Severe malnutrition in children in Papua New Guinea: effect of a multi-faceted intervention to improve quality of care and nutritional outcomes

Landi, M.; Swakin, Evelyn; Minijihau, Cecilia; Welch, Henry; Tefuarani, Nakapi; Duke, Trevor

doi:10.1080/20469047.2015.1106079

Cited by 8 publications

(17 citation statements)

References 7 publications

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“…The World Health Organization (WHO) guidelines for the management of SAM have been shown to be demonstrably effective when implemented appropriately [ 2 , 7 - 9 ], and well-trained, motivated staff have been shown to reduce SAM mortality in practice [ 9 - 11 ]. It has been suggested that by harnessing the potential of technology, particularly the internet, it should be possible to train health professionals at scale [ 12 - 14 ].…”

Section: Introductionmentioning

confidence: 99%

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

Choi¹,

Yuen²,

Annan³

et al. 2018

J Med Internet Res

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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.

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Section: Introductionmentioning

confidence: 99%

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

Choi¹,

Yuen²,

Annan³

et al. 2018

J Med Internet Res

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“…Second, the case fatality rate fell from 5.8% preintervention to 1.9%, even though participating hospitals managed more SAM children themselves postintervention instead of transferring them to tertiary hospitals for treatment. In-service face-to-face training has been shown to benefit quality of care and case-fatality in severely malnourished children11–13 but as far as we are aware this is the first time that an eLearning course has been evaluated and found to be effective in improving the identification, clinical management, and survival of children with SAM. This is important because it demonstrates that the eLearning course can scale up the training of health professionals in the management of SAM, which is identified as the key to substantially decreasing case-fatality rates worldwide 14.…”

Section: Discussionmentioning

confidence: 97%

Improved care and survival in severe malnutrition through eLearning

et al. 2019

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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.

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“…The WHO guidelines for the management of SAM have been shown to be demonstrably effective when implemented appropriately [2,[21][22][23] and well trained, motivated staff have been shown to reduce SAM mortality in practice [23][24][25]. These studies, which illustrate the efficacy of the WHO guidelines in reducing child mortality and improving recovery, also highlight the importance of 'motivated' and 'skilled' staff who follow the WHO Ten Steps with fidelity, and optimize the impact on clinical outcomes.…”

Section: Previous Findingsmentioning

confidence: 97%

The Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: A Prospective Empirical Study (Preprint)

Choi¹,

Yuen²,

Annan³

et al. 2018

Preprint

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Severe malnutrition in children in Papua New Guinea: effect of a multi-faceted intervention to improve quality of care and nutritional outcomes

Abstract: Implementation of a multi-faceted intervention to improve the management of children with severe malnutrition was associated with improved quality of care and improved weight gain.

Cited by 8 publications

References 7 publications

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

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

Improved care and survival in severe malnutrition through eLearning

The Effectiveness of the Malnutrition eLearning Course for Global Capacity Building in the Management of Malnutrition: A Prospective Empirical Study (Preprint)

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