Developing Sustainable Prehospital Pediatric Care in Rwanda
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Updated: Sep 25, 2025
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Published on: May 26, 2023
Ashley Rosenberg1, Megan Wojick2, Basil Asay3
1From the Division of Acute Care Surgery, Department of Surgery, Virginia Commonwealth University School of Medicine.
Insights
A new pediatric emergency care course significantly improved prehospital provider skills in Rwanda. This training program effectively enhanced emergency pediatrics care (EPCC) capacity in a low-resource setting.
Area of Science:
- Global Health
- Pediatric Emergency Medicine
- Medical Education
Background:
- Unintentional injury is a leading cause of death in children globally, particularly in low- and middle-income countries.
- Effective prehospital care is crucial for improving outcomes in pediatric emergencies.
- Rwanda's public emergency medical service, Service d'Aide Medicale Urgente, sought to enhance its pediatric emergency care capabilities.
Purpose of the Study:
- To develop and implement a sustainable, context-specific prehospital emergency pediatrics care course (EPCC) in Rwanda.
- To assess the effectiveness of the EPCC program in improving knowledge and skills of healthcare providers.
- To establish a local cadre of instructors for future training sessions.
Main Methods:
- A 1-day context-specific EPCC was designed using international best practices and local input.
- Two cohorts of healthcare providers participated: EPCC 1 (train-the-trainer) and EPCC 2 (general providers).
- Participants completed a 50-question assessment pre- and post-course to measure knowledge gain.
Main Results:
- Both EPCC 1 and EPCC 2 showed significant improvements in post-course assessment scores (58% to 98% and 49% to 98%, respectively).
- The mean change in scores was statistically significant for both groups (P < 0.0001), with EPCC 2 showing a slightly larger increase (46% vs 40%).
- Analysis indicated that baseline training level did not affect post-assessment scores, suggesting universal effectiveness.
Conclusions:
- The implemented EPCC program was effectively delivered in Kigali, Rwanda.
- The context-appropriate training program demonstrates success in building prehospital pediatric care capacity.
- Utilizing qualified local instructors offers a sustainable model for future prehospital care development in Rwanda.
Objective:
Unintentional injury is the leading cause of death in children older than 1 year and disproportionately affects pediatric patients in low- and middle-income countries.Improved prehospital care capacity has demonstrated the ability to improve care and save lives. Our collaboration developed and implemented a sustainable prehospital emergency pediatrics care course (EPCC) for Service d'Aide Medicale Urgente, the public emergency medical service in Rwanda.
Methods:
A 1-day context-specific EPCC was developed based on international best practices and local feedback. Two cohorts were created to participate in the course. The first group, EPCC 1, was made of 22 Service d'Aide Medicale Urgente providers with preexisting knowledge on the topic who participated in the course and received training to lead future sessions. After completion of the EPCC1, this group led the second cohort, EPCC 2, which was composed of 26 healthcare providers from around Rwanda. Each group completed a 50 question assessment before and after the course.
Results:
Emergency pediatrics care course 1 mean scores were 58% vs 98% (pre vs post), EPCC 2 mean scores were 49% vs 98% (pre vs post), using matched-pair analysis of 22 and 32 participants, respectively. When comparing unequal variances across the groups with a 2-tailed paired t test, EPCC 1 and EPCC 2 had a statistically significant mean change in pretest and posttest assessment test scores of 40% compared with 46%, P < 0.0001, with 95% confidence interval. A 1-way analysis of variance mean square analysis for the change in scores showed that regardless of the baseline level of training for each participant, all trainees reached similar postassessment scores (F(1) = 1.45, P = 0.2357).
Conclusions:
This study demonstrates effective implementation of a context-appropriate prehospital pediatric training program in Kigali, Rwanda. This program may be effective to support capacity development for prehospital care in Rwanda using a qualified local source of instructors.
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