The following slides were presented
at a meeting of potential editors
and methods advisors for the
proposed Cochrane review group in
February 2008. The slides were
designed to promote discussion
rather than represent the views and
directions of this group.
1
MEETING THE NEEDS OF & INVOLVING PEOPLE
FROM LOW/MIDDLE INCOME COUNTRIES (LMICs)
Omar Abdulwadud (Australia)
Ruhi Saith (India)
Josiane Bonnefoy (Chile)
Edmonton, Canada (4-5 March 2008)
2
NEEDS & CHALLENGES FACING PUBLIC
HEALTH REVIEW GROUP (PHRG)
Low participation rate
Low-level of awareness of Cochrane Collaboration
Lack of training & mentorship
Practical help with review completion
Poor access to information/Cochrane Library
Funding
Developing stronger link
Published reviews not always relevant
3
Organisations connected with LMICs

Regional Cochrane Centres

SACC (Nigeria branch)
•

African Cochrane Network proposed
SACN (based in India)
INCLEN (Network of Clinical Epidemiology
Units/CEUs)





INCLEN-Africa:7 CEUs & 120 members
India-CLEN: 8 CEUs & over 200 members
Cochrane Developing Countries Network
Other Cochrane Review Groups
4
COCHRANE CENTRES/ BRANCHES IN LMICs
Venezuelan
Branch
India
branch
South Asian
Cochrane
Network
Nigerian
Branch
Brazilian CC
SACC
(Source: Cochrane Collaboration)
5
INCLEN
(http://www.inclentrust.org/)
6
Cochrane Developing Countries Network (CDCN)
(http://dcn.cochrane.org/en/index.html)
Promote & develop
awareness & dissemination
of activities
Become the information & resource
point for activities & resources
(training, dissemination,
research, mentoring, etc.)
Promote & develop
training activities
in DCs
Support review
authors
Promote access to
The Cochrane Library
Establish mechanisms
for networking & actively
Promoting synergies from
current entities
AIMS
&
OBJECTIVES
Identify trials
relevant to DCs
Detect & channel their
needs that may be
addressed by CC
Establish strategic alliances
with other organisations
whose activities are
devoted to DCs
Promote greater
participation &
inclusiveness within
the Collaboration
Identify funding
opportunities that
are beyond the current
entities scope
Raise funds for extending
the Collaboration
Activities to DCs
Increase the no.
of high quality
reviews relevant
to DCs
7
TRAINING & SUPPORT
Organisations that provide training (LMICs)
Cochrane Centre-related


SACC
SACN
INCLEN-related


INCLEN- Africa
India-CLEN
Other CRGs (?)
Cochrane DCs Network (?)
8
Types of training & support initiatives for
reviewers in LMICs
Activity
FOCUS
Recruitment
• Researchers
• Medical & Public Health professionals
• Policy makers
Training
Skills/knowledge
• Learn to write (protocol/ review)
• Learn to use RevMan
• Meta-analysis
• Training of trainers to allow periodic/regular cycles of
training
Support
Formal support:
• Institutional
• Funding
• Facility (computers/ venue)
• Materials (information i.e. literature-electronic & nonelectronic)
Informal support:
• Mentoring (1st time reviewers)
9
• Networking (within/outside country)
KEY ISSUES FOR DISCUSSION
NEEDS & CHALLENGES ARE MANY


LMICs participation right from the start is
vital
To ensure:
Sense of ownership &
 Sustainability.

STRONGER LINK with
Individuals or
 institutions?
 Implications i.e. sustainability

10
Stronger link,coordinated training & support for
LMICs
Cochrane
Collaboration
(Steering Group)
INCLEN
(Executive Office)
PHRG &
Other RGs
INCLEN
Regional Offices (7)
INCLEN
Country based CEU
UNICEF
Regional
Offices
Regional
Offices
CDC
Cochrane
Developing
Countries
Network
Cochrane Centres/
branches (e.g.
SACC/Nigeria)
Low & middle income country
(Researchers/institutions/
policy makers)
Omar Abdulwadud, Monash University (March 2008)
WHO
Country
Office
Field
Office
Country
Office
Resource utilization better
Implementation easier
Evaluation easier
Program sustainability assured
11
DISCUSSION: Training & Support
Incentive scheme?
 Fellowship program/financial assistance to attract
reviewers.
 Topic selection, protocol development to review
completion.
Work with others? (CRGs, Centres/branches, CDCs
Network).
Separate or merge with existing training programs?
 e.g. HIV/AIDS mentoring & Reviewers for Africa
Programmes
Use established communication channel?
Engage new partners? (e.g. WHO, CDC, UNICEF,
INCLEN)
Funding? Source?
12
DISCUSSION

Relevance (published reviews)





Editors & peer referees to assess suitability & relevance of
reviews (topic selection & prior to publication)
Restrict reviews to priority topics (Waters & Doyle, BMJ 2004)
Involve funding organisations/policy makers in topic selection?
Feedback from CCs prior to publishing?
Enhance accessibility of published reviews







Via CEUs, WHO & UNICEF offices, professional associations?
Publish in free electronic & open-source journals easily available?
Reporting in media
Follow model of evidence updates? (publish 2-pages review
summaries relevant to LMICs)
Design dissemination strategies from start for each review?
Tailor reporting of review findings to different users? (Journalsacademics; short summaries -policy makers & program
managers)
Addressing issue of local languages
13
REFERENCES
Taryn Young. Strengthening evidence based health care in
Africa: Proposal for an African Cochrane Network. The South
African Cochrane Centre 07/08/2007.
Paul Chinnock, Nandi Siegfried, Mike Clarke. Is EvidenceBased Medicine Relevant to the Developing World?
Systematic reviews have yet to achieve their potential as a
resource for practitioners in developing countries. eCAM
2005.
The South African Cochrane Centre (SACC) Email based
survey 2004.
Allen C, Clarke M & Tharyan P. International Activity in the
Cochrane Collaboration with particular reference to India.
The National Medical J. of India 2007;20 (5):250-55.
International Clinical Epidemiology Network (INCLEN)
http://www.inclentrust.org/
Cochrane Developing Countries Network (CDCN)
(http://dcn.cochrane.org/en/index.html)
http://www.liv.ac.uk/evidence/evidenceupdate/home.htm
14
THANK YOU!:
The Public Health Agency of Canada
(PHAC)
The National Collaborating Centre for
Methods & Tools (NCCMT)
Professor Elizabeth Waters & Her staff
EPHPP
15