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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