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PUBLISHED DATE: - 16-11-2024
DOI: -
https://doi.org/10.37547/tajiir/Volume06Issue11-12
PAGE NO.: - 204-214
IMPLEMENTING AND EVALUATING A
PAEDIATRIC EMERGENCY MANAGEMENT
TRAINING PROGRAM FOR PRIMARY
HEALTHCARE WORKERS IN ZARIA
Peter Omeiza Suberu
MPH, Cardiorespiratory Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
Kennedy Oberhiri Obohwemu
PhD, Department of Health, Wellbeing & Social Care, Global Banking School/Oxford Brookes
University, Birmingham, United Kingdom;
PENKUP Research Institute, Birmingham, United Kingdom
Victoria Yewande Soyobi
MBBS, Oni Memorial Children Hospital, Ibadan, Nigeria; Riverside Nursing Home, Aberdeen,
United Kingdom
Ibiangake Friday Ndioho
PhD, Department of Health Professions, Manchester Metropolitan University, Manchester,
United Kingdom
Corresponding Author: Obohwemu Kennedy Oberhiri, PhD
RESEARCH ARTICLE
Open Access
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INTRODUCTION
A medical emergency is an acute health condition
that poses an immediate risk to a person's life or
long-term health if not treated promptly. In
paediatric patients, these emergencies are
particularly concerning due to their rapid
progression and the unique physiological
responses of children compared to adults.
Paediatric emergencies are classified as those
affecting individuals under 18 years of age and
represent a significant burden on healthcare
systems globally (Barbiellini et al., 2021; Jordan et
al., 2022; Newgard et al., 2023). They remain a
Abstract
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leading cause of morbidity and mortality,
especially among children under five years of age,
who are particularly vulnerable due to their
developing immune systems and dependency on
caregivers for timely medical intervention. The
World Health Organization (WHO) emphasizes
that paediatric emergencies require urgent
medical attention to prevent death or severe long-
term health consequences (WHO, 2016; Elhassan
et al., 2021).
The incidence and pattern of paediatric
emergencies tend to be consistent across regions
with similar socio-demographic characteristics,
reflecting common public health challenges and
resource limitations. For example, a study
conducted in Khartoum, Sudan, reported that
respiratory tract infections accounted for 33% of
paediatric emergencies, followed by diarrheal
disorders (29.9%), infectious diseases (8.3%),
severe malaria (5.5%), and severe acute
malnutrition (3.5%) (Elhassan et al., 2021). These
findings align with those from other regions in
Sub-Saharan Africa, where similar patterns have
been observed. In a five-year review of paediatric
admissions at the Children's Emergency Room of
the University of Nigeria Teaching Hospital
(UNTH) in Enugu, the most frequent emergencies
included febrile convulsions (21.5%), severe
malaria with anaemic heart failure (18.4%), acute
pneumonia (16.1%), diarrheal diseases (12.3%),
sickle cell anaemia crises (7.6%), acute
neurological conditions (7.6%), and acute severe
asthma (5.2%) (Fagbamigbe et al., 2017; Oguonu et
al., 2018). These studies underscore the critical
need for effective training programs tailored to the
specific emergency care needs in paediatric
populations, particularly in regions where these
conditions are prevalent.
The high burden of paediatric emergencies,
particularly in low-resource settings, underscores
the critical need for effective emergency
management protocols at the primary healthcare
(PHC) level. In many developing countries,
including Nigeria, PHC centres are the first point of
contact for most patients, especially in rural areas.
However, these centres are often under-resourced
and inadequately staffed, leading to suboptimal
care during emergencies (Oleribe et al., 2016;
Agodirin et al., 2019).
Training healthcare workers in the management of
paediatric emergencies is essential to improving
outcomes in these critical situations. Studies have
shown that targeted training programs can
significantly enhance the preparedness of
healthcare workers, thereby reducing morbidity
and mortality rates in paediatric emergencies
(Auerbach et al., 2018; Topjian et al., 2020).
However, despite the recognized importance of
training, there remains a paucity of studies
evaluating the effectiveness of such programs in
Nigeria's PHC settings, particularly in northern
regions like Zaria, Kaduna State.
The Alma-Ata Declaration of 1978 emphasized the
importance of primary health care as a key
strategy for achieving "Health for All" by the year
2000, highlighting the need for accessible,
equitable, and affordable health care services. In
Nigeria, PHC is the cornerstone of the health policy
and represents the first level of contact between
individuals and the health care system (WHO,
2008). However, the effectiveness of PHC in
Nigeria is often compromised by inadequate
infrastructure, limited access to essential drugs,
and a shortage of trained personnel (Oleribe et al.,
2016; Suberu, Obohwemu & Soyobi, 2024; Suberu
et al., 2024a). The situation is exacerbated in rural
areas, where the burden of disease is higher and
the availability of trained healthcare workers is
lower (Fagbamigbe et al., 2017; Suberu et al.,
2024b).
