North and South: bridging the information gap

Strategies to promote better research on oral health in Africa: A Delphi consensus study

Background:

Research on oral health contributes to improved health outcomes; it is an indispensable tool in health policy. But how to fill the gaps in research oral health and to strengthen its capacity is the question. The main objective of the present study is to identify the current status of oral health research and potential strategies, thereby strengthening the research infrastructure and capacity. Delphi consultation, in the perspective of assisting decision-makers to identify strategies to promote better research on oral health in Africa, was initiated.

Design and Methods:

The panels of 30 experts were asked to complete the questionnaire with 42 items into four groups by web survey. Each indicator statement was considered to be in consensus if the expert's opinion rating was of “A or B” for more than 75% in a scale of seven categories. Quantitative analysis was made from the answers of Delphi round.

Results:

There was a strong consensus about three items concerning the role of oral health research, the development of research policy for oral health going through an effective governance of research institutes, migration of researchers and fund raising.

Conclusion:

This study shows strong many dispersal opinions by experts, but highlights the need for to improve the effectiveness of oral health research capacity strengthening activities. Africa's researchers, policy makers and partners will have to give special attention to ensuring that knowledge generated from oral health research is acted on to improve health for all.

How international are the leading orthopedic journals: a look at the composition of the editorial board members of the top orthopedic journals

BACKGROUND

Researches from the developing world contribute only a limited proportion to the total research output published in leading orthopedics journals. Some of them believe that there is substantial editorial bias against their work. We assessed the composition of the editorial boards of leading orthopedic journals.

METHODS

The editorial boards of 18 leading orthopedic journals according to their impact factor were retrieved from their website. We evaluated in which countries the editorial board members were based and classified these countries using the World Bank income criteria.

RESULTS

Individuals from number of countries can be found on the editorial boards of the investigated journals, but most of them are based in high-income countries. While 1,302 of the 1,401 editorial board members are based in countries with a high income according to the World Bank criteria, 37 are based in an upper middle income, 2 in lower middle income and none in a low-income economy.

CONCLUSION

The percentage of editorial board members in leading orthopedic journals is dominated by high-income countries with serious underrepresentation from low-income countries.

Diffusion of e-health innovations in 'post-conflict' settings: a qualitative study on the personal experiences of health workers

BACKGROUND

Technological innovations have the potential to strengthen human resources for health and improve access and quality of care in challenging 'post-conflict' contexts. However, analyses on the adoption of technology for health (that is, 'e-health') and whether and how e-health can strengthen a health workforce in these settings have been limited so far. This study explores the personal experiences of health workers using e-health innovations in selected post-conflict situations.

METHODS

This study had a cross-sectional qualitative design. Telephone interviews were conducted with 12 health workers, from a variety of cadres and stages in their careers, from four post-conflict settings (Liberia, West Bank and Gaza, Sierra Leone and Somaliland) in 2012. Everett Roger's diffusion of innovation-decision model (that is, knowledge, persuasion, decision, implementation, contemplation) guided the thematic analysis.

RESULTS

All health workers interviewed held positive perceptions of e-health, related to their beliefs that e-health can help them to access information and communicate with other health workers. However, understanding of the scope of e-health was generally limited, and often based on innovations that health workers have been introduced through by their international partners. Health workers reported a range of engagement with e-health innovations, mostly for communication (for example, email) and educational purposes (for example, online learning platforms). Poor, unreliable and unaffordable Internet was a commonly mentioned barrier to e-health use. Scaling-up existing e-health partnerships and innovations were suggested starting points to increase e-health innovation dissemination.

CONCLUSIONS

Results from this study showed ICT based e-health innovations can relieve information and communication needs of health workers in post-conflict settings. However, more efforts and investments, preferably driven by healthcare workers within the post-conflict context, are needed to make e-health more widespread and sustainable. Increased awareness is necessary among health professionals, even among current e-health users, and physical and financial access barriers need to be addressed. Future e-health initiatives are likely to increase their impact if based on perceived health information needs of intended users.

The challenges of publishing on health informatics in developing countries

The Journal of Health Informatics in Developing Countries was established to meet a perceived need for Health Informaticians in developing countries to be able to share the results of their research in an affordable and easy-to-access online publication. The journal was developed using the open source platform "Open Journal System," and has now published 67 articles across 13 issues. A collaborative editorial approach has been established to address the problems of limited research budgets, difficulties with translating to English and other problems specific to authors from developing countries. The journal faces many challenges including ensuring future financial sustainability and inclusion in journal indexing systems. However, the continuing support of an international body of Associate Editors and Editorial Board Members has enabled a wide range of useful and informative health informatics research to be disseminated across the developing world.

