Osula VO, Sanders JE, Chakare T, Mapota-Masoabi L, Ranyali-Otubanjo M, Hansoti B, McCollum ED. COVID-19 advanced respiratory care educational training programme for healthcare workers in Lesotho: an observational study.
BMJ Open 2022;
12:e058643. [PMID:
35487754 PMCID:
PMC9058317 DOI:
10.1136/bmjopen-2021-058643]
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Abstract
OBJECTIVE
To develop and implement a 'low-dose, high-frequency' (LDHF) advanced respiratory care training programme for COVID-19 care in Lesotho.
DESIGN
Prospective pretraining-post-training evaluation.
SETTING
Lesotho has limited capacity in advanced respiratory care.
PARTICIPANTS
Physicians and nurses.
INTERVENTIONS
Due to limited participation in May-September 2020, the LDHF approach was modified into a traditional 1-day offsite training in November 2020 that reviewed respiratory anatomy and physiology, clinical principles for conventional oxygen, heated high-flow nasal cannula and non-invasive ventilation management. Basic mechanical ventilation principles were introduced.
OUTCOME MEASURES
Participants completed a 20-question multiple choice examination immediately before and after the 1-day training. Paired t-tests were used to evaluate the difference in average participant pretraining and post-training examination scores.
RESULTS
Pretraining and post-training examinations were completed by 46/53 (86.7%) participants, of whom 93.4% (n=43) were nurses. The overall mean pretraining score was 44.8% (SD 12.4%). Mean scores improved by an average of 23.7 percentage points (95% CI 19.7 to 27.6, p<0.001) on the post-training examination to a mean score of 68.5% (SD 13.6%). Performance on basic and advanced respiratory categories also improved by 17.7 (95% CI 11.6 to 23.8) and 25.6 percentage points (95% CI 20.4 to 30.8) (p<0.001). Likewise, mean examination scores increased on the post-training test, compared with pretraining, for questions related to respiratory management (29.6 percentage points, 95% CI 24.1 to 35.0) and physiology (17.4 percentage points, 95% CI 12.0 to 22.8).
CONCLUSIONS
An LDHF training approach was not feasible during this early emergency period of the COVID-19 pandemic in Lesotho. Despite clear knowledge gains, the modest post-training examination scores coupled with limited physician engagement suggest healthcare workers require alternative educational strategies before higher advanced care like mechanical ventilation is implementable. Conventional and high-flow oxygen is better aligned with post-training healthcare worker knowledge levels and rapid implementation.
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