title: In-service training for health professionals to improve care of the seriously ill newborn or child in low and middle-income countries (Review).
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.
  
  
  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.
authors.affiliation: Child and Newborn Health Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, Kenya, 00100 GPO.
authors.forename: Newton
authors.initials: N
authors.lastname: Opiyo
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: 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
references.citation: Lancet. 2004 Oct 30-Nov 5;364(9445):1595-602
references.pmid: 15519629
references.citation: Cochrane Database Syst Rev. 2004;(3):CD004173
references.pmid: 15266521
references.citation: Implement Sci. 2007 Jun 26;2:19
references.pmid: 17594495
references.citation: Bull World Health Organ. 2003;81(4):298-300
references.pmid: 12764497
references.citation: Health Policy Plan. 2005 Dec;20 Suppl 1:i69-i76
references.pmid: 16306072
references.citation: Bull Pan Am Health Organ. 1996 Jun;30(2):106-17
references.pmid: 8704751
references.citation: Bull World Health Organ. 2007 Jan;85(1):42-8
references.pmid: 17242757
references.citation: Resuscitation. 2005 Dec;67 Suppl 1:S181-9
references.pmid: 16321713
references.citation: Int J Qual Health Care. 2002 Dec;14(6):521-3
references.pmid: 12515339
references.citation: J Nutr. 2004 Feb;134(2):357-62
references.pmid: 14747672
references.citation: J Obstet Gynecol Neonatal Nurs. 2007 Nov-Dec;36(6):531-41
references.pmid: 17973696
references.citation: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003030
references.pmid: 19370580
references.citation: Cochrane Database Syst Rev. 2001;(2):CD003109
references.pmid: 11406080
references.citation: Health Policy Plan. 2012 May;27(3):179-93
references.pmid: 21515912
references.citation: BMJ. 2005 Apr 30;330(7498):995
references.pmid: 15797893
references.citation: Bull World Health Organ. 2004 Jul;82(7):509-15
references.pmid: 15508195
references.citation: Ann Emerg Med. 1996 Dec;28(6):690-8
references.pmid: 8953961
references.citation: Lancet Infect Dis. 2003 Sep;3(9):547-56
references.pmid: 12954560
references.citation: Bull World Health Organ. 2006 Apr;84(4):314-9
references.pmid: 16628305
references.citation: Arch Dis Child. 1999 Dec;81(6):473-7
references.pmid: 10569960
references.citation: Lancet. 1999 Sep;354 Suppl 2:SII16-20
references.pmid: 10507254
references.citation: Resuscitation. 2007 Nov;75(2):345-9
references.pmid: 17583409
references.citation: Arch Dis Child. 2003 Feb;88(2):118-21
references.pmid: 12538311
references.citation: Arch Pediatr Adolesc Med. 2000 Oct;154(10):1049-54
references.pmid: 11030858
references.citation: PLoS One. 2008 Feb 13;3(2):e1599
references.pmid: 18270586
references.citation: Arch Dis Child. 2008 Sep;93(9):799-804
references.pmid: 18719161
references.citation: Lancet. 2001 Jan 13;357(9250):106-10
references.pmid: 11197397