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Table 4 Research evidence on task-sharing and paediatric and child health service delivery: finding from a systematic search and scoping review

From: Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities

Author Service shifted/shared Country Study type Sharing from/to Input Outcome
Minor surgery
Bowa et al. 2013 [21] Neonatal male circumcision Zambia Non-randomized trial From: Doctor/specialist
To: Doctor, NW, CO, nurse
Didactic lectures, practice on models of neonatal genitalia and clinical practice Total adverse event rate 4.9% though including performed by physicians
Kankaka et al. 2017a [22] Early infant male circumcision Uganda Non-randomized trial From: Doctor/specialist
To: CO, NW
5-day didactic training, hands-on surgical training on 15 cases Knowledge and competency score increased for CO, NW
Pain scores similar in two groups, adverse event rate 3.5%
Kankaka et al. 2017b [23] Early infant male circumcision Uganda RCT From: Doctor/specialist
To: CO, NW
Trained (no detail of training) Adverse event rate 2.4% for CO and 1.6% for NW, maternal satisfaction high (99.6% and 100%, respectively)
Young et al. 2012 [24] Early infant male circumcision Kenya Non-comparative evaluation From: Doctor/specialist
To: CO and nurse
Not reported Adverse event rate 2.7% and patient satisfaction rate 96%
Frajzyngier et al. 2014 [25] Male circumcision Kenya Non-randomized trial From: Doctor/specialist
To: CO, nurse
Training developed based on WHO/UNAIDS manual Adverse event rate (2.1% for nurses and 1.9% for CP) and client satisfaction over 99%
Mwandi et al. 2012 [26] Male circumcision Kenya Non-comparative evaluation From: Doctor/specialist
To: CO, Nurse
Not reported Adverse event rate 1.4% for CO and nurse, respectively, and 0% for medical officer
Alawamlh 2019 [27] Male circumcision Kenya RCT From: Doctor/specialist
To: NPC
Not reported Mean pain score, mean operation time and rate of complete wound healing similar in two RCT arms, no adverse event
Rode et al. 2015 [28] Burn service (minor) South Africa Case study/review From: Doctor/specialist
To: Doctor, nurse
Referral to higher level facility Not reported
Other complex surgery and intensive care
Tyson et al. 2014 [29] Burn surgery, neurosurgery (VP shunting), general surgery ENT surgery, Malawi Non-randomized trial From: Specialist
To: CO
3-year education and 1-year rotation clinical internship
Oversight and supervision
Higher re-operation rate (7.1% for doctors, 17% for CO), similar complication rate (4.5% vs. 4.0%), mortality rate (2.5% vs. 2.1%), length of stay (10 vs. 24 day) considering case mix (burn usually managed by COs)
Wilhelm et al. 2011 [33] VP shunting Malawi Non-randomized trial From: Specialist
To: CO
3-year pre-service training, 1-year internship
Study compared effect with and without supervision
Postoperative mortality rates (6.6% vs 5.9%), wound infection rates (3.3% vs 3.9%), rates of early shunt revision (0 vs. 3.9%) in CO only and surgeon present group. Length of stay shorter in surgeon present group
Tindall et al. 2005 [30] Clubfoot deformity Malawi Non-comparative evaluation From: Doctor/specialist
To: CO
3-day residential and practical workshop
1:1 teaching & supervision
98 of 100 clubfeet in our study were corrected to plantigrade or better by COs
Wilhelm et al. 2017 [31] Major amputation, open reduction, internal fixation with plates Malawi Non-randomized trial From: Specialist
To: CO
Diploma in clinical orthopaedics (18 months) Peri-operative mortality 15.6% vs 12.9%, blood transfusion 32.5% vs. 41.9%, infection 16.9% vs. 19.4%, re-operation 15.6% vs. 19.4%, length of stay 18d vs 20d in CO only and surgeon present group
Grimes et al. 2014 [32] Amputation, fracture, etc. Malawi Cost-effectiveness From: Doctor/specialist
To: CO
Not reported Cost-effectiveness of providing orthopaedic care through CO training was US$92.06 per DALY averted
Emergency care
Tiemeier et al. 2013 [35] Emergency medicine Uganda Cross-sectional From: Doctor/specialist
To: NPC
Not reported Not reported
Chamberlain et al. 2015; Rice et al. 2016 [36, 37] Emergency medicine Uganda Before-after, Non-comparative evaluation From: Specialist
To: Emergency care practitioner (nurse, new cadre)
Initially paired with emergency medicine physician for nine months, continued teaching by rotating volunteer physicians 3-day in-hospital mortality rate 5.04% for unsupervised, 2.90% for supervised. Patients that not severely ill mortality rate showed no difference (2.17% vs. 3.09%)
Under-five case fatality rate 1.9% for malaria, 4.1% for pneumonia, 1.6% for trauma and 6.8% for malnutrition
Olayo et al. 2019 [34] CPAP Kenya Non-comparative evaluation From: Specialist
To: Doctor, nurse, CO
2-day training session Knowledge and skills scores higher for trained providers
Total mortality rate 24%, 95% no adverse event
James et al. 2019 [38] Trauma and ETAT Ghana Before–after From: Doctor/specialist
To: Physician assistant, nurse, midwife
ETAT + course and one module of trauma teaching Confidence and knowledge score increased for injury management after training
Complex and chronic conditions
Aliku et al. 2018 [45] RHD prevention and management Uganda Before–after study From: Doctor/specialist
