Bhandari CM1, Suwal S2, Mareschal G2, Retis C3, Bista R4, Rana S5, Pokhrel S6
1Ministry of Health and Population, Nepal, Kathmanudu, Nepal, 2Humanity and Inclusion (Formerly Handicap International), Kathmandu, Nepal, 3Humanity and Inclusion (Formerly Handicap International), Technical Resources Division, Phnom Penh, Cambodia, 4Humanity & Inclusion (Formerly Handicap International), Kathmanudu, Nepal, 5Research Coordinator Consultant, Sydney, Australia, 6Humanity & Inclusion( formerly Handicap International), Kathmanudu, Nepal

Background: The negative effects of impairments on the development of children can be minimized through early detection and timely management. Reducing the burden of disability allows the best opportunities for children to develop their potential . In Nepal children with impairments who live in remote areas have a very limited access to rehabilitation services. One strategy to address this issue involves the use of primary health workers (HWs) and female community health volunteers (FCHVs) to detect children with impairments to be referred to rehabilitation services. There is limited global evidence and no local experience of such a training intervention.

Purpose: The primary purpose of this study was to determine the effectiveness of training provided by Nepali physiotherapists to HWs and FCHVs on the detection of impairments in children and referral to health and rehabilitation services.

Methods: A 12 months quasi-experimental longitudinal study was used to measure training effectiveness, by comparing an intervention site (training) to a control site (no training). Effectiveness was determined by the number of cases detected, the referral utilization rate and the accuracy of impairment detection. Trainees' knowledge improvement was assessed by comparing pre-training test to immediate post training test and test knowledge retention at the end of the study. Trainees and detected children's caregivers' experiences were evaluated through interviews.

Results: The training packages effectively transferred long-term knowledge of impairments (HW, 51.1% pre-test, 83% immediate-post test, 65.8%12-month-post test; FCHVs, 33.1% pre-test, 60.6% immediate-posttest, 46.9% 12-month-posttest). 54 verified cases were detected by trainees in the intervention site, and 3 verified in the control site. From the intervention site, 61.1% of cases referred by trained HWs attended at least one hospital and/or rehabilitation centers, where 22 cases were received and 16 cases were treated .There was good accuracy of case detection by trainees (81.5%, 54 cases). Counselling by trainees positively influenced many caregivers to use referral services. Carers who had not yet used referral services cited poor finances or home situation as reasons for delaying treatment. Community perception of impairments after the trainings was found to be mostly positive as reported by FCHVs and caregivers.

Conclusion(s): As a result of training, an increased number of cases were detected in the intervention site, leading to greater use of referral services including rehabilitation centres. The effectiveness of the training was further strengthened by trainee capacity to accurately detect cases and the quality of their counsel to families, which convinced many to seek treatment for their children although financial barrier to reach rehabilitation centers remains an issue. We can conclude that the training intervention by physiotherapists is an effective approach to increase case detection and early treatment of children with impairments.

Implications: The intervention should be rolled out and scaled up to include additional training for HWs targeting more complex impairments. A review of rehabilitation service delivery should be considered by policy makers to plan for services that better serve populations in remote locations as currently rehabilitation services including physiotherapy are limited to regional centres preventing access and utilization.

Keywords: Training, remote and rural, case detection

Funding acknowledgements: USAID, through the “Pilot study on Early Detection of Impairments in Children, implemented by Handicap International-Humanity &Inclusion Nepal

Topic: Paediatrics; Disability & rehabilitation; Education

Ethics approval required: Yes
Institution: Nepal Health Research Council
Ethics committee: Nepal Health Research Council
Ethics number: study number 130/2017

All authors, affiliations and abstracts have been published as submitted.

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