Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda
Introduction: The COVID-19 pandemic highlighted the gaps and the need to strengthen the emergency care system in Uganda. The Ugandan Ministry of Health implemented an emergency care capacity-building program during the COVID-19 pandemic response to improve COVID-19 case management in Uganda. We desc...
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| Language: | English |
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Elsevier
2025-03-01
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| Series: | African Journal of Emergency Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X25000011 |
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| author | Sulaiman Bugosera Wasukira Carl Trevor Kambugu Judith Nanyondo S Emmanuel Candia Stephen Emmanuel Aporu Patricia Ikwaru Racheal Kwagala Andrew Kwiringira Peter Mukiibi Costance Murungi Marek Ma Celine Jacobs Cliff Asher Aliga Afizi Kibuuka Dathan M. Byonanebye Sylvia Natukunda Kenneth Bagonza Rose Muhindo Prisca Kizito Benard Toliva Opar Nathan Kenya-Mugisha Wilson Etolu Paska Apiyo Mohammed Larmode Joseph Oumo Rony Bahatungire John Baptist Waniaye Annet Alenyo-Ngabirano |
| author_facet | Sulaiman Bugosera Wasukira Carl Trevor Kambugu Judith Nanyondo S Emmanuel Candia Stephen Emmanuel Aporu Patricia Ikwaru Racheal Kwagala Andrew Kwiringira Peter Mukiibi Costance Murungi Marek Ma Celine Jacobs Cliff Asher Aliga Afizi Kibuuka Dathan M. Byonanebye Sylvia Natukunda Kenneth Bagonza Rose Muhindo Prisca Kizito Benard Toliva Opar Nathan Kenya-Mugisha Wilson Etolu Paska Apiyo Mohammed Larmode Joseph Oumo Rony Bahatungire John Baptist Waniaye Annet Alenyo-Ngabirano |
| author_sort | Sulaiman Bugosera Wasukira |
| collection | DOAJ |
| description | Introduction: The COVID-19 pandemic highlighted the gaps and the need to strengthen the emergency care system in Uganda. The Ugandan Ministry of Health implemented an emergency care capacity-building program during the COVID-19 pandemic response to improve COVID-19 case management in Uganda. We describe the curriculum development and rollout using a cascade model. Methods: In June 2021, the World Health Organisation (WHO) Hospital Emergency Unit Assessment Tool (HEAT) was used to assess emergency units and document existing capacity gaps in regional referral hospitals and general hospitals. The WHO Basic Emergency Care curriculum was modified to a training curriculum for emergency care principles for COVID-19 management. Training of trainers was conducted across 14 health regions in July and August 2021. The trainers trained cascaded the training through facility-based training during continuous professional development sessions. Results: Using the HEAT, 115 health facilities (14 regional and 101 general hospitals) were assessed. Only 31.3% (36/115) of the health facilities had a formal triage system. 53.5% (54/101) of general hospitals lacked non-rotating staff in the emergency unit. Some 511 healthcare workers from 205 facilities were trained as trainers, of whom 51.8% were nurses. The trainers trained cascaded the training to 3,550 healthcare workers. There was a significant difference between the overall median pre-test (71%) and median post-test (86.8%) scores of trainers trained (p<0.001). Conclusion: There was a general lack of emergency unit protocols and a shortage of fixed staff at the emergency units. The cascade model facilitated the dissemination of emergency care knowledge to seven times more healthcare workers than the trainers trained. This demonstrates the efficiency of this approach in knowledge dissemination and its ability to be replicated in other low resource settings. |
| format | Article |
| id | doaj-art-7f0eb272e3984552b4f69a52bdc18a7d |
| institution | Kabale University |
| issn | 2211-419X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj-art-7f0eb272e3984552b4f69a52bdc18a7d2025-02-03T04:16:41ZengElsevierAfrican Journal of Emergency Medicine2211-419X2025-03-01151565570Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in UgandaSulaiman Bugosera Wasukira0Carl Trevor Kambugu1Judith Nanyondo S2Emmanuel Candia3Stephen Emmanuel Aporu4Patricia Ikwaru5Racheal Kwagala6Andrew Kwiringira7Peter Mukiibi8Costance Murungi9Marek Ma10Celine Jacobs11Cliff Asher Aliga12Afizi Kibuuka13Dathan M. Byonanebye14Sylvia Natukunda15Kenneth Bagonza16Rose Muhindo17Prisca Kizito18Benard Toliva Opar19Nathan Kenya-Mugisha20Wilson Etolu21Paska Apiyo22Mohammed Larmode23Joseph Oumo24Rony Bahatungire25John Baptist Waniaye26Annet Alenyo-Ngabirano27Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; Department of Emergency Medical Services, Ministry of Health Uganda, Uganda; Corresponding author at: Infectious Diseases Institute, Makerere University, PO Box 22418, Kampala, Uganda.Infectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; Department of Emergency Medical Services, Ministry of Health Uganda, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; Department of Emergency Medical Services, Ministry of Health Uganda, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; Department