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

Opiyo, Newton; English, Mike

The limited available evidence can be explained by several factors. First, a large number of studies were excluded on the basis of weak design (lack of appropriate controls, retrospective surveys). Most of the available evidence is therefore unreliable because of high risk of bias. Second, the lack of rigorous studies could be due to design and ethical challenges in the evaluation of educational interventions in practice settings. Desirable features such as protec-tion against contamination cannot be fully achieved within routine clinical settings. In addition, random assignment of health providers and sick babies to a control arm and observation of practices performed by untrained providers raise clear ethical concerns. Third, effective sample sizes will always be difficult to achieve, as severe illness episodes and resuscitation events remain relatively uncommon events in practice. Large multi-centre studies with relatively long observation periods would be needed to effectively assess the effects of emergency care courses. Apart from high costs, such studies would have to contend with the difficulty of securing continued availability and participation of health providers.