Table 2

Characteristic of included studies (training and outcomes)

Sr. No.AuthorTrainingNo. of births
A: control/pre
B: intervention/post
OutcomesCriteria for delivery outcomes
A: inclusion
B: exclusion
DurationTraining settingTypeTrainersTraineesAssessment
1Bang et al20NRCommunity
(86 villages)
A package of home-based neonatal care, health education including
  • ENC

  • Suction, stimulation

  • Artificial respiration by mouth to mask and tube and mask

NR
  • Community birth attendants

  • Village health workers

NRA: 1159
B: 1005
1. SB
2. NMR: day 7
3. Perinatal mortality
A: NR
B: NR
2Ariawan et al* 8NRCommunityNRT including
  • Use of tube mask

  • Refresher training at 3, 6 and 9 months, use of video

  • Post resuscitation care

NRMidwivesNRA: 9816
B: 16 053
1. SB
2. NMR: day 28
A: NR
B: NR
3Carlo et al17**3 daysRural communities
(7 sites in 6 countries for ENC; 88 for NRP)
ENC sensitisation followed by in-depth NRT including
  • Initial resuscitation steps

  • BMV

  • AAP-trained trainer

  • Research staff, either a physician or nurse

Community birth attendantsNRA: 359
B: 273
1. SB
2. FSB
3. NMR: day 7
4. PNMR
A: BW <1500 g
B: NR
4Carlo et al183 daysRural communities
(7 sites in six countries for ENC; 88 for NRP)
ENC sensitisation followed by in-depth NRT including
  • Initial resuscitation steps

  • BMV

  • AAP-trained trainer

  • Research staff, either a physician or nurse

Community birth attendantsNRA: 35 017
B: 29 715
1. SB
2. FSB
3. NMR: day 1
4. NMR: day 7
5. PNMR
A: BW >1500 g
B: NR
5Gill et al212 weeksCommunity
(rural district setting)
NRT modified from AAP/AHA including
  • Initial steps

  • PPV

  • Use of manikins to demonstrate and practice skills

NR60 Community birth attendants/TBAsOne to one skills assessmentA: 1536
B: 1961
1. SB
2. NMR: day 7
3. NMR: day 28
4. PNMR
A: NR
B: NR
6Zhu et al26NRHospital
(1 hospital)
NRPG curriculum established from AAP and AHA including
  • Suction

  • BMV or ET ventilation

  • Intubation

NRHospital birth attendantsNRA: 1722
B: 4751
1. NMR: day 1
2. NMR: day 7
A: NR
B: NR
7Deorari et al24NRHospital
(14 teaching hospitals)
AAP/AHA-modified NRT with
  • ToT approach

2 Faculty member trainer per facilityHospital-based birth attendantsNo skills assessmentA: 7070
B: 25 713
1. NMR: day 28A: NR
B: NR
8Jeffery et al289 weeksHospital
(3 tertiary care, 13 district hospitals)
A package of perinatal practices with NRTAustralian-trained Macedonian teachers (doctors and nurses)Doctors and nursesMCQ, SAQ and OSCE (practical test)A: 69 840
B: 45 458
1. SB
2. NMR: day 7
3. PNMR
A: NR
B: NR
9Vakrilova et al30NRHospital
(delivery rooms of city hospitals)
French–Bulgarian Program on NRTNR
  • Neonatologist

  • Obstetrician

  • Midwives

NRA: 67 948
B: 67 647
1. NMR: day 7A: NR
B: NR
10O’Hare et al2510 days training
(5 days classroom+5 days delivery suite)
Hospital
(1 teaching hospital)
NRT including
  • Airway management

  • BMV

  • Cardiac massage

  • Use of manikins to demonstrate and practice skills

NR5 members of nursing staffNRA: 1296
B: 1046
1. SBA: NR
B: NR
11Opiyo et al191 dayHospital
(1 maternity hospital)
NRT including
  • Initial steps

  • BMV (use of bag valve mask device)

  • CC

  • Use of manikins to demonstrate and practice skills

Instructor completed Kenya Resuscitation Council Advanced Life Support Generic Instructor CourseNurse/midwivesMCQ and formal test scenario evaluating skillsA: 4084
B: 4302
1. SB
2. NMR: day 28
A: NR
B: NR
12Boo31NRHospitalAAP-NRT tailored to local needs including
  • Initial steps

  • BMV

  • CC

  • ET

  • ToT approach, a national-level training programme

  • 37 Core instructors

  • Doctors and nurses

14 575
  • Doctors

  • Nurses

  • Medical assistants

  • Medical students

Written and practical testA: 541 721
B: 465 140
1. SB
2. NMR: day 28
3. PNMR
A: NR
B: NR
13Sorensen et al292 daysHospital
(1 referral hospital)
ALSO a widespread EmONC
  • Use of manikins to demonstrate and practice skills

NRHigh-level and mid-level staff involved in deliveryNRA: 577
B: 565
1. SBA: BW >1000 g
B: Missing data
14Hole et al321 dayHospital
(1 university hospital and 1 referral hospital)
AAP modified NRT to include
  • Initial steps

