ABSTRACT
BACKGROUND: Scaling up improved management of severe acute malnutrition (SAM) has been identified as the nutrition intervention with the greatest potential to reduce child mortality but it requires improved operational capacity. OBJECTIVE: To investigate whether an eLearning course, which can be used at scale in resource-poor countries, leads to improved diagnosis, clinical management and survival of children with SAM. DESIGN: A 2-year preintervention and postintervention study between January 2015 and February 2017. SETTING: Eleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador. INTERVENTION: Scenario-based eLearning course 'Caring for infants and young children with severe malnutrition'. MAIN OUTCOME MEASURES: Identification of children with SAM, quality of care, case-fatality rate. METHODS: Medical record reviews of children aged 0-60 months attending eleven hospitals between August 2014 and July 2016, observations in paediatric wards, and interviews with senior hospital personnel. RESULTS: Postintervention there was a significant improvement in the identification of SAM: more children had the requisite anthropometric data (34.9% (1300/3723) vs 15.9% (629/3953)) and more were correctly diagnosed (58.5% (460/786) vs 47.1% (209/444)). Improvements were observed in almost all aspects of the WHO 'Ten Steps' of case-management, and case-fatality fell from 5.8% (26/449) to 1.9% (14/745) (Post-pre difference=-3.9%, 95% CI -6.6 to -1.7, p<0.001). CONCLUSIONS: High quality, interactive eLearning can be an effective intervention in scaling up capacity building of health professionals to manage SAM effectively, leading to a reduction in mortality.
Subject(s)
Child Nutrition Disorders/therapy , Computer-Assisted Instruction , Quality Improvement , Capacity Building/methods , Child Nutrition Disorders/diagnosis , Child Nutrition Disorders/mortality , Child, Preschool , Computer-Assisted Instruction/methods , El Salvador/epidemiology , Ghana/epidemiology , Guatemala/epidemiology , Health Policy , Humans , Infant , Quality Improvement/organization & administration , Quality Improvement/statistics & numerical data , Quality of Health Care , Treatment OutcomeABSTRACT
BACKGROUND: Scaling up improved management of severe acute malnutrition has been identified as the nutrition intervention with the largest potential to reduce child mortality, but lack of operational capacity at all levels of the health system constrains scale-up. We therefore developed an interactive malnutrition eLearning course that is accessible at scale to build capacity of the health sector workforce to manage severely malnourished children according to the guidelines of the World Health Organization. OBJECTIVE: The aim of this study was to test whether the malnutrition eLearning course improves knowledge and skills of in-service and preservice health professionals in managing children with severe acute malnutrition and enables them to apply the gained knowledge and skills in patient care. METHODS: This 2-year prospective, longitudinal, cross-country, interrupted time-series study took place in Ghana, Guatemala, El Salvador, and Colombia between January 2015 and February 2017. A subset of 354 in-service health personnel from 12 hospitals and 2 Ministries of Health, 703 preservice trainees from 9 academic institutions, and 204 online users participated. Knowledge gained after training and retention over time was measured through pre- and postassessments comprising questions pertaining to screening, diagnosis, pathophysiology and treatment, and prevention of malnutrition. Comprehension, application, and integration of knowledge were tested. Changes in perception, confidence, and clinical practice were assessed through questionnaires and interviews. RESULTS: Before the course, awareness of the World Health Organization guidelines was 36.73% (389/1059) overall, and 26.3% (94/358) among in-service professionals. The mean score gain in knowledge after access to the course in 606 participants who had pre- and postassessment data was 11.8 (95% CI 10.8-12.9; P<.001)-a relative increase of 41.5%. The proportion of participants who achieved a score above the pass mark posttraining was 58.7% (356/606), compared with 18.2% (110/606) in pretraining. Of the in-service professionals, 85.9% (128/149) reported applying their knowledge by changing their clinical practice in screening, assessment, diagnosis, and management. This group demonstrated significantly increased retained knowledge 6 months after training (mean difference [SD] from preassessment of 12.1 [11.8]), retaining 65.8% (12.1/18.4) of gained knowledge from the training. Changes in the management of malnutrition were reported by trained participants, and institutional, operational, and policy changes were also found. CONCLUSIONS: The malnutrition eLearning course improved knowledge, understanding, and skills of health professionals in the diagnosis and management of children with severe acute malnutrition, and changes in clinical practice and confidence were reported following the completion of the course.