The Cochrane Developing Countries Network

Beijing, Octubre 2007

The Cochrane DevelopingCountries Network:An initiative to improve equitable access toknowledge and information and to its management.

Zulma Ortiz1-2, Mona Nasser M1-3, Li Wang1-4 Youping Li1-4, Jordi Pardo1-5, Xavier Bonfill1-5.

1) The Cochrane Developing Countries Network.2) Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina.3) Dental School, Shaheed Behehshti University of Medical Sciences, Tehran, Iran4) The Chinese Cochrane Centre/ Chinese EBM Center, West China Hospital, Sichuan University,Chengdu,China.5) The Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau. Barcelona, Spain.


There is a need to have access to valid and systematicallycollected data and appropriate scientific evidence.

According to Black et al1, in the year 2000, 42 countriesaccounted for 90% of the 10.8 million infant deaths.

Universal availability of 15 preventive interventions and eighttreatment interventions may reduce infant mortality by 63% inthese 42 countries.2

1) Black R, Morris S, Bryce J. where and why are 10 million children dying evry year? Lancet 2003;361:2226-34.2) Jones G, Steketee R, Black R, Bhutta Z, Morris S, Belaggio Child Survival Study Group. How many childdeaths can we prevent this year? Lancet 2003; 362:65-71.

Background 1/7


Archie Cochrane, have warned in the 1970s againstthe significant knowledge gap about the effects ofhealth care administered by health care systems,arguing the need of better use of scientific evidencefor healthcare policy making.

Background 2/7

“…as resources will always be limited, these should be used insuch a way as to equally provide those health care forms

which have been shown to be effective through appropriatelydesigned assessments...”


In view of this challenge, the Cochrane Collaboration (CC) hasbeen developed to prepare updated systematic reviews on theeffects of health care, and to make them public in order to helpthose who need to make well-supported clinical and health caredecisions.

There is a wide consensus in the CC nowadays that more needsto be done to extend the activities and outputs of theCollaboration to developing countries (DC).

Background 3/7


Until 2005, less than a 10% of the Cochrane Reviews wereauthored by people based in a developing country.

Furthermore, many topics relevant to the developing world andaddressing problems that affect large populations remainneglected. Moreover, there is a low awareness of the CC andthe Cochrane activities in many DC.

Background 4/7


The production of systematic reviews in developing countries isa challenging process.

There are not only methodological challenges but also political,economic and socio-cultural barriers

Background 5/7


Some of the methodological challenges are

(1) Formulation of research questions consistent with localneeds,

(2) Lack of communication skills because of the language thatdo not allow the networking with the Cochrane ReviewGroups,

(3) Access to the evidence,

(4) Need of policy-makers, clinicians and other types ofconsumer advocacy approach.

Background 6/7


Background 7/7

In 2007, of the 15,804 contributors, 2134 were from low, lower-middle and upper-middle income countries, accounting for 13.5%

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2000

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6000

8000

10000

12000

14000

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2000 2002 2003 2004 2005 2006 2007

Low , low er-middle-income

Upper-middle-income

High-Income

5.6%, 7.2% 8.2% 9.4% 10% 11.2% 13,5%

Source: Claire Allen, Mike Clarke, Diana Wyatt. International Activity within Cochrane Review Groups.


What can The Cochrane Collaboration do to supportpeople living in developing countries?

2001, the CC Steering Group promoted a Developing CountryInitiative (DCI). This initiative was initially coordinated byYouping Li and later by Xavier Bonfill.

In each annual Colloquium, several meetings

2004, a new survey was designed and conducted by theSouth-African Cochrane Centre. Overall results showed24% response rate of 1927 emails sent;55% were affiliated to a Cochrane Review Group (CRG).

(…)

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(…)

While most respondents were either very comfortable orcomfortable reading or writing English, 19% were either veryuncomfortable or uncomfortable with English.A significant number of respondents had limited knowledgeabout the Collaboration.One of the main needs identified was related to limitation(s) inawareness of CC, training and mentorship, practical assistancewith review completion, funding, access to information andinclusivity.A major need mentioned by respondents was limitedawareness and access of (to) The Cochrane Library.

(…)

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(…)

2007, the Developing Countries Initiative was officiallyregistered as Cochrane Developing Countries Network (CDCN).

CDCN has a Coordinating Group, consisting of people living in alow or middle income country and representing the different DCareas in the world: Sub-saharian Africa, Middle East and NorthAfrica, South East Asia and Pacific, South Asia, China, Latin-America and Eastern Europe countries. Also, an Advisory Boardwill be created.

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The vision of the CDCN for the next five years is to builda network that becomes the best way for people living indeveloping countries to be involved in The CochraneCollaboration particularly where there is no Cochrane activity.

Our goals are to facilitate the access and increase theproduction of systematic reviews and to address researchquestions relevant to the developing world in collaboration withother Cochrane entities which are actively promoting the CC indeveloping countries.


The objectives are:

To analyze the mechanisms for networking in developingcountries and actively promoting synergies from currententities devoted to health researchTo establish strategic alliances with other organizationswhose activities are devoted to developing countriesTo promote the knowledge translation and dissemination inthe developing countries.

Our challenges are:

To increase the number of high quality reviews relevant todeveloping countries and made by people living in developingcountries.To identify funding opportunities to help people from DC


The action plan

CDCN would be organized in three components

a) Building capacity

b) Provision of methodological support

c) Investigating the gaps


Since February2007, the CDCN

have made severalprogresses including

the launch ofwebsite to help

authors fromdeveloping countries

to get involved, toprovide English

editing support andto develop

collaboration withseveral international

institutes likeCOHRED and

INCLEN.

http://dcn.cochrane.org/en/index.html


There has been an increase of over 25% in thetotal number of contributors from low, lower-middle and upper-middle-income countries in thelast twelve months, with the number of authorsincreasing from 226 in 2000 to 1433.


Conclusions

The Collaboration's key to success is to find the best way tooptimize the use of specific interests and enthusiasm fromindividuals who support the Collaboration's global aims, as wellas to find various ways to finance the preparation and theupdates of systematic reviews.

CDCN attempts to promote greater participation andinclusiveness within the Cochrane Collaboration for peopleliving in developing countries, to become the information andresource point for health research activities related to evidencebased heath care for DC, and to reduce the inequity access tosystematic reviews.

The Cochrane Developing Countries Network

Documents

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