The TeAMS Toolkit: A co-designed tool to support team-based management of children
with acute malnutrition at Migori County Referral Hospital
Authors:   Kenya Medical Research Institute,
            Centre for Clinical Research, Nairobi, Kenya, Olieng’o Geoffrey , Amam Phlona ,   Kenya Medical Research
            Institute, Centre for Clinical Research, Nairobi, Kenya, Oduol Chrisantus ,   Kenya Medical Research
            Institute, Centre for Clinical Research, Nairobi, Kenya, Achieng Catherine ,   Kenya Medical Research
            Institute, Centre for Clinical Research, Nairobi, Kenya, Gimbel Sarah ,   Department of Child, Family,
            and Population Health Nursing and Department of Global Health, University of Washington,
            Seattle, WA, USA, Kolko Beth ,   Department of Human Centered
            Design & Engineering, University of Washington, Seattle, WA, USA, Rubin Means Arianna ,   Department of Global Health,
            University of Washington, Seattle, WA, USA, Singa Benson ,   Kenya Medical Research
            Institute, Nairobi, Kenya, M. Coe Megan ,   School of Nursing,
            University of Washington, Seattle, WA, USA
Published: September 2024

Malnutrition is a leading contributor to deaths in children, with six times higher
risk for hospital mortality among wasted children compared to those who are well
nourished. Although national guidelines for management of acute malnutrition have been
available for decades, adherence to them remains suboptimal. In this exploratory mixed
method study, health workers who provide care to children with severe acute malnutrition
at Migori County Referral Hospital (MCRH) identified an important barrier to
implementing care according to guidelines. Through a participatory co-design process, we
identified the content and features they preferred in a toolkit to help address the
challenges faced when a nutritionist is not available. The co-design process
incorporated feedback from 24 pre-pilot surveys, 18 design sessions with health workers,
and a consensus meeting with 6 health workers representing all cadres to refine the Team
Approach to Malnutrition Services (TeAMS) Toolkit prior to piloting. The Toolkit
included sections on (1) teamwork skills, (2) roles and responsibilities, (3) summarized
information from the Integrated Management of Acute Malnutrition guideline, and (4)
monitoring and documentation. The TeAMS Toolkit was then piloted for ten weeks and then
the usability and feasibility of the toolkit and the perceived competence, teamwork
attitudes, and role perceptions of health workers were assessed using quantitative
surveys and qualitative interviews. Usability of the toolkit was scored as 77.4/100 on
the System Usability Scale, which indicates good usability of the tool. This aligned
with qualitative feedback that highlighted the benefits of having this easy reference,
especially for feeding prescriptions. Pre/post surveys identified an increase in mean
scores on five out of six measures of teamwork attitudes, including knowing your own
role (3.74/5 to 4.26/5) and sharing information (3.79/5 to 4.42/5). Participants
described a change from a perception that offering feeding was only for the nutritionist
to one of ensuring that feeding was provided in good time by other team members in case
a nutritionist was not available. In this pilot study, the co-designed TeAMS Toolkit
supported multi-disciplinary care for children with SAM. Further refinement and
alignment with updated guidelines will ready this resource for delivery at additional
facilities. Keywords: Severe Acute Malnutrition, Teamwork, Co-design, Roles,
Usability