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Table 6 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 vasectomy performed by medical students compared to vasectomy performed by doctors?

Patient or population: patients with vasectomy

Setting: Chulalongkorn Hospital, Bangkok, Thailand (Bunyaratavej et al. [25])

Intervention: Medical students performing vasectomy

Comparison: Doctors performing vasectomy

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 vasectomy

Medical students performing vasectomy

    

Complication rates during surgery1

See comment

See comment2

Not estimable

463 (1 study)

⊕⊕⊕⊝ moderate3

 

Early post-operative complication rates (within 7 days)4

43 per 1000

33 per 1000 (13 to 85)

RR 0.78 (0.31 to 1.99)

456 (1 study)

⊕⊕⊝⊝ low,5

 

Post-operative oligospermia rates (after 3 months)6

29 per 1000

76 per 1000 (25 to 225)

RR 2.59 (0.87 to 7.70)

322 (1 study)

⊕⊕⊝⊝ low4,7

 

Unintended pregnancy rates8 - not measured

See comment

See comment

Not estimable8

-

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. 1Defined as errors made in identifying and resecting the vas deferens.
  9. 2No complications found in either group.
  10. 3Downgraded because of unclear risk of contamination and blinding.
  11. 4Complications included bleeding (ecchymosis and/or minor hematoma(<2cms) requiring no treatment or hematoma requiring evacuation of blood clot) and infection (mild or superficial requiring no antibiotic treatment or moderately severe requiring antibiotic treatment).
  12. 5Downgraded because of imprecision (i.e. because of wide confidence intervals).
  13. 6Defined as sperm count <10,000/ml.
  14. 7Downgraded because of high loss to follow-up.
  15. 8The study did not measure unintended pregnancy rates.
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Reproductive Health

ISSN: 1742-4755