Nutrition Diet and Lifestyle
Biomedical Research Unit
KE7 Requirements: Malnutri tion
Caring for infants and children with acute
malnutrition
Professor Alan Jackson, Dr Reginald Annan, Dr Sunhea Choi
24th March 2011
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
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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
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Target audience
• Individualised learning for health professionals with
responsibility for child care
– paediatricians,
– Nurses and nursing students
– medical students and doctors
Goal
• On completion, user gains the core knowledge and
competencies for SAM management
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www.som.soton.ac.uk/learn/test/nutrition
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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
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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
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The course
• How it works
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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
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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
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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
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Study venue
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Participants: Nurses and midwife trainees
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Participants – Doctors and medical students
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Participants – Doctors and medical students
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The team at work
Dr Reggie Annan
Dr Sunhea Choi
The team from the right
Dr Sunhea Choi
Flo Tuyarshemererwa
Trevor Martin Pickup
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Focus group discussions
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Findings: Knowledge
90
80
70
60
50
Participants Pre-Test
40
Participants Post-Test
30
20
10
0
All
Medicine students Student nurses
& doctors
Midwifery
students
Others
(nutritionists,
journalist,
agriculturist, etc)
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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
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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.”
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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.”
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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
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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
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The project team
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•
•
•
•
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
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Looking with a nutritional lens: Sheema
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Thank you
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