{Reference Type}: Meta-Analysis
{Title}: Task shifting cesarean sections in low- and middle-income countries: A systematic review and meta-analysis.
{Author}: Zakhari A;Konci R;Nguyen DB;Amar-Zifkin A;Smith JP;Mansour FW;Krishnamurthy S;
{Journal}: Int J Gynaecol Obstet
{Volume}: 160
{Issue}: 3
{Year}: Mar 2023
{Factor}: 4.447
{DOI}: 10.1002/ijgo.14401
{Abstract}: <B>BACKGROUND: </B>Safe and timely access to cesarean section (CS) in low- and middle-income countries (LMIC) remains a significant challenge.<BR><B>OBJECTIVE: </B>To compare maternal and perinatal outcomes of CS by non-physician clinicians (NPCs) versus physicians in LMIC.<BR><B>METHODS: </B>A systematic search of Ovid MEDLINE, EMBASE, Cochrane Library (including CENTRAL), Web of Science, and LILACS was performed from inception to January 2022.<BR><B>METHODS: </B>Data were extracted by two independent reviewers and meta-analysis was performed when possible.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>NPCs have comparable maternal and neonatal outcomes for CS compared with standard providers, albeit with increased odds of wound complication.<BR><B>UNASSIGNED: </B>CRD42020217966.