title: A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies.
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.
  
  
  METHODS
  Systematic review with meta-analysis.
  
  
  METHODS
  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.
  
  
  METHODS
  Controlled studies.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
authors.forename: Amie
authors.initials: A
authors.lastname: Wilson
authors.forename: David
authors.initials: D
authors.lastname: Lissauer
authors.forename: Shakila
authors.initials: S
authors.lastname: Thangaratinam
authors.forename: Khalid S
authors.initials: KS
authors.lastname: Khan
authors.forename: Christine
authors.initials: C
authors.lastname: MacArthur
authors.forename: Arri
authors.initials: A
authors.lastname: Coomarasamy
mesh_terms: D002585:Cesarean Section / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D018849:Controlled Clinical Trials as Topic; D003906:Developing Countries; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D009774:Obstetrics / Q000592:standards*; D054238:Perinatal Mortality; D010823:Physician Assistants / Q000193:education / Q000592:standards*; D011247:Pregnancy; D013530:Surgical Wound Infection