Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19

BackgroundAccess to high-quality medical oxygen has been a long-standing challenge in Liberia due to barriers that span across the health system, which were amplified during the COVID-19 pandemic. The surge in cases requiring oxygen therapy necessitated rapid capacity-building for healthcare workers...

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Main Authors: Mark B. Luke, Moses Ziah, Lily Zhi Ning Lu, Michael D. Davis, Samson Arzoaquoi, Eva Drucker, Foday Kanneh, Gorbee G. Logan, Moses Massaquoi
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-02-01
Series:Frontiers in Public Health
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Online Access:https://www.frontiersin.org/articles/10.3389/fpubh.2025.1490134/full
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author Mark B. Luke
Moses Ziah
Moses Ziah
Lily Zhi Ning Lu
Michael D. Davis
Michael D. Davis
Samson Arzoaquoi
Eva Drucker
Foday Kanneh
Gorbee G. Logan
Moses Massaquoi
author_facet Mark B. Luke
Moses Ziah
Moses Ziah
Lily Zhi Ning Lu
Michael D. Davis
Michael D. Davis
Samson Arzoaquoi
Eva Drucker
Foday Kanneh
Gorbee G. Logan
Moses Massaquoi
author_sort Mark B. Luke
collection DOAJ
description BackgroundAccess to high-quality medical oxygen has been a long-standing challenge in Liberia due to barriers that span across the health system, which were amplified during the COVID-19 pandemic. The surge in cases requiring oxygen therapy necessitated rapid capacity-building for healthcare workers. In response, an emergency oxygen training package was adapted and implemented by the Liberia Ministry of Health and the National Incidence Management System. This manuscript evaluates the implementation of a short-term respiratory care training package to rapidly build healthcare worker capacity during the COVID-19 response and its adaptation for routine in-service training post-response.MethodsThe emergency training used the “hot and cold” simulation approach from the 2014 Ebola response, consisting of a cold phase (3-days) with didactic lectures and practical sessions, and mock COVID treatment unit simulations (2-days); and a hot phase within an active CTU. Participants were doctors, physician assistants, nurses, or midwives, deployed to COVID treatment units at major health centers and hospitals across all counties in Liberia. Training assessments consisted of a paper-based knowledge test pre- and post-training, and Objective Structured Clinical Examinations post-training.ResultsThe emergency training as part of COVID response included 123 health care workers from 43 health facilities and saw a significant increase in knowledge (median score of 46% pre-training vs. 84% post-training, p < 0.001). Adaptation and piloting of the package for routine in-service training was also effective at increasing knowledge amongst 81 health care workers (median score of 41% pre-training vs. 78% post-training, p < 0.001). High post-training Objective Structured Clinical Examination scores demonstrated clinical competency achievement in both cohorts. For emergency training, median scores were 92% (pulse oximetry), 81% (oxygen cylinders), and 83% (oxygen concentrators). For routine in-service training, scores were 88, 82, and 84%, respectively.ConclusionWe demonstrate that the implementation of a healthcare worker training package in oxygen therapy during the COVID response in Liberia and its eventual integration into a routine in-service training program was able to achieve significant improvements in health care worker knowledge and skills. This highlights the feasibility of using rapid and short-term training to enhance clinical capacity within both emergency and post-response settings in a resource-limited country.
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spelling doaj-art-b3bc87f84a9543f597a695bdc1ffc31d2025-08-20T02:48:08ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-02-011310.3389/fpubh.2025.14901341490134Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19Mark B. Luke0Moses Ziah1Moses Ziah2Lily Zhi Ning Lu3Michael D. Davis4Michael D. Davis5Samson Arzoaquoi6Eva Drucker7Foday Kanneh8Gorbee G. Logan9Moses Massaquoi10Liberia Ministry of Health, Monrovia, LiberiaLiberia Ministry of Health, Monrovia, LiberiaLiberia National COVID-19 Incidence Management System, Monrovia, LiberiaClinton Health Access Initiative, Monrovia, LiberiaWells Center for Pediatric Research/Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children at Indiana University School of Medicine, Bloomington, IN, United StatesPartner Liberia, Monrovia, LiberiaClinton Health Access Initiative, Monrovia, LiberiaClinton Health Access Initiative, Monrovia, LiberiaClinton Health Access Initiative, Monrovia, LiberiaLiberia National COVID-19 Incidence Management System, Monrovia, LiberiaClinton Health Access Initiative, Monrovia, LiberiaBackgroundAccess to high-quality medical oxygen has been a long-standing challenge in Liberia due to barriers that span across the health system, which were amplified during the COVID-19 pandemic. The surge in cases requiring oxygen therapy necessitated rapid capacity-building for healthcare workers. In response, an emergency oxygen training package was adapted and implemented by the Liberia Ministry of Health and the National Incidence Management System. This manuscript evaluates the implementation of a short-term respiratory care training package to rapidly build healthcare worker capacity during the COVID-19 response and its adaptation for routine in-service training post-response.MethodsThe emergency training used the “hot and cold” simulation approach from the 2014 Ebola response, consisting of a cold phase (3-days) with didactic lectures and practical sessions, and mock COVID treatment unit simulations (2-days); and a hot phase within an active CTU. Participants were doctors, physician assistants, nurses, or midwives, deployed to COVID treatment units at major health centers and hospitals across all counties in Liberia. Training assessments consisted of a paper-based knowledge test pre- and post-training, and Objective Structured Clinical Examinations post-training.ResultsThe emergency training as part of COVID response included 123 health care workers from 43 health facilities and saw a significant increase in knowledge (median score of 46% pre-training vs. 84% post-training, p < 0.001). Adaptation and piloting of the package for routine in-service training was also effective at increasing knowledge amongst 81 health care workers (median score of 41% pre-training vs. 78% post-training, p < 0.001). High post-training Objective Structured Clinical Examination scores demonstrated clinical competency achievement in both cohorts. For emergency training, median scores were 92% (pulse oximetry), 81% (oxygen cylinders), and 83% (oxygen concentrators). For routine in-service training, scores were 88, 82, and 84%, respectively.ConclusionWe demonstrate that the implementation of a healthcare worker training package in oxygen therapy during the COVID response in Liberia and its eventual integration into a routine in-service training program was able to achieve significant improvements in health care worker knowledge and skills. This highlights the feasibility of using rapid and short-term training to enhance clinical capacity within both emergency and post-response settings in a resource-limited country.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1490134/fullCOVID-19oxygenrespiratory carein-service trainingcase managementpandemic response
spellingShingle Mark B. Luke
Moses Ziah
Moses Ziah
Lily Zhi Ning Lu
Michael D. Davis
Michael D. Davis
Samson Arzoaquoi
Eva Drucker
Foday Kanneh
Gorbee G. Logan
Moses Massaquoi
Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19
Frontiers in Public Health
COVID-19
oxygen
respiratory care
in-service training
case management
pandemic response
title Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19
title_full Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19
title_fullStr Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19
title_full_unstemmed Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19
title_short Effectiveness of a short-term oxygen therapy training program in Liberia during and after COVID-19
title_sort effectiveness of a short term oxygen therapy training program in liberia during and after covid 19
topic COVID-19
oxygen
respiratory care
in-service training
case management
pandemic response
url https://www.frontiersin.org/articles/10.3389/fpubh.2025.1490134/full
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