Existe viés de publicação para artigos brasileiros sobre câncer?

Objective:

To investigate whether Brazilian articles on cancer are published in journals with an impact factor and/or repercussion (measured by the number of citations) inferior to those that come from foreign organizations.

Methods:

A search was carried out in PubMed for the MeSH term “neoplasm” with the limits clinical trial, affiliation of the Brazilian author(s), and interval from July 1^st, 2009 to June 30, 2010. Selected for matching were non-Brazilian related articles published from three months prior to three months after the date of publication of the Brazilian study. The numbers of citations were obtained from two databases, as well as the impact factor for the journals in which the articles were published.

Results:

Fortythree national and 876 related international articles were identified. The Brazilian publications had a mean impact factor of 3.000 versus 3.430 of the international ones (p=0.041). There was no statistically significant difference as to the number of citations between the two groups. The affiliation of the first author with a Brazilian or foreign organization did not significantly influence the number of citations or the impact factor.

Conclusion:

Brazilian articles are significantly less accepted in journals with higher impact factors, although it does not compromise its repercussion on the scientific community.

Developing-world disaster research: present evidence and future priorities

OBJECTIVES

The technology and resource-rich solutions of the developed world may not be completely applicable to or replicable in disasters occurring in the developing world. With the current looming hazards of pandemics, climate change, global terrorism and conflicts around the world, policy makers and governments will need high-quality scientific data to make informed decisions for preparedness and mitigation. The evidence on disasters in peer-reviewed journals about the developing world was examined for quality and quantity in this systematic review.

METHODS

PubMed was searched using the Medical Subject Heading (MeSH) terms disasters, disaster medicine, rescue work, relief work, and conflict and then refined using the MeSH term developing country. The final list of selected manuscripts were analyzed by type of article, level of evidence, theme of the manuscript and topic, author affiliation, and region of the study.

RESULTS

After searching and refining, <1% of the citations in PubMed addressed disasters in developing countries. The majority was original research articles or reviews, and most of the original research articles were level IV or V evidence. Less than 25% of the authors were from the developing world. The predominant themes were missions, health care provision, and humanitarian aid during the acute phase of disasters in the developing world.

CONCLUSIONS

Considering that 85% of disasters and 95% of disaster-related deaths occur in the developing world, the overwhelming number of casualties has contributed insignificantly to the world's peer-reviewed literature. Less than 1% of all disaster-related publications are about disasters in the developing world. This may be a publication bias, or it may be a genuine lack of submissions dealing with these disasters. Authors in this part of the world need to contribute to future disaster research through better-quality systematic research and better funding priorities. Aid for sustaining long-term disaster research may be a more useful investment in mitigating future disasters than short-term humanitarian aid missions to the developing world.

Assessing research activity on priority interventions for non-communicable disease prevention in low- and middle-income countries: a bibliometric analysis

INTRODUCTION

Action is urgently needed to curb the rising rates of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) and reduce the resulting social and economic burdens. There is global evidence about the most cost-effective interventions for addressing the main NCD risk factors such as tobacco use, unhealthy diets, physical inactivity, and alcohol misuse. However, it is unknown how much research is focused on informing the local adoption and implementation of these interventions.

OBJECTIVE

To assess the degree of research activity on NCD priority interventions in LMICs by using bibliometric analysis to quantify the number of relevant peer-reviewed scientific publications.

METHODS

A multidisciplinary, multi-lingual journal database was searched for articles on NCD priority interventions. The interventions examined emphasise population-wide, policy, regulation, and legislation approaches. The publication timeframe searched was the year 2000-2011. Of the 11,211 articles yielded, 525 met the inclusion criteria.

RESULTS

Over the 12-year period, the number of articles published increased overall but differed substantially between regions: Latin America & Caribbean had the highest (127) and Middle East & North Africa had the lowest (11). Of the risk factor groups, 'tobacco control' led in publications, with 'healthy diets and physical activity' and 'reducing harmful alcohol use' in second and third place. Though half the publications had a first author from a high-income country institutional affiliation, developing country authorship had increased in recent years.

