Abstract
Introduction
Care of children with diabetes is best delivered by a specialist multidisciplinary team of paediatric endocrinologists, diabetes nurse educators, dietitians, and psychologists. The Allied Healthcare Paediatric Diabetes Educator Course for Africa (ADECA) is the first specialised paediatric diabetes educator training programme for nurses working in sub-Saharan Africa. The aim of the paper was to describe the course structure and evaluation findings of the first ADECA programme.
Methods
The ADECA course is a hybrid 1-year course, organised in six phases, including online modules, in-person modules, and work-based assessments. Fifteen nurses from seven sub-Saharan African countries were selected to undertake the first course. The course was evaluated using the Kirkpatrick model, which rates the results of training courses against four levels of criteria: reaction, learning, behaviour, and results.
Results
All nurses successfully completed the course. Overall, 100% strongly agreed that the “in-person” modules were beneficial and enjoyable, compared to 87.5% of nurses for the online modules. Eighteen months following completion, the nurses are contributing to care of children and young people with diabetes and taking a lead in training other healthcare professionals. Seventy-three percent have joined national committees, with 27% actively involved in developing national guidelines and influencing policy. Forty percent have presented at either national or international scientific conferences.
Conclusion
The ADECA course has successfully created a pool of competent paediatric diabetes nurse educators who can support children and their families as well as train other healthcare personnel in diabetes care and become future faculty members. This bespoke course can be adapted for use in other low-income countries.
Keywords: Children and adolescents, Diabetes care, Type 1 diabetes, Type 2 diabetes, Africa, Nursing education
Introduction
Type 1 diabetes (T1D), which is the commonest form of childhood diabetes, is a chronic condition, which is due to destruction of the beta cells of the pancreas leading to insulin deficiency. Management is complex and requires patients to have regular access to insulin, glucose monitoring, and a self-management plan that includes healthy eating and physical exercise. Other rare types of childhood diabetes seen in sub-Saharan Africa include type 2 diabetes, monogenic diabetes, and malnutrition-related diabetes mellitus [1, 2]. A well-trained multidisciplinary team (MDT) consisting of paediatric endocrinologists, paediatric diabetes nurse educators (PDNEs), dietitians, and psychologists is needed to support the children and their families [3].
Sub-Saharan Africa has 42 countries, five islands and a population of approximately 1.17 billion people [4]. Many of the countries in sub-Saharan Africa have low income, with an average gross domestic product (GDP) per capita of only USD 1,701 [4].
The incidence and prevalence of T1D in most parts of sub-Saharan Africa are unknown as there are limited population-wide studies [5]. The T1D index estimated that approximately 111,000 children and young people (CYP) aged less than 20 years are living with T1D in sub-Saharan Africa in 2021 [5, 6]. The majority present with diabetic ketoacidosis at disease onset with reported rates of 35–77% [7, 8]. There are numerous reports of T1D being misdiagnosed as other conditions such as pneumonia, malaria, and typhoid [9, 10], and deaths from such misdiagnosis have been estimated at 14,500 per year in this region [6]. Following diagnosis, the glycaemic outcome is generally poor, with reported median glycated haemoglobin (HbA1c) of 9.5% (80 mmol/mol) in Cameroon [11], 12.3% (111 mmol/mol) in Tanzania [12], 10.5% (91 mmol/mol) in Nigeria [13], 11.1% (98 mmol/mol) in Kenya [14]. In addition, many suffer high rates of severe hypoglycaemia (53.6% in Kenya and 74% in South Africa) [14, 15]. It is therefore not surprising that rates of chronic complications occurring in childhood are high [16, 17]. Majaliwa et al. [16] reported that 34% of their paediatric cohort in Tanzania had evidence of neuropathy, whilst 32% had developed retinopathy.
