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Improving Providers' Skills In Caring for Adolescents In Uganda

Saturday, October 20, 2012
Room 346-347 (Morial Convention Center)
Betsy Pfeffer, MD1, Sabrina Bakeera-Kitaka, MBChB2, Denis Lewis Bukenya3, David L. Bell, MD, MPH1, Susan Rosenthal, PhD1 and Philip LaRussa, MD1, (1)Pediatrics, Columbia University & The Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, (2)Pediatrics, Makerere University College of Health Sciences/Mulago National Referral Hospital, Kampala, Uganda, (3)Naguru Teenage Centre, Kampala, Uganda

Program Evaluation Caring for adolescents requires special skills as has been acknowledged in the U.S, by the residency training requirement, and status as a sub-specialty.  As is true in the U.S, adolescents in the developing world exist in the space between childhood and adulthood and engage in behaviors that place them at risk for morbidity and mortality.  In many developing countries, and in Uganda specifically, there is limited training available to address the health care needs of adolescents.  Therefore, Makerere and Columbia Universities jointly sponsored two 2-day workshops (2010, 2011) in Kampala to foster the knowledge base of a core group of providers who then would be able to disseminate this knowledge.

Methods:  These didactic and interactive workshops were conducted in collaboration with two professionals in Uganda that had adolescent-specific expertise and an interest in fostering sustainability.  Attendees included a variety of professionals from the Kampala area who were engaged in the care of adolescents. The first workshop focused on general psychosocial assessment and the second on the specific needs of the young male.  Evaluation of the first workshop was informal; for the second, a questionnaire was completed by participants to assess changes in medical knowledge (21 questions), psychosocial assessment (16 questions), and confidence in skills (8 questions).  Pre- and post-test scores were compared using the GEE method with binomial distribution.

Results The two workshops were attended by 60 individuals (39 & 31, respectively, with 10 from the 1st also attending the 2nd). Twenty-five 2nd workshop attendees completed both pre- and post-2ndworkshop tests. Raw scores improved overall for both medical (18/25) and psychosocial (19/25) knowledge.  Responses improved significantly across attendees for medical (p= 0.0084; 95% CI of odds ratio, 1.17, 2.07), and psychosocial (p = 0.0021; 95% CI of odds ratio, 1.48, 3.42) knowledge.  Twenty-three of 25 respondents also answered post-conference “confidence in skills” questions. Nineteen of 23 respondents answered either agree or strongly agree to at least 6 of the 8 questions concerning whether they were now confident that they could effectively deal with issues of adolescent male health.  The participants in both workshops reporting using the materials for presentations at other local and national meetings, and have initiated the process of creating an adolescent health section of the Uganda Pediatric Association.  Plans are underway to implement a regional workshop.

Conclusion  These workshops had a demonstrated impact on knowledge in the short term and on interest in adolescent medicine as evidenced by the dissemination activities and planning for an adolescent section of the pediatric association.   Future investigations should evaluate long-term gains in knowledge and ability to translate knowledge into practice.