Supplementary Material for: Effectiveness of neonatal resuscitation training programs, implementation and scale-up in low- and middle-income countries

Introduction: To describe recent evidence regarding the most effective neonatal resuscitation training program and scale-up of these programs in low-and middle-income countries (LMICs), which has contributed to the upcoming Lancet Global Newborn Care Series 2025, and forms part of a supplement describing an extensive synthesis on effective newborn interventions in LMICs. Methods: We included relevant studies from Medline, Embase, CINAHL, Cochrane CENTRAL and Global Index Medicus databases on the effectiveness and scale-up of Neonatal Resuscitation Training Programs (NRTP), with searches run August 2022. Data extraction and quality assessments were completed independently and in duplicate. Results: A total of 93 unique records met the eligibility criteria and were included in our analyses across the reviews. NRTPs improved most knowledge and skill-based outcomes but impact on mortality varied. Included studies identified knowledge and skill retention, standardized training protocols, and limited training opportunities for health care providers as challenges to current NRTPs. Conclusion: Reported knowledge, skills, and mortality outcomes were similar across NRTPs. The Helping Babies Breathe (HBB) program was found to be cost-effective in Tanzania, suggesting that the HBB program or elements thereof are low-cost and scalable in LMICs. Future research across diverse settings should evaluate the cost-effectiveness of other NRTPs. To scale-up current NRTPs, programs should focus on improving long-term retention outcomes and improving training material accessibility.