KE7 Requirements: Malnutrition Caring for infants and children with acute malnutrition Professor Alan Jackson, Dr Reginald Annan, Dr Sunhea Choi 24 th March 2011 Nutrition Diet and Lifestyle Biomedical Research Unit

Background and Problem Malnutrition is common - Severe Acute Malnutrition (SAM) affects 19 million children under 5 Malnutrition: major cause of death and disability –One-thirds of deaths –20% loss of healthy life years Addressing malnutrition critical to the Millennium Development Goals 2

Why malnutrition management has failed Inappropriate of systems and structures Limited competency of health professionals –Building capacity of health professionals to address competency 3

Commitments Global agenda to address lack of competencies –The Johannesburg Resolution in 2010 –The ANEC IV Nairobi Declaration in 2010 –WHO’s standard guidelines: 10 steps to management works  Scaling up is essential Fact-to-face training using guidelines cannot meet needs –Accessibility –Adequacy –Timeliness 4

Solution The IMTF and eLearning developed a course called “Caring for infants and children with Severe Acute Malnutrition (SAM)” Provides standardised and interactive learning in 3 modules: –Module 1: Definition and Classification –Module 2: Assessment and identification –Module 3: Application and management 5

Goal On completion, user gains the core knowledge and competencies for SAM management 6 Individualised learning for health professionals with responsibility for child care –paediatricians, –Nurses and nursing students –medical students and doctors Target audience

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Key requirements for malnutrition course Support user to develop the core competencies for SAM management Support existing and future health care practitioners. Potential for continuous professional development (CPD) Take 6-9 hours Based on WHO’s guidelines –Standardised, accessible and certificated 8

Design Rich in media Run on low spec computer and internet –Developing and developed regions Interactive, engaging and reflective learning experience Use of community characters 9

The course How it works 10

Evaluation study in Uganda Collaboration –Uganda Paediatric Association (UPA) and Makerere Medical School In December 2010 Venue: Medical School Work Station, Mulago Hospital Aim of pilot – Investigate effectiveness and appropriateness of delivery 11

Methods Four team members in Kampala Using: -Pre- and post- knowledge tests -Pre and post questionnaires -Observation -Individual interviews and diaries and -Focus groups discussions 12

Participants Eighty six, comprising –Doctors and final year medical students = 41 (47%) –Nurses = 8 (9.3%) –midwife trainees = 16 (18.6%) –Others (nutritionists, journalist, agriculturist) = 21 (24.4%) took part in three half-days training 80 completed it in full 13

Study venue 14

Participants: Nurses and midwife trainees 15

Participants – Doctors and medical students 16

Participants – Doctors and medical students 17

The team at work 18 Dr Sunhea Choi The team from the right Dr Sunhea Choi Flo Tuyarshemererwa Trevor Martin Pickup Dr Reggie Annan

Focus group discussions 19

Findings: Knowledge 20

Understanding, competency and design Identifying appropriate management option Reductive adaptation Community based management Easy/enjoy using Interactive, conversational and reflective learning approach Community characters Perception of malnutrition 21

Participants comments “ From now I will be able to diagnose children with malnutrition in acute ward and in the community and give advice accordingly.” “I learnt a lot from the pilot course, my knowledge has been broadened and the use of the Community in this study has made me feel as though I have gained actual experience in identifying and treating malnutrition.” 22

Participants overall experience “This is a highly innovative and timely venture that I am proud to contribute to. We need more of such modules.” “Thanks for the good course, many children in villages and community are suffering from malnutrition -- so thanks because I will be able to teach and advise now I have more knowledge about it.” “Thanks a lot, by teaching/training us, you trained 100-fold and hope fewer children will suffer the morbidity & mortality due to malnutrition.” 23

Way forward Enabling children to grow is fundamental Our eLearning solution works –It is easy, relatively cheap, accessible, standardised, can reach many people Challenges –Exploring other means: mobile phones? We can make a difference 24

Funding support for the project International Malnutrition Task Force, IUNS/IPA Royal College of Paediatric and Child Health (RCPCH), UK Faculty of Medicine, University of Southampton World Health Organisation (WHO) United Nations Children’s Fund (UNICEF) International Atomic Energy Agency (IAEA) Microlink South East Central Strategic Health Authority 25

The project team Chief investigator: Professor Alan Jackson Project manager and learning designer: Dr Sunhea Choi Lead author: Dr Reginald Annan Reviewer: Professor Ann Ashworth Hill Design and development: SoM eLearning team Evaluation team Sunhea Choi Reginald A Annan Flo Turyashemererwa Trevor P Pickup 26

Looking with a nutritional lens: Sheema 27

Thank you 28