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Diango K, Mafuta E, Wallis LA, Cunningham C, Hodkinson P. Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study. Afr J Emerg Med 2023; 13:258-264. [PMID: 37790995 PMCID: PMC10542602 DOI: 10.1016/j.afjem.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research. Methods We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data. Results Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, p < 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted. Conclusion A CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.
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Affiliation(s)
- Ken Diango
- Division of Emergency Medicine, Department of Family, Community and Emergency Care, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Eric Mafuta
- Kinshasa School of Public Health, University of Kinshasa, Commune Lemba, Kinshasa, DR Congo
| | - Lee A. Wallis
- Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Charmaine Cunningham
- Division of Emergency Medicine, Department of Family, Community and Emergency Care, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Peter Hodkinson
- Division of Emergency Medicine, Department of Family, Community and Emergency Care, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Stephens N, Nilson C, Reibel T, Marriott R. The availability and delivery of culturally responsive Australian Aboriginal infant resuscitation education programmes: a structured literature review. Prim Health Care Res Dev 2023; 24:e51. [PMID: 37548185 PMCID: PMC10466204 DOI: 10.1017/s1463423623000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/22/2023] [Accepted: 06/25/2023] [Indexed: 08/08/2023] Open
Abstract
AIM To critically appraise the literature to determine availability and identify the cultural responsiveness of infant resuscitation education for Aboriginal and Torres Strait Islander populations. BACKGROUND Despite overall reductions in infant mortality in the last two decades, Aboriginal people have some of the highest rates of infant mortality of any developed nation. One of the key factors that has attributed to improvements in infant mortality rates is parent and carer education around risk factors and actions of first responders. Identifying gaps in the current basic first-aid initiatives available to Aboriginal communities may contribute to developing resources to contribute to reductions in Aboriginal neonatal mortality rates. METHOD The review used key terms and Boolean operators across an 11-month time frame searching for research articles utilising the databases of CINAHL, Scopus, Ovid Emcare, Informit, Pubmed and Proquest. After review, 39 articles met the inclusion criteria, 25 articles were discarded due to irrelevant material and 14 articles were included in the structured literature review. The search process was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Articles were assessed for validity and inclusion using the Critical Appraisal Skills Program checklist. RESULTS Research literature relating to First Nation community-based CPR and first-aid education programmes in Canada, USA, India, UK and Europe, Asia and Africa were identified; however, none pertaining specifically to CPR and first-aid education in Australian Aboriginal communities were found. DISCUSSION Despite the lack of research evidence relating to infant cardiopulmonary resuscitation (CPR) education for Australian Aboriginal populations, the reviewed studies noted the importance of culturally responsive education designed in collaboration with First Nation peoples, using novel ways of teaching CPR, that align with the language, culture and needs of the communities it is intended for. CONCLUSION Further research is required to create a framework for the delivery of culturally responsive infant resuscitation education for Australian Aboriginal parents and communities.
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Affiliation(s)
- Nakita Stephens
- Murdoch University, College of Health and Education - School of Nursing, Mandurah, Western Australia, 6210, Australia
| | - Caroline Nilson
- Murdoch University, College of Health and Education - School of Nursing, Mandurah, Western Australia, 6210, Australia
| | - Tracy Reibel
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, 6150, Australia
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Western Australia, 6150, Australia
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Conradie NJ, Vincent-Lambert C, Stassen W. A comparison of the content taught in critical care transportation modules across South African bachelor's degrees in emergency medical care. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2022; 38:10.7196/SAJCC.2022.v38i1.498. [PMID: 35685205 PMCID: PMC9159535 DOI: 10.7196/sajcc.2022.v38i1.