Hindawi Publishing Corporation International Journal of Pediatrics Volume 2012, Article ID 408689, 8 pages doi:10.1155/2012/408689 Research Article A Neonatal Resuscitation Curriculum in Malawi, Africa: Did It Change In-Hospital Mortality? Michael K. Hole,1 Keely Olmsted,2 Athanase Kiromera,3 and Lisa Chamberlain1 1 Stanford University School of Medicine, 251 Campus Drive, X215, Stanford, CA 94305, USA 2 Sutter Medical Center, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128, USA 3 St. Gabriel’s Hospital, Namitete, Malawi Correspondence should be addressed to Michael K. Hole, mhole@stanford.edu Received 6 August 2011; Revised 19 September 2011; Accepted 20 September 2011 Academic Editor: Thomas H. Shaﬀer Copyright © 2012 Michael K. Hole et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. The WHO estimates that 99% of the 3.8 million neonatal deaths occur in developing countries. Neonatal resuscitation training was implemented in Namitete, Malawi. The study’s objective was to evaluate the training’s impact on hospital staﬀ and neonatal mortality rates. Study Design. Pre-/postcurricular surveys of trainee attitude, knowledge, and skills were analyzed. An observational, longitudinal study of secondary data assessed neonatal mortality. Result. All trainees’ (n = 18) outcomes improved, (P = 0.02). Neonatal mortality did not change. There were 3449 births preintervention, 3515 postintervention. Neonatal mortality was 20.9 deaths per 1000 live births preintervention and 21.9/1000 postintervention, (P = 0.86). Conclusion. Short-term pre- /postintervention evaluations frequently reveal positive results, as ours did. Short-term pre- and postintervention evaluations should be interpreted cautiously. Whenever possible, clinical outcomes such as in-hospital mortality should be additionally assessed. More rigorous evaluation strategies should be applied to training programs requiring longitudinal relationships with international community partners. 1. Introduction There are 3.82 million neonatal deaths each year with a global neonatal mortality rate of 30 per 1000 live births [1]. The World Health Organization (WHO) estimates that each year 99% of those neonatal deaths occur in developing countries [2]. Neonatal mortality from birth asphyxia ranges from 40 to 610 neonatal deaths per 1000 live births [3– 5], and nearly 1 out of every 4 neonatal deaths in Malawi is a result of birth asphyxia [6]. A lack of protocol and systemized training in neonatal resuscitation to reduce neonatal mortality secondary to birth asphyxia is common across sub-Saharan Africa [7]. As such, the United Nations’ Millennium Development Goal 4—to reduce the 1990 mor- tality rate among under-ﬁve children by two-thirds by 2015—cannot be realized without educational eﬀorts in neonatal resuscitation. As neonatal deaths make up 41% of under-5 mortality [8], neonatal resuscitation training is key. Eﬀective neonatal resuscitation is possible with basic equipment and skills in low-resource settings [9]. Case studies from China and India reveal that 90% of newborns with asphyxia require only drying, warming, and stimulation for complete revival [10, 11]. Such techniques coupled with ensuring a patent airway, suctioning, ventilation, admin- istering oxygen, and chest compressions are part of the Neonatal Resuscitation Program (NRP) [12], an educational intervention based on the consensus of science and resus- citation guidelines of the International Liaison Committee on Resuscitation and published by the American Academy of Pediatrics and the American Heart Association. NRP is the developed world’s standard of care to prevent death and complications of cerebral palsy due to asphyxia [13], and, when systematically implemented by trained personnel, has the potential to annually prevent 192 000 intrapartum- related neonatal deaths worldwide and 5–10% of deaths related to preterm complications [14]. Curriculums with components of NRP have signiﬁcantly improved healthcare