KE7 Requirements: Malnutri tion

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

2. 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

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

4. 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

5. 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

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

7. www.som.soton.ac.uk/learn/test/nutrition

8. 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

9. 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

10. The course • How it works

11. 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

12. 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

13. 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

14. Study venue

15. Participants: Nurses and midwife trainees

16. Participants – Doctors and medical students

17. Participants – Doctors and medical students

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

19. Focus group discussions

20. Findings: Knowledge

21. 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

22. 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.”

23. 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.”

24. 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

25. 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

26. 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

27. Looking with a nutritional lens: Sheema

28. Thank you