Minor surgery |
Bowa et al., 2013 [21] | Neonatal male circumcision | Zambia | Non-randomized trial | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Specialist • 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 | • Specialist • 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 | • Doctor/specialist • 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 | • Specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • NPC | • Not reported | • Not reported |
Chamberlain et al., 2015; Rice et al., 2016 [36, 37] | Emergency medicine | Uganda | Before-after, Non-comparative evaluation | • Specialist • 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 | • Specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • CO, nurse, nurse assistant, midwife | • 3-month RHD education training program | • 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 | • Doctor/specialist • 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 | • Specialist • 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 | • Specialist • CO | • 3 half-days didactic & computer-based training, 2 hours 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 | • Doctor/specialist • Nurse, technician | • Standardized, computer-based training | • Sensitivity and specificity 85% and 87% |
Engelman et al., 2015 [42] | RHD screening | Fiji | Cross-sectional | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • 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 | • Specialist • 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 | • Doctor/specialist • 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 & Harris, 2013 [47] | Epilepsy treatment | Uganda | Case study/review | • Specialist • 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 | • Doctor/specialist • 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 | • Doctor/specialist • CO, nurse, others | • Not reported | • Not reported |
Some et al., 2016 [49] | Epilepsy management, sickle cell | Kenya | Non-comparative evaluation | • CO • 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 | • Doctor/specialist • Nurse specialist | • Not reported | • Not reported |
Kengne, Sobngwi, et al., 2008 [73] | Asthma diagnosis and treatment | Cameroon | Non-randomized trial | • Doctor/specialist • 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 | • Doctor/specialist • Nurse | • 2-week collaborative education program training | • Not reported |
Mafwiri et al., 2014 [75] | Eye care prophylaxis, ocular conditions control | Tanzania | Before-after study, interview | • Doctor/specialist • 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 [51–54] | Counselling for PTSD | South Africa | RCT, interview | • Specialist • Nurse | • 1-year advanced psychiatry diploma, 4-day workshop, 16-hour 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 | • Doctor/specialist • Non-physician clinician | • Two-week training course and four-week internship | • Improved confidence in caring for child patient |
Akol et al., 2017 [56] | Mental, neurological, substance use disorder identification | Uganda | Before-after study | • Doctor/specialist • 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 |