Education and training of prehospital first responders in low- and middle-income countries.

Prehospital emergency medical services play a vital role in providing essential emergency medical and trauma care. However, in many low- and middle-income countries, there is a significant lack of adequate emergency medical services coverage, a problem compounded by a profound deficit of first responder training programs. The African Federation of Emergency Medicine classifies prehospital emergency care into 2 categories: tier-1, which includes laypersons, and tier-2, consisting of professionals equipped with dispatch capabilities. Both tier-1 and tier-2 first responders require protocolized training, integration, and coordination to varying degrees, with tier-1 programs focusing primarily on immediate stabilization and hospital transportation and tier-2 programs dedicating increased focus toward formal dispatch and advanced life support interventions. Training for both tiers of emergency medical services typically involves in-person didactic lectures with practical skills sessions. However, the content of these courses is highly context-dependent, and there is no international consensus regarding pedagogical methods or curriculum content for first responder training in low- and middle-income countries. Similarly, there is a lack of consensus in monitoring and evaluating training programs, including assessment methods, passing scores, and certification requirements. Although many programs use knowledge or skills acquisition testing, the content and depth of these examinations vary greatly, and long-term follow-up reporting is limited. As such, the educational landscape of both tier-1 and tier-2 emergency medical services in low- and middle-income countries remains highly varied and often faces a dual challenge of lacking clear international guidelines while still maintaining local appropriateness. Modular curricula developed in conjunction with standardized needs assessments, accompanied by the adoption of the training of trainers model, may present a pathway for local adaptability by leveraging local community members to inform and proliferate training. Although there have been notable improvements in prehospital training programs in resource-limited settings during the past 3 decades, challenges related to maintaining fidelity in monitoring and evaluation, expanding programs within resource constraints, and adapting to specific contexts continue to offer opportunities for further development in the future.

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study.

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.

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

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.

Evaluation of needs and supply of emergency care in Kinshasa, Democratic Republic of Congo: a cross-sectional household survey.

OBJECTIVE: Emergency care can address over half of deaths occurring each year in low-income countries. A baseline evaluation of the specific needs and gaps in the supply of emergency care at community level could help tailor suitable interventions in such settings. This study evaluates access to, utilisation of, and barriers to emergency care in the city of Kinshasa, Democratic Republic of Congo. DESIGN: A cross-sectional, community-based household survey. SETTING: 12 health zones in Kinshasa, Democratic Republic of Congo. PARTICIPANTS: Three-stage randomised cluster sampling was used to identify approximately 100 households in each of the 12 clusters, for a total of 1217 households. The head of each household or an adult representative responded on behalf of the household. Additional 303 respondents randomly selected in the households were interviewed regarding their personal reasons for not accessing emergency care. PRIMARY OUTCOME: Availability and utilisation of emergency care services. RESULTS: In August 2021, 1217 households encompassing 6560 individuals were surveyed (response rate of 96.2%). Most households were economically disadvantaged (70.0% lived with

Awareness, attitude and perceived knowledge regarding First Aid in Kinshasa, Democratic Republic of Congo: A cross-sectional household survey.

Introduction: Emergency care can potentially address half of deaths and one-third of disability in low-and-middle income countries. First Aid (FA) is at the core of out-of-hospital emergency care and is crucial to empower laypersons to preserve life, alleviate suffering and improve emergency response and outcomes. This study aimed to gauge FA awareness, the attitude and perceived knowledge in households in the low socioeconomic setting of Kinshasa, Democratic Republic of Congo (DRC). Methods: We undertook a cross-sectional community-based household survey in twelve health zones in Kinshasa. A three-stage randomised cluster sampling was used to identify 1217 households. The head of each household or an adult representative answered on behalf of himself/herself and the household. The primary outcome was FA awareness, attitude and perceived knowledge. Results: Most households had a poor socio-economic background, with 70.0% living on

African Federation for Emergency Medicine's Francophone Working Group - May 2018 Report.

Even though the African Federation for Emergency Medicine (AFEM) has been successfully developing emergency care in Africa for the past nine years, a considerable amount of potential AFEM members from the African-Francophone countries are not able to access AFEM resources. In response, an AFEM Francophone Working Group has been created to coordinate all existing and new initiatives to promote emergency care in African-Francophone countries.

African federation for emergency medicine's francophone working group ­ may 2018 report

Even though the African Federation for Emergency Medicine (AFEM) has been successfully developing emergency care in Africa for the past nine years, a considerable amount of potential AFEM members from the African-Francophone countries are not able to access AFEM resources. In response, an AFEM Francophone Working Group has been created to coordinate all existing and new initiatives to promote emergency care in African-Francophone countries