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Implementation of evidence-based African First Aid Materials (AFAM) in Sub-Saharan Africa

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Implementation of evidence-based African First Aid Materials (AFAM) in Sub-Saharan Africa

  1. 1. Implementation of evidence-based African First Aid Materials (AFAM) in Sub-Saharan Africa A view from the field Emmy De Buck Centre for Evidence-Based Practice Belgian Red Cross-Flanders Rode Kruis Brian Bilal Kanaahe Mwebaze Program Manager First Aid and Road Safety Uganda Red Cross Society
  2. 2. Disclosure of interests I certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect significantly my views on the subject on which I am presenting, other than the following: Financial relationships: Employment at the Centre for Evidence-Based Practice of Belgian Red Cross-Flanders Non-financial relationships: Member of the First Aid Task Force of the International Liaison Committee on Resuscitation, developing international first aid guidelines
  3. 3.  Development of African First Aid Materials  Initiatives to enhance guideline implementation  Feedback from the field: − Red Cross National Societies in Sub-Saharan Africa and other users − Detailed view from the field from the Uganda Red Cross Society Content
  4. 4.  First aid training: a cost-effective opportunity to decrease the burden of disease & injury in Sub-Saharan Africa (World Bank).  Aim: To develop guidelines and materials with up-to-date first aid and prevention advice, specifically directed at the African context Context
  5. 5. First step: selection of topics  Based on published injury and disease statistics for Sub- Saharan Africa  Criteria: o Topics that contribute the most to the burden of disease o Injuries or diseases that can be addressed by first aid  Selected topics: o Sudden illness, such as stroke, fever, diarrhoea, … o Injuries, such as bleeding, burns, snake bite, head injury, … o Poisoning o Emergency childbirth
  6. 6. Second step: collection of evidence  Stepwise literature review for each topic and development of evidence summaries.  Databases consulted: − WHO, GIN, NGC, The Cochrane Library, MEDLINE, Embase − Specific African databases such as “African Index Medicus” and “Afrolib”  Focus on studies performed in Africa  Selection criteria: alternative interventions, household level, limited resources  Relevant studies were checked for their quality
  7. 7. Second step: collection of evidence Potentially relevant studies with relevance to first aid n = 23998 Studies selected for full text evaluation n = 885 Included studies n = 143 Studies excluded from titles and abstracts n = 23113 Studies excluded from full text n = 742 Unavailable studies n = 6 Other language n = 22 Study design criteria n = 197 Population criteria n = 39 Intervention criteria n = 125 Outcome criteria n = 12 Evidence covered in other included studies n = 341
  8. 8.  Composition: − 5 African specialists − 5 representatives of African Red Cross societies − a medical anthropologist  Tasks: − Discussion and validation of the draft recommendations and didactical material − Formulation of Good Practice Points where evidence was lacking Third step: validation by experts
  9. 9. Third step: validation by experts
  10. 10. Fourth step: consultation round  Feedback from external peer reviewers  Conclusions pilot study (Uganda and Swaziland): − Some of the illustrations in AFAM were adapted to reflect the African context as close as possible − It is not possible to make a general manual that is adapted to all African countries, regions, habits,… − The experiences and lessons learnt integrated in an implementation guide, in order to help organisations to make their own adapted materials
  11. 11. Fourth step: consultation round
  12. 12. Fifth step: AFAM implementation  Implementation was started in 2011 in 8 African Red Cross National Societies receiving support from Belgian Red Cross-Flanders
  13. 13.  Development of African First Aid Materials  Initiatives to enhance guideline implementation  Feedback from the field: − Red Cross National Societies in Sub-Saharan Africa and other users − Detailed view from the field from the Uganda Red Cross Society Content
  14. 14. 1. Materials adapted to the target group  Conditions are classified according to the most important signs for easy recognition.  Instructions are simple.  Simple and clear drawings that are easy to copy.  Texts and African illustrations including youths, adults and elderly people from multiple ethnic and religious backgrounds.  In English, French, Portuguese. Rinse out the eye straight away with preferably clean water. Do this for 10 – 15 minutes, from the nose outwards so that none of the liquid runs out from one eye into the other.
