Welcome to the CDCF meeting 20th Cochrane Collaboration Colloquium / Auckland - New Zealand

Tuesday 2 October 2012 - 15:30 - 17:00Location: Regatta D Dr. Mario Tristan

CDCF Coordinator from IHCAI Foundation

presented by Dr. Regina El Dib

Faculdade de Medicina de Botucatu (FMB) Universidade Estadual Paulista "Júlio de Mesquita Filho” – Brazil

The new CDCF In December 2006 the group was officially registered as Cochrane Developing Countries Network (CDCN) which became the Cochrane Developing Countries Field (CDCF) in 2010.

The CDCF is based in IHCAI FOUNDATION -COSTA RICA- since 2007.

This decision was taken during the XV Cochrane Colloquium in Sao Pablo, Brazil, 2007.

The new CDCF the decision and the challenge

During some years we need to admit, the production of the CDCN and after CDCF was very limited …

Given this we analyzed the situation and some considered that the filed should be closed.

However during the Madrid 19 Cochrane Colloquium we discussed this during the fields meeting and closed meeting with the participation of Mario Tristan, L. Susan Wieland from Monitoring and Registration Committee, Ashraf Nabhan from Egypt and Damian Francis from Jamaica agreed to keep the CDCF for one more year – All agreed that was needed to re-launching the CDCF and making it effective accordingly with the inspirational aim of the field.

The agreement …. “After a meeting held in Costa Rica in 2008, the group was trying to strengthen and motivate itself, but its actions were severely limited by a lack of resources and a previous weak strategic plan that contained no concrete short-term goals that could be useful for other Cochrane entities.

This was particularly important, as it would have proved the importance of our field.

In October 2011, a meeting was held in Madrid, regarding the state of the CDCF and whether or not it was advisable to continue it in the same way it was created, given the difficulties the CDCF was experiencing in achieving its goals.

The core functions of Cochrane Fields were reviewed at this meeting, and ways in which the CDCF could meet these core functions were discussed. It was decided that the best course of action would be to continue the Field, as the proposed activities of the CDCF related to the core functions are of great importance to global health issues.

Through this and other meetings held digitally, we have continued this project, developing a working plan that has a high resource production without the high cost. It was also agreed to name a coordinating committee that, for the span of one year, will work together to identify several measurable short-term goals that will serve as the foundation of long-term success in meeting core functions and goals of the CDCF. In this way we hope to support the future development of our Field. As such, the current committee was started with the people present.”

Taken from Current State and 2012 Module => http://dcf.cochrane.org/current-state-and-2012-module

This year 2012…

This Year 2012 cont..

CDCF is currently led by Dr. Mario Tristan, along with an executive assistant and regional coordinator from the following regions: China, Eastern Europe, Latin America, Middle East and North Africa, South East Asia and the Pacific, and South Asia. However, the actions and responses to the secretariat calls have obviously decreased, probably because of the changes occurred during 2008, the lack of funding to convey the original action plan, and of course to some extend the lack of effective communication between the secretariat and the regional representatives during 2009.

Tagging Systematic Reviews for low and middle income countries

Image taken from => http://dcf.cochrane.org/current-state-and-2012-module

2012 Module the crucial task…“This year we have re evaluated our methods, and decided that the best course of action is the creation of criteria for the identification of Cochrane Reviews that are important for developing countries.

After this criteria is stated a framework must be produced to tag Cochrane reviews with a stated level of importance , which will allow us to both focus efforts in dissemination of existing Cochrane evidence that is relevant to developing countries, and to identify geographical and topic gaps where Cochrane evidence has yet to be produced, This will facilitate the content relevance of The Cochrane Library content in Developing Countries, since even though the research production of developing country authors has increased to 38%,meny topic relevant to the developing world and the best way to address problems that affect large populations, still remain neglected. To initiate tagging, we need to produce a list of possible, reliable contributors willing to go along with the project”.

Taken from => http://dcf.cochrane.org/current-state-and-2012-module

First, we need to make us visible …We are now in …

LINK: https://www.facebook.com/CochraneDCF

LINK: https://twitter.com/CochraneDCF

The CDCF newsletter

FIND it at : http://www.cochrane.org/sites/default/files/uploads/Newsletters/cdcf-news.html

And we have BLOG

LINK: http://Cochranedevelopingcountriesfield.wordpress.com

Responding the needs of LOW and MIDDLE income countries burden of diseases.

The rationale for tagging systematic reviews:

“Having those numbers helps health authorities determine whether they are focussing on the right kinds of public health actions that will reduce the number of preventable deaths and disease. Globally, around 57 million people die each year. Almost 15% of these deaths occur in children under the age of 5. Most of these preventable deaths in children occur in low- and middle-income countries.” Source => Global Health Observatory (GHO).

http://www.who.int/gho/mortality_burden_disease/en/index.html. Consulted August 14 2012.

