Safe (safe) paediatric anaesthesia

What is this work about?

Eighty-five per cent of children in sub-Saharan Africa will require surgery before they turn 15 years old. However, there are very few physician anaesthetists in sub‐Saharan Africa, and even fewer with training in specialist paediatric anaesthesia. Because of the lack of specialists, anaesthesia for children is administered by non-specialist non-physicians, who have usually received 12-18 months of training, with little follow on support.

To address this, a 3‐day course in paediatric anaesthesia was developed in partnership between the Association of Anaesthetists, the World Federation of Societies of Anaesthesiologists (WFSA) and the Association of Anesthesiologists of Uganda (AAU), forming part of the Safer Anaesthesia from Education (SAFE)® project (see: The SAFE paediatric anaesthesia course is accompanied by a Train‐the‐Trainer course, which means attendees can go on to train others in their organisations, making sure the training has a long lasting effect. The course was first piloted in Uganda in 2014, before this larger expanded project across East and Central Africa.

What did we hope to achieve?

This study aimed to evaluate the training to explore:

  • Whether knowledge and skills of local providers could be improved in paediatric anaesthesia using this short course model;
  • If learning would be maintained over time;
  • what the impact of the course would be in the clinical work of these anaesthesia providers.

What did we do?

We collected three types of data:

  1. Anonymous feedback from participants at the end of the course
  2. Knowledge (a multiple choice true/false questionnaire) and skills test.
  3. Behaviour change that occurred in the participants’ place of work after the training.

What did we find?

381 participants attended 11 SAFE courses between January 2016 – March 2017 across five countries (Ethiopia, Kenya, Malawi, Uganda and Zambia). The majority of these (335) were non-physician anaesthetists. Five Train-the-Trainer courses also took place, training 59 new members, with 46 going on to teach a SAFE course as part of the project.

The data showed that the SAFE training had significantly increased participants’ knowledge and skills scores immediately after the course. One hundred and twenty‐six participants in Malawi, Uganda and Zambia were visited in their workplace 3–6 months later, and the knowledge and skills had been maintained. Unfortunately, follow‐up visits were not possible in Ethiopia due to a state of emergency, and in Kenya due to extended healthcare worker strikes.

Analysis of the interviews with participants showed positive behaviour changes in:

  • preparation
  • peri‐operative care
  • resuscitation
  • management of the sick child
  • communication and teaching

Conclusion – Why is this important?

This study shows that the SAFE paediatric anaesthesia course is an effective way to deliver training, and could be used to help strengthen emergency and essential surgical care for children as a component of universal health coverage.

Dissemination- where has this study been shared?

This has been published in the journal Anaesthesia:

Credits- Who was involved in this work?

Behavioural scientists: Jo Hart, Lucie Byrne-Davies,

Partnership staff: N Boyd, E Sharkey, M Nabukenya, J Tumukunde, N Sipuka, M Zyambo, I Walker

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