Pediatric assessment and early resuscitation capacity building: Multi-country implementation of the StART
Rona Breese1, Jean de Dieu H Tuyishime2, Ibrahim Salisu3
1Independent Training Consultant, Dar es Salaam, Tanzania.
Insights
The Systematic Assessment Resuscitation Training (StART) course effectively improved pediatric resuscitation knowledge and skills in sub-Saharan Africa. This training model shows promise for sustainable, locally led emergency care improvements.
Area of Science:
- Pediatric Emergency Medicine
- Global Health Equity
- Medical Education & Training
Background:
- Child mortality in sub-Saharan Africa is high, with many deaths linked to delayed critical care in hospitals.
- Limited access to practical pediatric resuscitation training exacerbates disparities in emergency care quality.
- The Systematic Assessment Resuscitation Training (StART) course was developed to address these critical care gaps.
Purpose of the Study:
- To evaluate the feasibility, acceptability, and effectiveness of the StART pediatric resuscitation course and its Training-of-Trainers (ToT) model in diverse African hospital settings.
- To measure changes in knowledge, competence, and confidence among healthcare professionals receiving the StART training.
- To assess the sustainability and practicality of the ToT model for local implementation.
Main Methods:
- A mixed-methods pilot evaluation was conducted in Uganda, Nigeria, and Rwanda.
- Quantitative data included pre- and post-course tests and skills assessments for 134 participants (nurses, doctors, anesthesia providers).
- Qualitative data involved participant surveys and thematic analysis of open-ended responses, including 14 ToT program completers.
Main Results:
- Significant knowledge score increases were observed across all sites (p < 0.0001), with all participants achieving Basic Life Support (BLS) competency.
- Follow-up surveys indicated self-reported application of learned skills in clinical practice and improved confidence and teamwork.
- The Training-of-Trainers (ToT) model was perceived as practical and achievable within local resource constraints.
Conclusions:
- The StART pediatric resuscitation course is feasible, acceptable, and effective in African hospital contexts, demonstrating significant learning gains and competence.
- The embedded ToT model offers a sustainable approach to developing local capacity for resuscitation training.
- Further research should focus on long-term skill retention, institutional adoption, and patient outcome impact.
Abstract:
Child mortality remains marked by profound inequities in sub-Saharan Africa, where many deaths occur within the first 24 hours of hospital admission due to delays in recognizing and managing critical illness. Access to practical, context-appropriate pediatric resuscitation training is limited, contributing to disparities in the quality of emergency care. The Systematic Assessment Resuscitation Training (StART) course was developed to address this gap through a one-day, multidisciplinary pediatric Basic Life Support (BLS) program with an embedded Training-of-Trainers (ToT) model, promoting sustainability. A mixed-methods pilot evaluation was conducted in three African countries: Uganda, Nigeria, and Rwanda. Quantitative data from pre- and post-course multiple-choice tests and BLS skills assessments measured knowledge and competence. Immediate and follow-up surveys captured participants' perceptions of relevance and confidence, as well as self-reported application of learning in practice. Qualitative data from open-ended responses were analyzed thematically. A total of 134 participants completed the StART course, including nurses, doctors, and anesthesia providers, with 14 completing the ToT program. Knowledge scores increased significantly across all sites (mean improvement 3.4 points on a 15-point test scale; p < 0.0001), with all participants meeting BLS competency standards. Gains were consistent across professions and countries. Follow-up surveys (response rate 67%) indicated participant-reported application of learning in clinical care, with perceived improvements in confidence and teamwork. Trainers described the ToT model as practical and achievable within local resource constraints. The StART pediatric resuscitation course was feasible, acceptable, and effective across diverse African hospital contexts. It demonstrated measurable learning gains and practical competence, alongside early participant-reported indications of improvements in teamwork and application of learning in clinical practice. The ToT model presents a promising approach to sustainable, locally led resuscitation training. Further evaluation is needed to assess long-term skill retention, institutional uptake, and impact on patient outcomes.
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