Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: Cross-Country Interrupted Time-Series Study

Abstract

BackgroundScaling 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.ObjectiveThe 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.MethodsThis 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.ResultsBefore 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.ConclusionsThe 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.

Improved care and survival in severe malnutrition through eLearning

“…Information from interviews with senior hospital personnel matched the observed changes. The observed changes also matched the reported changes described in the companion paper,7 including increased screening for SAM among under-fives and improved identification and treatment of SAM. Greater staff confidence in diagnosis and case-management was also noted.…”

“…Second, the observation period was short and may have failed to capture differences in practices among shifts, weekends etc. Nevertheless, the observed changes are in keeping with the changes reported by the individual health professionals7 and senior hospital personnel. Third, we have no precise figure as to the percentage of staff who were trained, as access to the course was open to all and it was used for in-service training in several hospitals after the initial offering of the course as part of the study.…”

“…The course has three modules, each taking about 2–3 hours to complete, and is based on WHO guidelines for the management of severe acute malnutrition5 6 and is described elsewhere 7. The modules include assessing children for chronic and acute malnutrition; pathophysiological changes in malnutrition and consequences for treatment; managing malnourished children using the WHO Ten Steps; inpatient and community-based management; and how to support mothers and carers to prevent recurrence of malnutrition.…”

“…In a recently reported 2-year evaluation study, we found that the course improved knowledge, understanding, skills and confidence of health professionals in the assessment, diagnosis and management of children with severe acute malnutrition (SAM) 7. Many also reported changing their clinical practices.…”

Implementing effective eLearning for scaling up global capacity building: findings from the malnutrition elearning course evaluation in Ghana

“…The content is set at a level suitable for in-service and pre-service health professionals who are, or will be, working with undernourished children. Further details are described elsewhere [30][31][32][33]. Following the development of the malnutrition eLearning course, various dissemination approaches, including institutional grants and best practice awards for curriculum implementation, social media campaigns, exhibitions and regular release of newsletters, were used to encourage and scale up its utilization.…”