Implementation and Evaluation of the WHO Basic Emergency Care Course in Rwanda: A Multi-Phase Study

Abstract

Introduction: Basic, affordable training can improve emergency systems to reduce morbidity and mortality among patients with acute emergent conditions. This study evaluates knowledge retention of Rwandan clinicians and their patient management following implementation of the World Health Organization and the International Committee of the Red Cross’s Basic Emergency Care (BEC) course. This is the first study to evaluate patient care immediately before and after participation in the BEC course. Methods: A three-phase prospective, nonrandomized study was conducted at the University Teaching Hospital of Kigali, Rwanda, from 2022-2024, including 41 Urgent Medical Aid Service (SAMU) responders and Nurses (Phase 1), 25 general practitioners (GP, Phase 2), and 34 graduating medical students (Phase 3). Paired t-test compared mean pre- and post-test scores. GPs’ patient management for cases involving abnormal vital signs and/or hypoglycemia before and after course participation was assessed using Pearson’s Chi-squared test. Results: There were significant gains in knowledge pre- to post-course (mean Δ nurses = +16.3%, GP = +15.2%, medical students = 14.1%; p <0.001), with no significant difference between these groups (p = 0.70). In Phase 2, comparing pre versus post course patient management, (n = 264 pre, n = 108 post), there were non-significant increases for appropriate antibiotic use for sepsis (62.1% vs 70.3%,p = 0.26), oxygen administration for hypoxia (97.9% vs 100%, p = 0.34), and fluid delivery for shock(83.0% vs 84.1, p =0.81). There was also a non-significant decrease in glucose administration for hypoglycemia (88.2% vs 86.7%, p = 0.87). Conclusion: Across medical providers, the education intervention had a significant and beneficial effect in increasing knowledge overall. There were no significant differences in recorded patient management. Future studies may be targeted towards early career clinicians with limited clinical experience to determine if a more targeted intervention matching the clinical experience of GPs would change patient management.