The Paediatric Endocrinology Training Centre for Africa (PETCA) and Paediatric Endocrinology Training Centre for West Africa (PETCWA), in Nairobi, Kenya, and Lagos, Nigeria, respectively [18], as well as the Paediatric Endocrinology and Diabetology Training in Francophone Africa (PEDAF) [19] provide formal postgraduate training in paediatric endocrinology. Many paediatric endocrinologists trained in these centres have set up doctor-centric diabetes clinics. As a result, more children with diabetes and other endocrine conditions are being recognised, diagnosed and given supervised care. However, the care of CYP with diabetes works best within an MDT setting. The International Society for Paediatric and Adolescent Diabetes (ISPAD) guidelines recommend that the MDT consists of 1.0–1.25 diabetes nurses, 0.75–1.0 paediatric diabetologists, 0.5 dietitians, and 0.3 social workers/psychologists per 100 children with diabetes [3]. There are no PDNE and allied health professional certification programmes available in sub-Saharan Africa. This has resulted in incomplete specialised care for children and adolescents with diabetes in this region.
The aim of ADECA (Allied Healthcare Paediatric Diabetes Educator Course for Africa) was to develop and deliver a bespoke specialised paediatric diabetes educator training programme for nurses and allied healthcare professionals working in sub-Saharan Africa, which can be adapted for other low-income countries. The objective was to train “trainers” who can train other healthcare professionals in their countries. The emphasis is on capacity building and knowledge transfer. This paper describes the structure of the course and the findings of the evaluation of the first ADECA programme.
Methods
The programme data were obtained contemporaneously to inform the course; however, data analysis and publication were decided later.
Curriculum
The ADECA curriculum was co-produced by paediatric endocrinologists, PDNEs, and dietitians who are either members of ISPAD or the African Society for Paediatric and Adolescent Endocrinology (ASPAE). It is based on ISPAD guidelines [20]. The course is funded by an educational grant from ISPAD and the LFAC (Life for a Child) programme [21]. The curriculum focuses on three major areas: management of childhood diabetes, health education and health promotion, and clinical practice. A competency framework was developed by the faculty, to clarify the proficiency levels needed for successful course completion (see online suppl. Material 1; for all online suppl. material, see https://doi.org/10.1159/000546936). Each student was assigned two mentors – a local paediatric endocrinologist, ideally working in the same centre as the student, and an international mentor who was part of the ADECA faculty. ADECA was structured as a hybrid course comprising six phases summarised in Figure 1.
Fig. 1.
Six phases of the ADECA curriculum.
Phase 1 was a 3-month online course hosted on a commercial online Learning Management System (360 Learning) [22] that allows for collaborative engagement between faculty and learners. Time spent on the platform was prospectively monitored. During this phase of the course, the nurses were expected to attend clinics in their local centre and “adopt” a family with a child or adolescent with T1D to understand their journey and challenges with living with T1D. They were expected to present the case study to the faculty and peers during the second phase of the course.
Phase 2 was a 2-week “immersive” in-person course held in Muhimbili Teaching Hospital in Dar es Salaam, Tanzania. The nurses were encouraged to “live” as if they had T1D and were “placed” on different insulin regimens to help them learn and practise adjusting insulin doses in response to varying carbohydrate food content, exercise, sick days, and fluctuating blood glucose levels. They observed clinic consultations, took part in role play sessions (to improve their communication and teaching skills), and participated in practical sessions on various aspects of diabetes care, including Q&A sessions with CYP with diabetes and their families. The days also included lectures and workshops. A highlight was visiting a local market to learn about making healthy choices and carbohydrate counting of locally available foodstuffs.
In phase 3, the nurses returned to their home institutions during this 6-month period. They were expected to keep a portfolio of clinics attended and complete workplace-based assessments (WBA). The latter consisted of Direct Observation of Procedural Skills (DOPS); Mini-clinical Evaluation Exercise (Mini-CEX), in which the mentor observes real-life interaction between the nurse and a patient; Case-based Discussions (CBD); and Multi-source Feedback (MSF) (see online suppl. material 2 for details of WBA). During this phase, the ADECA faculty held further webinars, which included both nurses and their local mentors as well as other members of their MDT. The aim was to upskill all team members and ensure a uniformity of approach to the care of CYP with diabetes.
In phase 4 during this 8-week period, the nurses completed a project on a topic chosen earlier in the course and supervised by their local mentor. This could be an audit, quality improvement project, campaign, or teaching project. In phase 5, a 1-week period of self-study in preparation for the final assessment.
