The use of low cost android tablets to train community health workers in Mukono, Uganda in the recognition, treatment and prevention of pneumonia in children under five: a pilot randomised controlled trial.

Introduction: To address the shortage of trained health workers in low- and middle-income countries, the World Health Organization has encouraged the training and deployment of Community Health Workers (CHWs). Since 2012 The World Health Organization and UNICEF have advocated for CHWs to be trained in Integrated Community Case Management (iCCM). Despite the effectiveness of iCCM, CHWs face many barriers to accessing training. This pilot study assesses the impact of introducing locally made videos loaded onto low cost Android tablets to train CHWs on the pneumonia component of iCCM guidelines. Materials and Methods: We conducted an open-label pilot randomised controlled trial with CHWs across different localities in the Mukono District of Uganda, allocating themto one of two groups: control or intervention in a 1:1 ratio. CHWs in the control group received training in the recognition, treatment and prevention of pneumonia as it is currently delivered; through a one-day, in-person workshop delivered by a CHW supervisor. CHWs allocated to the intervention group received training via locally made educational videos hosted on low cost Android tablets. The primary outcome was change in knowledge acquisition, assessed through a multiple-choice questionnaire before and after training, and a post-training clinical assessment. Results: 129 CHWs were enrolled in the study; 63 and 66 in the control and intervention groups respectively. CHWs in both groups demonstrated an improvement in multiple choice question test scores before and after training, however there was no statistically significant difference in the improvement between groups (t=-1.24, p=0.216). In the group receiving traditional training, each additional year of education was estimated to increase the improvement in scores by 0.21 on a 24-point scale test (β-coefficient=0.263, p=0.030). No equivalent effect was found in the group receiving tablet-based training (β-coefficient=0.015, p=0.910), suggesting prior educational attainment is not as important when using tablet based methods as a training tool. Conclusion: Tablet based training is comparable to traditional training in terms of knowledge acquisition. Traditional learners appeared to benefit when they had additional years of education. Further research is required to understand long-term knowledge retention and the impacts of scaling such an intervention. Data files: We have uploaded the full original raw data files containing the anonymised demographic details, pre and post test scores for both the intervention and control CHWs. Study information: ClinicalTrials.gov identifier: NCT02971449 (https://clinicaltrials.gov/ct2/show/NCT02971449)