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Commentary: Challenges and Priorities for Pediatric Critical Care Clinician–Researchers in Low- and Middle-Income Countries

DOI:10.3389/fped.2018.00038
Authors:
Abi Beane at The University of Edinburgh
Abi Beane
Priyantha Lakmini Athapattu
Priyantha Lakmini Athapattu
Priyantha Lakmini Athapattu
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Arjen M. Dondorp
Arjen M. Dondorp
Arjen M. Dondorp
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Rashan Haniffa at University of Oxford
Rashan Haniffa
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February 2018 | Volume 6 | Article 381
GENERAL COMMENTARY
published: 27 February 2018
doi: 10.3389/fped.2018.00038
Frontiers in Pediatrics | www.frontiersin.org
Edited by:
Srinivas Murthy,
University of British
Columbia, Canada
Reviewed by:
Ericka L. Fink,
University of Pittsburgh,
United States
Amelie von Saint Andre-von Arnim,
University of Washington,
United States
*Correspondence:
Rashan Haniffa
rashan@nicslk.com
Specialty section:
This article was submitted to
Pediatric Critical Care,
a section of the journal
Frontiers in Pediatrics
Received: 10January2018
Accepted: 09February2018
Published: 27February2018
Citation:
BeaneA, AthapattuPL, DondorpAM
and HaniffaR (2018) Commentary:
Challenges and Priorities for Pediatric
Critical Care Clinician–Researchers in
Low- and Middle-Income Countries.
Front. Pediatr. 6:38.
doi: 10.3389/fped.2018.00038
Commentary: Challenges and
Priorities for Pediatric Critical Care
Clinician–Researchers in Low- and
Middle-Income Countries
Abigail Beane1, Priyantha Lakmini Athapattu2, Arjen M. Dondorp3,4 and Rashan Haniffa1*
1 Network for Improving Critical Care Systems and Training (NICST), Colombo, Sri Lanka, 2 Ministr y of Health, Nutrition and
Indigenous Medicine, Colombo, Sri Lanka, 3 Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine,
Mahidol University, Bangkok, Thailand, 4 Centre for Tropical Medicine, Medical Sciences Division, University of Oxford,
Oxford, United Kingdom
Keywords: low- and middle-income countries, low resource settings, researchers, pediatric critical care, support
of research, surveys and questionnaires, intensive care unit
A commentary on
Challenges and Priorities for Pediatric Critical Care Clinician–Researchers in Low- and Middle-
Income Countries
by Von Saint Andre-Von Arnim AO, Attebery J, Kortz TB, Kissoon N, Molyneux EM, Musa NL, etal.
Front Pediatr (2017) 5:277. doi: 10.3389/fped.2017.00277
Von Saint Andre-Von Arnim and colleagues noted that LMIC clinicians should be empowered to
inuence local and global research agendas for critically unwell children (1). We too can report
that clinicians trained in LMIC acknowledge the need for systematic gathering of outcome data in
improving services and endorse the role that non-LMIC collaborators can play in contributing to
training, surveillance, and research (2). Interestingly, these perceptions were more strongly held
when compared to High Income Country (HIC) counterparts with experience in LMIC settings.
ese ndings perhaps point to untapped opportunities to upskill LMIC clinicians to build equitable
research and training partnerships with their non-LMIC counterparts.
Network for Improving Critical Care Systems and Training (NICST) is an LMIC-based organiza-
tion working collaboratively, since 2012, with clinical teams to build capacity for research, train-
ing, and continuous audit to improve patient outcomes (3). A collaboration between clinicians,
researchers, and educational experts based in HICs and LMIC, the network, funded in part by a UK
grassroots charity of the same name, links over 110 state and private sector hospitals and has trained
over 4,500 nurses and doctors in acute and critical care skills.
e NICST platform, a clinician-led mobile electronic health information initiative, is an example
of a setting-adapted national registry for critically unwell adults, children, and neonates in Sri Lanka
and beyond. Output from the registry supports a critical care bed availability system that facilitates
access to and utilization of resources and provides information on post-hospital outcomes (4).
Mobile applications linked to the platform improve the availability of information essential for the
care of individual patients and enable practical training for nurses and doctors (5). Partnered with
institutions based in HIC (UK and the Netherlands), it is creating educational opportunities (MSc,
PhD pathways) (6, 7) and undertaking frontline quality improvement projects in Sub-Saharan Africa
and South Asia.
