Article Text

Strengthening emergency care knowledge and skills in Uganda and Tanzania with the WHO-ICRC Basic Emergency Care Course
  1. Sean M Kivlehan1,
  2. Julia Dixon2,
  3. Joseph Kalanzi3,
  4. Hendry R Sawe4,
  5. Emily Chien5,
  6. Jordan Robert6,
  7. Lee Wallis6,
  8. Teri A Reynolds7
  1. 1 Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2 Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
  3. 3 Department of Emergency Medicine, Makerere University, Kampala, Uganda
  4. 4 Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  5. 5 Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
  6. 6 Department of Emergency Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
  7. 7 Integrated Health Services, World Health Organization, Geneve, Switzerland
  1. Correspondence to Dr Sean M Kivlehan, Emergency Medicine, Brigham and Women's Hospital, Boston MA 02115, USA; smkivlehan{at}bwh.harvard.edu

Abstract

Background There is a pressing need for emergency care (EC) training in low-resource settings. We assessed the feasibility and acceptability of training frontline healthcare providers in emergency care with the World Health Organization (WHO)-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) Course using a training-of-trainers (ToT) model with local providers.

Methods Quasiexperimental pretest and post-test study of an educational intervention at four first-level district hospitals in Tanzania and Uganda conducted in March and April of 2017. A 2-day ToT course was held in both Tanzania and Uganda. These were immediately followed by a 5-day BEC Course, taught by the newly trained trainers, at two hospitals in each country. Both prior to and immediately following each training, participants took assessments on EC knowledge and rated their confidence level in using a variety of EC skills to treat patients. Qualitative feedback from participants was collected and summarised.

Results Fifty-nine participants completed the four BEC Courses. All participants were current healthcare workers at the selected hospitals. An additional 10 participants completed a ToT course. EC knowledge scores were significantly higher for participants immediately following the training compared with their scores just prior to the training when assessed across all study sites (Z=6.23, p<0.001). Across all study sites, mean EC confidence ratings increased by 0.74 points on a 4-point Likert scale (95% CI 0.63 to 0.84, p<0.001). Main qualitative feedback included: positive reception of the sessions, especially hands-on skills; request for additional BEC trainings; request for obstetric topics; and need for more allotted training time.

Conclusions Implementation of the WHO-ICRC BEC Course by locally trained providers was feasible, acceptable and well received at four sites in East Africa. Participation in the training course was associated with a significant increase in EC knowledge and confidence at all four study sites. The BEC is a low-cost intervention that can improve EC knowledge and skill confidence across provider cadres.

  • emergency care systems
  • acute care
  • education
  • global health

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article.

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Footnotes

  • Handling editor Richard Body

  • Twitter @Sean_Kivlehan

  • Presented at An early version of this manuscript was published as a preprint at https://doi.org/10.21203/rs.2.19074/v1.

  • Contributors SK, JD, HS, JK, LW and TAR contributed to the design of the study. SK, JD, EC and JR collected and analysed data. SK drafted the manuscript. All authors critically reviewed and edited the article and have approved this final version.

  • Funding This work was supported by the Esther B. Khan Young Investigator in Emergency Medicine Award and a Research Seed Grant, both administered by the Department of Emergency Medicine at the Brigham and Women’s Hospital in Boston, Massachusetts, USA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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