Effectiveness and sustainability of neonatal resuscitation training programs in reducing neonatal mortality rates in low- and middle-income countries: a systematic review

Globally, 75% of neonatal deaths occur in the first week of life. Despite a 52% reduction in the neonatal mortality rate (1990–2022), significant disparities persist in low- and middle-income countries (LMICs). This systematic review synthesises evidence on the effectiveness and sustainability of neonatal resuscitation training programs in LMICs, with a focus on training programs, design, provider competency outcomes, and sustainability features. Systematic searches of five electronic databases (Embase, PubMed, MEDLINE (Ovid), Scopus, and CINAHL) were conducted in accordance with PRISMA guidelines to identify studies published between January 2020 and January 2025. Studies evaluating neonatal resuscitation training for healthcare providers in LMICs and reporting competency or mortality outcomes were eligible. Risk of bias and methodological quality were assessed using the Mixed Methods Appraisal Tool. Fifty-two studies across 23 LMICs met the inclusion criteria. The majority demonstrated immediate improvements in provider knowledge and skills, although the magnitude and durability of effects varied across study designs and settings. Helping Babies Breathe was the most evaluated training program. Multi-component interventions incorporating training, mentorship, and quality improvement were associated with greater mortality reductions than training alone in narrative comparisons. Limited long-term follow-up constrains sustainability conclusions. Neonatal resuscitation training programs improve healthcare providers’ competencies and, when implemented with system-level support, are associated with reduced mortality. Future research should incorporate validated sustainability assessment frameworks and extended follow-up to strengthen the evidence base for long-term program impact. This review was registered on PROSPERO (CRD42024623116). This review received no external funding.