Task shifting cesarean sections in low- and middle-income countries: A systematic review and meta-analysis

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 and analysis Data were extracted by two independent reviewers and meta-analysis was performed when possible. Main results 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, I-2 = 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, I-2 = 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.

Automated summary

There is no significant difference in maternal and perinatal outcomes between non-physician clinicians and physicians performing cesarean sections in low- and middle-income countries, although the NPC group has a higher rate of wound complications.