In phase 6, this 1-week phase was focused on final assessment. The students presented their projects, practised further consultation, and revised practical procedures. This was followed by an observed structured clinical examination as well as review of their portfolio to confirm that they had successfully completed the work-based assessments in phase 3. The Tanzanian Nursing and Midwifery Council approved the course for continuous professional development.
Recruitment
The course was advertised on the website of ISPAD as well as the WhatsApp page of ASPAE. The faculty scored the applications and the nurses were chosen on the basis of their ability to be supervised by a qualified doctor in a paediatric diabetes clinic, the number of children attending their local diabetes clinic (with a preference for those that worked in large centres), personal statement, geographic location (in order to service different areas of large countries), and ability to stay in a diabetes educator role for a minimum of 3 years.
Evaluation Strategy
We adopted the Kirkpatrick model, which rates the results of training courses against four levels of criteria: reaction, learning, behaviour, and results (Fig. 2) [23]:
Level 1: reaction to the course was measured by a feedback questionnaire completed by the nurses 6 months after finishing the course.
Level 2: the degree to which learning occurred was measured in phase 1 by a pre- and post-phase multiple-choice question assessment with a score of ≥80% set as the pass mark. In phase 2, it was measured by oral examination assessing competence in managing insulin therapy, nutrition/carbohydrate counting, hypoglycaemia, hyperglycaemia, and sick days. In phase 3, it was measured by completion of a series of WBA. The nurses completed a self-assessment of level of proficiency attained, in phase 3 and 5 months later in phase 4, using a standardised competency framework developed by the faculty. The nurses used the self-assessments to guide their learning and discussions with their mentors. The faculty and mentors used it to identify topics to schedule further webinars during the course.
Level 3: the transfer of learned skills to behaviour at work was assessed by submission of completed multisource 360-degree feedback on the nurses’ behaviour, skills, and attitudes by the local mentors, in addition to other documented evaluations.
Level 4: the impact of the learning on the nurse’s organisation was assessed by analysing questionnaires completed by the local mentors and the nurses. We were unable to measure impact on patient outcomes as the organisations did not have diabetes registries with robust data.
Fig. 2.
Kirkpatrick’s evaluation model.
Results
Recruitment
The first ADECA course started in June 2022 and ended in May 2023. There were 630 applicants, and 144 nurses were shortlisted. From those shortlisted, 15 nurses were chosen (Tanzania [4], Nigeria [4], Kenya [3], and one each from Ghana, Uganda, Cameroon, and Malawi). Each nurse was assigned to both an international mentor and a local mentor to support their learning.
Evaluation
Level 1: reaction: all fifteen of nurses strongly agreed that the in-person modules were beneficial and enjoyable, compared to 87.5% for the online modules. Sixty percent reported experiencing technical issues such as unstable Internet connections, difficulty with downloading the pre-recorded lectures, and timing of the webinars during the online course. The nurses spent a median of 12 h (range 6–66 h) on the learning management platform watching the pre-recorded videos with 86.6% (13/15) of nurses spending more than the required minimum of 9 h.
Level 2: the degree to which learning occurred: following the phase 1 online course, 14/15 nurses achieved the 80% pass mark in the post-course test with only one requiring a resit to pass. Overall, 13/15 passed the phase 2 oral exam at first sitting. Those requiring a resit later passed.
Analysis of the self-assessments completed showed that the number of nurses reporting as well developed in more than 90% of the topics rose from 47% (7/15) in phase 3 to 80% (12/15) in phase 4 (see Fig. 3). Nutrition was the most frequently identified “competency area” in which they needed further development.
Fig. 3.
Percentage of topics in which nurses self-assessed themselves as fully developed.
All nurses passed end-of-phase 6 objective structured clinical examination after successfully completing their work-based assessments, case presentations, and preceding phases of the course. This included the two nurses that scored themselves less in their self-assessment. Online supplementary material 3 lists the projects completed by the nurses.
Level 3: all the nurses completed all the stipulated WBA and had positive multisource feedback on their skills, knowledge, and attitudes from their local mentors and colleagues. Thirteen of 15 local mentors completed the post-course questionnaire. A qualitative analysis of the local mentors’ free-text comments resulted in four categories: knowledge, education, patient satisfaction, and capacity.
