Abstract
Background
Cameroon is home to over 28 million inhabitants and 40 neurologists giving a neurologist/inhabitant ratio of 1.4 per 1,000,000 inhabitants. These neurologists are located in the urban areas. In most rural health facilities in Cameroon, nurses and community health workers are the primary providers of care, often with limited training in the diagnosis and management of health conditions such as headache disorders. The aim of this project was to train primary healthcare nurses in rural areas on the assessment and management of migraine and tension-type headaches, as well as the identification and early referral of secondary headaches. We also aimed to provide them with tools that will allow them to accurately diagnose, treat, and/or refer patients with headaches who present to their health centres.
Methods
Thirty-three randomly selected primary healthcare nurses working in rural communities were trained on the basic assessment and management of migraine and tension-type headaches. Follow up training sessions were organized quarterly to reinforce knowledge and skills. A pre- and post-training assessments were done based on the Kirkpatrick taxonomy, to assess the impact of the training on the clinical practice of the nurses.
Results
There was a statistically significant improvement in the participants’ knowledge in the definition of headache (P < 0.001), differentiating between primary and secondary headache (P < 0.001), identification of red flags of headaches (P < 0.001), prescription of medications for migraine and tension-type headaches (P < 0.001), medication overused headaches (P = 0.001), when to refer a headache case (P = 0.022) and patient counselling (P < 0.001). Furthermore, there was a statistically significant improvement in the confidence in assessing, managing and referring a patient with a headache.
Conclusion
Where there are no physicians or neurologists, task-shifting care of migraine and tension-type to primary healthcare nurses may help to reduce the treatment gap.