Developing and Implementing a Pediatric Emergency Care Curriculum for Providers at District Level Hospitals in Sub-Saharan Africa: A Case Study in Kenya

Abstract

IntroductionEmergency medicine is a relatively new field in sub-Saharan Africa and dedicated training in pediatric emergency care is limited. While guidelines from the African Federation of Emergency Medicine (AFEM) regarding emergency training exist, a core curriculum in pediatric emergency care has not yet been established for providers at the district hospital level.MethodsThe objective of the project was to develop a curriculum for providers with limited training in pediatric emergencies, and contain didactic and simulation components with emphasis on treatment and resuscitation using available resources. A core curriculum for pediatric emergency care was developed using a validated model of medical education curriculum development and through review of existing guidelines and literature. Based on literature review, as well as a review of existent guidelines in pediatric and emergency care, 10 core topics were chosen and agreed upon by experts in the field, including pediatric and emergency care providers in Kenya and the United States. These topics were confirmed to be consistent with the principles of emergency care endorsed by AFEM as well as complimentary to existing Kenyan medical school syllabi. A curriculum based on these 10 core topics was created and subsequently piloted with a group of medical residents and clinical officers at a community hospital in western Kenya.ResultsThe 10 core pediatric topics prioritized were airway management, respiratory distress, thoracic and abdominal trauma, head trauma and cervical spine management, sepsis and shock, endocrine emergencies, altered mental status/toxicology, orthopedic emergencies, burn and wound management, and pediatric advanced life support. The topics were incorporated into a curriculum comprised of ten 1.5-h combined didactic plus low-fidelity simulation modules. Feedback from trainers and participating providers gave high ratings to the ease of information delivery, relevance, and appropriateness of the curriculum.ConclusionWe present here a core curriculum in pediatric emergency care for district hospital level providers in Kenya which can be used as a framework for further development and implementation of training programs throughout sub-Saharan Africa.

Effectiveness of a Pediatric Emergency Medicine Curriculum in a Public Tanzanian Referral Hospital

“…Furthermore, of the pediatric curricula that have been implemented, most have only evaluated providers' self-efficacy and knowledge acquisition. [9][10][11][12] A rare few have attempted to show changes in provider behavior or patient outcomes. 13,14 In response, the African Federation for Emergency Medicine (AFEM) assembled a working group with expertise in pediatric EM (PEM) from seven American and African academic institutions to develop a comprehensive PEM curriculum for three different tiers of healthcare professionals that would be made freely available.…”

A mixed methods needs assessment of pediatric emergency and critical care in Tanzanian providers: a model for curriculum development

“…Several studies have used needs assessments to identify the most common pediatric emergencies in low-resource settings, and our study shows an alignment of topics including pneumonia and other respiratory illnesses, sepsis, heart disease, malnutrition, gastroenteritis, malaria, fractures, anemia, and seizure disorders. [21][22][23][24][25] Additionally, our quantitative data demonstrate that a majority of perceived key pediatric topics are reflective of actual patient presentations.…”

“…3,4 Since its recognition there has been increasing efforts to develop and implement formal emergency care training programs however such systems are still in their infancy in many countries in sub-Saharan Africa. 5,6 It is estimated that up to 27% of all emergency visits involve patients less than 13 years old, yet there are still no dedicated, formal Pediatric Emergency Medicine (PEM) training programs in sub-Saharan Africa. [7][8][9] This number is likely to increase as the population of the region is expected to continue trending towards a younger subset.…”

“…11 There have been previously published proposals for pediatric emergency care training, however no studies to date have dived deeper to investigate the unique needs and challenges faced by frontline providers in sub-Saharan Africa, and how these shape their practice. 6,12 While increasing access to pediatric-specific training is important, it is imperative to understand the context into which the training must be delivered in order to ensure that it is relevant and effective for target providers working in low-and middle-income countries. 13 In 2017, the African Federation for Emergency Medicine (AFEM), a professional organization with over 2000 members dedicated to bringing high-quality emergency care to the continent, convened a working group to develop an open-access, pediatric-specific emergency care curriculum.…”

Mortality Outcomes in Task-Sharing for Emergency Care: Impact of Emergency Physician Supervision on Non-Physician Emergency Care in Rural Uganda

“…[29,[39][40][41][42][43][44] There are documentation a few short-courses designed to teach NCP EC skills in SSA. [45][46][47][48] Consistent with this limited evidence base, no standards exist describing if, when or how to transition to reduced supervision or independent NPC care following initial training. The impact of transitioning to decreased levels of supervision on quality of NPC care and patient outcomes is therefore unknown.…”