Applying the WHO-ICRC BEC course to train emergency and inpatient healthcare workers in Sierra Leone early in the COVID-19 outbreak

Abstract

Background Treating critical illness in resource-limited settings during disease outbreaks is feasible and can save lives. Lack of trained healthcare workers is a major barrier to COVID-19 response. There is an urgent need to train healthcare workers to manage COVID-19. The World Health Organization and International Committee of the Red Cross’s Basic Emergency Care course could provide a framework to cross-train personnel for COVID-19 care while strengthening essential health services. Methods We conducted a prospective cohort study evaluating the Basic Emergency Care course for healthcare workers from emergency and inpatient units at two hospitals in Sierra Leone, a low-income country in West Africa. Baseline, post-course, and six month assessments of knowledge and confidence were completed. Questions on COVID-19 were added at six months. We compared change from baseline in knowledge scores and proportions of participants “very comfortable” with course skills using paired Student’s t-tests and McNemar’s exact tests, respectively. Results We enrolled 32 participants of whom 31 completed pre- and post-course assessments. Six month knowledge and confidence assessments were completed by 15 and 20 participants, respectively. Mean knowledge score post-course was 85% (95% CI: 82% to 88%), which was increased from baseline (53%, 48% to 57%, p-value < 0.001). There was sustained improvement from baseline at six months (73%, 67% to 80%, p-value 0.001). The percentage of participants who were “very comfortable” performing skills increased from baseline for 27 of 34 skills post-training and 13 skills at six months. Half of respondents strongly agreed the course improved ability to manage COVID-19. Conclusions This study demonstrates the feasibility of the Basic Emergency Care course to train emergency and inpatient healthcare workers with lasting impact. The timing of the study, at the beginning of the COVID-19 pandemic, provided an opportunity to illustrate the strategic overlap between building human resource capacity for long-term health systems strengthening and COVID-19. Future efforts should focus on integration with national training curricula and training of the trainers for broader dissemination and implementation at scale.

Introduction of WHO BEC course for nurses at Bugando Medical Center in Mwanza, Tanzania

“…Subgroup analysis comparing differences between cohorts and nurses of different demographic groups was performed using independent t-tests. For the pre- and post-course self-confidence assessments, McNemar's exact test for paired proportions was used to compare the difference in the proportion of participants who reported “very comfortable” in each skill before and after the course, to keep consistent in reporting with prior studies [ 11 , [13] , [14] , [15] ]. Differences in pre-course and post-course confidence scores between cohort 1 and cohort 2 were evaluated using fisher exact test.…”

“…The course targets a wide audience including students, nurses, physicians, pre-hospital providers, and other locally appropriate providers. The BEC course has been implemented in numerous SSA countries including Ethiopia [9] , Uganda [ 6 , 10 , 11 ], Tanzania [10] , [11] , [12] , Nigeria [13] , Zambia [ 11 , 14 ], and Sierra Leone [15] . Following course completion, participants endorsed increased confidence, preparedness, and skills in managing emergency conditions and demonstrated improvements in knowledge-based test performance [10] , [11] , [12] , [13] , [14] , [15] .…”

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit

“…In addition to the pilot BEC programs in Zambia, Tanzania, and Uganda, additional iterations have been implemented in emergency facilities in Nigeria, Sierra Leone, Ukraine, and Kiribati and adapted for each clinical context [30][31][32][33]. In these cases, knowledge acquisition was similarly measured by comparing pre-and post-course assessments.…”

Desafíos en la formación de los valores del profesionalismo médico en tiempos del COVID-19 y de crisis social

“…A fines del siglo pasado, el concepto de profesionalismo médico como sistema de valores fue amenazado por el modelo mercantilista, que reduce el encuentro médico a relaciones de oferta y demanda 2 . Los ideales humanitarios son confrontados con las exigencias de la productividad, la globalización y la rápida transformación tecnológica 3,4 .…”