Differential learning outcomes among health cadres from Child and Adolescent Mental Health training in Uganda

Objective Mental ill health among children and adolescents has severe consequences for quality of life in later years but still goes largely undetected in low and middle income countries (LMIC). Poor detection results in a treatment gap which can be met through integration of child and adolescent mental health (CAMH) into primary health care (PHC). We trained PHC clinical staff in CAMH. Our objective was to determine the effect of this training on levels of CAMH knowledge. Methodology CAMH training for 5 days was done for 36 Ugandan PHC staff in October 2015. The training curriculum was adapted from the WHO mhGAP and administered by CAMH psychiatrists and psychologists. Knowledge was tested pre- and post-training. The change in knowledge was assessed for the groups of participant cadres by comparing median percentage scores in the course participants’ pre and post training tests. Chi square statistics assessed the differential changes in knowledge between cadres of health workers. Results Of the 36 PHC staff trained, 53% (n= 19) were clinical officers with a diploma in medical practice and the rest held a certificate in nursing or midwifery. The median change in knowledge was 12% (pre 55% to 67% post) overall; 16% (range: -16% – 36%) for clinical officers compared to 8% (range: 12% - 37.5%) for nurses / midwives. The proportion of PHC staff who gained 25% or more in knowledge was significantly higher for clinical officers (p=0.019) than for nurse / midwives. Conclusion The improvements in CAMH knowledge from a 5-day training or PHC workers is significantly higher for clinical officers than for nurses and midwives. CAMH integration into PHC in LMIC should involve PHC staff with a diploma in medical practice