Consideration of sex and gender in Cochrane reviews of interventions for preventing healthcare-associated infections: a methodology study.
Author: López Alcalde, Jesús; Stallings, Elena; Cabir Nunes, Sheila; Fernández Chavez, Abelardo; Daheron, Mathilde; Bonfill Cosp, Xavier; Zamora, Javier
Abstract: Background: Healthcare-associated infections (HAIs) are common and increase morbidity, mortality, and healthcare
costs. Their control continues to be an unresolved issue worldwide. HAIs epidemiology shows sex/gender
differences. Thus the lack of consideration of sex/gender in Cochrane reviews will limit their applicability and
capacity to support informed decisions. This study aims to describe the extent to which Cochrane reviews of
interventions for preventing HAIs consider sex and gender.
Methods: Methodology study appraising Cochrane reviews of interventions to prevent HAIs. Search methods:
Cochrane Database of Systematic Reviews from 1995 (launch of the journal) to 31 December 2016. Two authors
independently extracted data with EPPI-Reviewer 4 software, and independently appraised the sex/gender content
of the reviews with the Sex and Gender Appraisal Tool for Systematic Reviews (SGAT-SR).
Results: This study included 113 reviews assessing the effects of interventions for preventing HAIs. 100 reviews
(88%) used at least one sex or gender-related term. The terminology used was heterogeneous, being “sex” the term
used in more reviews (51%). No review defined neither sex nor gender. Thus we could not assess the definitions
provided. Consideration of sex and gender was practically absent in the included reviews; in fact, no review met all
the applicable items of the SGAT-SR, and 51 reviews (50%) fulfilled no item. No review provided a complete
description of the sex and the gender of the samples of the included studies. Only ten reviews (10%) planned to
perform sex- and gender-based analysis and only three (3%) could complete the analysis. The method chosen was
always the subgroup analysis based on sex (one review) or gender (two reviews). Three reviews (3%) considered
sex or gender-related findings in the conclusions.
Conclusion: Consideration of sex and gender in Cochrane reviews of interventions for preventing HAIs was
practically absent. This lack of attention to sex and gender reduces the quality of Cochrane reviews, and their
applicability for all people: women and men, boys and girls, and people of diverse gender identities. Cochrane
should attempt to address the shortfalls detected.
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