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Review
. 2010 Apr 14:(4):CD007071.
doi: 10.1002/14651858.CD007071.pub2.

In-service training for health professionals to improve care of the seriously ill newborn or child in low and middle-income countries (Review)

Newton Opiyo  1 , Mike English
Affiliations
Review

In-service training for health professionals to improve care of the seriously ill newborn or child in low and middle-income countries (Review)

Newton Opiyo et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: A variety of emergency care training courses based on developed country models are being promoted as a strategy to improve the quality of care of the seriously ill newborn or child in developing countries. Clear evidence of their effectiveness is lacking.

Objectives: To investigate the effectiveness of in-service training of health professionals on their management and care of the seriously ill newborn or child in low and middle-income settings.

Search strategy: We searched The Cochrane Register of Controlled Trials (CENTRAL), the Specialised Register of the Cochrane EPOC group (both up to May 2009), MEDLINE (1950 to May 2009), EMBASE (1980 to May 2009), CINAHL (1982 to March 2008), ERIC / LILACS / WHOLIS (all up to October 2008), and ISI Science Citation Index Expanded and ISI Social Sciences Citation Index (both from 1975 to March 2009). We checked references of retrieved articles and reviews and contacted authors to identify additional studies.

Selection criteria: Randomised controlled trials (RCTs), cluster-randomised trials (CRTs), controlled clinical trials (CCTs), controlled before-after studies (CBAs) and interrupted time series studies (ITSs) that reported objectively measured professional practice, patient outcomes, health resource /services utilization, or training costs in healthcare settings (not restricted to studies in low-income settings).

Data collection and analysis: We independently selected studies for inclusion, abstracted data using a standardised form, and assessed study quality. Meta-analysis was not appropriate. Study results were summarised and appraised.

Main results: Two studies of varied designs were included. In one RCT of moderate quality, Newborn Resuscitation Training (NRT) was associated with a significant improvement in performance of adequate initial resuscitation steps (risk ratio 2.45, 95% confidence interval (CI) 1.75 to 3.42, P < 0.001, adjusted for clustering) and a reduction in the frequency of inappropriate and potentially harmful practices (mean difference 0.40, 95% CI 0.13 to 0.66, P = 0.004). In the second RCT, available limited data suggested that there was improvement in assessment of breathing and newborn care practices in the delivery room following implementation of Essential Newborn Care (ENC) training.

Authors' conclusions: There is limited evidence that in-service neonatal emergency care courses improve health-workers' practices when caring for a seriously ill newborn although there is some evidence of benefit. Rigorous trials evaluating the impact of refresher emergency care training on long-term professional practices are needed. To optimise appropriate policy decisions, studies should aim to collect data on resource use and costs of training implementation.

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Figures

Figure 1
Figure 1
Forest plot of comparison: 2 Opiyo 2008, outcome: 2.1 Mortality.
Figure 2
Figure 2
Forest plot of comparison: 1 Senarath 2007, outcome: 1.1 Practice of preparedness of resuscitation.
Figure 3
Figure 3
Forest plot of comparison: 1 Senarath 2007, outcome: 1.2 Preparedness for resuscitation - adjusted for clustering.
See this image and copyright information in PMC

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References

References to studies included in this review

Opiyo 2008 {published data only}
    1. Opiyo N, Were F, Govedi F, Fegan G, Wasunna A, English M. Effect of newborn resuscitation training on health worker practices in Pumwani Hospital, Kenya. PLoS ONE. 2008;13(3(2)):e1599. - PMC - PubMed
Senarath 2007 {published data only}
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    2. * Indicates the major publication for the study

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