of Emergency Medical Services, Ministry of Health Uganda, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; Department of Emergency Medical Services, Ministry of Health Uganda, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; Department of Emergency Medical Services, Ministry of Health Uganda, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, UgandaDepartment of Emergency Medical Services, Ministry of Health Uganda, UgandaSeed Global Health, UgandaAgha Khan University, Kampala, Uganda; Emergency Care Society of Uganda, Uganda; Walimu Uganda, UgandaJinja Regional Referral Hospital, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; School of Public Health, Makerere University, UgandaMbarara Regional Referral Hospital, UgandaEmergency Care Society of Uganda, Uganda; Mbarara University of Science and Technology, Uganda; Mbarara Regional Referral Hospital, UgandaMbarara University of Science and Technology, Uganda; Mbarara Regional Referral Hospital, UgandaMbarara University of Science and Technology, Uganda; Mbarara Regional Referral Hospital, UgandaWalimu Uganda, UgandaWalimu Uganda, UgandaSoroti Regional Referral Hospital, UgandaGulu Regional Referral Hospital, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, UgandaDepartment of Emergency Medical Services, Ministry of Health Uganda, UgandaDepartment of Emergency Medical Services, Ministry of Health Uganda, UgandaDepartment of Emergency Medical Services, Ministry of Health Uganda, UgandaInfectious Diseases Institute, College of Health Sciences, Makerere University, Uganda; Department of Emergency Medical Services, Ministry of Health Uganda, Uganda; Seed Global Health, UgandaIntroduction: The COVID-19 pandemic highlighted the gaps and the need to strengthen the emergency care system in Uganda. The Ugandan Ministry of Health implemented an emergency care capacity-building program during the COVID-19 pandemic response to improve COVID-19 case management in Uganda. We describe the curriculum development and rollout using a cascade model. Methods: In June 2021, the World Health Organisation (WHO) Hospital Emergency Unit Assessment Tool (HEAT) was used to assess emergency units and document existing capacity gaps in regional referral hospitals and general hospitals. The WHO Basic Emergency Care curriculum was modified to a training curriculum for emergency care principles for COVID-19 management. Training of trainers was conducted across 14 health regions in July and August 2021. The trainers trained cascaded the training through facility-based training during continuous professional development sessions. Results: Using the HEAT, 115 health facilities (14 regional and 101 general hospitals) were assessed. Only 31.3% (36/115) of the health facilities had a formal triage system. 53.5% (54/101) of general hospitals lacked non-rotating staff in the emergency unit. Some 511 healthcare workers from 205 facilities were trained as trainers, of whom 51.8% were nurses. The trainers trained cascaded the training to 3,550 healthcare workers. There was a significant difference between the overall median pre-test (71%) and median post-test (86.8%) scores of trainers trained (p<0.001). Conclusion: There was a general lack of emergency unit protocols and a shortage of fixed staff at the emergency units. The cascade model facilitated the dissemination of emergency care knowledge to seven times more healthcare workers than the trainers trained. This demonstrates the efficiency of this approach in knowledge dissemination and its ability to be replicated in other low resource settings.http://www.sciencedirect.com/science/article/pii/S2211419X25000011Emergency careCapacity buildingEmergency medical servicesCascadeCOVID-19 |
| spellingShingle | Sulaiman Bugosera Wasukira Carl Trevor Kambugu Judith Nanyondo S Emmanuel Candia Stephen Emmanuel Aporu Patricia Ikwaru Racheal Kwagala Andrew Kwiringira Peter Mukiibi Costance Murungi Marek Ma Celine Jacobs Cliff Asher Aliga Afizi Kibuuka Dathan M. Byonanebye Sylvia Natukunda Kenneth Bagonza Rose Muhindo Prisca Kizito Benard Toliva Opar Nathan Kenya-Mugisha Wilson Etolu Paska Apiyo Mohammed Larmode Joseph Oumo Rony Bahatungire John Baptist Waniaye Annet Alenyo-Ngabirano Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda African Journal of Emergency Medicine Emergency care Capacity building Emergency medical services Cascade COVID-19 |
| title | Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda |
| title_full | Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda |
| title_fullStr | Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda |
| title_full_unstemmed | Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda |
| title_short | Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda |
| title_sort | implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the covid 19 outbreak in uganda |
| topic | Emergency care Capacity building Emergency medical services Cascade COVID-19 |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X25000011 |
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