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Meta-Analysis
. 2011 May 13:342:d2600.
doi: 10.1136/bmj.d2600.

A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies

Amie Wilson  1 , David Lissauer, Shakila Thangaratinam, Khalid S Khan, Christine MacArthur, Arri Coomarasamy
Affiliations
Meta-Analysis

A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies

Amie Wilson et al. BMJ. .

Abstract

Objective: To review the effectiveness and safety of clinical officers (healthcare providers trained to perform tasks usually undertaken by doctors) carrying out caesarean section in developing countries compared with doctors.

Design: Systematic review with meta-analysis.

Data sources: Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, BioMed Central, the Reproductive Health Library, and the Science Citation Index (inception-2010) without language restriction.

Study selection: Controlled studies.

Data extraction: Information was extracted from each selected article on study characteristics, quality, and outcome data. Two independent reviewers extracted data.

Results: Six non-randomised controlled studies (16,018 women) evaluated the effectiveness of clinical officers carrying out caesarean section. Meta-analysis found no significant differences between the clinical officers and doctors for maternal death (odds ratio 1.46, 95% confidence interval 0.78 to 2.75; P=0.24) or for perinatal death (1.31, 0.87 to 1.95; P=0.19). The results were heterogeneous, with some studies reporting a higher incidence of both outcomes with clinical officers. Clinical officers were associated with a higher incidence of wound infection (1.58, 1.01 to 2.47; P=0.05) and wound dehiscence (1.89, 1.21 to 2.95; P=0.005). Two studies accounted for confounding factors.

Conclusion: Clinical officers and doctors did not differ significantly in key outcomes for caesarean section, but the conclusions are tentative owing to the non-randomised nature of the studies. The increase in wound infection and dehiscence may highlight a particular training need for clinical officers.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that no support from any institution for the submitted work; no relationships with any institution that might have an interest in the submitted work in the previous 3 years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and have no non-financial interests that may be relevant to the submitted work.

Figures

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Fig 1 Study selection in review
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Fig 2 Clinical officers compared with doctors on outcomes of caesarean section
See this image and copyright information in PMC

Comment in

References

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