Effective training-of-trainers model for the introduction of continuous positive airway pressure for neonatal and paediatric patients in Kenya

• Published in: Paediatrics and international child health 2019-07, Vol.39 (3), p.193-200
• Main Authors: Olayo, Bernard, Kirigia, Caroline Kendi, Oliwa, Jacquie Narotso, Agai, Odero Nicholas, Morris, Marilyn, Benckert, Megan, Adudans, Steve, Murila, Florence, Wilson, Patrick T.
• Format: Article
• Language: English
• Subjects: Continuous positive airway pressure; Continuous Positive Airway Pressure - instrumentation; Continuous Positive Airway Pressure - methods; Curriculum; Humans; infant; Kenya; paediatrics; pneumonia; Respiratory Therapy - education; Respiratory Therapy - instrumentation; Teacher Training; United States
• ISSN: 2046-9047; 2046-9055
• DOI: 10.1080/20469047.2019.1624007

Background: Continuous positive airway pressure (CPAP) is a relatively low-cost technology which can improve outcome in neonatal and paediatric patients with respiratory distress. Prior work in a lower middle-income country demonstrated degradation of CPAP skills and knowledge after the initial training. Aims: To determine if a training-of-trainers (ToT) curriculum can decrease gaps in skills and knowledge between first-generation (trained by a United States physician and nurse) and second-generation healthcare providers (trained by local trainers) in Kenya, and to describe the usage pattern, outcome and safety in patients who received CPAP following the trainings. Methods: The first day of training entailed didactic and simulation sessions. On the second day participants were taught how to train others to use CPAP. First- and second-generation healthcare providers were tested on their skills and knowledge. Unpaired t-tests were used to test for equivalence. Prospective data on CPAP usage was collected following the initial trainings. Results: 37 first-generation healthcare providers (16 nurses; 21 physicians, medical/clinical officers) were trained as trainers and 40 second-generation healthcare providers (19 nurses, 21 physicians, medical/clinical officers) trained by first-generation healthcare providers were available for skills and knowledge testing. There were no statistically significant differences between first- and second-generation healthcare providers' skills (90%, 95% CI 87-93 vs 89%, 95% CI 86-92) or knowledge scores (91%, 95% CI 88-93 vs 90%, 95% CI 88-93). A total of 1111 patients were placed on CPAP mostly by nurses (61%), prematurity/acute respiratory distress syndrome was the most common indication, nasal injury/bleeding (2%) was the most common reported adverse event, and the overall mortality rate was 24%. Conclusion: The ToT model was successful, nurses initiated CPAP most commonly, prematurity with acute respiratory distress syndrome was the most common indication, and adverse events were uncommon.