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

Opiyo, Newton; English, Mike

We eventually excluded 20 studies that initially met the review eligibility criteria. These are listed in the Characteristics of excluded studies table. Six studies were excluded in the original review: Bryce 2005, a non-randomised controlled study on health facility IMCI training, was excluded, as the training intervention was combined with and was impossible to separate from concurrent district health strengthening activities (skills reinforcement through supervised clinical practice). El-Arifeen 2004, a cluster-randomised trial on the effects of IMCI training on quality of care, was excluded, as data on referral rate (appropriate health worker response to an encounter with a seriously ill child and our outcome of interest) were not reported for seriously ill children. Gouws 2004, a clusterrandomised trial on the effects of IMCI training on health worker antibiotic use, was excluded, as no baseline assessment of outcomes was performed. Nadel 2000, an intervention study of periodic mock resuscitations combined with an eight-hour resuscitation course, was excluded, as it lacked a concurrent comparison group/ used a historical control group. Two further studies were excluded, as they enrolled only apparently well children (Pelto 2004) or those with mild acute respiratory infection episodes (Ochoa 1996) . In this update, we excluded 14 studies because of ineligible designs (non-randomised designs, uncontrolled before-after designs, community-based settings) (n = 6 studies) and inappropriate outcome measures/simulated provider practices (n = 8 studies).