Source Global Health Observatory (GHO) http://www.who.int/gho/child_health/mortality/causes/en/index.html# Consulted August 14 -2102

The tagging: Target groups

WE ARE CONSIDERING TO POTENTIAL USER:

INTERNAL - THE COCHRANE GROUPS AND AUTHORS.

EXTERNAL - CLINICIANS AT THE POINT OF CARE ND POLICY MAKERS IN L&MIC.

THE HIGHER EVIDENCE QUALITY THE HIGHER THE RELEVANCE !!!

THERE ARE SYSTEMATICS REVIEWS THAT BECAUSE OF THE QUALITY OF FINDINGS ARE RELEVANT FOR ANY COUNTRY.

THERE IS VARIATION ON HTE POWER OF SYSTEMATICS REVIEWS MUTS OF THE TIMES FOR LACK OF GOOD QUALITY STUDIES .

WE ARE USING THE SAME GRADE GROUP CATEGORIES FOR SCORING TAGGED SYSTEMATIC REVIEWS.

HIGH => Further research is very unlikely to change our confidence in the estimate of effect.

MODERATE => Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.

LOW => Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.

THE TOPICS BASED ON THE BURDEN

OF DISEASES HIGH PRIORTY THEMES

Child and women health. Infectious diseases in adults. Chronic diseases in children and adults Occupational diseases . Disaster mitigation . Health care services. Behavioural and learning disorders in adults. Other no included in these topics.

WE STARTED: CHILD AND MOTHER (WOMEN)

HEALTH RELEVANT TOPICS beyond health care... Antibiotics reviews

“1- Irrational prescribing and drug resistance make an important, but overlooked, contribution to the inequities of the medical poverty trap. For example, in India, 52% of out-of-pocket health expenditure went towards medicines and fees, as did 71% of in-patient expenditure...

2-Vietnam’s high frequency of antibiotic resistance is a clear indication of the adverse health effects of inappropriate drug sales and irrational consumption.32 In a poor region of Mexico, 74% of health-care visits resulted in inadequate treatment or advice, especially from traditional healers or retail drug sellers.33 On average, the equivalent of 13 days minimum wage was spent unnecessarily per patient, in 1 month, because of inadequate prescribing…

Poor people receive ineffective, or even dangerous treatment, including inappropriate or inadequate antituberculosis treatment regimens, …”

Source => Whitehead, M et all “Equity and health sector reforms: can low-income countries escape the medical poverty trap? THE LANCET • Vol 358 • September 8, 2001

The following Cochrane groups were included in this first stage

and are shown in order of relevancy according to burden of diseases in very low-income countries…

1. Neonatal Group -291 Active published reviews.2. Cochrane Pregnancy and Childbirth Group- 471 Active published reviews.3. Cochrane Infectious Diseases Group- 126 Active published reviews. 4. Cochrane HIV/AIDS Group- 117 Active published reviews. 5. Sexually Transmitted Infections Group- 12 Active published reviews.6. Public Health Group – 23 Active published reviews.7. Menstrual disorders and Fertility group- Active 210 published reviews.8. Cochrane Cystic Fibrosis and Genetic Disorders Group-Active 129

published reviews.9. Cochrane Breast Cancer Group- 44 Active published reviews.10. Cochrane Childhood Cancer Group- 31 Active published reviews.11. Pain, Palliative and Supportive Care Group- 195 Active published reviews.12. Cochrane Gynaecological Cancer Group- Active 129 published reviews.13. TOTAL : 1778

SOURCE : ARCHIE, MAY-AUGUST , 2012

Examples of tagged (1)Systematic reviews

Antibiotic regimens for suspected early neonatal sepsis (Review) Mtitimila EI, Cooke RWI. Antibiotic regimens for suspected early neonatal sepsis. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004495. DOI: 10.1002/14651858.CD004495.pub2.

Editorial group: Cochrane Neonatal Group.Publication status and date: Edited (no change to conclusions), published in Issue 1, 2009. Review content assessed as up-to-date: 15 June 2004. SCORE : LOW

THE OBJECTIVE OF THIS REVIEW:To compare antibiotic monotherapies, monotherapy with combination therapy, and combination therapies for empirical treatment of suspected early neonatal sepsis (within 48 hours after birth), for both effectiveness and adverse effects. THE REVIEW RESULTS ARE NOT CONCLUSIVE BECAUSE LACK OF EVIDENCE “…. There were no differences between the two groups. Both of the studies were published in the 1980s and are probably out of date. The authors of this review concluded that there is no evidence for using a particular kind of antibiotic for early neonatal sepsis. …”

Antibiotic regimens for suspected late onset sepsis in newborn infants Gordon A, Jeffery HE. Antibiotic regimens for suspected late onset sepsis in newborn infants. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004501. DOI: 10.1002/14651858.CD004501.pub2. Review content assessed as up-to-date: 1 March 2005. The authors WROTE “…In developing countries infection is estimated to cause 30 - 40% of neonatal deaths (WHO 1999). SCORE : LOW

THE OBJECTIVE OF THIS REVIEW:To compare the effectiveness and adverse effects of different antibiotic regimens for treatment of suspected late onset sepsis in newborn infants. THE REVIEW RESULTS ARE NOT CONCLUSIVE BECAUSE LACK OF EVIDENCE Authors’ conclusions…There is inadequate evidence from randomised trials in favour of any particular antibiotic regimen for the treatment of suspected late onset neonatal sepsis. The available evidence is not of high quality. Although suspected sepsis and antibiotic use is common, quality research is required to specifically address both narrow and broad-spectrum antibiotic use for late onset neonatal sepsis. Future research also needs to assess cost effectiveness and the impact of antibiotics in different settings such as developed or developing countries and lower gestational age groups.

