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


OBJECTIVE
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.


METHODS
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.


METHODS
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).


METHODS
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.


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.


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.
Opiyo
Newton
N
Child and Newborn Health Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, Kenya, 00100 GPO.
English
Mike
M
D002648:Child; D003906:Developing Countries; D006801:Humans; D007231:Infant, Newborn; D007318:Inservice Training / Q000379:methods*; D009359:Neonatology / Q000193:education*; D010500:Perinatology / Q000193:education*; D011787:Quality of Health Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic
Lancet. 2004 Oct 30-Nov 5;364(9445):1595-602
15519629
Cochrane Database Syst Rev. 2004;(3):CD004173
15266521
Implement Sci. 2007 Jun 26;2:19
17594495
Bull World Health Organ. 2003;81(4):298-300
12764497
Health Policy Plan. 2005 Dec;20 Suppl 1:i69-i76
16306072
Bull Pan Am Health Organ. 1996 Jun;30(2):106-17
8704751
Bull World Health Organ. 2007 Jan;85(1):42-8
17242757
Resuscitation. 2005 Dec;67 Suppl 1:S181-9
16321713
Int J Qual Health Care. 2002 Dec;14(6):521-3
12515339
J Nutr. 2004 Feb;134(2):357-62
14747672
J Obstet Gynecol Neonatal Nurs. 2007 Nov-Dec;36(6):531-41
17973696
Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003030
19370580
Cochrane Database Syst Rev. 2001;(2):CD003109
11406080
Health Policy Plan. 2012 May;27(3):179-93
21515912
BMJ. 2005 Apr 30;330(7498):995
15797893
Bull World Health Organ. 2004 Jul;82(7):509-15
15508195
Ann Emerg Med. 1996 Dec;28(6):690-8
8953961
Lancet Infect Dis. 2003 Sep;3(9):547-56
12954560
Bull World Health Organ. 2006 Apr;84(4):314-9
16628305
Arch Dis Child. 1999 Dec;81(6):473-7
10569960
Lancet. 1999 Sep;354 Suppl 2:SII16-20
10507254
Resuscitation. 2007 Nov;75(2):345-9
17583409
Arch Dis Child. 2003 Feb;88(2):118-21
12538311
Arch Pediatr Adolesc Med. 2000 Oct;154(10):1049-54
11030858
PLoS One. 2008 Feb 13;3(2):e1599
18270586
Arch Dis Child. 2008 Sep;93(9):799-804
18719161
Lancet. 2001 Jan 13;357(9250):106-10
11197397