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Table 5 Summary of findings

From: Optimizing the delivery of contraceptives in low- and middle-income countries through task shifting: a systematic review of effectiveness and safety

What is the effectiveness of tubal ligation performed by midwives compared to tubal ligation performed by doctors?

Patient or population: patients with tubal ligation

Settings: Hospital setting, Khon Kaen, Thailand1 (Dusitsin et al. [23])

Intervention: Midwives performing tubal ligation

Comparison: Doctors performing tubal ligation

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect (95% CI)

No of Participants (studies)

Certainty of the evidence (GRADE)

Comments

Assumed risk

Corresponding risk

 

Doctors performing tubal ligation

Midwives performing tubal ligation

    

Complication rates during surgery2

5 per 1000

11 per 1000

RR 2.12

1168

⊕⊕⊝⊝

 

(3 to 34)

(0.64 to 6.88)

(1 study)

low3,4

Postoperative complications5

60 per 1000

70 per 1000

RR 1.16

292

⊕⊕⊝⊝

 

(29 to 161)

(0.48 to 2.66)

(1 study)

low3,4

Duration of operation

The mean length of operation in the intervention groups was 6.6 minutes higher (5.58 to 7.62 minutes higher)

 

292

⊕⊕⊕⊝

 

(1 study)

moderate3

Uptake of contraceptives6 - not measured

See comment

See comment

Not estimable6

-

See comment

 

Unintended pregnancy rates6 - not measured

See comment

See comment

Not estimable6

-

See comment

 
  1. *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
  2. CI: Confidence interval; RR: Risk ratio;
  3. GRADE Working Group grades of evidence.
  4. High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
  5. Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
  6. Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
  7. Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
  8. 1As the setting is not specified in the paper, we assumed that the intervention was delivered in a hospital. Midwives were recruited at Khon Khaen Maternal and Child Health Center, Thailand.
  9. 2Complications during surgery were reported to be due to thick abdominal fat, tubal adhesions, dextroverted uterus and inadequate sedation/analgesia.
  10. 3Downgraded because of differences in baseline characteristics.
  11. 4Downgraded because of imprecision (i.e. the confidence interval indicates both benefit and harm).
  12. 5Post-operative complications included mild pyrexia, respiratory infection, cystitis and wound breakdown at 5 days and 6 weeks after operation.
  13. 6The study did not measure uptake of contraceptives or unintended pregnancy rates.
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Reproductive Health

ISSN: 1742-4755