The Else Kröner-Fresenius-Stiftung (EKFS) has launched a special call for proposals to improve child health in developing countries and will fund the following two projects for at least five years with a total of three million euros.
Project: Improvement of Child Health in Low-Resource-Settings through Implementation of Ultrasonography
Organisation: German Society of Tropical Paediatrics and International Child Health (GTP) e.V.
Partner country: Malawi, Tanzania, Nepal
Partner organisation in partner country:
- Pediatric Association Tanzania (PAT), Dodoma Tanzania
- Department of Pediatrics, Muhimbili University Hospital, Daresalaam, Tanzania
- University of Dodoma (UDOM), Dodoma, Tanzania
- Zomba Central Hospital, Zomba, Malawi
- College of Medicine, Blantyre, Malawi
- Department of Pediatrics, Kathmandu University Hospital Dhulikhel, Nepal
Term: 5 years
In low resource settings (LRS) as in our partner countries, insufficient medical imaging services contribute to a limited and delayed diagnosis and treatment. Ultrasonography has a major influence on patient management in LRS, as alternative imaging techniques are hardly accessible. Especially children in LRS have limited access. Not only reduced availability but also the necessity of sedation/ narcosis for sectional imaging techniques like MRI or CT Scans in young children present additional obstacles in LRS. Ultrasound as a non-invasive, painless and radiation free imaging technique for diagnostic purposes, intervention and follow up is especially suitable in paediatrics. Through training of local Doctors and other health workers (nurses, Clinical Officers) in paediatric ultrasonography, and by making adequate devices and scientific supervision available, high quality paediatric ultrasonography will be implemented by this project. In cooperation with the partner hospitals, the local and regional need of ultrasonography training will be defined, in order to plan the corresponding training courses and to advertise them locally. In particular the institutions where the GTP has already conducted ultrasound training will be developed into regional training hubs.
- Creation of an international network for intensified and qualitative use of ultrasonography in Paediatrics in LRS (Else Kröner-Fresenius-Network for Paediatric Ultrasound).
- Establishmnet of an integrated access to ultrasonography in Paediatric and Adolescent Medicine through a continuous offer of ultrasonography training.
- Increasing independence and sustainability of our partners in the improvement of their diagnostic and therapeutic capacities.
- Number of course participants who take part in the trainings offered by the ultrasound network each year: Target of at least 625 course participants at the end of the project duration (25 course participants per year at each of the 5 partner hospitals).
- Number of local competent tutors and multipliers delivering the courses annually: Target of at least 10.
- Increase in competent use of ultrasound in everyday clinical practice: Comparison of the number of patients in the partner hospitals before and after project implementation who receive high-quality ultrasound and its impact on diagnosis and disease progression.
- Development of a standard curriculum for ultrasound courses for everyday clinical practice in paediatrics in the partner countries
- Delivery and evaluation of ultrasound courses through joint teaching of local and international tutors and experts
- Development of new point-of-care protocols for clinical use
- Establishment of an online platform for teaching and content exchange of clinical ultrasound diagnostics
- Identification and/or training of at least 2-3 local tutors and experts as multipliers and course leaders per site
- Further training through observation visits of local tutors and experts at German paediatric clinics
- Establishment of an international network for the transnational exchange of ultrasound experts and joint strengthening of the application of clinical ultrasound.
Through standardised ultrasound courses an evidence-based teaching structure is created, with the 5 partner hospitals acting as course sites and being developed into central training centres for continuing education nationwide. In these training hubs regular courses in paediatric ultrasonography and echocardiography will be offered with emphasis on training of trainers and mentoring, in order to establish long-lasting and sustainable training opportunities locally. The development of the curriculum will be done jointly with existing local ultrasound experts and health personnel working with the project partners qualified in ultrasonography will be integrated in the group of lecturers/trainers.
Depending on the local setting a fee from course participants may cover the local costs of the courses (use of training rooms, consumables and catering), thereby securing the sustainability of course offers beyond the duration of the project. The project will develop and improve the competence of clinical staff in ultrasound diagnostics in the clinical practice of treating children in the partner countries. The GTP specifically aims at supporting a South-South cooperation with increasing professional exchange as well as teaching and training capacities in the partner institutions and countries. The role of the GTP will be focused on advisory and networking support.
The outcome of this project will be an institutionalized international paediatric ultrasound network (Else Kröner-Fresenius-Paediatric-Ultrasound-Network) with lecturers from multiple countries, which will offer continuous training activities in sonography and will facilitate the implementation of high-quality ultrasound diagnostic services within the health services for children in need in the partner countries.
