Simulation-based neonatal resuscitation training in low- and middle-income countries: A scoping review

Neonatal mortality remains high in low- and middle-income countries (LMICs), where simulation-based training could enhance frontline providers’ resuscitation skills. This scoping review maps evidence on simulation-based neonatal resuscitation training for nurses, midwives, and birth attendants in LMICs. Following PRISMA-ScR guidelines, three databases (Pubmed, Google scholar and Epistemonikos) were searched from 2015 to 2025 for studies on simulation training targeting nurses/midwives in LMICs. Two reviewers screened titles/abstracts and full texts, charting data on intervention design, outcomes, facilitators, and barriers. Seventeen studies were included, mainly from Tanzania ( n = 6), India ( n = 4), Uganda, Kenya, Pakistan, Zambia, Liberia, and Latin America. Interventions included Helping Babies Breathe (HBB; n = 9), PRONTO ( n = 3), and low-dose refreshers, varying in duration (1–6 days), fidelity (low-high), and follow-up (immediate to 12 months). Providers showed gains in knowledge, skills (bag-mask ventilation proficiency), and confidence, but retention waned without refreshers. Barriers encompassed equipment scarcity, staffing shortages, and integration challenges. Simulation training is feasible and effective short-term for LMIC providers, supporting scalable models like HBB with mentoring. Gaps in long-term neonatal outcomes and qualitative insights warrant randomized trials and policy focus on sustainability.