Examples of tagged (2)Systematic reviews

OTHER TAGGED SR ON RELATED TOPICSANTIBIOTICS AND CHILD AND MATERNAL HEALTH TAGGED SYSTEMATIC REVIEWS

REVIEW GROUP EVIDENCE QUALITY AND POWER FOR MAIN OUTCOME

RELAVANCE FOR LMIC LAST UPDATE

Antibiotic adjuvant therapy for pulmonary infection in cystic fibrosis

Cochrane Cystic Fibrosis and Genetic Disorders Group

LOW MODERATE Published Online: 6 OCT 2010Assessed as up-to-date: 8 SEP 2010

Antibiotic regimens for the empirical treatment of newborn infants with necrotising enterocolitis

Cochrane Neonatal Group .

LOW HIGH Published Online: 15 AUG 2012Assessed as up-to-date: 18 FEB 2012

Antibiotic prophylaxis for cesarean section

Cochrane Pregnancy and Childbirth Group

LOW HIGH Published Online: 20 JAN 2010Assessed as up-to-date: 4 MAR 2002

Antibiotic prophylaxis for operative vaginal delivery

Cochrane Pregnancy and Childbirth Group

Published Online: 21 JAN 2009Assessed as up-to-date: 30 AUG 2008

Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth

Cochrane Pregnancy and Childbirth Group

LOW HIGH Published Online: 10 NOV 2010Assessed as up-to-date: 3 OCT 2010

Antibiotic regimens for endometritis after delivery

Cochrane Pregnancy and Childbirth Group

HIGH HIGH Published Online: 21 JAN 2009Assessed as up-to-date: 22 MAY 2002

Antibiotic regimens for management of intraamniotic infection

Cochrane Pregnancy and Childbirth Group

OUTDATED HIGH Publication status and date: Edited (no change to conclusions), published in Issue 9, 2011. Review content assessed as up-to-date: 22 May 2002.

Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections

Cochrane Pregnancy and Childbirth Group

OUTDATED

HIGH Publication status and date: Edited (no change to conclusions), published in Issue 9, 2011. Review content assessed as up-to-date: 22 May 2002

Antibiotics for preterm rupture of membranas

Cochrane Pregnancy and Childbirth Group

LOW HIGH Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 8, 2010. Review content assessed as up-to-date: 6 July 2010.

Doing synergy: Stakeholders and allies tagging SR for child and maternal health

Taken from => http://www.mascotfp7.eu/

MASCOT - F7 partners in developing countries

FUNDACION INSTITUTO CENTROAMERICANO DE SALUD INTERNACIONAL (COSTA RICA)http://www.ihcai.orgDr. Mario Tristan – mtristan@ihcai.org

CENTRE FOR HEALTH POLICY – UNIVERSITY OF THE WITWATERSRAND JOHANNESBURG (SOUTH AFRICA)http://www.wits.ac.za/chpProf. Matthew Chersich – matthew.chersich@wits.ac.za

NATIONAL INSTITUTE FOR MEDICAL RESEARCH (TANZANIA)http://www.nimr.or.tzDr. Michael Munga – michaelmunga@yahoo.com

MASCOT-F7 partners in developing countries… (contd.)

SCHOOL OF PUBLIC HEALTH – UNIVERSITY OF GHANA (GHANA) http://sph.ug.edu.ghDr. Patricia Akweongo – akweongo@gmail.com

HOPITAL FARHAT HACHED DE SOUSSE (TUNISIA)http://www.epidemiologie-sousse.orgProf. Hassen Ghannem – hassen.ghannem@rns.tn

UNIVERSIDAD CATOLICA DE LA SANTISIMA CONCEPCION (CHILE)http://www.ucsc.clDr. Patricia Marcela Cortes Jofre – p.cortes@ucsc.cl

INSTITUTO NACIONAL DE SALUD PUBLICA (MEXICO)http://www.insp.mxDr. Victor Becerril Montekio – victor.becerril@insp.mx

NEXT STEP …

WE WILL UPLOAD THE TAGGED REVIEWS TO ARCHIE ON OCTOBER 30 – 2012

IF ANY OF YOU IS INTERESTED TO JOIN US IS VERY WELCOME

SIGN UP HEREOR EMAIL US TO

Cochrane Developing Countries Field Secretariat cdcf@cochrane.ihcai.org>

Questions, comments and suggestions