Co-developing an online course for Health Practitioners in Africa: Nutrition for Low Birthweight (LBW) and premature infants

Project 15 Jan 2023

(Source of Funding: Newcastle University: GCRF & Newton Fund Consolidation Accounts- 2022)

Globally, more than 20 million newborns are low birthweight (LBW) or premature every year representing 1 in every 7 babies born, and most are born in sub-Saharan Africa or South Asia. Rates of mortality and serious morbidity are especially high in this population with diseases such as retinopathy of prematurity, and necrotising enterocolitis largely specific to preterm infants. Complications associated with premature birth affect lifelong cardio-respiratory, visual, cognitive, and metabolic outcomes and place a burden on children and families. Longer-term disability places a significant economic burden on healthcare systems and society. Limited access to healthcare resources and training result in worse outcomes and loss of human capital.

Nutritional management impacts on key neonatal morbidities and risk of death. Emerging data show that macronutrients (energy and protein) as well as micronutrients (iron, vitamins etc.) impact on brain development in LBW infants. Malnutrition results in poor growth and worse cognitive and metabolic outcomes over the life-course. However, these can be ameliorated by closer attention to widely accepted principles (WHO, UNICEF) that strongly support and promote breast feeding, and use of relatively ‘simple’ measures such as assessments of nutrition and growth. The WHO recognises the challenge presented by premature infants as “feeding in exceptionally difficult circumstances”. Most nutritional interventions are low-cost such as strong support for Kangaroo Mother Care (KMC), provision of breastmilk, nasogastric tube feeding and use of low-cost supplements such as vitamins and micronutrients. Because the risks and costs of poor nutrition are substantial, improved nutritional care is likely to be cost saving for national economies. 

We aim to co-create a 4-hour Massive Open Online Course (MOOC) on nutrition for low birthweight (LBW) infants, relevant to African hospitals and developed by members of the UKRI-funded Neonatal Nutrition Network for Africa and informed by local stakeholders and communities. We will host the course on a platform which provides global access to free learning resources. This will be a partnership between Newcastle University and Aga Khan University, Nairobi, Kenya, with input from clinicians in 5 African countries. We will widen stakeholder and community involvement by partnering with professional organisations in Africa including the Nigerian Society of Neonatal Medicine, and the African Neonatal Association with whom we have established successful links. We will work with other relevant organisations working in Africa including the Commonwealth Association of Paediatric Gastroenterology and Nutrition and parent-led advocacy organisation the African Foundation for Premature Babies & Neonatal Care.

The project will be led by a UKRI-funded African Research Leader (Dr Helen Nabwera) and will involve 11 other clinical leaders in co-development therefore improving capacity across the network through improved learning and knowledge of how to create high quality educational resources. Dr Nabwera and Prof Nicholas Embelton will mentor a Neonatal Fellow in Kenya to co-develop and lead the project. The course will consist of a series of short steps lasting around 10-15 minutes each. Steps consist of short written articles, videos <5 minutes, audio, quizzes, polls and discussions. These generate a series of conversations enabling peer interaction and sharing of practice and knowledge with other practitioners, and where lead educators contribute to these conversations. This raises both the profile of African educators/leaders and the role of our nutrition network. Each step will be presented by a senior paediatrician, neonatologist, neonatal nurse or dietician (“educator”) working clinically in African neonatal units. Steps will also include downloadable resources, references, and links to websites such as the WHO. The course will include quizzes to assess and test baseline knowledge and skills, end of course learning and confidence, and course feedback such as course rating, and ideas for additional topics or materials. Future projects will evaluate the success of the learning package.