The four categories are described below with some quotes from the free-text comments. The mentors described how the nurses’ improved knowledge had made them more confident and autonomous from the endocrinologist; they could make correct decisions on their own. “Nurses can make decisions and the right decision at that on patients that they used to ask for opinion.”
The nurses were active in education for patients, caregivers, and schools and made home visits. They had started carbohydrate counting: “Improved diabetes education especially on sick day management and carbohydrate counting.” The patients and caregivers were more satisfied and more willing to come to the clinic perhaps because they had free access to the nurse. “Clinic attendance by patients has improved.”
They also described how the nurses had reduced the workload on the endocrinologist and how the capacity at the clinic had been improved. “The clinics are better organised now.”
Level 4: the difference the training has made to organisations and patient outcomes: Figure 4 lists the various ways the nurses are contributing to their organisation as reported by the local mentors, and Figure 5 shows the nurses’ self-reported achievements.
Fig. 4.
Contribution of nurses as reported by their local mentors.
Fig. 5.
Self-reported achievements of the nurses.
Post-Course
The newly qualified PDNEs were supported in setting up a learning community that met virtually monthly to share experiences and learn from each other. One of the PDNEs has since joined the ADECA faculty, and four have been involved in developing national guidelines for the care of CYP with diabetes mellitus.
Discussion
This is the first report of a successful certified training programme for PDNEs in sub-Saharan Africa. Many children with diabetes mellitus living in sub-Saharan Africa face unique challenges, including lack of access to specialised diabetes care, food insecurity, inconsistent supply of insulin, limited number of blood glucose test strips, and lack of refrigeration to store insulin [24]. Many suffer isolation and discrimination due to various myths and misconceptions [24]. A tailored course for PDNEs working in Africa ensures that the nurses understand these challenges and have the appropriate knowledge, skills, and attitude to support these children and their families. The ADECA curriculum was developed as a co-production between members of ASPAE (who were working in sub-Saharan Africa) and ISPAD members working on other continents. This guaranteed that the course was grounded in the reality of practice in Africa whilst providing the nurses with training in best practice. Apart from theoretical and clinical competence, the course was also designed to give the nurses soft skills, such as the ability to deliver an age-appropriate educational session, constructive feedback, succinct presentations using PowerPoint, and family-centred consultations. There was also emphasis on a solution-focussed approach to consultation and mindfulness of language used.
ADECA is a hybrid programme with some phases of the course delivered online. The challenges of delivering an E-learning programme in sub-Saharan Africa, which is plagued by poor Internet connectivity, frequent power outages, and high data cost, have previously been described [25] and is similar to what our nurses described in their feedback of the online module. The hybrid nature of the course ensured that any knowledge deficiencies due to above challenges are addressed during the in-person modules.
Inclusion of WBA into the curriculum meant that it was possible to assess the nurse’s actual performance in the workplace. The value of WBA in enabling formative assessment of skills, behaviours, attitude, and actual performance, which are not possible by traditional modalities, is well documented [26, 27], and they are routinely used in many medical postgraduate programmes [28, 29]. Their inclusion in an African nursing programme is novel and needed the buy-in of both the local paediatric endocrinologist mentors and the nurses. The WBA was useful in assessing clinical competence, and the structured feedback that the nurses received helped them learn what they were doing well, as well as, where they needed to improve to achieve clinical competence.
The PDNE has a key role in the education of children with diabetes and their parents/carers [30]. The appointment of a PDNE has been shown to reduce length of stay in newly diagnosed children with T1D [30]. In a Welsh study, centres appointing a PDNE demonstrated significant improvement in glycaemic control versus those with no staffing change [31]. The feedback from the local mentors confirmed the various ways that the ADECA-trained PDNEs contributed to the improved care of CYP with diabetes. For many centres, these nurses are the first certified diabetes nurse educators, playing an important role in training other healthcare professionals in diabetes care; some are also involved in research, and others have contributed to developing national guidelines.
