Uganda health worker training of non-communicable diseases

Abstract

Background: According to the World Health Organization, 25% of Uganda deaths are attributable to cardiovascular diseases, diabetes, cancers, and chronic obstructive pulmonary diseases. Care for patients with non-communicable diseases (NCD) is often fragmented and requires an integrated approach to care. As NCDs increase in Uganda, it has become increasingly more important to focus on NCD education for healthcare workers. The Ministry of Health has undertaken NCD training activities as one of its many responsibilities which fall under its capacity building agenda. This study aimed to look at whether the selected NCD training was an effective way of positively impacting NCD knowledge in this population. Methods: The objectives to sensitize HCWs to the major NCDs in Uganda and to common risk factors in order to inform improved screening and early detection of NCDs through an integrated approach and to train these HCWs on how to appropriately refer patients with NCDs within the health system. Each five-day-long training activity for HCW, including nurses, clinical officers, medical officers, and consulting physicians. Cadres are combined due to the importance of a team-based approach to chronic care management. The training curriculum includes three components: group reading, role-plays, and group discussion. Findings: There were 165 health workers who received the NCD training. The average age of the health worker in this training program was 56.6 (SD 9.7) and the majority of health workers were male (61.8%). Workers from 13 different hospitals were trained. There were four types of health workers trained including Nursing Officers (32.4%), Clinical Officers (29.4%), Medical Officers (14.7%), and Physicians (23.5%). Qualifications were grouped into nursing degrees (35.3%), clinical officer training only (5.9%), clinical medicine and/ or community health degrees (23.5%), or an MBcHB (35.3%). Experience levels were grouped in increments of 5, beginning with 0- 5 years of experience and extending up to 35 years of experience. The average improvement in pre and post test score significantly increased by 11.9 percentage points after receiving the TOT training (S.D. 10.6, p < 0.0001). Score difference ranges from a 12 point decrease to a 36 point increase. ANOVA was done as a secondary analysis to determine if there were differences in those who reported positive scores versus those who reported negative scores based on age, sex, hospital, cadre, original qualification, and years of experience. No significant differences were detected. Interpretation: The pre and post tests showed significant positive increases in scores after health workers had received the TOT training. Follow-up studies should look at differences in score improvements among those who receive the training from the second round. Studies should also look to see if there are observable differences in scores between those of different experience levels and training types.