SynthesisBulletin of the World Health Organization2013
Quality of care provided by mid-level health workers: systematic review and meta-analysis.
Synthesis in Bulletin of the World Health Organization, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
32 citing papers in PubMed, 3 syntheses or guidelines pooled it, 88 citations in OpenAlex.
- Nurse-led task-shifting strategies to substitute for mental health specialists in primary care: A systematic review.International journal of nursing practice · 2022Pooled it
- Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries.The Cochrane database of systematic reviews · 2021Pooled it
- Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries.Human resources for health · 2016Pooled it
- Safety of Tubal Occlusion by Minilaparotomy Provided by Trained Clinical Officers Versus Assistant Medical Officers in Tanzania: A Randomized, Controlled, Noninferiority Trial.Global health, science and practice · 2018Trial
- Family Health Clinical Officers: Key professionals to strengthen primary healthcare in Kenya.African journal of primary health care & family medicine · 2024Article
- The role of clinical associates in South Africa as a health workforce: A scoping review.African journal of primary health care & family medicine · 2024Article
- Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales).International journal for equity in health · 2023Article
- Oral Health Workforce in Africa: A Scarce Resource.International journal of environmental research and public health · 2023Article
- Knowledge, confidence, and practices of clinical associates in the management of mental illness.The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa · 2023Article
- Investigating the Potential for Clinical Decision Support in Sub-Saharan Africa With AFYA (Artificial Intelligence-Based Assessment of Health Symptoms in Tanzania): Protocol for a Prospective, Observational Pilot Study.JMIR research protocols · 2022Article
- Association of Organizational Behavior with Work Engagement and Work-Home Conflicts of Physician in China.International journal of environmental research and public health · 2021Article
- Final-year medical students need to know their future supervisory role of clinical associates.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2020Article
- Article
- Mid-level health providers for primary healthcare: a rapid evidence synthesis.F1000Research · 2020Article
- Causal inference when counterfactuals depend on the proportion of all subjects exposed.Biometrics · 2019Article
- Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017.BMJ global health · 2019Article
- Assessing practice pattern differences in the treatment of acute low back pain in the United States Military Health System.BMC health services research · 2018Article
- What prevents midwifery quality care in Bangladesh? A focus group enquiry with midwifery students.BMC health services research · 2018Article
- Curriculum and training needs of mid-level health workers in Africa: a situational review from Kenya, Nigeria, South Africa and Uganda.BMC health services research · 2018Article
- Can task-shifting work at scale?: Comparing clinical knowledge of non-physician clinicians to physicians in Nigeria.BMC health services research · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo assess the effectiveness of care provided by mid-level health workers.
methodsExperimental and observational studies comparing mid-level health workers and higher level health workers were identified by a systematic review of the scientific literature. The quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria and data were analysed using Review Manager.
findingsFifty-three studies, mostly from high-income countries and conducted at tertiary care facilities, were identified. In general, there was no difference between the effectiveness of care provided by mid-level health workers in the areas of maternal and child health and communicable and noncommunicable diseases and that provided by higher level health workers. However, the rates of episiotomy and analgesia use were significantly lower in women giving birth who received care from midwives alone than in those who received care from doctors working in teams with midwives, and women were significantly more satisfied with care from midwives. Overall, the quality of the evidence was low or very low. The search also identified six observational studies, all from Africa, that compared care from clinical officers, surgical technicians or non-physician clinicians with care from doctors. Outcomes were generally similar.
conclusionNo difference between the effectiveness of care provided by mid-level health workers and that provided by higher level health workers was found. However, the quality of the evidence was low. There is a need for studies with a high methodological quality, particularly in Africa - the region with the greatest shortage of health workers.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.