  • BMV

  • CC and special consideration

  • Use of manikins to demonstrate and practice skills

Paediatrics residents from Stanford University
  • Physician

  • Clinical officers

  • Midwives

Survey covering knowledge, skills and attitudeA: 3449
B: 3515
1. NMR: day 28A: NR
B: NR
15Msemo et al221 dayHospital
(3 referral hospitals, 4 regional hospitals and 1 district hospital)
HBB training including
  • Stimulation

  • Suctioning

  • Face and mask ventilation

  • ToT approach

  • Use of simulators for hands on practice

  • FBOS training—reported by 1 site

40 TrainersHospital birth attendantsPractical testA: 8124
B: 78 500
1. SB
2. FSB
3. NMR: day 1
A: BW >750 g for live birth
BW >1000 g for FSB
16Goudar et al231 dayHospital
(primary health centres and rural and urban hospitals)
HBB–AAP-based NRT
  • Initial steps

  • Stimulation

  • Suctioning

  • BMV

  • ToT model

  • Paired teaching

  • Use of manikins to demonstrate and practice skills

  • 18 Master trainers trained by AAP

  • Physicians and nurses

599 Birth attendantsWritten and verbal MCQ, BMV by demonstration—OSCEA: 4187
B: 5411
1. SB
2. FSB
3. NMR: day 28
A: GA >28 wks
B: NR
17Vossius et al771 dayHospital
(1 tertiary hospital)
HBB–AAP-based NRT including
  • BNC and resuscitation

  • Simulation-based training using manikins

  • ToT approach

40 Master trainersHospital-based birth attendantsKnowledge and technical skillsA: 4876
B: 4734
1. FSB
2. NMR: day 7
A: NR
B: NR
18Ashish et al***2 daysHospital
(1 tertiary hospital)
HBB–AAP-based NRT with QIC; train the trainer model, paired teaching
  • Skills and practice

  • ToT model

  • Use of manikins to demonstrate and practice skills

NR
  • Obstetricians

  • Anaesthesiologist

  • Medical doctors

  • Students

  • Nurse/midwives

NRA: 9588
B: 15 520
1. SB
2. FSB
3. NMR: day 1
4. PNMR
A: GA >22 wks
B: NR
19Bellad et al273 daysHospital
(39 primary, 21 secondary and 11 tertiary facilities)
HBB–AAP-based NRT including
  • Initial steps

  • Stimulation, suctioning

  • BMV

  • Refresher training

  • QI activities

  • ToT model

  • Paired teaching

  • Use of manikins to demonstrate and practice skills

  • Neonatologists

  • Paediatricians

  • Obstetricians

  • Nurses

Hospital-based birth attendants
  • Paediatricians

  • Obstetricians

  • Physicians

  • Residents

  • Nursing staff

  • Medical assistants

MCQ, OSCE for skills assessmentA: 15 232
B: 15 985
1. FSB
2. NMR: day 1
3. NMR: day 7
4. NMR: day 28
5. PNMR
A: BW >1500 g
B: BW unknown,<1500, >5500 and MSB
20Patel et al***3 daysHospital
(2 primary, 4 secondary HTML validation and 7 tertiary facilities)
HBB–AAP-based NRT including
  • Initial steps

  • Stimulation, suctioning

  • BMV

  • Refresher training and

  • QI activities

  • ToT model

  • Paired teaching

  • Use of manikins to demonstrate and practice skills

  • Neonatologists

  • Paediatricians

  • Obstetricians

  • Nurses

eHospital-based birth attendants
  • Paediatricians

  • Obstetricians

  • Physicians

  • Residents

  • Nursing staff

  • Medical assistants

MCQ, OSCE for skills assessmentA: 38 078
B: 40 870
1. SB
2. FSB
3. NMR:  day 1
4. NMR: day 7
6. PNMR
A: GA >20 wks
B: NR
  • *Data for this study has been taken from Lee et al8.

  • **Data for very low-birth weight (<1500 g).

  • ***Unpublished data obtained via personal communication with the author

  • AAP, American Academy of Pediatrics; AHA, American Heart Association; ALSO, Advanced Life Support in Obstetrics; BMV, bag and mask ventilation; BW,  birth weight; CC, chest compression; EmONC, Emergency Obstetrics & Neonatal Care; ENC, essential newborn care; ET, endotracheal tube; FBOS, frequent brief onsite simulation; FSB, fresh stillbirth; GA, gestational age, HBB, helping babies breathe; MCQ, multiple choice questions; NICHD, National Institute of Child and Human Development; NMR, neonatal mortality rate; NORAD, Norwegian Agency for Development Cooperation; NR, not reported; NRPG, Neonatal Resuscitation Program Guidelines; NRT, neonatal resuscitation training; OSCE, objective structured clinical evaluation; PNMR, perinatal mortality rate; PPV, positive pressure ventilation; QI, quality improvement; QIC, quality improvement cycle; RCT, randomised control trial; SAQ, short answer questions; SB, all stillbirth; TBA, traditional birth attendants; ToT, training of trainer; wks, weeks.