Task shifting cesarean sections in low- and middle-income countries: A systematic review and meta-analysis.
Int J Gynaecol Obstet
; 160(3): 771-782, 2023 Mar.
Article
in En
| MEDLINE
| ID: mdl-35965383
ABSTRACT
BACKGROUND:
Safe and timely access to cesarean section (CS) in low- and middle-income countries (LMIC) remains a significant challenge.OBJECTIVES:
To compare maternal and perinatal outcomes of CS by non-physician clinicians (NPCs) versus physicians in LMIC. SEARCH STRATEGY AND SELECTION CRITERIA A systematic search of Ovid MEDLINE, EMBASE, Cochrane Library (including CENTRAL), Web of Science, and LILACS was performed from inception to January 2022. DATA COLLECTION ANDANALYSIS:
Data were extracted by two independent reviewers and meta-analysis was performed when possible. MAINRESULTS:
Ten studies from seven African countries were included. There was no significant difference in maternal mortality for CS performed by NPCs versus physicians (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.56-2.14, P = 0.8, I2 = 70%, P < 0.05, eight studies, n = 20 711) or in perinatal mortality (OR 1.18, 95% CI 0.86-1.61, P = 0.3, I2 = 88%, n = 19 716). Despite heterogeneous clinical settings between providers, there was no difference in the rates of wound infection or re-operation, although there was a higher rate of wound complications (such as dehiscence) in the NPC group (OR 1.89, 95% CI 1.21-2.95, P = 0.005, n = 6507).CONCLUSIONS:
NPCs have comparable maternal and neonatal outcomes for CS compared with standard providers, albeit with increased odds of wound complication. PROSPERO REGISTRATION CRD42020217966.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Cesarean Section
/
Perinatal Death
Type of study:
Systematic_reviews
Limits:
Female
/
Humans
/
Newborn
/
Pregnancy
Language:
En
Journal:
Int J Gynaecol Obstet
Year:
2023
Document type:
Article
Affiliation country:
Canada