sought to evaluate the extension of ETAT training from a regional hospital to paediatric HCWs at local primary care health centres (PHCs) in Guatemala.

Methods Prior to providing a 16 h ETAT training module, immediately after, and at 3, 6 and 12 months, we used written pre-tests and post-tests and five-point Likert surveys to evaluate, respectively, clinical knowledge and provider confidence in providing acute care paediatrics; hands-on clinical skills were tested at 3, 6 and 12 months.

Results Fifty-two HCWs (14 general physicians, 38 nurses) from four regional PHCs participated; 65%, 60% and 46% completed 3-month, 6-month and 12-month follow-ups, respectively. Test scores show significant acquisition of clinical knowledge initially, which was retained over time when tested at 3, 6 and 12 months (46 vs 70, p<0.001). Hands-on clinical skills scores demonstrated retention at 3, 6 and 12 months. Although participants were more confident about acute care paediatrics immediately after training (66 vs 104, p<0.001), this decreased with time, though not to pre-intervention levels.

Conclusions ETAT trainings were successfully extended to PHCs in a resource-limited setting with significant knowledge acquisition and retention over time and improved HCW confidence with acute care paediatrics. This process could serve as a successful model for in-country and international scale-up of ETAT.

  • paediatrics, paediatric emergency medicine
  • triage
  • education, assessment

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