ETAT+ TRAINING IN KENYA
Irimu G, Wamae A, English M.
(On behalf of colleagues in the Ministry of Health1, University of Nairobi2 and KEMRI Wellcome Trust3.)

Abstract
The under-5 mortality rate in most developing countries remains high yet many deaths could be averted if available knowledge was put into practice. For seriously ill children in hospital investigations in low-income countries commonly demonstrate incorrect diagnosis and treatment and frequent prescribing errors. Most of these deaths occur in the first 48hours of admission. Any intervention to reduce the mortality must therefore target the emergency triage assessment and treatment plus the initial admission care (ETAT+). To help improve hospital management of the major causes of inpatient childhood mortality we developed simple clinical practice guidelines (CPGs) for use in Kenya, a low-income setting. These guidelines were adapted from existing WHO materials by participatory process. To facilitate dissemination and implementation of the guidelines we developed a 5.5 days training programme. We attempted to base our training on modern theories around adult learning and deliberately attempted to train a ‘critical mass’ of health workers within each institution at low cost. Our experience suggests that with sustained effort it is possible to develop locally owned, appropriate clinical practice guidelines for emergency and initial hospital care for seriously ill children with involvement of pertinent stake holders throughout. To ensure sustainability of such innovation it is fundamental to incorporate the training in the pre-service training and the medical teaching institutions. We hereby describe the progress in pre-service and in-service ETAT+ training in public institutions in Kenya. To our knowledge the process described in Kenya is among a handful of attempts globally to implement inpatient or referral care components of WHO / UNICEF’s Integrated Management of Childhood Illness approach. However, whether guideline dissemination and implementation result in improved quality of care in our environment remains to be seen.

1Wamae A, Santau M, Mogoa W, Ngwiri T.
2 Irimu G, Wasunna A, Were F, Mbori-Ngacha.
3English M, Ntoburi S.

A Rose Charities article about ETAT+ is at:
http://www.rosecharities.net/kenya-emerg-course.pdf

Some reviews on the HIFA (Healthcare Information For All) website:
http://www.hifa2015.org/knowledge-base/health-care/triage/what-hifa2015-members-say/

There is some ETAT+ info on Mike English's bio site:
http://www.kemri-wellcome.org/people/researchers/mike-english
A BMJ article about it (needs subscription to see more than an extract):
http://adc.bmj.com/content/93/9/799.extract