Improved care and survival in severe malnutrition through eLearning

Abstract

BackgroundScaling 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.ObjectiveTo 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.DesignA 2-year preintervention and postintervention study between January 2015 and February 2017.SettingEleven healthcare facilities: nine in Ghana, one in Guatemala, and one in El Salvador.InterventionScenario-based eLearning course ‘Caring for infants and young children with severe malnutrition’.Main outcome measuresIdentification of children with SAM, quality of care, case-fatality rate.MethodsMedical 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.ResultsPostintervention 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).ConclusionsHigh 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.

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

“…We have previously demonstrated that the malnutrition eLearning course improved knowledge, understanding and skills of health professionals in the diagnosis and management of children with SAM, leading to changes in clinical practice and improved confidence, and improved identification of SAM and almost all aspects of the WHO 'Ten Steps' of casemanagement, and reduced case-fatality [32,33]. This study further demonstrates that scaling up capacity/ training in malnutrition management, a recognised challenge in most LMICs [22][23][24][25][26], is possible through eLearning if it is supported by contextually appropriate delivery and implemented as part of curriculum development or in-service training.…”

“…The malnutrition eLearning evaluation (MeLE) was a prospective, longitudinal, cross-country, interrupted time-series study that took place in Ghana, Guatemala, El Salvador and Colombia. The outcomes and impact of the malnutrition eLearning course on knowledge gain, changes in practice and clinical outcomes were measured and details of the methods and findings have been published [32,33]. As part of the study, we devised, implemented and evaluated different delivery models to overcome contextual IT infrastructure challenges in Ghana.…”

“…The study showed that the course improved knowledge, understanding and skills of health professionals in the diagnosis and management of children with SAM, and led to changes in clinical practice and improved confidence [32]. The course also led to improvement in the identification of SAM, improvements in almost all aspects of the WHO 'Ten Steps' of case-management, and a reduction in case-fatality [33].…”

“…The healthcare institutions that participated were 1 regional hospital, 7 district hospitals and 1 specialised children's hospital and their linked health community centres. Full details of the study participants are reported elsewhere [32,33].…”

“…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.…”