2 providers’ knowledge, skills, and attitudes in developing countries [15, 16] and decreased neonatal mortality in the developing world up to 65.7 percent [10, 17, 18]. One study revealed declines in national trends of neonatal mortality over an 8-year period following NRP integration across Malaysia [19]. Furthermore, a 44.6% decline in neonatal mortality was seen with WHO’s Essential Newborn Care (ENC) curriculum in Zambia, a resuscitation curriculum separate from the NRP [20]. Conversely, a recent study of ENC among 57 643 infants and NRP among 62 366 infants showed no reduction in mortality rates for either program [21]. Resource-constricted environments, often overﬂowing with competing needs and challenges like staﬀ turnover, outdated equipment, and low levels of education, can render true change challenging to accomplish. Because the literature reports conﬂicting results following NRP training, a meta- analysis was performed which was inconclusive on all-cause neonatal mortality [22]. An increasing number of medical students and residents spend professional time working abroad [23, 24]. Inter- national health experiences have been shown to increase students’ interest in public health, likelihood of choosing a career in primary care, and commitment to serving the underserved [25]. Many medical schools and resi- dency programs now oﬀer global health curriculum tracks, elective clinical rotations, and opportunities for research in developing world settings. Unfortunately, such research tends to examine short-term programs using pre- versus postintervention evaluations of participants while failing to evaluate patient outcomes. This reality is reﬂected in the current literature surrounding the assessment of neonatal resuscitation training eﬀorts in the developing world [26– 29]. Pediatric residents at Stanford University’s Lucile Packard Children’s Hospital (LPCH) developed a partnership with St. Gabriel’s Hospital in Namitete, Malawi, Africa in January 2008. Stanford residents conducted a needs assessment in March 2008 that identiﬁed an interest in neonatal resus- citation training for the hospital’s staﬀ to reduce neonatal mortality. In response, Stanford residents developed and implemented NRP-based training to train St. Gabriel’s Hospital physicians, clinical oﬃcers, and midwives (n = 14). The goal of this project was to evaluate the intervention on two levels: (1) the impact on trainees through a pre- /postcurricular evaluation and (2) the impact on neonatal mortality rates at St. Gabriel’s Hospital. 2. Methods 2.1. Neonatal Resuscitation Training 2.1.1. Intervention. The curriculum was based upon the American Academy of Pediatrics NRP [12] and tailored in response to the constricted time and resources deemed feasible by on-site community leaders. The curriculum required a total of 6 hours: two hours of lecture, one hour of demonstration, and three hours of hands-on, scenario- driven sessions using mannequins to address components of NRP techniques, and oxygen was available (Table 1). During International Journal of Pediatrics September of 2008, weekly training sessions for small groups of employees (n = 4-5) were held. The course was taught on one day by two Pediatrics residents in the same room with all 14 participants present. 2.1.2. Evaluation. A survey tool was developed to assess pre- /posteducational intervention impact. The survey consisted of 18 queries covering three domains: attitude, knowledge, and skills. This tool was developed with the assistance of an expert in survey design, pilot-tested, and modiﬁed accordingly. Students’ t-test was used to compare mean score changes for the pre-/post-educational intervention surveys. The pre-/postintervention instrument can be obtained by contacting the lead author. 2.2. Neonatal Mortality 2.2.1. Design. An observational, longitudinal study, and secondary data analysis was performed by data abstraction from existing hospital administration data provided by St. Gabriel’s Hospital. Total neonatal deaths was the primary outcome for this analysis. Retrospective data revealed 20.9 neonatal deaths per 1000 live births at St. Gabriel’s Hospital. Assuming a 44.6% decline [10, 17, 18, 20] to 11.6 neonatal deaths per 1000 live births, a two-tail test with 80% statistical power and a 95% conﬁdence interval required at least 2956 subjects in both arms. 2.2.2. Data Source. Health Facility Surveillance Forms (HFSFs), collected since 1971, contained anonymous data transferred from admission, delivery, and female ward books by a St. Gabriel’s Hospital Records Assistant. The HFSFs included total number of deliveries, neonatal and maternal complications, and live births reported for each calendar month. The neonatal complications recorded included 5-minute Apgar 5 or less/asphyxia, neonatal sepsis, born-before-arrival, premature baby, baby less than 2500 grams, malformation, and HIV-infected. Maternal compli- cations included prolonged obstructed labor, antepartum hemorrhage, postpartum hemorrhage, severe preeclampsia, eclampsia, puerperal sepsis, ruptured uterus, retained pla- centa, ectopic pregnancy, abortion, and anemia. Data for stillbirths were incomplete and thus unable to be analyzed. Birth datasets from 2006 to 2008 at St. Gabriel’s Hospital showed approximately 3000 live births during any 15-month period. Thus, datasets for 15 months (June 2007 to August 2008) before intervention and 15 months (October 2008 to December 2009) after intervention were analyzed. Datasets from September 2008, the month of neonatal resuscitation training, were excluded. 2.2.3. Statistical Analysis. Contingency tables of neonatal mortality and survival and a Fisher’s Exact Test were calcu- lated to compare the proportion of neonatal mortality prior to and following the LPCH NPR curriculum intervention. The evaluation was based on total number of deaths during the two 15-month periods. A P value of less than 0.05 was considered statistically signiﬁcant. SPSS version 17.0 software was used. The Stanford University Institutional Review Board determined that this study does not meet the