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background and objective Critical care transport (CCT) involves the movement of critically ill patients between healthcare facilities. South Africa (SA), like other low- to middle-income countries, has a relative shortage of ICU beds, making CCT an inevitability. In SA, CCTs are mostly done by emergency care practitioners; however, it is unclear how universities offering Bachelor in Emergency Medical Care (BEMC) courses approach their teaching in critical care and whether the content taught is consistent between institutions. In our study we formally evaluate and compare the intensive and critical care transport modules offered at SA universities in their BEMC programmes. Methods The electronic version of curricula of the critical care transport modules from higher education institutes in SA offering the BEMC were subjected to document analysis. Qualitative (inductive content analysis) and quantitative (descriptive analysis) methods were used to describe and compare the different components of the curriculum. Curricula were assigned into components and sub-components according to accepted definitions of curricula. The components included: aims, goals, composition and objectives of the course; content or teaching material and work-integrated learning. Results The four universities that offer BEMC programmes were invited to participate, and three (75%) consented and provided data. The duration of the modules ranged from 6 to 12 months, corresponding with notional hours of 120 - 150. A total of 83 learning domains were generated from the coding process. These domains included content on mechanical ventilation, patient monitoring, arterial blood gases, infusions and fluid balance, and patient preparation and transfer. Two universities had identical structures and learning outcomes, while one had a different structure and outcomes; it corresponded with a 58% similarity. Clinical placements were in critical and emergency care units, operating theatres and prehospital clinical services. Conclusion In all components compared, the universities offering BEMC were more similar than they were different. It is unclear whether the components taught are relevant to the SA patient population and healthcare system context, or whether students are adequately prepared for clinical practice. Postgraduate educational programmes might need to be developed to equip emergency care practitioners to function in this environment safely. Contributions of the study Owing to the limited availability of ICU beds in South Africa, optimising and standardising critical care transport is an important consideration. This study identifies important elements for improving emergency medical care training in South Africa, as well as areas needing further research.
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Affiliation(s)
- N J Conradie
- Division of Emergency Medicine, University of Cape Town, South Africa
| | - C Vincent-Lambert
- Department of Emergency Medical Care, University of Johannesburg, South Africa
| | - W Stassen
- Division of Emergency Medicine, University of Cape Town, South Africa
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Mwanza KE, Stassen W, Pigoga JL, Wallis LA. The views and experiences of Zambia's emergency medicine registrars in South Africa: Lessons for the development of emergency care in Zambia. Afr J Emerg Med 2021; 11:65-69. [PMID: 33680723 PMCID: PMC7910180 DOI: 10.1016/j.afjem.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Although low- and middle-income countries (LMICs) are beginning to integrate emergency medicine (EM) specialist physicians into their healthcare systems, they must often send these trainees to other countries with established registrar programmes. Given that retention of foreign-trained EM specialist physicians is low following repatriation, there is interest in understanding their expectations and intentions when they return. This study aimed to describe the expectations of Zambia's EM registrars regarding the development of various aspects of emergency care in Zambia. Methods In this qualitative, descriptive study, individual telephonic interviews were conducted with current Zambian EM registrars using a semi-structured interview schedule. Recorded interviews were transcribed verbatim, validated by participants, and subjected to inductive content analysis. Results Four interviews were completed, representing the entire population of interest. Two key categories emerged from these discussions: that the state of emergency care in Zambia was inadequate, and that there were numerous priority areas for further developing the emergency care system. A lack of recognition of EM as a specialty, resource and training constraints in emergency units, and the lack of a formal prehospital emergency care system were prominently identified as challenges. Priority aspects that registrars hoped to focus on when developing emergency care included expanding local training and knowledge, improving the supply chain for essential medications and equipment, increasing interprofessional collaborative practice, and advocating for emergency care. Conclusion Zambian EM registrars characterised the nascent emergency care system by challenges that are common in many LMICs and align with previous in-country assessments of emergency care. In order to ensure that registrars' strategies are ultimately implemented upon their return to Zambia, it is imperative they are communicated with stakeholders in-country. From there, mutual planning can occur between future EM specialists and government stakeholders, to ensure that there are mechanisms in place to facilitate dissemination.
