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Table 2 Characteristics of the included reviews for Human Resources-Task Shifting

From: Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings

Reviews (n=06)

Description of included interventions

Type of studies included (no)

Targeted health care providers

Outcome reported

Pooled data (Y/N)

Results

    

Other outcomes

MNCH specific outcomes

  

Bhutta 2012[71]

Mid-level healthcare provider defined as those who have received less training than doctors but who perform aspects of doctors’ tasks.

RCT/cRCT: 52

ITS: 02

Case Control:01

Before After: 01

Nurse, midwives, auxillary nurse, auxillary nurse midwife, surgical technicians in both HIC and LMIC

 

Wives versus doctors + midwives:

Yes

 
     

Rate of performing c- section

 

0.92 (0.81-1.15)

     

Postpartum hemorrhage

 

1.03 (0.82-1.29)

     

Overall fetal or neonatal deaths

 

0.95 (0.69-1.30)

     

Preterm births

 

0.87 (0.73-1.04)

     

Admission to neonatal intensive care

 

1.03 (0.77-1.38)

     

The use of intrapartum regional analgesia

 

0.88 (0.81-0.96)

     

Episiotomies

 

0.83 (0.77-0.90)

     

Rates of abortion complication

 

1.74 (0.82-3.70)

     

Adverse effects

 

1.15 (0.84-1.56)

     

Nurses versus doctors:

  
     

Repeat consultation

 

0.90 (0.35-2.32)

     

Better physical function

 

1.06 (0.97-1.15)

     

Attendance to follow-up visit

 

1.26 (0.95-1.67)

     

Attendance at emergency after receiving care

 

1.02 (0.87-1.14)

     

Satisfaction with the care received by nurses

 

0.20 (0.14-0.26)

Hatem 2008[47]

In midwife-led care, the midwife is the woman’s lead professional, but one or more consultations with medical staff are often part of routine practice.

RCT’s: 11

HIC

 

Antenatal hospitalization

 

0.90 (0.81-0.99)

     

Regional analgesia

 

0.81 (0.73-0.91)

     

Episiotomy

 

0.82 (0.77-0.88)

     

Instrumental delivery

 

0.86 (0.78-0.96)

     

Intra-partum analgesia/anesthesia

 

1.16 (1.05-1.29)

     

SVD

 

1.04 (1.02-1.06)

     

Feeling in control during child birth

 

1.74 (1.32- 2.30)

     

Birth attended by midwife

 

7.84 (4.15-14.81)

     

Initiate breast feeding

 

1.35 (1.03-1.76)

     

Cesarean births

 

0.96 (0.87-1.06)

     

Fetal loss before 24 weeks

 

0.79 (0.65-0.97)

     

Fetal loss/ neonatal death at least 24 weeks

 

1.01 (0.67-1.53)

     

Fetal / neonatal death

 

0.83 (0.70-1.00)

     

Hospital stay

 

-2.00 (-2.15- -1.85)

Laurant 2004[48]

Focus was on nurses working as substitutes for primary care doctors. Supplementation refers to the situation where a nurse supplements the care of the doctor by providing a new primary care service

RCT/Quasi: 13

Before After: 13

Doctors and nurses in HIC

Nurse versus doctors

 

Yes

 
    

Patient satisfaction

  

0.28 (0.21-0.34) favors nurses

    

Patient recall

  

1.34 (1.20-1.49) favors nurses

    

Prescribing rates

  

1.00 (0.96-1.05)

    

Referral rates

  

0.79 (0.58-1.07)

Lewin 2010[49]

Any intervention delivered by LHWs and intended to improve maternal or child health (MCH) or the management of infectious diseases.

RCT: 82

LHW’s majority in LMIC

 

Immunization uptake

 

1.22 (1.10-1.37)

     

Initiation of breastfeeding

 

1.36 (1.14 - 1.61)

     

Any breastfeeding

 

1.24 (1.10-1.39)

     

Exclusive breastfeeding

 

2.78 (1.74- 4.44)

     

TB cure rates

 

1.22 (1.13 - 1.31)

     

TB preventive treatment completion

 

1.00 (0.92 - 1.09)

     

Child morbidity

 

0.86 (0.75-0.99)

     

Child mortality

 

0.75 (0.55-1.03)

     

Neonatal mortality

 

0.76 (0.57-1.02)

     

Care seeking for childhood illness

 

1.33 (0.86-2.05)

Pyone 2012[41]

Training of GP’s and assistants o perform caesarean sections

Studies: 03

Assistant medical officers, GP

 

Maternal health outcomes, staff retention

No

Narrative

Thompson 2003[50]

Interventions included dietary advice given by a dietician or a nutritionist compared with another health professional (e.g. doctor or nurse) or self-help resources.

RCT’s: 12

Dietitians , health professionals, nurses, doctors in HIC

Dieticians vs. Dr.

 

Yes

-0.25 mmol/L (-0.37, -0.12)

    

Blood Cholesterol

  

Favors dietician

    

Dietician vs. self help

  

-0.10 mmol/L (-0.22, 0.03)

    

Blood cholesterol

   
    

Dietician vs. nurses

  

-0.06 mmol/L (-0.11, -0.01)

    

HDLc

  

Favors dietician

    

Dietician vs. counselor

  

-5.80 (-8.91, -2.69)

    

Body weight

  

Favors dietician

Vieira 2012[42]

Included studies where Traditional Birth Attendants had been attending births prior to the intervention; and a transition to skilled health personnel were in progress or planned. The intervention was an increase in birth rate with skilled health professionals

6 studies

Skilled health personnel

 

Obstetric mortality ratio

 

OR: 0.35 (95% CI 0.13-0.93)

     

Decrease in maternal deaths

 

OR: 0.31 (95% CI 0.11-0.81)

     

Birth by a physician

 

Increased with ranges from 22.4% to 70.2%

     

Birth by C-Section

 

1.67 times more likely