Title: A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies
Abstract: The authors tentatively concluded that there was no statistically significant difference in maternal or perinatal mortality in caesarean sections carried out by clinical officers compared with doctors, but wound dehiscence and wound infection were significantly more frequent in caesarean sections carried out by clinical officers. XCM: The review question was clear and supported by potentially reproducible inclusion criteria. The search strategy appeared to include a number of relevant sources and was not restricted by language, which reduced the possibility of language bias. It did not appear that specific searches were undertaken for unpublished studies, so some potentially relevant data may have been missed. Study selection was conducted in duplicate, but it was unclear whether similar methods to reduce error and bias were used for quality assessment and data extraction.Study quality was assessed using an appropriate tool and results were reported. Adequate details of primary studies were provided. Combining the results in meta-analyses may not have been appropriate given the variability of the studies and the statistical (and clinical) heterogeneity in the some of the meta-analyses.The authors' conclusions reflect the evidence presented, but given the variability between (and methodological shortcomings within) the included studies, together with poor reporting of the review process, their reliability is uncertain. XIM: Practice: The authors stated that there may be a particular training need for clinical officers in light of the increase in wound infection and dehiscence compared with doctors.Research: The authors did not state any implications for further research.