To: CO, nurse, nurse assistant, midwife
3-month RHD education training programme Knowledge score improved
BPG adherence level remained similar (95.8% vs 94.5), no adverse event following decentralization
Sanyahumbi, 2019 [46] RHD management Malawi Before–after study From: Doctor/specialist
To: Doctor, nurses, CO
3 half-day workshop Improvement in knowledge score, more comfortable prescribing/injecting benzathine penicillin
Sims et al. 2015 [39] RHD screening Malawi Cross-sectional From: Specialist
To: CO
3 half-day didactic & computer-based training, 2-day clinical attachment Kappa between specialist and CO was 0.72; overall sensitivity 0.92, specificity 0.80
Sims Sanyahumbi et al. 2017 [40] RHD screening Malawi Cross-sectional From: Specialist
To: CO
3 half-days didactic & computer-based training, 2 h practical learning Mean kappa statistic comparing CO with paediatric cardiologist was 0.72; sensitivity 0.91, specificity 0.65
Beaton et al. 2016 [41] RHD screening Brazil Cross-sectional From: Doctor/specialist
To: Nurse, technician
Standardized, computer-based training Sensitivity and specificity 85% and 87%
Engelman et al. 2015 [42] RHD screening Fiji Cross-sectional From: Doctor/specialist
To: Nurse
Classroom training for one-week, practical session Knowledge score increased, 98% nurses of adequate quality for diagnosis
Colquhoun et al. 2013 [43] RHD screening Fiji Cross-sectional From: Doctor/specialist
To: Nurse
A week-long training workshop, 2 weeks of screening under supervision
11-step basic algorithm
Sensitivity of 100% and 83%, and a specificity of 67.4% and 79%, respectively, for the two nurses
Ploutz et al. 2016 [44] RHD screening Uganda Cross-sectional From: Doctor/specialist
To: Nurse
4-h didactic, case study & computer-based training, 2-day hands-on session Sensitivity of 74.4%, specificity of 78.8%
Eberly et al. 2018 [70] Heart failure screening and treatment Rwanda Cross-sectional From: Specialist
To: Nurse
Not reported Nurse-performed echocardiography had sensitivity and specificity of 81% and 91% for other RHD;
Patel et al. 2019 [71] Epilepsy diagnosis and management Zambia Before–after study From: Doctor/specialist
To: CO
3-week six training model and open case discussion Increased knowledge on epilepsy medication management, recognition of focal seizure, etc.; limited knowledge on provoked seizures, diagnostic studies, general aetiologies
Harris and Harris 2013 [47] Epilepsy treatment Uganda Case study/review From: Specialist
To: CO
Extra training in epilepsy Higher patient follow-up (70%) in satellite clinics as compared with hospitals, better seizure management
Kengne et al. 2008 [48] Epilepsy treatment Cameroon Case study/review From: Doctor/specialist
To: Nurse
Physician available as needed
Dosage chart and protocol
Total mortality rate 2.7% and reduced seizure during follow-up period
Abbo et al. 2019 [50] Epilepsy treatment Uganda Case study/review From: Doctor/specialist
To: CO, nurse, others
Not reported Not reported
Some et al. 2016 [49] Epilepsy management, sickle cell Kenya Non-comparative evaluation From: CO
To: Nurse
1-week didactic & clinical case scenario
Supervising CO
Structured clinical support tool
Adherence to protocol for epilepsy: patient consultation (82%), weight checked (55%)
Paiva et al. 2012 [72] CNS tumour Brazil Case study/review From: Doctor/specialist
To: Nurse specialist
Not reported Not reported
Kengne, Sobngwi, et al. 2008 [73] Asthma diagnosis and treatment Cameroon Non-randomized trial From: Doctor/specialist
To: Nurse
4-day training, refresher course 1 year later
Physician available as needed
Clinical management algorithm
Median follow-up 2 visits, 39.1% re-hospitalization rate, no death in child and adolescent group
Buser, 2017 [74] Haematology service Tanzania Case study/review From: Doctor/specialist
To: Nurse
2-week collaborative education programme training Not reported
Mafwiri et al. 2014 [75] Eye care prophylaxis, ocular conditions control Tanzania Before–after study, interview From: Doctor/specialist
To: CO, nurses, students
Training, educational materials
Referral and torch for examination
Better knowledge on eye conditions and diagnostics skills
Better management (referral) of cataract and trauma
Mental health
Rossouw et al. 2016, 2018; van de Water et al. 2017, 2018
[51,52,53,54]
Counselling for PTSD South Africa RCT, interview From: Specialist
To: Nurse
1-year advanced psychiatry diploma, 4-day workshop, 16-h practical training
Group supervision every week
Improved patient PTSD (interviewer-rated from 35.32 to 9.29 at 6 month), depression (from 31.4 to 10.12), global functioning (from 52.01 to 67.26)
Tesfaye et al. 2014 [55] Child psychiatry Ethiopia Case study/review From: Doctor/specialist
To: Non-physician clinician
2-week training course and 4-week internship Improved confidence in caring for child patient
Akol et al. 2017 [56] Mental, neurological, substance use disorder identification Uganda Before–after study From: Doctor/specialist
To: CO, nurse, midwife
5-day residential training including classroom and practicum Improvement in mean test score for mental health knowledge, clinical officers had a higher mean score
  1. RCT randomized controlled trial; CO clinical officer; NW nurse and midwife