Abstract
BackgroundSerious childhood illnesses (SCI), defined as severe pneumonia, severe dehydration, sepsis, and severe malaria, remain major contributors to amenable child mortality worldwide. Inadequate recognition and treatment of SCI are factors that impact child mortality in Botswana. Skills assessments of providers caring for SCI have not been validated in low and middle-income countries.ObjectiveTo establish preliminary inter-rater reliability, validity evidence, and feasibility for an assessment of providers who care for SCI using simulated patients and remote video capture in community clinic settings in Botswana.MethodsThis was a pilot study. Four scenarios were developed via a modified Delphi technique and implemented at primary care clinics in Kweneng, Botswana. Sessions were video captured and independently reviewed. Response process and internal structure analysis utilized intra-class correlation (ICC) and Fleiss’ Kappa. A structured log was utilized for feasibility of remote video capture.ResultsEleven subjects participated. Scenarios of Lower Airway Obstruction (ICC = 0.925, 95%CI 0.695–0.998) and Hypovolemic Shock from Severe Dehydration (ICC = 0.892, 95%CI 0.596–0.997) produced excellent ICC among raters while Lower Respiratory Tract Infection (LRTI, ICC = 0, 95%CI -0.034–0.97) and LRTI + Distributive Shock from Sepsis (0.365, 95%CI -0.025–0.967) were poor. Oxygen therapy (0.707), arranging transport (0.706), and fluid administration (0.701) demonstrated substantial task reliability.ConclusionsInitial development of an assessment tool demonstrates many, but not all, criteria for validity evidence. Some scenarios and tasks demonstrate excellent reliability among raters, but others may be limited by manikin design and study implementation. Remote simulation assessment of some skills by clinic-based providers in global health settings is reliable and feasible.
Highlights
Worldwide, child mortality has fallen 52% over the last 25 years [1, 2]
Feasibility and preliminary validity evidence for remote video-based assessment in a global health setting (LRTI, intra-class correlation (ICC) = 0, 95%CI -0.034–0.97) and Lower Respiratory Tract Infection (LRTI) + Distributive Shock from Sepsis (0.365, 95% CI -0.025–0.967) were poor
Previous studies have demonstrated that situational awareness and operational performance of clinicbased providers in low and middle income countries (LMICs) are often poor and have significant variability [4,5,6,7]
Summary
Serious childhood illnesses (SCI), defined as severe pneumonia, severe dehydration, sepsis, and severe malaria, remain major contributors to amenable child mortality worldwide. Inadequate recognition and treatment of SCI are factors that impact child mortality in Botswana. Skills assessments of providers caring for SCI have not been validated in low and middle-income countries
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