High turnover of nurses is a worldwide problem that negatively affects healthcare systems. Factors that worsen staff turnover include poor work environment, low wages, and low job satisfaction. Retention of trained staff in Africa is a real challenge as economic situations worsen in sub-Saharan Africa and many leave to work in high-income countries [32]. A meta-analysis showed that the pooled proportion of nurses who were intending to leave their jobs in sub-Saharan Africa was very high at 50.74% [33]. It is therefore important to understand factors that can help stem this exodus. Bush and Lowery [34] found that nurses who completed postgraduate education were significantly more likely to report positive job satisfaction than those that had not completed postgraduate education. In that study, many of the nurses reported that a sense of increased autonomy at work contributed to the positive job satisfaction. There is evidence that staff are more likely to stay back and practice in Africa if they received their postgraduate training in Africa compared to if trained elsewhere [35]. Whilst the follow-up is currently short, it is encouraging that 18 months after completion of the course 14/15 of ADECA trained nurses are still working in diabetes clinics in their home countries while the 15th nurse is currently completing a compulsory National Youth Service Scheme prior to resuming their PDNE career in their home country.
Limitations
In this study, we were unable to measure the impact of ADECA-trained PDNEs on important patient outcomes such as hospital length of stay, readmission rates, diabetic ketoacidosis, and glycaemic control, due to a lack of baseline data, as many of the centres did not have robust registries.
There is currently only one centre (Muhimbili National Hospital Tanzania) for the in-person phases of the course; this not only limits the number of nurses that can be trained but also makes the course expensive as the nurses and international faculty have to travel from their various countries to the centre. As more PDNEs are trained and become members of the faculty, there will be less reliance on international faculty. The expectation is that more countries with trained PDNE will set up centres for the in-person module, thereby increasing the numbers that can be trained and reducing the cost of running the course.
In conclusion, the ADECA course is an innovative course that has successfully provided specialised training opportunity in sub-Saharan Africa that would previously have required staff to travel to high-income countries. It has created a pool of competent PDNEs who are able to support CYP and their families as well train other healthcare personnel in diabetes care and become future faculty members. The model can be adapted for use in other low-income countries.
Acknowledgments
The author wishes to thank the following for their contributions in either developing the curriculum or teaching on the course as a member of the faculty: Helen Phelan, Francesca Annam, John Pemberton, Sandhya Narayanan, Angie Middlehurst, Lizbeth Hudson, Dominic Bray, Emma Klatman, Esther Kerina, Marian Abdi, and all the paediatric endocrinologists who acted as local mentors.
Statement of Ethics
The nurses gave written informed consent to publish their data. Permission to publish without formal ethical approval was granted by the Clinical Research Training and Consultancy Unit, Ethics Committee of Muhimbili National Hospital Tanzania. This study did not require ethical approval as it reports the structure and evaluation of an innovative training programme only. Written informed consent to participate was not directly obtained but inferred by participation in the course.
Conflict of Interest Statement
Prof. Carine de Beaufort was a member of the journal’s editorial board at the time of submission. The other authors have no conflicts of interest to declare.
Funding Sources
The ADECA course is funded by an educational grant from International Society for Paediatric and Adolescent Diabetes (ISPAD) and the Life For a Child (LFAC) programme.
Author Contributions
All authors contributed to writing the manuscript. J.C.A. came up with the idea of the course and course structure, contributed to curriculum development, is the course director, and wrote the first draft of manuscript. K.C.M., J.M., E.A., D.C., A.L.-O., and C.B. contributed to developing the curriculum. K.C.M., J.M., E.A., D.C., and C.G. are members of the ADECA faculty. G.D.O. contributed to writing and reviewing the manuscript and also advised on the curriculum development.
Funding Statement
The ADECA course is funded by an educational grant from International Society for Paediatric and Adolescent Diabetes (ISPAD) and the Life For a Child (LFAC) programme.
Data Availability Statement
All data generated or analysed during this study are included in this article. Time-limited access to the videos and case scenarios will be granted on request to those wishing to set up similar courses, depending on how many licences to the platform are available. Further enquiries can be directed to the corresponding author.
Supplementary Material.
Supplementary Material.
Supplementary Material.