  15. 15. 2. Flexibility of didactical materials  AFAM is provided on a DVD: − Separate text-files, separate files of pictures and drawings − Didactical films to illustrate first aid techniques − Helps to develop own first aid manuals, first aid courses, posters, slides, flipcharts, …  Also ready-to-use generic manual available for those not able to develop own materials (2 versions: with and without supporting evidence)
  16. 16. 3. Implementation guide  Lessons learnt from the pilot study included  Booklet on www.afam.redcross.be + poster  Objective: to assist an organisation in making their own first aid training materials using AFAM  Every step indicates: - Preconditions (essential premises) - Supportive tools (online devices) - Expected outcome or result - Do you know that… - A few examples
  17. 17. 4. AFAM Website for sharing of materials www.afam.redcross.be
  18. 18.  Development of African First Aid Materials  Initiatives to enhance guideline implementation  Feedback from the field: − Red Cross National Societies in Sub-Saharan Africa and other users − Detailed view from the field from the Uganda Red Cross Society Content
  19. 19. Current AFAM users Countries with support from BRC-F Countries without support from BRC-F Botswana Sierra Leone Cameroun Mauritius Ghana Nigeria Gambia Seychelles Uganda Madagascar Swaziland South Sudan Kenya Sudan Namibia Somalia South-Africa Liberia Burundi Djibouti Malawi Lesotho Mozambique Monaco  W-Africa BRC-F: Belgian Red Cross-Flanders
  20. 20. Current AFAM users
  21. 21. Survey in countries using AFAM Number of African RCNS that received AFAM 24 Number of respondents 12 Number of RCNS that developed own materials: -with support of BRC-F -without support of BRC-F  Type of materials developed: manuals, posters  In addition to the drawings provided in AFAM, additional anatomical drawings are desirable  Main target users: Red Cross headquarters, commercial first aid  Reason for not using AFAM: lack of funding (100% of respondents not using AFAM) 9 8 1 Number of respondents using AFAM films 40% Number of respondents using the AFAM website for sharing 0 RCNS: Red Cross National Society; BRC-F: Belgian Red Cross-Flanders
  22. 22. Materials developed by African RCNS  Materials developed: extensive manual, pocket manual, posters
  23. 23. Materials developed by African RCNS (2) Drawings from manual developed by Burundi Red Cross
  24. 24.  Flexibility of materials allows organisations to use the materials according to their capacity/possibility  Lack of funding is a major barrier for organisations to develop own materials and to use the guidelines  More ready-to-use materials are necessary for those who are not able to develop own materials: − Different “packages” for different target populations (e.g. commercial, schools,…) − Films illustrating first aid techniques are interesting didactical materials (First Aid App…) − We should promote sharing of materials using the AFAM website as a platform Lessons learnt
  25. 25.  Development of African First Aid Materials  Initiatives to enhance guideline implementation  Feedback from the field: − Red Cross National Societies in Sub-Saharan Africa and other users − Detailed view from the field from the Uganda Red Cross Society Content
  26. 26. Disclosure of interests I certify that, to the best of my knowledge, no aspect of my current personal or professional situation might reasonably be expected to affect significantly my views on the subject on which I am presenting, other than the following: • First Aid Head quarter programming team at Uganda Red Cross, & in Project Areas, BRCF
  27. 27. FEED BACK FROM THE FIELD  PRESENTATION OUT LAY − Prehospital care situation in Uganda − Capacity development aspect of AFAM to URCS − Most significant Outcome from First Aid Programme & Staff of URCS, first aid trainers and volunteers, Uganda Police, medical community, community members, corporate institutions and academic institutions − Challenges and how they are being solved
