ABSTRACT
BackgroundA large proportion of front-line paediatric healthcare in Zambia is delivered by staff with no specialist paediatric training, and training this group could significantly reduce preventable child deaths. In 2019–2020, the Tropical Health and Education Trust undertook a 6-month paediatric capacity building project in Lusaka, Zambia, funded by Health Education England.ObjectivesThe aim of the project was to improve paediatric skills of front-line healthcare workers.MethodsThree volunteers were recruited (2 paediatric registrars and 1 programme and evaluation consultant) to work with first (district) level hospitals in Lusaka. A needs analysis found that there was an under-utilisation of the structured approach to the recognition and stabilisation of unwell children on the front line.The initial suggestion of embedding the Emergency Triage and Treatment (ETAT) course was not an option due to insufficient resources and funding for a five-day course. The volunteers worked with local and international colleagues to design a one-day alternative based on local data, priorities and available resources. The Paediatric Assessment and Stabilisation (PAS) course is based on national Zambia Paediatric Association and international protocols (including ETAT, APLS and WHO).A ‘teach the teacher’ approach was used with instructors nominated from four first level hospitals and University Teaching Hospital (the local tertiary referral hospital). Two half-day sessions were held to train instructors on course teaching methods, and encourage them to be local ‘PAS Champions’ to embed their new knowledge and skills amongst their own hospital teams post-course.The pilot was funded by Lusaka Provincial Health Office, with participants recruited from the same four first level hospitals as the instructors. The course was delivered in small groups using Peyton’s four stage approach and simulation. A simulation test scenario was used at the end of the course to ensure credibility. Impact of the course was measured using a Likert scale questionnaire to assess participant confidence in managing critically ill children before and after the course.ResultsThe pilot ran four separate PAS courses. These were attended by 91 participants (including clinical officers, medical officers and nurses) of which 88 passed. Pre and post course questionnaires showed participant confidence scores increased by 19% in assessment of unwell children, and by 22% in treatment of unwell children. Free text by participants showed a positive impact on individual clinical practice. 25 instructors were trained to teach on the PAS course, as well as 2 course directors and 1 course administrator. Instructors also fed back that critically unwell children were more effectively managed within their facilities after the course. Ownership of the course was handed back to the ZPA and Ministry of Health at the end of the pilot. Unfortunately, the COVID-19 pandemic prevented any further impact analysis, and any further PAS courses were put on hold.ConclusionsAt a time where national resources are limited to fund internationally recognised paediatric courses (e.g. ETAT), it is hoped that the structured approach learned on the PAS course can benefit front line paediatric care in Zambia at present, and become an effective ‘stepping-stone’ to these courses.