References
- 1. Matsha TE, Raghubeer S, Tshivhase AM, Davids SFG, Hon GM, Bjørkhaug L, et al. Incidence of HNF1A and GCK MODY variants in a South African population. Appl Clin Genet. 2020;13:209–19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Osman HA, Elsadek N, Abdullah MA. Type 2 diabetes in Sudanese children and adolescents. Sudan J Paediatr. 2013;13(2):17–23. [PMC free article] [PubMed] [Google Scholar]
- 3. Limbert C, Tinti D, Malik F, Kosteria I, Messer L, Jalaludin MY, et al. ISPAD Clinical Practice Consensus Guidelines 2022: the delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes. 2022;23(8):1243–69. [DOI] [PubMed] [Google Scholar]
- 4. World Bank open data. 2022. [cited 2024 Jun 21]. Available from: https://data.worldbank.org/region/sub-saharan-africa [Google Scholar]
- 5. Ogle GD, James S, Dabelea D, Pihoker C, Svennson J, Maniam J, et al. Global estimates of incidence of type 1 diabetes in children and adolescents: results from the International Diabetes Federation Atlas, 10th edition. Diabetes Res Clin Pract. 2022;183:109083. [DOI] [PubMed] [Google Scholar]
- 6. Ogle GD, Gregory GA, Wang F, Robinson TI, Maniam J, Magliano DJ, et al. The T1D index: implications of initial results, data limitations, and future development. Curr Diab Rep. 2023;23(10):277–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord. 2013;12(1):47. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Atkilt HS, Turago MG, Tegegne BS. Clinical characteristics of diabetic ketoacidosis in children with newly diagnosed type 1 diabetes in addis ababa, Ethiopia: a cross-sectional study. PLoS One. 2017;12(1):e0169666. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Ameyaw E, Asafo-Agyei SB, Thavapalan S, Middlehurst AC, Ogle GD. Clinical profile of diabetes at diagnosis among children and adolescents at an endocrine clinic in Ghana. World J Diabetes. 2017;8(9):429–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. Reddy Y, Ganie Y, Pillay K. Characteristics of children presenting with newly diagnosed type 1 diabetes. S Afr J CH. 2013;7(2):46–8. [Google Scholar]
- 11. Katte JC, Lemdjo G, Dehayem MY, Jones AG, McDonald TJ, Sobngwi E, et al. Mortality amongst children and adolescents with type 1 diabetes in sub-Saharan Africa: the case study of the Changing Diabetes in Children program in Cameroon. Pediatr Diabetes. 2022;23(1):33–7. [DOI] [PubMed] [Google Scholar]
- 12. McLarty RP, Alloyce JP, Chitema GG, Msuya LJ. Glycemic control, associated factors, acute complications of type 1 diabetes mellitus in children, adolescents and young adults in Tanzania. Endocrinol Diabetes Metab. 2021;4(2):e00200. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Ogugua CF, Chikani UN, Okiche CY, Ibekwe UM. Sociodemographic determinants of glycaemic control among children with type 1 diabetes in Southeastern Nigeria. Pan Afr Med J. 2021;38:250. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14. Ngwiri T, Were F, Predieri B, Ngugi P, Iughetti L. Glycemic control in Kenyan children and adolescents with type 1 diabetes mellitus. Int J Endocrinol. 2015;2015:761759. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15. Pirie FJ, Jairam V, Paruk IM, Connolly C, Motala AA. High frequency of hypoglycaemia in patients with type 1 diabetes mellitus attending a tertiary diabetes clinic in Durban, South Africa. Diabetes Res Clin Pract. 2019;155:107783. [DOI] [PubMed] [Google Scholar]
- 16. Majaliwa ES, Munubhi E, Ramaiya K, Mpembeni R, Sanyiwa A, Mohn A, et al. Survey on acute and chronic complications in children and adolescents with type 1 diabetes at muhimbili national hospital in dar es salaam, Tanzania. Diabetes Care. 2007;30(9):2187–92. [DOI] [PubMed] [Google Scholar]
