Background: Each year, over 810,000 neonatal deaths are attributed to intrapartum hypoxic events (birth asphyxia) worldwide. Survivors often suffer neurological impairments, with disproportionately high rates in Sub-Saharan Africa, including Ethiopia. Effective neonatal resuscitation (NR) reduces this risk, but its impact is limited by delayed or interrupted ventilation. Innovative strategies promoting early and continuous ventilation are needed.

Objective: To evaluate the effect of simulation-based NR training using an integrated device with real-time feedback on adverse neonatal outcomes in public health facilities in Debre Birhan, Ethiopia.

Methods: A non-randomized quasi-experimental study was conducted in Debre Birhan city public health facilities from March 1, 2024 to January 30, 2026. A total of 1260 asphyxiated babies were enrolled. Baseline assessments were conducted in both control and intervention sites. Providers in the control group received standard NR simulation training, while those in the intervention group received NR training enhanced with integrated device with a real-time feedback system. Data collected via KoboTool box were analyzed using Stata 17. Baseline comparability was assessed using Chi-square, or Fisher's exact and independent t-test. A Difference-in-Differences (DID) analysis was used to evaluate the intervention's effect on composite adverse neonatal outcomes.

Result: After accounting for six participants lost to follow-up, the final analysis included 1,254 newborns. Adjusting for maternal demographics, clinical conditions at admission, and delivery-specific variables, the intervention reduced the probability of adverse composite neonatal outcomes by 18.7 percentage points (average treatment effect (ATE) = -18.7; p = 0.011; 95% CI [-30.9, -6.5]).

Conclusion: Simulation-based neonatal resuscitation training with an integrated real-time feedback device significantly reduced adverse neonatal outcomes. Integrating such devices into clinical protocols could improve newborn survival.

Tebabere Moltot Kitaw has completed his Master of Public Health in Epidemiology from Debre Berhan University, Ethiopia, where he is currently a Lecturer and Researcher. He also holds an MSc in Clinical Midwifery from Bahir Dar University. He serves as a Lecturer and Researcher at Debre Berhan University and simultaneously implements the Midwifery Model of Care at Hakim Gizaw Hospital. He has over 35 publications in peer-reviewed journals, including BMC Pregnancy and Childbirth, PLOS ONE, and the BCM in Pediatrics Journal, with his work being cited over 485 times. His publication h-index is 13. He has successfully served as Principal Investigator on multiple funded research projects, including grants from the Laerdal Foundation (Norway) and the Royal Society of Tropical Medicine and Hygiene (UK). He is an active member of the Ethiopian Midwives Association, the Ethiopian Red Cross Association, and the Royal Society of Tropical Medicine and Hygiene. He has been serving as a peer reviewer and contributor to several reputable journals in the fields of maternal health, epidemiology, and midwifery.