The need for a comprehensive Paediatric
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Emergency Management Training Program for
PHC workers in Zaria is underscored by the
region's high under-five mortality rates, which are
among the highest in Nigeria (NDHS, 2013). The
lack of trained personnel in these settings often
leads to delays in the recognition and management
of paediatric emergencies, contributing to
preventable deaths. Training programs that focus
on equipping healthcare workers with the
necessary skills to manage common paediatric
emergencies could play a pivotal role in reducing
child mortality rates in these settings.
This study aims to implement and evaluate a
Paediatric Emergency Management Training
Program specifically designed for PHC workers in
Zaria. By focusing on the training needs of these
workers, the study seeks to improve the quality of
care provided during paediatric emergencies,
ultimately reducing the high rates of morbidity and
mortality among children in the region. The
program will be tailored to address the specific
challenges faced by PHC workers in Zaria,
including the management of common paediatric
emergencies such as severe malaria, respiratory
infections, and diarrheal diseases.
METHODOLOGY
Study Setting
This study was conducted in Zaria, a prominent
city in Kaduna State, Nigeria. Zaria has a
population of approximately 698,348 people,
served by 55 primary healthcare centres (PHCs).
These centres are the main access point for
healthcare services in the region, catering to a
diverse population that includes both urban and
rural residents. The study setting reflects the
broader healthcare landscape of northern Nigeria,
where PHCs play a crucial role in delivering
essential health services, particularly in
underserved
areas
(National
Population
Commission & ICF International, 2014; WHO,
2014).
Study Design
A cross-sectional descriptive study was employed
to evaluate the paediatric emergency management
skills of healthcare workers in the selected PHCs of
Zaria. This design was chosen for its effectiveness
in capturing a detailed snapshot of the skills
present at the time of the study, allowing for the
identification of strengths and gaps within the
healthcare workforce (Abodunrin et al., 2018;
Chinawa et al., 2020).
Study Participants
The participants included healthcare workers
actively engaged in patient care at the selected
PHCs. These workers included pharmacy
technicians, junior and senior community health
extension workers (J-CHEWs and S-CHEWs),
nurses, midwives, community health officers
(CHOs), and medical officers (doctors). To ensure
the participants had adequate experience in
handling paediatric emergencies, only those with a
minimum of six months of experience were
included in the study. This approach is consistent
with previous studies that focus on evaluating
practical skills among healthcare providers
(Akinyemi et al., 2017).
Exclusion Criteria
Healthcare workers who were on leave during the
data collection period or those not directly
involved in patient care were excluded. This
exclusion was necessary to focus the study on
individuals with active roles in managing
paediatric emergencies, thereby ensuring that the
findings were relevant to frontline healthcare
delivery (Okoli & Oli, 2015).
Sample Size
The sample size was calculated to ensure
representativeness and statistical validity. Using a
95% confidence level and a 5% margin of error,
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with an additional 10% allowance for attrition, the
final sample size was determined to be 146
healthcare workers. This sample size was
sufficient to detect significant differences in skill
levels among the participants, providing robust
data for analysis (Fagbamigbe et al., 2020; WHO,
2014).
Sampling
A multi-stage sampling technique was employed to
select participants. First, 15 wards were randomly
chosen from Zaria and Sabon Gari Local
Government Areas to ensure a representative
sample. Next, one PHC was randomly selected from
each ward. Finally, healthcare workers were
selected from each PHC based on their proportion
within the centre, using simple random sampling.
This approach minimized selection bias and
ensured that the sample accurately reflected the
healthcare workforce in the region (Uzochukwu &
Onwujekwe, 2004).
Data Collection Instrument
A structured questionnaire, developed and
pretested for reliability and validity, was used to
collect data. The questionnaire included sections
on demographics, work experience, and specific
questions assessing skills related to paediatric
emergency management. The instrument focused
on evaluating practical skills rather than
theoretical knowledge, ensuring that the study
directly addressed the competencies required in
real-world emergency scenarios (Abodunrin et al.,
2018; Chinawa et al., 2020).
Data Collection
Data collection occurred over a three-month
period, with researchers visiting the selected PHCs
to distribute and collect questionnaires.
Participants completed the questionnaires in a
private setting to ensure confidentiality.
Researchers were available to clarify any
questions, which helped improve the accuracy and
completeness of the responses (Akinyemi et al.,
2017).
