title: Impact of contextualized pediatric resuscitation training on pediatric healthcare providers in Botswana.
abstract: BACKGROUND
  Worldwide, 6.6 million children die each year, partly due to a failure to recognize and treat acutely ill children. Programs that improve provider recognition and treatment initiation may improve child survival.
  
  
  OBJECTIVE
  Describe provider characteristics and hospital resources during a contextualized pediatric resuscitation training program in Botswana and determine if training impacts provider knowledge retention.
  
  
  METHODS
  The American Heart Association's Pediatric Emergency Assessment Recognition and Stabilization (PEARS) course was contextualized to Botswana resources and practice guidelines in this observational study. A cohort of facility-based nurses (FBN) was assessed prior to and 1-month following training. Survey tools assessed provider characteristics, cognitive knowledge and confidence and hospital pediatric resources. Data analysis utilized Fisher's exact, Chi-square, Wilcoxon rank-sum and linear regression where appropriate.
  
  
  RESULTS
  61 healthcare providers (89% FBNs, 11% physicians) successfully completed PEARS training. Referral facilities had more pediatric specific equipment and high-flow oxygen. Median frequency of pediatric resuscitation was higher in referral compared to district level FBN's (5 [3,10] vs. 2 [1,3] p=0.007). While 50% of FBN's had previous resuscitation training, none was pediatric specific. Median provider confidence improved significantly after training (3.8/5 vs. 4.7/5, p<0.001), as did knowledge of correct management of acute pneumonia and diarrhea (44% vs. 100%, p<0.001, 6% vs. 67%, p<0.001, respectively).
  
  
  CONCLUSIONS
  FBN's in Botswana report frequent resuscitation of ill children but low baseline training. Provider knowledge for recognition and initial treatment of respiratory distress and shock is low. Contextualized training significantly increased FBN provider confidence and knowledge retention 1-month after training.
authors.affiliation: Children's Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
authors.forename: Shelton W
authors.initials: SW
authors.lastname: Wright
authors.affiliation: Children's Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States; Botswana-UPenn Partnership, 214 Independence Ave, Gaborone, Botswana; University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steenhoff
authors.affiliation: Children's Hospital of Philadelphia 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
authors.forename: Okan
authors.initials: O
authors.lastname: Elci
authors.affiliation: Children's Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Wolfe
authors.affiliation: Naval Hospital, 3475N Saratoga St, Oak Harbor, WA 98277, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Ralston
authors.affiliation: Clinical Services, Botswana Ministry of Health, Gaborone, Botswana.
authors.forename: Thandie
authors.initials: T
authors.lastname: Kgosiesele
authors.affiliation: Princess Marina Hospital, Botswana Ministry of Health, Gaborone, Botswana.
authors.forename: Ishmael
authors.initials: I
authors.lastname: Makone
authors.affiliation: University of Botswana School of Medicine, Gaborone, Botswana.
authors.forename: Loeto
authors.initials: L
authors.lastname: Mazhani
authors.affiliation: Children's Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: Children's Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States; Botswana-UPenn Partnership, 214 Independence Ave, Gaborone, Botswana. Electronic address: meaney@chop.edu.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meaney
mesh_terms: D001902:Botswana; D002648:Child; D004501:Education, Medical / Q000592:standards*; D004630:Emergencies; D006282:Health Personnel / Q000193:education*; D006801:Humans; D010372:Pediatrics / Q000193:education*; D012151:Resuscitation / Q000193:education*
keywords: Developing countries; Emergency training, Pediatric emergency training; PEARS; Pediatric Emergency Assessment Recognition and Stabilization; Resource-limited setting; Resuscitation education