Table 3.

Studies describing pulse oximetry training initiatives: perinatal assessment and monitoring*

WHERE: country (LMIC designation), sites	WHEN: year of training	WHO: population trained	WHY: purpose of training	WHAT: structure of training	HOW: pulse oximetry related outcomes
Region of the Americas
Argentina (UMIC): 1 hospital in San Luis, 1 hospital in Rosario [58]	San Luis – 2019; Rosario – 2017-2018	Neonatal nurses and neonatologists	CCHD screening	SIBEN Clinical Consensus	Increased screening after training with plans for universal screening
Bolivia (LMIC): 1 hospital in La Paz, 1 hospital in Sucre [58]	2018	Staff	CCHD screening	SIBEN Clinical Consensus	Unable to routinely screen due to lack of equipment and staff
Brazil (UMIC), 5 NICUs in Rio de Janeiro [59]	2009	Neonatal nurses and nurse assistants	Improving nursing care to decrease mortality and incidence of ROP	3-mo self-administered education package	78% of qualified nurses and 82% of nurse assistants were trained and knowledge improved after training. No significant impact on survival or ROP was found.
Colombia (UMIC): 1 hospital in Barranquilla [58]	2014	Neonatal group	CCHD screening	SIBEN Clinical Consensus	Increased screening after training and screening became mandatory in 2018
Costa Rica (UMIC): Nationwide [58]	2016	Not clearly stated, screening by respiratory therapists, nurses	CCHD screening	SIBEN Clinical Consensus	Screening nationwide after training
Cuba (UMIC): not stated [58]	Cuba: not provided	Not stated, screening in some neonatal centres	CCHD screening	SIBEN Clinical Consensus	Limited screening due to pulse oximetry shortage
Dominican Republic (UMIC): Nationwide [58]	2019	Neonatologists, neonatal nurses, neonatology residents	CCHD screening	SIBEN Clinical Consensus	Screening not yet started
El Salvador (LMIC): 1 hospital in San Salvador [58]	Not provided	Not stated	CCHD screening	SIBEN Clinical Consensus	Screening not yet started
Guatemala (UMIC), Tecpán municipality [60]	Year not provided. Study published in 2018.	Traditional birth attendants	Improve detection of maternal and perinatal complications and facility referral	4-d training on perinatal complications, indications for referral, and use of the mHealth platform and device (which included a pulse oximeter)	Rate of emergency referrals to facilities increased with the mHealth intervention and training.
Honduras (LMIC): Nationwide [58]	Not provided	Staff providing neonatal care	CCHD screening	SIBEN Clinical Consensus	Increased screening after training
Paraguay (UMIC): 1 hospital in Asunción [58]	2013	Nurses	CCHD screening	SIBEN Clinical Consensus	Increased screening after training
Peru (UMIC): 1 hospital in Lima. [58]	2018	Not clearly stated, screening by nurses	CCHD screening	SIBEN Clinical Consensus	Increased screening after training, pulse oximeter provision, and hiring dedicated staff for screening
African Region
South Africa (UMIC), 1 hospital in Port Elizabeth [61]	2012-2014	Paediatricians and NICU nurses	ROP prevention	Paediatric academic programme for paediatricians and educational sessions for nursing staff	More infants being screened for ROP after developing an ROP screening clinic. Training and provision of pulse oximeters and oxygen blenders made targeted oxygen supplementation possible.
Eastern Mediterranean Region
Iran (LMIC), Sistan and Baluchestan provinces [62]	2014	Midwives and general practitioners	Improve management of postpartum haemorrhage	2-d training based on WHO guidelines	Pulse oximetry use increased from 0 to 81.5% after the workshop.
South-East Asia Region
India (LMIC), Centres with high incidence of aggressive posterior ROP in North Karnataka [63]	2011-2015	NICU nurses and paramedical staff, paediatricians	Attempt to reduce severe ROP	ROP prevention guidelines and targeted training	More infants being are being screened for ROP but no mention of improved pulse oximetry use
Western Pacific Region
China (UMIC), Rural areas [64]	2015	Public health stakeholders, clinicians, rural health workers	CCHD, pneumonia, and sepsis detection	Train the trainer model	More than 52 000 newborns have been screened
China (UMIC), Rural county hospitals in Yunnan Province [65]	2015-2016	Obstetricians and obstetric nurses	CCHD screening training	1-d hands on training	Improved knowledge via MCQs immediately after training and at 3 mo follow up 61.6% of nurses reported frequent pulse oximeter and 23.2% reported sometimes using pulse oximeters at follow up. Newborn screening rates were 90.6%-98.0%

LMIC – lower middle-income country, UMIC – upper middle-income country, CCHD – critical congenital heart defects, SIBEN – Ibero American Society of Neonatology, NICU – neonatal intensive care unit, ROP – retinopathy of prematurity, m – months, d – days, MCQ – multiple choice question

*Stratified by WHO Regions.