Creating sustainable partnerships that harness the power of the existing LMIC-based network
enables equitable exchange of expertise and fosters greater understanding of setting-specic research
priorities. We anticipate that these successful collaborations coupled with rising awareness of the
importance of high-quality surveillance systems in LMIC will somewhat help address the challenges
2
Beane et al. NICS: Novel LMIC-Based Network
Frontiers in Pediatrics | www.frontiersin.org February 2018 | Volume 6 | Article 38
currently experienced by LMIC-based researchers approaching
traditional funding streams. We believe our model provides a
template for promoting setting-relevant research, which can
enable successful south-to-south (and perhaps south-to-north!)
collaborations.
AUTHOR CONTRIBUTIONS
RH and AB wrote the rst dra of the manuscript. AD and PA
approved and improved the manuscript. All the authors approved
the contents.
REFERENCES
1. Von Saint Andre-Von Arnim AO, Attebery J, Kortz TB, Kissoon N, Molyneux EM,
Musa NL, etal. Challenges and priorities for pediatric critical care clinician-
researchers in low- and middle-income countries. Front Pediatr (2017) 5:277.
doi:10.3389/fped.2017.00277
2. Hania R, De Silva AP, de Azevedo L, Baranage D, Rashan A, Baelani I, etal.
Improving ICU services in resource-limited settings: perceptions of ICU work-
ers from low-middle-, and high-income countries. J Crit Care (2017) 44:352–6.
doi:10.1016/j.jcrc.2017.12.007
3. Network for Improving Critical Care Systems and Training (NICST). Available
from: www.nicst.com (accessed February, 2018).
4. Rathnayake S. Smart Content for Smart People Best Practices of Sri Lankan
e-Content and Applications of 2014. (2014). p. 28–30. Available from:
http://www.eldis.org/vle/upload/1/Document/1503/Smart Content for Smart
People.pdf
5. De Silva AP, Harischandra PL, Beane A, Rathnayaka S, Pimburage R,
Wijesiriwardana W, et al. A data platform to improve rabies prevention, Sri
Lanka. Bull World Health Organ (2017) 95(9):646. doi:10.2471/BLT.16.188060
6. Hania R, Mukaka M, Munasinghe SB, De Silva AP, Jayasinghe KS, Beane A,
etal. Simplied prognostic model for critically ill patients in resource limited set-
tings in South Asia. Crit Care (2017) 21(1):250. doi:10.1186/s13054-017-1843-6
7. Beane A, Padeniya A, De Silva AP, Stephens T, De Alwis S, Mahipala PG, etal.
Closing the theory to practice gap for newly qualied doctors: evaluation of
a peer-delivered practical skills training course for newly qualied doctors
in preparation for clinical practice. Postgrad Med J (2017) 93(1104):592–6.
doi:10.1136/postgradmedj-2016-134718
Conict of Interest Statement:e authors declare that the research was con-
ducted in the absence of any commercial or nancial relationships that could be
construed as a potential conict of interest.
Copyright © 2018 Beane, Athapattu, Dondorp and Hania. is is an open-access
article distributed under the terms of the Creative Commons Attribution License
(CC BY). e use, distribution or reproduction in other forums is permitted, provided
the original author(s) and the copyright owner are credited and that the original
publication in this journal is cited, in accordance with accepted academic practice. No
use, distribution or reproduction is permitted which does not comply with these terms.
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Purpose: The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to practice gap' of doctors preparing for their internship. This paper evaluates the impact of a 2-day peer-delivered Acute Care Skills Training (ACST) course as part of the GIP. Study design: The ACST course was developed by an interprofessional faculty, including newly graduated doctors awaiting internship (pre-intern), focusing on the recognition and management of common medical and surgical emergencies. Course delivery was entirely by pre-intern doctors to their peers. Knowledge was evaluated by a pre- and post-course multiple choice test. Participants' confidence (post-course) and 12 acute care skills (pre- and post-course) were assessed using Likert scale-based questions. A subset of participants provided feedback on the peer learning experience. Results: Seventeen courses were delivered by a faculty consisting of eight peer trainers over 4 months, training 320 participants. The mean (SD) multiple choice questionnaire score was 71.03 (13.19) pre-course compared with 77.98 (7.7) post-course (p<0.05). Increased overall confidence in managing ward emergencies was reported by 97.2% (n=283) of respondents. Participants rated their post-course skills to be significantly higher (p<0.05) than pre-course in all 12 assessed skills. Extended feedback on the peer learning experience was overwhelmingly positive and 96.5% would recommend the course to a colleague. Conclusions: A peer-delivered ACST course was extremely well received and can improve newly qualified medical graduates' knowledge, skills and confidence in managing medical and surgical emergencies. This peer-based model may have utility beyond pre-interns and beyond Sri Lanka.