Simulation training for obstetric emergencies in low- and lower-middle income countries: A systematic review

Wing Kiu Chou, Nazifa Ullah, Arian Arjomandi Rad, Robert Vardanyan, Viraj Shah, Alina Zubarevich, Alexander Weymann, Nishel Shah, George Miller, Johann Malawana

Research output: Contribution to journalReview articlepeer-review

3 Citations (Scopus)


Background: This review aims to systematically evaluate the currently available evidence investigating the effectiveness of simulation-based training (SBT) in emergency obstetrics care (EmOC) in Low- and Lower-Middle Income Countries (LMIC). Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the field.

Methods: A systematic database search was conducted of original articles that explored the use of simulation-based training for EmOC in LMIC in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to January 2022.

Results: The literature search identified 1,957 articles of which a total of 15 studies were included in this review, featuring 8,900 healthcare professionals from 18 countries. The SBT programmes varied in the reviewed studies. The most common training programme consisted of the PRONTO programme implemented by four studies, comprising of 970 participants across four different countries. In general, programmes consisted of lectures, workshops and simulations of emergency obstetric scenarios followed by a debrief of participants. There were thirteen studies, comprising of 8,332 participants, which tested for improvements in clinical knowledge in post-partum haemorrhage, neonatal resuscitation, pre-eclampsia, shoulder dystocia and sepsis. All the included studies reported improvements in clinical knowledge following the simulation of scenarios. Changes in teamwork, improvement in leadership and in communication skills were also widely reported.

Conclusion: The use of SBT programmes is not only sustainable, feasible and acceptable in LMIC, but could also improve clinical knowledge, communication, and teamwork among healthcare providers, thus directly addressing the UN Sustainable Development Goals.
Original languageEnglish
Pages (from-to)74-81
Number of pages8
JournalEuropean Journal of Obstetrics & Gynecology and Reproductive Biology
Early online date8 Jul 2022
Publication statusPublished - Sep 2022


  • LMIC
  • Obstetric emergencies
  • Simulation training

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