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Development and Implementation of Short Courses to Support the Establishment of a Prehospital System in Sub-Saharan Africa: Lessons Learned from Tanzania. Emerg Med Int 2019; 2019:3160562. [PMID: 31871789 PMCID: PMC6913157 DOI: 10.1155/2019/3160562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Tanzania has no formal prehospital system. The Tanzania Ministry of Health launched a formal prehospital system to address this gap. The Muhimbili University of Health and Allied Sciences (MUHAS) was tasked by the Ministry of Health to develop and implement a multicadre/provider prehospital curriculum so as to produce necessary healthcare providers to support the prehospital system. We aim to describe the process of designing and implementing the multicadre/provider prehospital short courses. The lessons learned can help inform similar initiatives in low- and middle-income countries. Methods MUHAS collaborated with local and international Emergency Medicine and Emergency Medical Services (EMS) specialists to form the Emergency Medical Systems Team (EMST) that developed and implemented four short courses on prehospital care. The EMST used a six-step approach to develop and implement the curriculum: problem identification, general needs assessment, targeted needs assessment, goals and objectives, educational strategies, and implementation. The EMST modified current best EMS practices, protocols, and curricula to be context and resource appropriate in Tanzania. Results We developed four prehospital short courses: Basic Ambulance Provider (BAP), Basic Ambulance Attendant (BAAT), Community First Aid (CFA), and EMS Dispatcher courses. The curriculum was vetted and approved by MUHAS, and courses were launched in November 2018. By the end of July 2019, a total of 63 BAPs, 104 BAATs, 25 EMS Dispatchers, and 287 CFAs had graduated from the programs. The main lessons learned are the importance of a practical approach to EMS development and working with the existing government cadre/provider scheme to ensure sustainability of the project; clearly defining scope of practice of EMS providers before curriculum development; and concurrent development of a multicadre/provider curriculum to better address the logistical barriers of implementation. Conclusion We have provided an overview of the process of designing and implementing four short courses to train multiple cadres/providers of prehospital system providers in Tanzania. We believe this model of curricula development and implementation can be replicated in other countries across Africa.
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Sawe HR, Akomeah A, Mfinanga JA, Runyon MS, Noste E. Emergency medicine residency training in Africa: overview of curriculum. BMC MEDICAL EDUCATION 2019; 19:294. [PMID: 31366353 PMCID: PMC6670225 DOI: 10.1186/s12909-019-1729-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Emergency Medicine (EM) is a rapidly developing specialty in Africa with several emergency medicine residency-training programs (EMRPs) established across the continent over the past decade. Despite rapid proliferation of the specialty, little is known about emergency care curriculum structure and content. We provide an overview of Africa's EMRPs. METHODS This was a descriptive cross-sectional survey conducted of EMRPs in Africa between January 2017 and December 2017. Data were prospectively collected using a structured survey that was developed and administered through online data capture software, REDCap (Version 7.2.2, Vanderbilt, Nashville, TN, USA). Survey questions focused on curriculum structure and design, including clinical rotations, didactics, research, and evaluation. Data are summarized with descriptive statistics. RESULTS The survey was sent to the leadership of 15 EMRPs in 12 different African countries and 11 (73%) responded. Five (46%) of the responding programs were started by local non-EM trained faculty, two (18%) were started by international partners, and the remainder by a combination of local non-EM faculty and international partners. Overall, Seven (64%) of the countries offer a 4-year EMRP. In General, 40% of curriculums are influenced the contents developed by African Federation for Emergency Medicine. All programs offer resident led-didactics, with a median of 12 h (Interquartile range 9-6 h) per month. All EMRPs have a mandatory research requirement. All EMRPs offer clinical rotations in the ED, Paediatrics, and Obstetrics and Gynaecology, while only 2 programs offer rotations in radiology and neonatal intensive care units. Only 46% of EMRPs have in-ED clinical supervision by specialist. CONCLUSION The EMRPs in Africa were started by non-EM trained local faculty alone or collaboration with international partners. The curriculum offers most exposure to ED, and less exposure in radiology and neonatal intensive care. Residents are highly involved in leading didactics and less than half of the programs have in-ED specialist supervision of patient care.
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Affiliation(s)
- Hendry R. Sawe
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Abena Akomeah
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es salaam, Tanzania
- Emergency Department, University of Maryland, Baltimore, MD USA
| | - Juma A. Mfinanga
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es salaam, Tanzania
- Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Michael S. Runyon
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es salaam, Tanzania
- Emergency Department, Carolinas Medical Center Main, Charlotte, North Carolina USA
| | - Erin Noste
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es salaam, Tanzania
- Emergency Department, Carolinas Medical Center Main, Charlotte, North Carolina USA
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