- 17. Ahmed H, Elshaikh T, Abdullah M. Early diabetic nephropathy and retinopathy in patients with type 1 diabetes mellitus attending Sudan childhood diabetes centre. J Diabetes Res. 2020;2020:7181383. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Odundo GO, Ngwiri T, Otuoma O, Laigong P, Mukhwana R, Limbe MS, et al. The impact and successes of a paediatric Endocrinology fellowship program in Africa. Int J Endocrinol. 2016;2016:1560248. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Niang B, Boiro D, Bretones P, et al. 2 Development and implementation of a Pediatric Endocrinology Education Program in Francophone Africa (in French: Programme de formation en Endocrinologie et Diabètologie Pédiatrique pour l’Afrique subsaharienne Francophone. [PEDAF]). [cited 2025 Mar]. Available from: https://abstracts.eurospe.org/hrp/0097/hrp0097p1-536
- 20. ISPAD clinical practice consensus guidelines. 2022. [cited 2024 Oct]. Available from: https://www.ispad.org/page/ISPADGuidelines2022 [Google Scholar]
- 21. Life for a child. [cited 2024 Oct]. Available from: https://lifeforachild.org/ [Google Scholar]
- 22. 360Learning. [cited 2025 Mar]. Available from: https://360learning.com/ [Google Scholar]
- 23. Smidt A, Balandin S, Sigafoos J, Reed VA. The Kirkpatrick model: a useful tool for evaluating training outcomes. J Intellect Dev Disabil. 2009;34(3):266–74. [DOI] [PubMed] [Google Scholar]
- 24. Hapunda G, Abubakar A, van de Vijver F, Pouwer F. Living with type 1 diabetes is challenging for Zambian adolescents: qualitative data on stress, coping with stress and quality of care and life. BMC Endocr Disord. 2015;15:20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25. Kynge L. Finding the best way to deliver online educational content in low-resource settings: qualitative Survey Study. JMIR Med Educ. 2020;6(1):e16946. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26. Singh T, Modi JN. Workplace based assessment: a step to promote competency based postgraduate training. Indian Pediatr. 2013;50(6):553–9. [DOI] [PubMed] [Google Scholar]
- 27. Miller A, Archer J. Impact of workplace based assessment on doctors’ education and performance: a systematic review. BMJ. 2010;341:c5064. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28. Alazzawi S, Berstock J. Use of work-based assessments in postgraduate medical education. Br J Hosp Med. 2019;80(5):285–7. [DOI] [PubMed] [Google Scholar]
- 29. van der Vleuten C, Verhoeven B. In-training assessment developments in postgraduate education in Europe. ANZ J Surg. 2013;83(6):454–9. [DOI] [PubMed] [Google Scholar]
- 30. Cowan FJ, Warner JT, Lowes LM, Riberio JP, Gregory JW. Auditing paediatric diabetes care and the impact of a specialist nurse trained in paediatric diabetes. Arch Dis Child. 1997;77(2):109–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31. O'Hagan M, Harvey JN; Brecon Group . Glycemic control in children with type 1 diabetes in wales: influence of the pediatric diabetes specialist nurse. Diabetes Care. 2010;33(8):1724–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32. Socha-Dietrich K, Dumont J. International migration and movement of nursing personnel to and within OECD countries - 2000 to 2018: developments in countries of destination and impact on countries of origin. In: OECD health working papers, No. 125. Paris: OECD Publishing; 2021. [Google Scholar]
- 33. Ayalew E, Workineh Y, Semachew A, Woldgiorgies T, Kerie S, Gedamu H, et al. Nurses’ intention to leave their job in sub-Saharan Africa: a systematic review and meta-analysis. Heliyon. 2021;7(6):e07382. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34. Bush CT, Lowery B. Postgraduate nurse practitioner education: impact on job satisfaction. J Nurse Pract. 2016;12(4):226–34. [Google Scholar]
- 35. Talib Z, Narayan L, Harrod T. Postgraduate medical education in sub-saharan Africa: a scoping review spanning 26 Years and lessons learned. J Grad Med Educ. 2019;11(4 Suppl l):34–46. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
All data generated or analysed during this study are included in this article. Time-limited access to the videos and case scenarios will be granted on request to those wishing to set up similar courses, depending on how many licences to the platform are available. Further enquiries can be directed to the corresponding author.