Table 2

Characteristic of included studies (training and outcomes)

Sr. No.	Author	Training						No. of births A: control/pre B: intervention/post	Outcomes	Criteria for delivery outcomes A: inclusion B: exclusion
Sr. No.	Author	Duration	Training setting	Type	Trainers	Trainees	Assessment	No. of births A: control/pre B: intervention/post	Outcomes
1	Bang et al 20	NR	Community (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	NR	A: 1159 B: 1005	1. SB 2. NMR: day 7 3. Perinatal mortality	A: NR B: NR
2	Ariawan et al* 8	NR	Community	NRT including Use of tube mask Refresher training at 3, 6 and 9 months, use of video Post resuscitation care	NR	Midwives	NR	A: 9816 B: 16 053	1. SB 2. NMR: day 28	A: NR B: NR
3	Carlo et al 17**	3 days	Rural 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 attendants	NR	A: 359 B: 273	1. SB 2. FSB 3. NMR: day 7 4. PNMR	A: BW <1500 g B: NR
4	Carlo et al 18	3 days	Rural 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 attendants	NR	A: 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
5	Gill et al 21	2 weeks	Community (rural district setting)	NRT modified from AAP/AHA including Initial steps PPV Use of manikins to demonstrate and practice skills	NR	60 Community birth attendants/TBAs	One to one skills assessment	A: 1536 B: 1961	1. SB 2. NMR: day 7 3. NMR: day 28 4. PNMR	A: NR B: NR
6	Zhu et al 26	NR	Hospital (1 hospital)	NRPG curriculum established from AAP and AHA including Suction BMV or ET ventilation Intubation	NR	Hospital birth attendants	NR	A: 1722 B: 4751	1. NMR: day 1 2. NMR: day 7	A: NR B: NR
7	Deorari et al 24	NR	Hospital (14 teaching hospitals)	AAP/AHA-modified NRT with ToT approach	2 Faculty member trainer per facility	Hospital-based birth attendants	No skills assessment	A: 7070 B: 25 713	1. NMR: day 28	A: NR B: NR
8	Jeffery et al 28	9 weeks	Hospital (3 tertiary care, 13 district hospitals)	A package of perinatal practices with NRT	Australian-trained Macedonian teachers (doctors and nurses)	Doctors and nurses	MCQ, SAQ and OSCE (practical test)	A: 69 840 B: 45 458	1. SB 2. NMR: day 7 3. PNMR	A: NR B: NR
9	Vakrilova et al 30	NR	Hospital (delivery rooms of city hospitals)	French–Bulgarian Program on NRT	NR	Neonatologist Obstetrician Midwives	NR	A: 67 948 B: 67 647	1. NMR: day 7	A: NR B: NR
10	O’Hare et al 25	10 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	NR	5 members of nursing staff	NR	A: 1296 B: 1046	1. SB	A: NR B: NR
11	Opiyo et al 19	1 day	Hospital (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 Course	Nurse/midwives	MCQ and formal test scenario evaluating skills	A: 4084 B: 4302	1. SB 2. NMR: day 28	A: NR B: NR
12	Boo31	NR	Hospital	AAP-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 test	A: 541 721 B: 465 140	1. SB 2. NMR: day 28 3. PNMR	A: NR B: NR
13	Sorensen et al 29	2 days	Hospital (1 referral hospital)	ALSO a widespread EmONC Use of manikins to demonstrate and practice skills	NR	High-level and mid-level staff involved in delivery	NR	A: 577 B: 565	1. SB	A: BW >1000 g B: Missing data
14	Hole et al 32	1 day	Hospital (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 attitude	A: 3449 B: 3515	1. NMR: day 28	A: NR B: NR
15	Msemo et al 22	1 day	Hospital (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 Trainers	Hospital birth attendants	Practical test	A: 8124 B: 78 500	1. SB 2. FSB 3. NMR: day 1	A: BW >750 g for live birth BW >1000 g for FSB
16	Goudar et al 23	1 day	Hospital (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 attendants	Written and verbal MCQ, BMV by demonstration—OSCE	A: 4187 B: 5411	1. SB 2. FSB 3. NMR: day 28	A: GA >28 wks B: NR
17	Vossius et al 77	1 day	Hospital (1 tertiary hospital)	HBB–AAP-based NRT including BNC and resuscitation Simulation-based training using manikins ToT approach	40 Master trainers	Hospital-based birth attendants	Knowledge and technical skills	A: 4876 B: 4734	1. FSB 2. NMR: day 7	A: NR B: NR
18	Ashish et al***	2 days	Hospital (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	NR	A: 9588 B: 15 520	1. SB 2. FSB 3. NMR: day 1 4. PNMR	A: GA >22 wks B: NR
19	Bellad et al 27	3 days	Hospital (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 assessment	A: 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
20	Patel et al***	3 days	Hospital (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 assessment	A: 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 al 8.
**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.