Ultrasonography is gaining diagnostic importance worldwide due to technological progress. New compact, portable and affordable devices allow high quality ultrasound imaging and thereby enhance access to ultrasonography outside radiology departments, throughout different medical disciplines, and at the point of care (point-of-care ultrasound, POCUS). General paediatric ultrasound is the imaging technique of first choice for many paediatric conditions and usually comprises detailed organ system imaging. In contrast, POCUS is a limited examination focused on a specific medical question relevant to immediate patient management (e.g. “is there free fluid yes or no?”). POCUS has first become an integral component of medical algorithms in adult emergency medicine. In paediatric emergency medicine the potential of POCUS is becoming increasingly recognized. For the paediatric emergency department POCUS has been credited with the potential of “global improvement of paediatric patient care” (le Coz et al. 2018)*.
For the project, various paediatric ultrasound experts from all over Germany have joined forces with local experts and scientists from four German universities in order to create an evidence-based foundation for a needs-adapted implementation of ultrasound to improve the care of children in the various health care facilities, with scientific support and in partnership. In addition, POCUS protocols that are already being used sporadically are to be implemented and new innovative POCUS protocols for specific questions in the respective setting are to be developed and piloted.
*Le Coz, Julien; Orlandini, Silvia; Titomanlio, Luigi; Rinaldi, Victoria Elisa (2018): Point of care ultrasonography in the paediatric emergency department. In: Italian journal of paediatrics 44 (1), S. 87. DOI: 10.1186/s13052-018-0520-y.
Project: Umoyo Wa Ana Athu (For the health of our children); The Malawi - Else Kröner child health programme: levering synergies for prevention and care
Organisation: Friede Springer endowed professorship for global child health at the Witten/ Herdecke University
Partner country: Malawi
Partner organisation in partner country: Paediatric and Child Health Association of Malawi (PACHA); Kamuzu University of Health Sciences, Malawi (KUHeS)
Term: 5 years
Infectious diseases and infant mortality are falling in Malawi thanks to targeted programmes. However, high population growth and epidemiological change pose major challenges to the health system. Screening, prevention, diagnosis and treatment of chronic and non-communicable diseases (NCDs), injuries and disabilities are becoming more important.
To improve child health in Malawi and to achieve the relevant sustainable development goals, evidence-based, locally relevant child health interventions, especially for NCDs, will be provided and synergies will be used in guideline and training development, implementation and monitoring. The Malawi Else Kröner Child Health Program is tasked with developing treatment guidelines and training and communication materials to combat childhood and adolescent NCDs, testing them in selected facilities and implementing them nationwide. Initially, 16 health facilities with particularly high needs in six of the 22 districts were selected. Direct beneficiaries of the program will be 170 health workers supporting more than 100,000 children per year.
- Years 1-2: Capacity building for programme leadership, consensus building among national actors and partners, development of guidelines, training and Information, Education and Communication (IEC) materials, app and Monitoring & Evaluation (M&E) infrastructure.
- Years 3-4: Training and implementation of guidelines with on-the-job training, mentoring and supervision, deployment and piloting of an innovative app.
- Year 5: Consolidation of all processes and procedures, analysis and evaluation to measure impact.
Core components of the programme are:
- Guidelines that represent a high standard of child health care, combined with an M&E system that promotes accountability, serve to improve service quality.
- The evidence-based, multi-layered approach to effective training under the local leadership of PACHA and KUHeS, as well as postgraduate training for paediatric residents, sustainably strengthen health workers and the local health system.
- Implementing the guidelines first in districts with the highest burden of disease improves the accessibility of services.
- The process of developing and implementing the guideline and training packages involves all child health care stakeholders in the different departments of the Ministry of Health, KUHeS and PACHA - a nationwide consultation promotes local networks.
- The use of an innovative app facilitates interactive training, guideline-compliant care and collaboration between health professionals.
- The programme applies scientific methods to study its effects.
Factors that support sustainability:
- The programme's objectives and strategy are the result of a needs assessment and consultations by local Malawian child health experts. They correspond to national, bilateral and global health priorities.
- The programme involves different professional groups, fosters links between them and works across disciplines. The awareness-raising component increases demand for specific services in the communities. Thus, the programme avoids an isolated, stand-alone approach, and paves the way for sustainability.
- The programme is evidence-based. The new guidelines and training packages are based on the latest technical evidence and standards - tailored to the Malawian context.
- Health, especially of children, is closely linked to development and prosperity, the basis for the long-term development of the country.
- The development processes for guidelines, training packages, app, communication strategy, piloting of implementation and M&E are closely linked.
- Activities emanate from and strengthen national structures (PACHA, Ministry of Health)
- Focus on NCD