A scoping review will be conducted to identify and examine the existing research centered on the effects of neonatal resuscitation training on the practices of unskilled birth attendants in low-resource countries. In contrast to systematic reviews that aim to answer specific questions, scoping reviews produce a broad overview of the field. Hence, our study will be conducted using a methodological framework for scoping studies published by Arksey and O’Malley [8], which has been further developed by Levac et al [11] and the Joanna Briggs Institute [12]. As recommended by Tricco et al [13], this protocol will follow the relevant aspects of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines to ensure rigor and reduce bias in reporting the methodology [14]. Using this established protocol, we plan to review the existing literature systematically focusing on neonatal resuscitation training of unskilled birth attendants on practice and map out key concepts, thereby identifying the need for further research in this area. The framework includes the following stages: (1) identify the research question; (2) identify relevant studies; (3) perform study selection; (4) extract and chart the data; and (5) collate, summarize, and report the results.

The aim of this review is to identify what gaps exist within the research of neonatal resuscitation training of unskilled birth attendants and identify interventions that can be made to improve such gaps.

Furthermore, this study endeavors to create an understanding of how neonatal resuscitation training influences the practices of newborn care and what factors are essential in their implementation for achievement in a low-resource setting. We aim to provide answers to the following subquestions:

This review will use the Population, Concept, and Context (PCC) framework (Table 1) recommended by Joanna Briggs Institute for scoping reviews [12] to determine the eligibility of the research questions. PCC is a more adaptable substitute for the Population, Intervention, Comparison, and Outcomes (PICO) framework for systematic reviews.

The research team developed a search strategy with the college librarian. Our literature search was open, including peer-reviewed literature and grey literature (ie, research not published in peer-reviewed journals). Using databases of peer-reviewed research (PsycINFO and Wiley Online Library [via EBSCOhost], PubMed, MEDLINE with full-text, Google Scholar [via ScienceDirect], and CINAHL Plus with full text [via EBSCOhost]), as well as the websites of the WHO and other organizations with policies and guidelines on neonatal resuscitation, a systematic search for relevant studies was conducted. The search was limited to articles published between January 2008 and January 2019, given that we wanted to examine the effects of neonatal resuscitation training on the practices of unskilled birth attendants over an 11-year period. We also performed a nonsystematic search (or grey literature search) of reports and guidelines from agencies (eg, WHO), using search engines designed to find evidence from published relevant interventions and studies in low- and middle-income countries, and selected grey literature reports from governmental and nongovernmental organizations.

The primary research teams were focused on using variations of the following Medical Subject Headings (MeSH) terms: resuscitation, practice, unskilled birth attendants, neonate/newborn, community health workers, training, and low/middle resource setting. In addition, a number of terms and keywords were searched, including “unskilled birth attendants,” neonatal resuscitation training, community health workers, low/middle resources setting, and unskilled birth attendants, along with the relevant subheadings. They were systematically combined into phrases using Boolean operators (AND, OR) to capture relevant fields. A complete list of the search terms is presented in Table 2. All researchers will update the number of publications identified and date of each literature search using Table 2. After searching, duplicates will be deleted, and the remaining papers will be exported to a web-based software platform that streamlines the inclusion eligibility screening for systematic reviews [15].

A library will be created for this review using EndNote X7.8 (Clarivate) referencing software. The investigators will search systematically and screen study titles from the database. All eligible study titles will be exported to the EndNote library. All duplicates will be removed, and abstract screening will be performed. Two reviewers (AAO and HA) will independently conduct abstract screening, followed by full-test screening of all studies selected using guidelines from the eligibility criteria. A third reviewer (BPN) will be consulted in cases of disagreement between the reviewers.

Where articles are not available, authors will be contacted. We will exploit our local library services (University of KwaZulu-Natal) to retrieve articles to be included in the full article screening. Reporting will be done according to the PRISMA-ScR flow diagram [14] in Figure 1. Additional articles will be identified through reference mining of included studies. Subsequently, discussion will follow to establish a consensus on which papers will be included.

The inclusion criteria are as follows: (1) studies focused on neonatal resuscitation with unskilled birth attendants; (2) original research or reviews published in peer-reviewed journals relevant to the study; and (3) studies conducted in low- and middle-resource countries. Non–English-language studies will be excluded from the review. We will also exclude any studies without a focus on neonates or newborns and/or studies reporting preterm deaths.

Three independent team reviewers (AAO, HA, and BPN) will extract data from all eligible studies in triplicate using a standardized Google Forms tool for the abstracts. A data charting table will be used to extract and process the information from all studies. Data to be extracted and described will include the following: bibliographic details, study design, assessment of knowledge of health providers, practices, the effectiveness of training intervention, and study setting. Information specific to community health workers as unskilled birth attendants, descriptions of interventions as neonatal resuscitation training, and geographical locations of the studies will also be extracted. The team will autonomously design and compare the form for accuracy using the PCC framework of the review for the abstract [12]. Two reviewers (AAO and HA) will independently screen and select all references and process the relevant information from each included article. The third reviewer (BPN) will be consulted during the review to achieve harmony.

The main aim of this study is to scope the existing evidence and summarize the findings as presented across articles. After data extraction is concluded, the research team will carry out a thematic analysis of the studies, where a narrative account of the data extracted from the included studies will be analyzed and an overview of the reviewed data will be provided. Data will be extracted and described according to the following features: bibliographic details, study design, assessment of knowledge of health providers, practices, effectiveness of training intervention, and study setting. Emerging themes from study results on neonatal resuscitation training for birth attendants who are unskilled will be coded by all authors independently. NVivo software (version 12; QSR International Pty Ltd [16]) will be expended to code the data from the included studies according to the above classifications. More importantly, the study team will scrutinize the meaning of findings as they relate to the overall aim of the study and discuss the implications for future research, practice, and policy.

Basic neonatal resuscitation training can be successfully accomplished by health workers, resulting in a decline in intrapartum-related mortality [17]. Training programs in neonatal resuscitation can effectively increase the competence of health workers in conducting neonatal resuscitation and reduce potentially harmful practices [18]. Targeted research on neonatal resuscitation and its impact on the practice of community health workers who are unskilled birth attendants is needed. Training of community health care workers in neonatal resuscitation will enhance their skills and practice and improve the prevention of intrapartum-related deaths. Evidence from countries like India and Indonesia showed that community-based neonatal resuscitation training may be possible and helpful in reducing intrapartum-related mortality in settings with high rates of home births and delivery attendance by community health workers [19].

The proposed scoping review will generate findings that will aid in describing the links between neonatal resuscitation training and practices among community health workers who are unskilled birth attendants. This review will enable the authors to answer key questions, clarifying what is known and unknown about the links between this phenomenon in low- and middle-resource countries.

As such, the findings of this review will contribute to knowledge on this topic and impact skills for practice, policy, and research in the area of newborn survival and child health. Evidence generated in this scoping review may serve as a basis on which prevention strategies may be established for newborn mortality as a result of perinatal asphyxia.

Furthermore, this review will be significant in identifying research gaps and other ways in which reduction in newborn mortality can be achieved. Findings in this review will become relevant to researchers as evidence for the need for more work in this area.

The protocol outlines a rigorous design that comprises an established research framework, a search strategy, and a selection process. The inclusion of grey literature and the use of peer-reviewed literature take into consideration a wide synopsis of various study designs and methodologies and emphasize the state of existing literature surrounding neonatal resuscitation training. The scoping review is an effective method for investigating and mapping comprehensive and different topics. The possible limitation regarding the amount of data for this scoping review study is that this study is not going to analyze the direct impact of training on mortality.