@article{ref1,
title="Delivering a sustainable trauma management training programme tailored for low-resource settings in East, Central and Southern African countries using a cascading course model",
journal="Injury",
year="2015",
author="Peter, N. A. and Pandit, H. and Le, G. and Nduhiu, M. and Moro, E. and Lavy, C.",
volume="47",
number="5",
pages="1128-1134",
abstract="BACKGROUND: Injuries cause five million deaths and 279 Disability Adjusted Life Years (DALYS) each year worldwide. The COSECSA Oxford Orthopaedic Link (COOL) is a multi-country partnership programme that has delivered training in trauma management to nine sub-Saharan countries across a wide-cadre of health-workers using a model of &quot;primary&quot; courses delivered by UK instructors, followed by &quot;cascading&quot; courses led by local faculty. This study examines the impact on knowledge and clinical confidence among health-workers, and compares the performance of &quot;cascading&quot; and &quot;primary&quot; courses delivered in low-resource settings. <br><br>METHODS: Data was collated from 1030 candidates (119 Clinical Officers, 540 Doctors, 260 Nurses and 111 Medical Students) trained over 28 courses (9 &quot;primary&quot; and 19 &quot;cascading&quot; courses) in nine sub-Saharan countries between 2012 and 2013. Knowledge and clinical confidence of candidates were assessed using pre- and post-course MCQs and confidence matrix rating of clinical scenarios. Changes were measured in relation to co-variants of gender, job roles and primary versus cascading courses. Multivariate regression modelling and cost analysis was performed to examine the impact of primary versus cascading courses on candidates' performance. <br><br>FINDINGS: There was a significant improvement in knowledge (58% to 77%, p<0.05) and clinical confidence (68% to 90%, p<0.05) post-course. &quot;Non-doctors&quot; demonstrated a greater improvement in knowledge (22%) and confidence (24%) following the course (p<0.05). The degree of improvement of MCQ scores differed significantly, with the cascading courses (21%) outperforming primary courses (15%) (p<0.002). This is further supported by multivariate regression modelling where cascading courses are a strong predictor for improvement in MCQ scores (Coef=4.83, p<0.05). <br><br>INTERPRETATION: Trauma management training of health-workers plays a pivotal role in tackling the ever-growing trauma burden in Africa. Our study suggests cascading PTC courses may be an effective model in delivering trauma training in low-resource settings, however further studies are required to determine its efficacy in improving clinical competence and retention of knowledge and skills in the long term.<p /> <p>Language: en</p>",
language="en",
issn="0020-1383",
doi="10.1016/j.injury.2015.11.042",
url="http://dx.doi.org/10.1016/j.injury.2015.11.042"
}