Data Management and Analysis
After data collection, the questionnaires were
reviewed, coded, and entered into SPSS version 21
for analysis. Descriptive statistics were used to
summarize the demographic and skill data, while
chi-square tests were employed to examine
associations between categorical variables, such as
skill levels and educational background. A p-value
of less than 0.05 was considered statistically
significant, indicating strong associations between
variables (Okoli & Oli, 2015).
Scoring
The study utilized a scoring system to categorize
the skill levels of healthcare workers in paediatric
emergency
management.
Responses
were
classified into four categories: very poor, poor,
good, and excellent. This system was based on
predefined criteria from the pilot study, which
helped to objectively measure and compare the
skill levels of the participants (Abodunrin et al.,
2018).
Ethical Considerations
Ethical approval was obtained from the
Department of Community Medicine at Ahmadu
Bello University, Zaria. In addition, permissions
were secured from the Directors of Primary Health
Care in Sabon Gari and Zaria Local Government
Areas, as well as from the heads of the participating
PHCs. All participants provided informed written
consent, ensuring they were aware of the study's
purpose, procedures, and their rights, including
the option to withdraw at any time. Confidentiality
was maintained throughout the study by
anonymizing responses and securely storing data
(Federal Ministry of Health, 2010; National
Population Commission & ICF International,
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2014).
Study Limitations
The cross-sectional design of this study captures
the skill levels of healthcare workers as of
December 2016. However, it does not account for
changes in skills or healthcare practices that may
have occurred since then due to policy changes,
training programs, or resource updates.
Additionally, the reliance on self-reported data
introduces the potential for bias, as participants
may either overestimate their skills or
underreport deficiencies. To mitigate this, the
study included practical scenario-based questions
to complement the self-assessment and provide a
more accurate picture of the participants' skills
(World Health Organization, 2014).
RESULTS
A total of 146 questionnaires were administered,
resulting in a response rate of 95% with 139
completed questionnaires returned. The collected
data were analysed using SPSS version 21 and
presented in tables and charts to address the study
objectives. The high response rate of 95%
indicates the cooperation and engagement of the
healthcare workers involved in the study,
enhancing the representativeness of the findings.
As seen in Table 1, most (35.3%) of the
respondents were within the age group 26-35
years with a mean age of 30.9±8.8 standard
deviation. Majority (83.5%) of them were females,
69.1% of them were married, 83.5% of were
Hausa, majority (85.6%) of them were Muslims,
most of them (87.8%) have had tertiary education,
and 29.5% of them were nurses/midwives.
Table 1: Socio-demographic characteristics of respondents
Variable
Frequency (n=139)
Percent (%)
Age (years)
<26
26-35
36-45
>45
Sex
Male
Female
Marital status
Married
Single
Divorced
Widowed
Tribe
Hausa
Yoruba
Igbo
Others
46
49
35
9
23
116
96
41
1
1
116
5
4
14
33.1
35.3
25.2
6.5
16.5
83.5
69.1
29.5
0.7
0.7
83.5
3.6
2.9
10.1
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Religion
Christianity
Islam
Others
Education status
Primary
Secondary
Tertiary
Qualification
Nurse/midwife
CHO
SCHEW
JCHEW
EHO
Medical Lab Technician
Others
18
119
2
2
15
122
41
10
25
20
15
11
17
12.9
85.6
1.4
1.4
10.8
87.8
29.5
7.2
18.0
14.4
10.8
7.9
12.2
Fifty-five (39.6%) of the respondents had a health care working experience of less than 3 years, 31
(22.3%) had experience of between 3-5 years while 53 (38.1%) of respondents have been health workers
for more than 5 years.
Table 2: Work experience of respondents
Variable
Frequency (n=139)
Percent
Below 3 years
55
39.6
3-5 years
31
22.3
Greater than 5 years
53
38.1
Majority (65.5%) of the respondents have had some form of medical training within the last two years
preceding this study.
Table 3: PHC workers who have had some form of medical training in the last two years of
practice
Medical training
Frequency (n=139)
Percent (%)
Had
91
65.5
Not had
48
34.5
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Majority (65.5%) of the respondents would like to attend a training to improve their knowledge of the
management of common paediatric emergencies.
Figure 1: PHC workers who would like to attend a training to improve their knowledge of the
management of common paediatric emergencies
DISCUSSION
The implementation of a Paediatric Emergency
Management Training Program for primary
healthcare (PHC) workers in Zaria is crucial for
enhancing the emergency care capabilities at the
grassroots level. This study, aimed at evaluating
the impact of such a program, revealed several
critical insights into the preparedness and training
needs of healthcare workers in this region.
