Article
A partnership to strengthen paediatric emergency care in the Alaotra Mangoro region, Madagascar: preliminary findings of a multipronged approach to capacity building
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Authors
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Miora Miadanaarisoa
- Faculty of Medicine, University of Mahajanga, Mahajanga, Madagascar
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Martina Fier
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Cynthony Noa
- Faculty of Medicine, University of Mahajanga, Mahajanga, Madagascar
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Herizo H. Rajaobary
- Ministry of Health, Regional Public Health Directorate Alaotra Mangoro, Madagascar
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Michael Galatsch
- Institute of Nursing, School of Health Science, Zürich University of Applied Science, Winterthur, Switzerland
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Karen Fahlbusch
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Farzana Yasmin
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Todisoa Nomenjanahary Andriatahina
- Société Malgache de Pédiatrie (SOMAPED), Madagascar
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Hans-Jörg Lang
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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Diavolana Köcher-Andrianarimanana
- Faculty of Medicine, University of Mahajanga, Mahajanga, Madagascar; Faculté de Médecine, Université d’Antananarivo, Madagascar
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Ralf Weigel
- Friede Springer endowed professorship for Global Child Health, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| Published: | November 4, 2024 |
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Outline
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Research question/project description: Although the country’s under-five mortality rate declined from 156 to 66 death per 1000 live births over the last 30 years, the reduction has been uneven. To address the gap the University of Mahajanga and the Witten/Herdecke University collaborate to provide training in paediatric emergency care (PEC) across Alaotra Mangoro. Training modalities included workshops for hospital leadership (LS-WS) and communities (C-WS), on-line training sessions, a training of trainers (ToT), and on-site mentoring visits. Here, we present the findings from the evaluations conducted so far.
Methodology: The evaluation includes quantitative and qualitative methods:
- 1.
- LS-WS and two C-WS: A questionnaire using a five-point Likert scale (LS) (5= definitely agree; 1= definitely disagree) and open questions and In-depth interviews for C-WS.
- 2.
- Online training sessions: A questionnaire using a four-point LS with (1= definitely agree; 4= definitely disagree) and a “one-minute paper”.
- 3.
- Two five-day ToT sessions: Questionnaires with open and closed questions for the course examination and to assess engagement [four-point LS with (1= definitely agree; 4= definitely disagree)]. A clinical simulation assessed by exam sheets.
Results: LS-WS (July 2023): The 7 participants included a MoH representative and hospital directors. LS scale results indicated high satisfaction with a mean (SD) of 4.6 (0.3) with the workshop's relevance and content. The C-WS analysis is under way. Online training sessions (February to May 2023): The interactive sessions targeted ToT candidates. 9 of 11 individuals answered the online questionnaire reporting a mean (SD) of 2.5 (0.9) for the engagement dimension and 1.95 (0.85) for the overall experience. Participant’s feedback suggested adaptations for the 2nd phase of online training. Five-day ToT sessions (July 2023): 10 medical doctors and 5 nurses/midwives participated. 13 participants passed the exam. All simulation participants (n=7) passed the assessment. The post-ToT Engagement questionnaire (n=15) showed a mean (SD) engagement score of 1.8 (0.6) and an overall experience score of 1.4 (0.6).
Discussion: Overall, the program appears to be successful. Enablers might be the strong bonds between collaborators resulting from co-creation and co-implementation, and the alignment between trainings’ objectives with participants’ needs. On-site visits revealed many challenges health facilities face, affecting the projects’ implementation. Adverse weather conditions and poor infrastructure affect accessibility and professional exchange. However, despite these limitations, the project proves feasible as evidenced by the engagement of stakeholders involved. Follow-up evaluation at the project’s end will offer more insights.
Conclusion: Capacity building in PEC in Alaotra Mangoro is challenging. Success may depend on a strong collaboration between multiple partners, stakeholder engagement and flexible and tailored approaches.
