SCDAA 46th Annual National Convention

Abstract

Authors:
Dr. Baba Inusa- Guys and St. Thomas Hospital, Dr. Lewis Hsu- University of Illinois at Chicago,
Dr. Wale Atoyebi- Oxford University, Dr. Dogara Livingstone-Barau Dikko Teaching Hospital / Kaduna State University, Mrs. Bola Ibilola- SCORE Charity, Dr. Andrea Lamont- University of South Carolina, Dr. Juliana Olufunke Lawson- SCORE Charity, Mrs. Olukemi Ajamufua- Guys and St. Thomas Hospital, Dr. Kofi Anie- Imperial College, London

BACKGROUND: Nigeria leads the world in births with sickle cell disease (SCD), and
effective management should incorporate newborn screening. Learning from past
mistakes, we are applying the implementation science approach "Getting To Outcomes (GTO)" to incorporate stakeholder goals, capacity, and motivation to plan for pilot programs for SCD newborn screening in Nigeria's Kaduna and Niger States. Needs assessment and Training are needed for personnel in the whole process: key policymakers, laboratory technicians, health care workers (primary care and specialist care), and community workers like Community Health Extension Workers (CHEWs), and Traditional Birth Attendants (TBAs). Community awareness can be built up by SCD community groups and volunteer community mobilizers (VCM). Education theory highlights that the role-playing format is a good match for adult learners. Scenarios also permit rehearsal and planning for actual problems before the trainees encounter them.
GOAL: Develop the training content and format for SCD newborn screening across
these stakeholder groups.
METHODS: Needs assessment was conducted with stakeholder focus groups for 2
days in Kaduna in November 2017, followed by a 4 day training workshop in Kaduna in February 2018 to plan for newborn screening. Participants were invited: key policymakers, doctors, nurses, midwives, primary healthcare workers, CHEWs, TBAs, VCM, and SCD non-governmental organizations (NGOs). This was facilitated by a faculty of international and local experts, including one by e-conference. An interactive training approach was developed that included case discussions and role-playing, plus visual aids and a video drama.
RESULTS:
Role-playing was extremely well-received by the CHEW, TBA, VCM, nurse/midwives, and even legislators. Team-building occurred, as people started to refer to each other smilingly by the catch-phrases they had used during role-playing. Additional information emerged during the role-playing as experienced clinicians added rich details: the TBA are pivotal for follow-up; traditional healers prefer not to combine treatments with Western medicine; "difficult-to-reach" areas are served by an infrastructure of TBA, VCM, Emergency Transport (ETS), junior CHEW. Policy-makers using role-playing to apply the GTO approach expressed understanding about the value of stakeholder engagement to mold a plan to their local context. Legislators and medical personnel asked for additional case scenarios with local newborn screening issues, so that they could use the GTO framework more effectively.
CONCLUSION:
Role-playing can be a key approach for future training for SCD newborn screening and care in Nigeria. Role-playing can particularly be powerful for remembering key concepts, facilitating adaptation to local needs, and seeing the needs of other stakeholders. A recording of the case scenarios could be used to disseminate the learning and further raise awareness of SCD in Nigeria. This training approach also aligned well with the implementation science framework "Getting To Outcomes" for involving stakeholders in the newborn screening project.