Resuscitation 88 (2015) 57–62 Contents lists available at ScienceDirect Resuscitation j ourna l h o me pa g e : www.elsevier.com/locate/resuscitation Simulation and education Impact of contextualized pediatric resuscitation training on pediatric healthcare providers in Botswana  Shelton W. Wright a , Andrew P. Steenhoff a,b,g , Okan Elci c , Heather A. Wolfe a , Mark Ralston d , Thandie Kgosiesele e , Ishmael Makone f , Loeto Mazhani g , Vinay M. Nadkarni a , Peter A. Meaney a,b,∗ a Children’s Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States b Botswana-UPenn Partnership, 214 Independence Ave, Gaborone, Botswana c Children’s Hospital of Philadelphia 3400 Civic Center Blvd, Philadelphia, PA 19104, United States d Naval Hospital, 3475N Saratoga St, Oak Harbor, WA 98277, United States e Clinical Services, Botswana Ministry of Health, Gaborone, Botswana f Princess Marina Hospital, Botswana Ministry of Health, Gaborone, Botswana g University of Botswana School of Medicine, Gaborone, Botswana a r t i c l e i n f o Article history: Received 2 July 2014 Received in revised form 21 October 2014 Accepted 1 December 2014 Keywords: Developing countries Emergency training, Pediatric emergency training Resuscitation education PEARS Pediatric Emergency Assessment Recognition and Stabilization Resource-limited setting a b s t r a c t Background: Worldwide, 6.6 million children die each year, partly due to a failure to recognize and treat acutely ill children. Programs that improve provider recognition and treatment initiation may improve child survival. Objectives: Describe provider characteristics and hospital resources during a contextualized pediatric resuscitation training program in Botswana and determine if training impacts provider knowledge reten- tion. Design/methods: The American Heart Association’s Pediatric Emergency Assessment Recognition and Stabilization (PEARS) course was contextualized to Botswana resources and practice guidelines in this observational study. A cohort of facility-based nurses (FBN) was assessed prior to and 1-month following training. Survey tools assessed provider characteristics, cognitive knowledge and confidence and hospi- tal pediatric resources. Data analysis utilized Fisher’s exact, Chi-square, Wilcoxon rank-sum and linear regression where appropriate. Results: 61 healthcare providers (89% FBNs, 11% physicians) successfully completed PEARS training. Refer- ral facilities had more pediatric specific equipment and high-flow oxygen. Median frequency of pediatric resuscitation was higher in referral compared to district level FBN’s (5 [3,10] vs. 2 [1,3] p = 0.007). While 50% of FBN’s had previous resuscitation training, none was pediatric specific. Median provider confidence improved significantly after training (3.8/5 vs. 4.7/5, p < 0.001), as did knowledge of correct management of acute pneumonia and diarrhea (44% vs. 100%, p < 0.001, 6% vs. 67%, p < 0.001, respectively). Conclusion: FBN’s in Botswana report frequent resuscitation of ill children but low baseline training. Provider knowledge for recognition and initial treatment of respiratory distress and shock is low. Con- textualized training significantly increased FBN provider confidence and knowledge retention 1-month after training. © 2014 Elsevier Ireland Ltd. All rights reserved.  A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.12.007. ∗ Corresponding author at: Children’s Hospital of Philadelphia, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States. E-mail address: meaney@chop.edu (P.A. Meaney). 1. Background Globally, 6.6 million children under the age of five died in 2012, largely due to pneumonia and diarrhea. 1 Although survival has improved over the last 20 years, much faster progress is needed to achieve Millennium Development Goal 4 by 2015. 1 Botswana is an upper middle-income country, 2 and eighty-four percent of the million population resides with in 5 km from a medical facility. 3 11.5% of the population is under the age of 5, 4 diarrhea and http://dx.doi.org/10.1016/j.resuscitation.2014.12.007 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.