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In-service training for health professionals to improve care of the seriously ill newborn or child in low and middle-income countries (Review)

  • Review
  • Intervention

Authors

  • Newton Opiyo,

    Corresponding author
    1. Kenya Medical Research Institute/Wellcome Trust Research Programme, Child and Newborn Health Group, Nairobi, Kenya
    • Newton Opiyo, Child and Newborn Health Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi, 00100 GPO, Kenya. nopiyo@nairobi.kemri-wellcome.org.

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  • Mike English

    1. Kenya Medical Research Institute/Wellcome Trust Research Programme, Child and Newborn Health Group, Nairobi, Kenya
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Abstract

Background

A variety of emergency care training courses based on developed country models are being promoted as a strategy to improve the quality of care of the seriously ill newborn or child in developing countries. Clear evidence of their effectiveness is lacking.

Objectives

To investigate the effectiveness of in-service training of health professionals on their management and care of the seriously ill newborn or child in low and middle-income settings.

Search methods

We searched The Cochrane Register of Controlled Trials (CENTRAL), the Specialised Register of the Cochrane EPOC group (both up to May 2009), MEDLINE (1950 to May 2009), EMBASE (1980 to May 2009), CINAHL (1982 to March 2008), ERIC / LILACS / WHOLIS (all up to October 2008), and ISI Science Citation Index Expanded and ISI Social Sciences Citation Index (both from 1975 to March 2009). We checked references of retrieved articles and reviews and contacted authors to identify additional studies.

Selection criteria

Randomised controlled trials (RCTs), cluster-randomised trials (CRTs), controlled clinical trials (CCTs), controlled before-after studies (CBAs) and interrupted time series studies (ITSs) that reported objectively measured professional practice, patient outcomes, health resource /services utilization, or training costs in healthcare settings (not restricted to studies in low-income settings).

Data collection and analysis

We independently selected studies for inclusion, abstracted data using a standardised form, and assessed study quality. Meta-analysis was not appropriate. Study results were summarised and appraised.

Main results

Two studies of varied designs were included. In one RCT of moderate quality, Newborn Resuscitation Training (NRT) was associated with a significant improvement in performance of adequate initial resuscitation steps (risk ratio 2.45, 95% confidence interval (CI) 1.75 to 3.42, P < 0.001, adjusted for clustering) and a reduction in the frequency of inappropriate and potentially harmful practices (mean difference 0.40, 95% CI 0.13 to 0.66, P = 0.004). In the second RCT, available limited data suggested that there was improvement in assessment of breathing and newborn care practices in the delivery room following implementation of Essential Newborn Care (ENC) training.

Authors' conclusions

There is limited evidence that in-service neonatal emergency care courses improve health-workers’ practices when caring for a seriously ill newborn although there is some evidence of benefit. Rigorous trials evaluating the impact of refresher emergency care training on long-term professional practices are needed. To optimise appropriate policy decisions, studies should aim to collect data on resource use and costs of training implementation.

摘要

背景

衛生專業人員之在職培訓以改善對重病的新生兒或中低收入國家兒童之照護 (評論)

根據已發展中的國家模式之各種不同的緊急護理訓練課程正被提倡以改善對於重病的新生兒或發展中國家兒童之照護。其效果的明確證據是缺乏的。

目標

研究衛生專業人員在職培訓,對於他們處理重病的新生兒或中低收入國家兒童照護之效益。

搜尋策略

我們搜尋了The Cochrane Register of Controlled Trials (CENTRAL), the Specialised Register of the Cochrane EPOC group (皆至2009年5月), MEDLINE (1950年至2009年5月), EMBASE (1980年至2009年5月), CINAHL (1982年至2008年3月), ERIC / LILACS / WHOLIS (皆至2008年10月), and ISI Science Citation Index Expanded and ISI Social Sciences Citation Index (皆從1975年至2009年3月). 我們檢查引用的檢索文章和評論,並聯絡作家,以確定進一步的研究。

選擇標準

隨機對照試驗 (Randomised controlled trials; RCTs) 、群集隨機試驗 (clusterrandomised trials; CRTs) 、對照臨床試驗 (controlled clinical trials; CCTs) 、控制前後之研究 (controlled beforeafter studies; CBAs) 及中斷性時間序列研究 (interrupted time series studies; ITSs) 客觀地記述測量專業實踐,患者治療效果,衛生資源/服務的利用,或在醫療機構的培訓費用(不僅限於在低收入環境中研究)。

資料收集與分析

我們獨立選擇納入之研究,利用標準表格選擇摘要數據,並評估研究品質。整合分析 (Metaanalysis) 是不適當的。研究的結果被總結及評價。

主要結論

列入兩篇設計不同的研究。在一個中等品質的隨機對照試驗中,新生兒復甦訓練 (Newborn Resuscitation Training; NRT) 與適當的初步復甦步驟的顯著改善表現 (risk ratio 2.45, 95% confidence interval (CI) 1.75 to 3.42, P <0.001, 依群集調整) 及減少不適當和潛在危害做法的頻率相關 (mean difference 0.40, 95% CI 0.13 to 0.66, P = 0.004) 。在第二個隨機對照試驗中,有限的數據顯示,對於呼吸評估和遵循必要新生兒護理 (Essential Newborn Care; ENC) 訓練,在產房中新生兒護理練習是有改善。

作者結論

雖然有部份有利的證據,但對於在職新生兒緊急護理課程能改善衛生工作者練習照護重病新生兒的證據有限。嚴格的試驗以評估緊急照護訓練對於長期專業實踐的影響是必需的。為使適當的政策決定更趨完美,研究的目的應是收集資源使用和培訓費用執行情況的數據。

翻譯人

本摘要由李宛臻翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

衛生專業人員之在職培訓以改善對重病的新生兒或兒童之效度:在開發中國家,尋求醫療設施照護的極重病嬰兒及孩童常於48小時內死亡。目前,已開發國家之急救照護課程數已在開發中國家被提倡,以改善對於重病新生兒或孩童的照護品質。這些課程是否改善衛生工作者的能力以提供適當的照護仍不清楚。僅管這兩篇被納入的研究顯示,緊急照護訓可改善衛生工作人員的實踐,但因研究的數量較小以及研究方法的弱點,一般不可能斷定,當他們面對重病孩童時,這些在職訓練可改善衛生工作者的練習。因此進一步執行良好的研究是需要的, 以提供可靠證據證明這些在職訓練的成就。為引導決定投入那種介入,此種研究也應收集資源使用的數據及訓練介入的成本。

Plain language summary

Effectiveness of in-service training in the care of the seriously ill newborn or child

In developing countries, most deaths in very ill babies and children who seek care in healthcare facilities happen within 48 hours of being seen. Currently, a number of emergency care courses, adapted from developed countries are being promoted in developing countries as a means to improving the quality of care provided to seriously ill newborns or children. Whether these courses result in improvement in health workers’ ability to provide appropriate care remains unclear.

Although the results from the two included studies showed that emergency care training could be followed by improvement in health workers’ practices, because of the small number of studies, differences in the training courses, and weaknesses in the study methods, it is not possible to conclude that in general such in-service training improves health worker practices when they are faced with a seriously ill child. Further well-conducted studies are therefore needed to provide reliable evidence on what such courses achieve. To guide decisions regarding which interventions to invest in, such studies should also collect data on resources used and costs of training interventions.

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