Knowledge acquisition and retention following Saving Children’s Lives course for healthcare providers in Botswana: a longitudinal cohort study

Abstract

ObjectivesMillions of children die every year from serious childhood illnesses. Most deaths are avertable with access to quality care. Saving Children’s Lives (SCL) includes an abbreviated high-intensity training (SCL-aHIT) for providers who treat serious childhood illnesses. The objective of this study was to examine the impact of SCL-aHIT on knowledge acquisition and retention of providers.Setting76 participating centres who provide primary and secondary care in Kweneng District, Botswana.ParticipantsDoctors and nurses expected by the District Health Management Team to provide initial care to seriously ill children, completed SCL-aHIT between January 2014 and December 2016, submitted demographic data, course characteristics and at least one knowledge assessment.MethodsRetrospective, cohort study. Planned and actual primary outcome was adjusted acquisition (change in total knowledge score immediately after training) and retention (change in score at 1, 3 and 6 months), secondary outcomes were pneumonia and dehydration subscores. Descriptive statistics and linear mixed models with random intercept and slope were conducted. Relevant institutional review boards approved this study.Results211 providers had data for analysis. Cohort was 91% nurses, 61% clinic/health postbased and 45% pretrained in Integrated Management of Childhood Illness (IMCI). A strong effect of SCL-aHIT was seen with knowledge acquisition (+24.56±1.94, p<0.0001), and loss of retention was observed (−1.60±0.67/month, p=0.018). IMCI training demonstrated no significant effect on acquisition (+3.58±2.84, p=0.211 or retention (+0.20±0.91/month, p=0.824) of knowledge. On average, nurses scored lower than physicians (−19.39±3.30, p<0.0001). Lost to follow-up had a significant impact on knowledge retention (−3.03±0.88/month, p=0.0007).ConclusionsaHIT for care of the seriously ill child significantly increased provider knowledge and loss of knowledge occurred over time. IMCI training did not significantly impact overall knowledge acquisition nor retention, while professional status impacted overall score and lost to follow-up impacted retention.

Health-related reasons patients transfer from a clinic or health post to the Emergency Department in a District Hospital in Botswana

“…The higher number of inpatient admissions despite a lower triage category may indicate the under-triaging of patients. In a study conducted in a district hospital in Botswana [29] , the most under-triaged patient category by the nurses was the very urgent category. There is a variance in the triaging of patients by nurses because nurses are assigned to the EC without prior training.…”

Knowledge acquisition and retention after a high flow training programme in Peru: a quasi-experimental single group pre–post design

“…Other studies have reported challenges with knowledge retention after training programmes at intervals ranging from 3 to 12 months after initial training. [6][7][8][9][10][11] All reported varying degrees of knowledge loss over time, but none performed interim refresher training but rather relied on clinical experience to reinforce concepts between assessment's time points. Two studies assessing the effect of cardiopulmonary resuscitation (CPR) refresher training reported improved participant confidence 13 and time to obtain skill success.…”

“…Open access respiratory technology in RLS is the presence of a highquality training programme. 5 Current data suggest that knowledge and skills retention after initial training programmes decline over time, [6][7][8][9][10][11] highlighting the need for ongoing refresher training in order to sustain competency. As part of the initial deployment of high flow in the paediatric intensive care unit (PICU) at Instituto Nacional de Salud del Niño (INSN) in 2016, we developed a comprehensive multidisciplinary high flow training programme that included initial and refresher training sessions for all PICU staff.…”

Implementing adaptive e-learning for newborn care in Tanzania: an observational study of provider engagement and knowledge gains

“…Forgetfulness, first described by Ebbinghaus, is an exponential decay of knowledge with knowledge returning to baseline days or weeks after initial learning 30 31. We have seen this decay in our previous work in low-/middle-income countries (LMICs) with paediatric acute care knowledge and CPR (Cardiopulmonary Resuscitation) skills 17 20. Forgetfulness can be addressed with refresher assignments, spacing learning over time 32–34.…”