  28. 28. About our catchment area  Current Uganda’s population: 36 million Annual growth rate: 3.2% − Doctor: Patient Ratio: 1:25,000  Hospitals: 2 National Referral Hospitals, 5 Recognized Regional Referral Hospitals, 32 District Referral Hospitals. A lot of private clinics and hospitals have developed. − Complaints of understaffing & Medicines availability − No standard emergence toll free line − No compulsory individual health insurance programme − Good Samaritan law:-not yet in place: ongoing advocacy  Uganda Red Cross operates in 51 branches all over the country. − Providing basic quality first aid training to every one without discrimination is a core activity of URCS. (www.redcrossug.org )
  29. 29. Capacity Development Aspect  First Aid Project in 5 branches of Uganda Red Cross (2011-2013)  1st National First Aid Refresher Training On Latest FA Guidelines (in 2011) − Oriented 22 National First Aid Trainers from all 5 regions in the country on the latest evidence based and scientific guidlines in first aid − Printing and provision of updated 10,000IEC Materials, (60) FA Trainers Manual, 5,000 First Aid Booklets, & 1 Resource AFAM CD. − Distribution of 5 Computers, 5 Cameras, 5 Printers, 8 CPR Mannequins (Adult & Infant)
  30. 30. Capacity Development cont’d  1st National First Aid Simulation Training − Empowered 25 National First Aid Trainers with basic simulation skills to be able to use locally available materials as a step to improving the quality of first aid trainings. − Trainer: An international simulator from Belgium − More 98 First Aid Trainers distributed over the country with evidence based first aid guidelines and simulation. − All first aid trainings have an aspect of simulation. No longer, the ‘assume there is a wound here…’ − Trained 3,356 people in evidence based first aid in 2013 − Conducted 27 First Aid simulations for the public
  31. 31. First National First Aid Simulation Training
  32. 32. First Aid Simulations for the Public − At national level (At International Airport) − At branch level (Black spots, Schools…)
  33. 33. Most Significant Outcomes  ‘We strongly welcome this new approach of AFAM in First Aid trainings for the police. We hope they will be able to be resourceful enough to use these materials in the local contexts of the zones they work in’. Special Forces UPDF Mission to Somalia  ‘Most often, we’ve been challenged by the local communities when they could ask us about the scientific basement to using locally used materials. Now, we’ve been saved’, First Aid Trainer  ‘The good thing with AFAM is that there is no excuse. Materials are available , cheap and fit into the culture. So, there is more accessibility and realization that First Aid is for medical people alone’ First Aid Community Volunteer
  34. 34.  ‘By this AFAM approach, the Uganda Red Cross has re affirmed its leading role in providing emergency health services but needs to form a medical research team in the whole country to ensure that more research is done to document more of the undocumented practices in prehospital care’ Medical Professor, Mbarara University of Science & Technology  ‘We want to invest in evidence based practices. First aid is always changing and evolving. The burden of injuries which would have been preventable is evident’ Stanbic Bank  As a programme, AFAM makes our life easier. It’s a reflection of the CBHFA approach where communities are actively involved in addressing their own community health needs’ Uganda Red Cross Trainer
  35. 35. Areas for improvement & way forward  Setting up a National First Aid Advisory & Research Board. (A medical board)  Developing, printing and distribution of MORE of all the evidence based first aid IEC Materials  Embracing Multilateral funding and public private partnerships at National level to the community level  More standard First Aid training equipment  Comprehensive approach including road safety  Finalising & launching the First Aid App (1st Sept 2014)
  36. 36. Acknowledgements  Prof. Jimmy Volmink and the AFAM expert panel  Belgian Red Cross-Flanders colleagues  AFAM prevention guidelines: co-funded by FICA (Flanders International Cooperation Agency).  Development of didactical materials: supported by FICA as well as DGD (the Belgian Directorate General Development).  All Uganda Red Cross Staff, Volunteers, First Aid Trainers and cooperate bodies who accepted to be mentioned in this presentation

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