The study highlighted a significant gap in the
formal training of PHC workers, particularly in the
management of paediatric emergencies. Despite
the relatively high interest in further training
(94.2% of respondents), the actual knowledge and
skill levels in critical areas such as severe malaria
management,
dehydration
treatment,
and
emergency response protocols were found to be
inadequate. For instance, only 30.4% of healthcare
workers correctly identified IV artesunate as the
first-line treatment for severe malaria, reflecting a
broader trend of insufficient familiarity with up-to-
date treatment guidelines (Akinyemi et al., 2017;
Chinawa et al., 2020)
This lack of preparedness underscores the urgent
need for targeted training interventions. The
disparities in knowledge and skills among
healthcare workers, particularly when compared
to studies in more resource-rich settings, highlight
the consequences of insufficient training. In high-
income countries, standardized training programs
such as Paediatric Advanced Life Support (PALS)
have been shown to dramatically improve the
readiness of healthcare providers, with over 93.5%
of participants achieving high scores on
competency assessments (Topjian et al., 2020). In
contrast, the lower performance observed in Zaria
can be attributed to the absence of similar,
rigorous training frameworks in the Nigerian PHC
system.
Moreover, the study revealed that most healthcare
workers did not possess adequate skills in
94.2%
2.9%
2.9%
Interested
Not interested
Not sure
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emergency
response,
with
only
23.6%
demonstrating good diagnostic skills for paediatric
emergencies. This is particularly concerning given
the high incidence of paediatric emergencies such
as severe dehydration, which requires prompt and
accurate intervention (World Health Organization,
2014; Okoli & Oli, 2015). The study's findings are
consistent with previous research in similar
settings, where healthcare workers often struggle
with the practical application of theoretical
knowledge in emergency situations (Abodunrin et
al., 2018).
The successful implementation of a Paediatric
Emergency Management Training Program in
Zaria would likely address these deficiencies by
providing comprehensive, hands-on training
tailored to the specific challenges faced by
healthcare workers in this region. Such a program
should include modules on the management of
common paediatric emergencies, the use of
emergency equipment, and adherence to
standardized treatment protocols. The training
should also incorporate simulation-based learning,
which has been shown to significantly improve
clinical skills and decision-making in emergency
scenarios (Auerbach et al., 2018).
Furthermore, the study highlights the importance
of continuous professional development. Given the
rapidly evolving nature of medical guidelines and
the introduction of new treatment modalities, it is
imperative that healthcare workers in PHCs
receive ongoing training to keep their skills and
knowledge up to date (Fagbamigbe et al., 2020).
This could be facilitated through periodic refresher
courses, workshops, and access to updated clinical
guidelines.
The findings of this study clearly demonstrate the
need for a structured and ongoing Paediatric
Emergency Management Training Program in
Zaria. Such a program would not only enhance the
knowledge and skills of PHC workers but also
improve the overall quality of care provided to
children in emergency situations. Implementing
this training program would be a critical step
towards achieving better health outcomes for
children in Zaria and similar settings across
Nigeria.
CONCLUSION
The statistically significant relationship between
academic qualifications and knowledge levels in
both the causes and treatment of paediatric
emergencies suggests that improving educational
standards and providing regular, structured
training can significantly enhance the competency
of healthcare workers. Establishing a sustained
partnership between the Department of
Paediatrics at Ahmadu Bello University Teaching
Hospital and the Departments of Primary Health
Care in Zaria and Sabon Gari Local Governments is
crucial. Regular training workshops, held
quarterly, are recommended to ensure that PHC
workers are consistently equipped with the
necessary skills to manage paediatric emergencies
effectively.
By addressing the gaps in knowledge and skills
through ongoing training and support, it is possible
to improve the quality of care provided at PHC
centres. This, in turn, can lead to a significant
reduction in childhood mortality rates in the
region, ultimately contributing to better health
outcomes for children in Nigeria. The study’s
findings advocate for a proactive approach to
healthcare worker training, emphasizing the
importance
of
continuous
professional
development in the fight against preventable
childhood diseases.
Availability of Data and Materials
The authors declare consent for all available data
present in this study.
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FUNDING
This research did not receive any grant from
funding agencies in the public, commercial, or not-
for-profit sectors.
Authors’ Contributions
The entire study procedure was conducted with
the involvement of all writers.
Competing Interests
The authors declare no conflicts of interest.
ACKNOWLEDGEMENTS
The authors would like to acknowledge the
management and technical staff of PENKUP
Research Institute, Birmingham, United Kingdom
for their excellent assistance and for providing
medical writing/editorial support in accordance
with Good Publication Practice (GPP3) guidelines.
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