Evidence AidSystematic reviews and trials:

The what and the how and the why in challenging circumstances

Bonnix Kayabu (Co-ordinator) and Claire Allen (Knowledge Manager)

Outline of presentation

• Background to Evidence Aid.• The Evidence Aid team.• The what, the why and the how of systematic

reviews.• Reflections about systematic reviews from

those preparing for and responding to natural disasters, humanitarian crises and major healthcare emergencies.

• Conclusion.

Evidence Aid – why?• Established after Indian Ocean tsunami - December

2004. • Uses knowledge from systematic reviews (SRs) to

provide reliable, up-to-date evidence for disasters, humanitarian crises and other major healthcare emergencies.

• Provides urgent response, by bundling together brief summaries of the findings of SRs.

• Improves access to SRs on the effects of interventions and actions of relevance, so as to improve health-related outcomes in major healthcare emergencies.

Who are we?

Claire AllenKnowledge Manager

Oxford, UK

Mike ClarkeProject Lead

Dublin, Ireland Belfast, UK

Bonnix KayabuCo-ordinator

Dublin, Ireland

We make up the equivalent of 1.5 full-time staff

Questions

Do decision makers need this evidence?Do decision makers want this evidence?What are their priorities?

Do relevant studies exist?Do relevant systematic reviews exist?How should we deliver this knowledge?

Can we get the job done?

Do decision makers need the evidence?

What is a systematic review?

• A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies.

(from: http://www.cochrane.org/glossary/5#letters)

Why is a Systematic Review different?

• Explicitly different from traditional literature reviews or expert commentaries in that they are transparent, rigorous and replicable.

Have trials been done inchallenging circumstances?

Few trials have been done in disaster settings. However, some have been carried out, e.g.:• Onder et al randomized 103 adults to one of three different drugs to treat post traumatic stress disorder (PTSD) after the 1999 Turkish earthquake.• Catani et al randomized 31 children with a preliminary diagnosis of PTSD in a refugee camp in north-eastern Sri Lanka to six sessions of Narrative Exposure Therapy for children, called KIDNET, or six sessions of meditation-relaxation after the Indian Ocean tsunami.• Habib et al in Pakistan in 2006 allocated 200 children affected by an earthquake to take zinc in suspension form or as tablets as a treatment for diarrhoea.

We need to bring together the trials in a systematic way to present the overall results of all the trials.

Systematic review process• A relevant research question developed in

consultation with users.• A search strategy to find all the available studies,

including journals, grey literature and unpublished studies.

• A set of inclusion and exclusion criteria to select the studies for review.

• A quality appraisal strategy. • Methods for synthesising the studies.

Why are systematic reviews important?

• To help understand risks, benefits and consequences of decision making.

• To establish whether an intervention works, does not work, or has the potential to cause harm.

• To present a clearer and more consistent picture of the body of evidence.

• To avoid decision-making on the basis of a single study.• To ensure decisions are based on information that is

transparent, rigorous and replicable.

Reflections about systematic reviews

• 83% of respondents said SRs are useful in disasters.• “Evidence from SRs could have a positive role in

humanitarian interventions “ 69% “strongly agreed” and 29% “agreed”.

• “SRs are not practical in decision-making about humanitarian interventions” 50% “disagreed”, 20% “strongly disagreed”.

Reflections about systematic reviews

• Humanitarian interventions should be based on reliable knowledge of which interventions work, which don’t work and which are potentially harmful (‘agreed’ 25%; ‘strongly agreed’ 71%).

• SRs could be used to assess the likely effects of interventions before providing funding (83% of those who have worked with donor agencies agreed).

• Improved access to SRs would improve responses to natural disasters (82%).

Conclusion• Opinions on the potential role of SRs were positive.• Trials and SRs can be done in challenging

circumstances, but more needs to be done to help.• Humanitarian aid workers and donors need SRs to

improve their interventions and assess impact of their efforts.

• They have many uncertainties for which they need research evidence.

• Evidence Aid is engaging with aid workers to prioritise their needs on systematic reviews.

Thank you for listening!

Contact us using:Website: www.evidenceaid.org

Twitter: @evidence AidFacebook: Evidence Aid

E-mail: callen@evidenceaid.org