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

Opiyo, Newton; English, Mike

Both studies were randomised trials done in delivery rooms/theatres in Kenya (Opiyo 2008) and Sri Lanka (Senarath 2007). Healthcare providers were nurses in Opiyo 2008 and were mixed (doctors, nurses, midwives) in Senarath 2007. Targeted behaviours included newborn resuscitation (Opiyo 2008) and general management/preparation and conduct of delivery care for newborns (Senarath 2007) . Postintervention data were collected over a period of 50 days in Opiyo 2008 and three months in Senarath 2007. Individual healthcare providers (n = 83) were randomly assigned in Opiyo 2008, and hospitals (n = 5) were randomly assigned in Senarath 2007. Both studies were adequately powered (90%) for primary outcomes. Neither study examined training/implementation costs. Opiyo 2008 assessed the effects of one-day newborn resuscitation training on health worker resuscitation practices in a maternity hospital in Kenya. The course, which was adapted from the UK Resuscitation Council,presented an A (airway), B (breathing), C (circulation) approach to resuscitation and laid down a clear step-by-step strategy for the first minutes of resuscitation at birth. Training included focused lectures and practical scenario sessions in which infant manikins were used. Participants were provided a course manual two weeks before training for self learning. Participants were randomly allocated to receive early training (n = 28) or late training (control group, n = 55). Data were collected on 97 and 115 resuscitation episodes over seven weeks after early and late training, respectively. Senarath 2007 assessed the effects of four-day essential newborn care training on health provider practices in hospitals in Sri Lanka. The course was adapted from the WHO Training Modules on Essential Newborn Care and Breastfeeding. Participants were provided teaching aids on newborn care and resuscitation. Training comprised lectures, demonstrations, hands-on training and small group discussions. Hospitals were randomly assigned to intervention (n = 2 hospitals) and control groups (n = 3 hospitals). The main sample for data collection by exit interview included 446 mother/newborn pairs before intervention and 446 pairs after intervention (223 each in intervention and control groups). These exit interview data were not relevant to the topic of this review. Direct observations of delivery practices were made on a subsample consisting of 96 healthcare providers (48 before and 48 after the intervention). Postintervention data collection commenced three months after training.