Following the successful set-up of the skeletal structure of the Paediatric Intensive Care Unit (PICU) at the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, a non-governmental organization, Health Place for Children Initiative (HPCI) plans to set up another five-bed Paediatric ICU at the Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi, Anambra State, in 2021. According to the group, it will ship a 40’ container of medical supplies to Nigeria in preparation for the new Paediatric ICU at NAUTH.
In a statement, the Founder of the group, Dr Odiraa Nwankwo, said despite improved immunization, the Under-5 mortality ratio was still high both in Nigeria and other sub-Saharan African countries.
He said, “Data from the Nigerian Demographic Health Survey in 2013 suggests that one out of every eight children born in Nigeria will die before their fifth birthday. Majority of the causes of these high mortality rates are either preventable or reversible. For Nigeria to achieve the 2030 Sustainable Development Goal 3.2, a smart comprehensive approach that includes improved immunization, health promotion, provision of prompt acute and critical care services should be promptly adopted.
“Sadly, in Nigeria today, if a child is in respiratory distress/failure and goes to an emergency room at most of the teaching hospitals, they do not have the capacity and resources to incubate and mechanically ventilate the child. It is on this premise that Health Place for Children Initiative (www.healthplaceforchildren.org) a not-for profit, non-governmental organization embarked on the ‘Nigeria PICU Project’ at UNTH, Ituku-Ozalla, Enugu. This is a pilot project, with the goal to upscale to other teaching hospitals in Nigeria. We hope to establish at least one Pediatric ICU at a major teaching hospital in each of the six geo-political regions in Nigeria by the end of 2025, applying the UNTH model.”
Dr Nwankwo said setting up a PICU in a low-resourced setting would require these five essential elements: Assembling of equipment/devices and medical supplies; training of healthcare providers (Doctors, Nurses, Respiratory Therapists etc); strong support from the hospital leadership; establishing a pipeline/system of maintenance of the equipment for sustainability; and a dedicated financial structure to sustain the clinical operation in the ICU.
The UNTH Model:
In the UNTH project, Dr. Nwankwo recalled that they “assembled the required equipment/devices and supplies valued at over two hundred and fifty thousand US dollars ($250,000.00) and in September, 2019, my team (a 10-member team) and I travelled to UNTH Ituku-Ozalla, Enugu, Nigeria to set up a 5-Bed Pediatric ICU. This will be the 1st organized Pediatric ICU in Nigeria.
“We started the initial phase of training for the doctors, nurses and physiotherapists (who function as respiratory therapists). Due to the emergence of COVID-19 pandemic, we have started a web-based training sessions using the Zoom platform. Since June 2020, we have been offering two training sessions every month via Zoom.”
The structure of the programme, according to Dr Nwankwo, are as follows:
- A 3-year programme starting September 2019- August 2022
- An initial training in September 2019 using modified Basic Life Support (BLS) and modified Pediatric Advanced Life Support (PALS) courses, with pre-and post-training course assessment This has been completed.
- Six structured training sessions; including two sessions every year. Each session would include a series of lectures, skills stations, mock codes etc.
- Training of Biomedical personnel at UNTH who could troubleshoot and repair minor mechanical equipment failures.
- In 2021, the group is sending one Paediatric Consultant to the University of Cape Town/Red Cross War Children’s Memorial Hospital, Cape Town, South Africa for 1-year fellowship training in Paediatric Critical Care. In addition, it is sending one Paediatric Nurse to Gertrude’s Children’s Hospital Kenya for one year training in Paediatric Critical Care Nursing. These two providers will be on ground at UNTH on completion of their training to anchor this programme. They will also train other doctors and nurses at the hospital. Preparation for this training is in progress.
- A financial structure with a revolving fund mechanism to sustain the clinical operations of the PICU.
- Collaborations with Medical Schools, Paediatric Residency and Paediatric Critical Fellowships programmes in the US to use UNTH PICU as a Global Health elective site in Nigeria.
- Virtual clinical recommendations and support where appropriate, through Telemedicine (logistics and confidentiality issues to be worked out)
- Improvement in paediatric critical care delivery among the trained doctors, nurses and other health care workers at UNTH.
- A functional PICU that meets the health needs of the local communities.
- Expected improvement in defined outcome measures (Under-5 Mortality Ratio)
- Replication of this model in other tertiary paediatric centres in Nigeria.
- Development of clinical guidelines and protocols in collaboration with the Paediatric Association of Nigeria and the Critical Care Society of Nigeria.
- Explore opportunities to collaborate with peers in data collection and sharing in a safe manner. This will help to support best and evidence-based practices.
Dr. Nwankwor is a Clinical Assistant Professor of Paediatrics at the Sidney Kimmel Medical College at Jefferson University Philadelphia, and an Assistant Professor (Adjunct) of Paediatrics at the Cooper Medical School of Rowan University, Camden, New Jersey. He is a Paediatric Intensivist at both the Alfred I. DuPont Hospital for Children, Wilmington Delaware and Cooper University Hospital, Camden New Jersey, USA.