The use of low-cost Android tablets to train community health workers in Mukono, Uganda, in the recognition, treatment and prevention of pneumonia in children under five: a pilot randomised controlled trial

Abstract

Background: Since 2012, The World Health Organization and UNICEF have advocated for community health workers (CHWs) to be trained in Integrated Community Case Management (iCCM) of common childhood illnesses, such as pneumonia. Despite the effectiveness of iCCM, CHWs face many barriers to accessing training. This pilot study compares traditional training with using locally made videos loaded onto low-cost Android tablets to train CHWs on the pneumonia component of iCCM.

Methods: We conducted a pilot randomised controlled trial with CHWs in the Mukono District of Uganda. The unit of randomisation was the sub-county level, and the unit of analysis was at the level of the individual CHW. Eligible CHWs had completed basic iCCM training but had not received any refresher training on the pneumonia component of iCCM in the preceding 2 years. CHWs in the control group received training in the recognition, treatment, and prevention of pneumonia as it is currently delivered, through a 1-day, in-person workshop. CHWs allocated to the intervention group received training via locally made educational videos hosted on low-cost Android tablets. The primary outcome was change in knowledge acquisition, assessed through a multiple choice questionnaire before and after training, and a post-training clinical assessment. The secondary outcome was a qualitative evaluation of CHW experiences of using the tablet platform.

Results: In the study, 129 CHWs were enrolled, 66 and 63 in the control and intervention groups respectively. CHWs in both groups demonstrated an improvement in multiple choice question test scores before and after training; however, there was no statistically significant difference in the improvement between groups (t = 1.15, p = 0.254). There was a statistically significant positive correlation (Pearson's r = 0.26, p = 0.03) linking years of education to improvement in test scores in the control group, which was not present in the intervention group. The majority of CHWs expressed satisfaction with the use of tablets as a training tool; however, some reported technical issues (n = 9).

Conclusion: Tablet-based training is comparable to traditional training in terms of knowledge acquisition. It also proved to be feasible and a satisfactory means of delivering training to CHWs. Further research is required to understand the impacts of scaling such an intervention.

Trial registration: Registered on 23/11/2016 at clinicaltrials.gov ( NCT02971449 ).

Keywords: Community health worker (CHW); Integrated Community Case Management (iCCM); Mobile technologies; Pneumonia; Uganda; mHealth.

Conflict of interest statement

Ethics approval and consent to participate

The study was registered at clinicaltrials.gov (NCT02971449) [39]. Ethical approval was received from The Uganda National Council for Science and Technology. Investigational Review Board (IRB) approval was obtained from the Mengo Hospital Research Review Committee. Written informed consent was obtained from all study participants with appropriate translation and literacy resources provided as necessary. The consent form and process were approved by the IRB. All CHW test scores were de-identified with the CHWs receiving an individual study number. We adhered to Wellcome Trust guidelines on research involving subjects in LMICs [40].

Consent for publication

Not applicable

Competing interests

KK and MC are salaried employees of Omni Med, a registered non-profit organisation in the USA and Uganda. Omni Med did not provide the funding for this study, which was funded by a grant from The British Medical Association secured by JOD; rather, Omni Med were an implementation partner.

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