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Review
. 2015 May 13;2015(5):CD007071.
doi: 10.1002/14651858.CD007071.pub3.

In-service training for health professionals to improve care of seriously ill newborns and children in low-income countries

Newton Opiyo  1 , Mike English
Affiliations
Review

In-service training for health professionals to improve care of seriously ill newborns and children in low-income countries

Newton Opiyo et al. Cochrane Database Syst Rev. .

Abstract

Background: A variety of in-service emergency care training courses are currently being promoted as a strategy to improve the quality of care provided to seriously ill newborns and children in low-income countries. Most courses have been developed in high-income countries. However, whether these courses improve the ability of health professionals to provide appropriate care in low-income countries remains unclear. This is the first update of the original review.

Objectives: To assess the effects of in-service emergency care training on health professionals' treatment of seriously ill newborns and children in low-income countries.

Search methods: For this update, we searched the Cochrane Database of Systematic Reviews, part of The Cochrane Library (www.cochranelibrary.com); MEDLINE, Ovid SP; EMBASE, Ovid SP; the Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library (www.cochranelibrary.com) (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register); Science Citation Index and Social Sciences Citation Index, Institute for Scientific Information (ISI) Web of Knowledge/Science and eight other databases. We performed database searches in February 2015. We also searched clinical trial registries, websites of relevant organisations and reference lists of related reviews. We applied no date, language or publication status restrictions when conducting the searches.

Selection criteria: Randomised trials, non-randomised trials, controlled before and after studies and interrupted-time-series studies that compared the effects of in-service emergency care training versus usual care were eligible for inclusion. We included only hospital-based studies and excluded community-based studies. Two review authors independently screened and selected studies for inclusion.

Data collection and analysis: Two review authors independently extracted data and assessed study risk of bias and confidence in effect estimates (certainty of evidence) for each outcome using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). We described results and presented them in GRADE tables.

Main results: We identified no new studies in this update. Two randomised trials (which were included in the original review) met the review eligibility criteria. In the first trial, newborn resuscitation training compared with usual care improved provider performance of appropriate resuscitation (trained 66% vs usual care 27%, risk ratio 2.45, 95% confidence interval (CI) 1.75 to 3.42; moderate certainty evidence) and reduced inappropriate resuscitation (trained mean 0.53 vs usual care 0.92, mean difference 0.40, 95% CI 0.13 to 0.66; moderate certainty evidence). Effect on neonatal mortality was inconclusive (trained 28% vs usual care 25%, risk ratio 0.77, 95% CI 0.40 to 1.48; N = 27 deaths; low certainty evidence). Findings from the second trial suggest that essential newborn care training compared with usual care probably slightly improves delivery room newborn care practices (assessment of breathing, preparedness for resuscitation) (moderate certainty evidence).

Authors' conclusions: In-service neonatal emergency care courses probably improve health professionals' treatment of seriously ill babies in the short term. Further multi-centre randomised trials evaluating the effects of in-service emergency care training on long-term outcomes (health professional practice and patient outcomes) are needed.

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Conflict of interest statement

Both review authors are authors of one included study (Opiyo 2008).

Figures

1
1
Study flow diagram.
2
2
Forest plot of comparison: 2 Opiyo 2008, outcome: 2.1 Mortality.
3
3
Forest plot of comparison: 1 Senarath 2007, outcome: 1.1 Practice of preparedness of resuscitation. Mean difference = mean percentage change.
4
4
Forest plot of comparison: 1 Senarath 2007, outcome: 1.2 Preparedness for resuscitation ‐ adjusted for clustering. Mean difference = mean percentage change.
1.1
1.1. Analysis
Comparison 1 Opiyo 2008, Outcome 1 Mortality.
2.1
2.1. Analysis
Comparison 2 Senarath 2007, Outcome 1 Preparedness for resuscitation.
2.2
2.2. Analysis
Comparison 2 Senarath 2007, Outcome 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

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References to other published versions of this review

Opiyo 2010
    1. Opiyo N, English M. In‐service training for health professionals to improve care of the seriously ill newborn or child in low and middle‐income countries. Cochrane Database of Systematic Reviews 2010, Issue 4. [DOI: 10.1002/14651858.CD007071.pub2] - DOI - PMC - PubMed

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