A systematic review of the effectiveness of training in emergency obstetric care in low-resource environments.

BACKGROUND Training of healthcare workers can play an important role in improving quality of care, and reducing maternal and perinatal mortality and morbidity. OBJECTIVES To assess the effectiveness of training programmes aimed at improving emergency obstetric care in low-resource environments. SEARCH STRATEGY We searched Pubmed, Embase, Popline and selected websites, and manually searched bibliographies of selected articles. Language was not an exclusion criterion. SELECTION CRITERIA All papers describing postgraduate training programmes aimed at improving emergency obstetric care in low-resource environments were included. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted the data and classified these according to the level of the measured effects (reaction of participants, improved knowledge and skills, changes in behaviour and outcomes in practice). Any disagreements were resolved by discussion with a third author until agreement was reached. MAIN RESULTS A total of 38 papers were selected. Training programmes vary considerably in length, content and design. The evaluation of effects is often hampered by inadequate study design and the use of non-validated measuring instruments. Most papers describe positive reactions, increased knowledge and skills, and improved behaviour after training. Outcome is assessed less frequently, and positive effects are not always demonstrated. Measures that can contribute to a positive effect of training programmes include hands-on practise, team approaches and follow-up on training efforts. AUTHOR'S CONCLUSIONS Training programmes may improve quality of care, but strong evidence is lacking. Policymakers need to include evaluation and reporting of effects in project budgets for new training programmes.