Background: Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+)
intervention – a locally adapted pediatric advanced life support program – introduced in Rwanda
in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The current
thesis was undertaken as part of a larger program of research that aims to evaluate the ETAT+
implementation in Rwanda.
Methods: Data were gathered during a cross-sectional study in 8 district hospitals across
Rwanda; an audit in these hospitals was undertaken to establish a baseline description of the
availability of essential resources and process of care related to the leading causes of under-five
mortality in Rwanda. To determine changes in participating healthcare providers’ knowledge and
practical skills (n=374) between pre- and post ETAT+ implementation, a one group pre-posttest
design was used. Paired t-test was used to assess the effect of ETAT+ training on knowledge
improvement; and, linear and logistic regression models were fitted to examine factors
associated with healthcare providers’ performance on ETAT+ knowledge and skills assessments
in Rwanda.
Results: Baseline assessment reveals some deficiencies in processes of care (i.e. assessment,
treatment and follow-up care), poor organization of some hospital services (e.g., triage), and poor
uptake of current pediatric clinical practice guidelines (e.g., dehydration). Post ETAT+,
participants’ knowledge scores improved on average by 22.8% (95% CI 20.5, 25.1). Compared
to participants who identified as proficient in French, those who identified as proficient in both
English and French had on average a higher improvement in knowledge (least square
mean=6.64; 95% CI 3.79, 9.49) and were more likely to pass the practical skills assessment
(adjusted odds ratio=2.58; 95% CI 1.28, 5.48).
Conclusions: The audit of medical records reveals gaps in the process of pediatric care; and
these gaps were found to be consistent with knowledge gaps among healthcare providers, as
assessed through the ETAT+ pre-assessment. Improvements in post-ETAT+ performance were
significant and a number of factors (e.g., language barriers) were identified as important
influences on ETAT+ training outcomes. These factors need to be taken in account when
implementing ETAT+ and other continuing medical education interventions within the Rwandan
context.