Getting Up to Date with What Works: A Systematic Review on the Effectiveness and Safety of Task Sharing of Modern Methods in Family Planning Services
Table 3
Summary of findings on tubal ligation by associate clinicians.
Is tubal ligation performed by associate clinicians compared to tubal ligation performed by advanced-level associate clinicians safe and effective?
Patient or population: minilaparotomy clients Setting: Tanzania, Africa Intervention: tubal ligation performed by associate clinicians Comparison: tubal ligation performed by advanced-level associate clinicians
Outcomes
Anticipated absolute effects (95% CI)
Relative effect (95% CI)
No. of participants (studies)
Certainty of the evidence (GRADE)
Comments
Risk with tubal ligation performed by advanced-level associate clinicians
Risk with tubal ligation performed by associate clinicians
Overall major adverse events (42-day postsurgery) (MAEs)
0 per 1000
0 per 1000 (0 to 0)
RR 0.00050 (0.00007 to 0.00360)
1962 (1 RCT)
⨁⨁⨁◯ Moderatea
Major and minor adverse events (7-day postsurgery)
2 per 1000
3 per 1000 (1 to 18)
RR 1.5 (0.3 to 8.9)
976 (1 RCT)
⨁⨁⨁◯ Moderatea
Time to complete procedure (duration)
The mean time to complete procedure was 26.0 mn
0 mn (0.09 lower to 0.09 higher)
—
1962 (1 RCT)
⨁⨁⨁⨁ High
Request supervisor assistance with procedure
15 per 1000
17 per 1000 (7 to 39)
RR 1.08 (0.47 to 2.52)
1962 (1 RCT)
⨁⨁⨁◯ Moderatea
Participant satisfaction
861 per 1000
869 per 1000 (757 to 990)
RR 1.01 (0.88 to 1.15)
1945 (1 RCT)
⨁⨁⨁◯ Moderateb
Maximum pain during procedure (pain)
The mean maximum pain during procedure was 4.12
Mean 0.01 higher (0.2 lower to 0.22 higher)
—
1962 (1 RCT)
⨁⨁⨁◯ Moderateb
The risk in the intervention group (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). CI: confidence interval; RR: risk ratio
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect 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 Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect 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
aDowngraded due to the very small number of events. bDowngraded over concerns on measurement bias (subjective outcome and no blinding).
