Implementation of evidence-based African First Aid
Materials (AFAM) in Sub-Saharan Africa
A view from the field
Rode Kruis
Emmy De BuckCentre for Evidence-Based Practice Belgian Red Cross-Flanders
Brian Bilal Kanaahe MwebazeProgram Manager First Aid and Road Safety
Uganda Red Cross Society
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
Disclosure of interests
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
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
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 Poisoningo Emergency childbirth
First step: selection of topics
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
Second step: collection of evidence
Second step: collection of evidence
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
Potentially relevant studies with relevance to first aid n = 23998
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
Third step: validation by experts
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
Fourth step: consultation round
Fourth step: consultation round
Fifth step: AFAM implementation
Implementation was started in 2011 in 8 African Red Cross National Societies receiving support from Belgian Red Cross-Flanders
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
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.
1. Materials adapted to the target group
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.
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)
2. Flexibility of didactical materials
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
3. Implementation guide
www.afam.redcross.be
4. AFAM Website for sharing of materials
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
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
Current AFAM users
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)
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
98
1
Number of respondents using AFAM films 40%
Number of respondents using the AFAM website for sharing 0RCNS: Red Cross National Society; BRC-F: Belgian Red Cross-Flanders
Materials developed: extensive manual, pocket manual, posters
Materials developed by African RCNS
Materials developed by African RCNS (2)
Drawings from manual developed by Burundi Red
Cross
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
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
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
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
FEED BACK FROM THE FIELD
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 )
About our catchment area
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)
Capacity Development Aspect
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
Capacity Development cont’d
First National First Aid Simulation Training
− At national level (At International Airport)
− At branch level (Black spots, Schools…)
First Aid Simulations for the Public
‘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
Most Significant Outcomes
‘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
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)
Areas for improvement & way forward
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
Acknowledgements
