The Safer Anaesthesia from Education (SAFE)^® paediatric anaesthesia course: educational impact in five countries in East and Central Africa

Abstract

Summary There is an urgent need to improve access to safe surgical and anaesthetic care for children living in many low‐ and middle‐income countries. Providing quality training for healthcare workers is a key component of achieving this. The 3‐day Safer Anaesthesia from Education (SAFE)® paediatric anaesthesia course was developed to address the specific skills and knowledge required in this field. We undertook a project to expand this course across five East and Central African countries (Ethiopia, Kenya, Malawi, Uganda and Zambia) and train local faculty. This study reports the outcomes from course evaluation data, exploring the impact on knowledge, skills and behaviour change in participants. Eleven courses were conducted in a 15‐month period, with 381 participants attending. Fifty‐nine new faculty members were trained. Knowledge scores (0–50 scale) increased significantly from mean (SD) 37.5 (4.7) pre‐course to 43.2 (3.5) post‐course (p < 0.0001). Skills scores (0–10 scale) increased significantly from 5.7 (2.0) pre‐course to 8.0 (1.5) post‐course (p < 0.0001). One hundred and twenty‐six participants in Malawi, Uganda and Zambia were visited in their workplace 3–6 months later. Knowledge and skills were maintained at follow‐up, with scores of 41.5 (5.0) and 8.3 (1.4), respectively (p < 0.0001 compared with pre‐course scores). Content analysis from interviews with these participants highlighted positive behaviour changes in the areas of preparation, peri‐operative care, resuscitation, management of the sick child, communication and teaching. This study indicates that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.

The impact of the Safer Anaesthesia from Education (SAFE) Obstetric Anaesthesia training course in Ethiopia: A mixed methods longitudinal cohort study

“…The three-day SAFE Paediatric course has also been demonstrated to lead to improved, and retained, knowledge and skills, following courses in Ethiopia, Kenya, Uganda, Zambia and Malawi, 21 , 22 with reported improvements in confidence, 21 and improved communication and positive behavioural changes. 22…”

Mixed methods analysis of factors influencing change in clinical behaviours of non‐physician anaesthetists in Kenya following obstetric anaesthesia training

“…improved patient outcomes) . Previous evaluations of the SAFE courses have described improvements in knowledge and skills as well as changes in behaviour . However, self‐reported behavioural change may suffer from recall and social desirability biases and does not provide any insight into what actually happens in the workplace.…”

Adaptations in pediatric anesthesia care and airway management in the resource‐poor setting

“…With the development of low‐cost mobile applications such as SimMon™, low‐cost, low‐fidelity mannequins, and realistic context‐appropriate scenarios, simulation opportunities in pediatric airway management are now available for use in the low‐resource setting. The SAFE Paediatric Anaesthesia Course (SAFE‐Paeds) and the Management of Emergencies in Paediatric Anaesthesia (MEPA) are both examples of refresher courses that incorporate simulation as part of their core teaching modalities and are appropriate for use in the LMIC setting . During these courses, simple airway maneuvers like bag‐mask ventilation and more complex skills such as direct laryngoscopy techniques and management of the difficult airway are practiced.…”