CONTEXT: Learning problems are common, affecting up to 1 in 10 children. Refugee children may have cumulative risk for educational disadvantage, but there is limited information on learning in this population. OBJECTIVE:To review the evidence on educational outcomes and learning problems in refugee children and to describe their major risk and resource factors. RESULTS:Thirty-four studies were included. Refugee youth had similar secondary school outcomes to their native-born peers; there were no data on preschool or primary school outcomes. There were limited prevalence data on learning problems, with single studies informing most estimates and no studies examining specific language disorders or autism spectrum disorders. Major risk factors for learning problems included parental misunderstandings about educational styles and expectations, teacher stereotyping and low expectations, bullying and racial discrimination, premigration and postmigration trauma, and forced detention. Major resource factors for success included high academic and life ambition, "gift-and-sacrifice" motivational narratives, parental involvement in education, family cohesion and supportive home environment, accurate educational assessment and grade placement, teacher understanding of linguistic and cultural heritage, culturally appropriate school transition, supportive peer relationships, and successful acculturation. LIMITATIONS:Studies are not generalizable to other cohorts. CONCLUSIONS:This review provides a summary of published prevalence estimates for learning problems in resettled refugee children, highlights key risk and resource factors, and identifies gaps in research.

IntroductionPulse oximetry is a life-saving tool for identifying children with hypoxaemia and guiding oxygen therapy. This study aimed to evaluate the adoption of oximetry practices in 12 Nigerian hospitals and identify strategies to improve adoption.MethodsWe conducted a mixed-methods realist evaluation to understand how oximetry was adopted in 12 Nigerian hospitals and why it varied in different contexts. We collected quantitative data on oximetry use (from case notes) and user knowledge (pretraining/post-training tests). We collected qualitative data via focus groups with project nurses (n=12) and interviews with hospital staff (n=11). We used the quantitative data to describe the uptake of oximetry practices. We used mixed methods to explain how hospitals adopted oximetry and why it varied between contexts.ResultsBetween January 2014 and April 2017, 38 525 children (38% aged ≤28 days) were admitted to participating hospitals (23 401 pretraining; 15 124 post-training). Prior to our intervention, 3.3% of children and 2.5% of neonates had oximetry documented on admission. In the 18 months of intervention period, all hospitals improved oximetry practices, typically achieving oximetry coverage on >50% of admitted children after 2–3 months and >90% after 6–12 months. However, oximetry adoption varied in different contexts. We identified key mechanisms that influenced oximetry adoption in particular contexts.ConclusionPulse oximetry is a simple, life-saving clinical practice, but introducing it into routine clinical practice is challenging. By exploring how oximetry was adopted in different contexts, we identified strategies to enhance institutional adoption of oximetry, which will be relevant for scale-up of oximetry in hospitals globally.Trial registration numberACTRN12617000341325.