CONCLUSIONS

While rising global attention to NCDs has likely produced an increase in peer-reviewed publications on NCDs in LMICs, publication rates directly related to cost-effective interventions are still very low, suggesting either limited local research activity or limited opportunities for LMIC researchers to publish on these issues. More research is needed on high-priority interventions and research funders should re-examine if intervention research is enough of a funding priority.

Can UK healthcare workers remotely support medical education in the developing world?: Focus group evaluation

Objectives

To evaluate the feasibility of providing regular, live, text-based teaching to medical students and junior doctors in Somaliland using a dedicated case-based medical education website (www.MedicineAfrica.com).

Design

Review of MedicineAfrica database for details of teaching sessions held in Somaliland from December 2008-October 2010 and evaluation of user experiences through focus groups.

Setting

King's College Hospital, London, UK and Ahmoud University, Borama, Somaliland.

Participants

Final year medical students, newly graduated interns and second year interns at Ahmoud University, Borama, Somaliland.

Main outcome measures

Qualitative and quantitative user rating of online case-based tutorials in the context of pre-existing educational opportunities available to them.

Results

Regular online teaching sessions are received enthusiastically by students and junior doctors and are reported to improve their clinical practice.

Conclusions

Despite technological limitations in Somaliland, a live text-based teaching service can be delivered effectively and streamlined with local curricula. This represents an alternative to traditional static teaching methodologies currently used in international medical education.

Impact of the Number of Dermatologists on Dermatology Biomedical Research: A Canadian Study

Background:

Fewer dermatologists than other clinical specialists are entering and being retained as physicians in the Canadian medical workforce. Studies suggest that dermatologist numbers may influence skin disease outcomes. No study has questioned whether the number of clinical dermatologists can influence academic productivity.

Objective:

To quantify the correlation of the number of dermatologists with biomedical scientific production in this field from 1996 to 2008 in Canada.

Methods:

Canadian dermatology biomedical scientific production from SCImago Journal & Country Rank (SJR) were merged with Canadian Medical Association (CMA) dermatologist demographic data. Linear regression analyses were used to model the relationships.

Results:

The low growth of dermatologist numbers by 8.16% in Canada from 1996 to 2008 correlates with a small increase in articles by 7.59% published in this subject area during this period. This has reduced the scientific importance of Canadian dermatology in the world.

Conclusion:

The number of dermatologists was a significant predictor of biomedical research production in the field of dermatology. This suggests that specialist availability may be one factor influencing dermatology research and publications.

Building a national model for knowledge exchange in Malawi: findings from a health information needs assessment

Getting the right information into the right hands at the right time is a challenge for many health systems in developing countries. Health workers need access to reliable and up-to-date health information in order to support their clients. This health information needs assessment, conducted in the capital city and 3 districts of Malawi from July 2009 to September 2009, aimed to determine access to, and need for, health information in HIV/AIDS and family planning/reproductive health at all levels of the health system. Using qualitative research methods, the study showed the need to (a) build the capacity of government technical working groups to collect and store information and to promote information exchange at all levels of the health system; (b) improve information synthesis and packaging, particularly for users at peripheral levels; (c) strengthen the district level to serve as an information hub for district- and community-level providers; and (d) explore mobile technologies to increase provider access to knowledge and information.

Understanding health information needs and gaps in the health care system in Uttar Pradesh, India

Health information and the channels that facilitate the flow and exchange of this information to and among health care providers are key elements of a strong health system that offers high-quality services,yet few studies have examined how health care workers define, obtain, and apply information in the course of their daily work. To better understand health information needs and barriers across all of levels of the health care system, the authors conducted a needs assessment in Lucknow, Uttar Pradesh, India. Data collection consisted of 46 key informant interviews and 9 focus group discussions. Results of the needs assessment pointed to the following themes: (a) perceptions or definitions of health information related to daily tasks performed at different levels of the health system; (b) information flow in the public health structure; (c) need for practical information; and (d) criteria for usability of information. This needs assessment found that health information needs vary across the health system in Uttar Pradesh. Information needs are dynamic and encompass programmatic and service delivery information. Providing actionable information across all levels is a key means to strengthen the health system and improve the quality of services. An adequate assessment of health information needs, including opportunities, barriers, and gaps, is a prerequisite to designing effective communication of actionable information.

Can online conference systems improve veterinary education? A study about the capability of online conferencing and its acceptance

In veterinary medicine, there is an ongoing need for students, educators, and veterinarians to exchange the latest knowledge in their respective fields and to learn about unusual cases, emerging diseases, and treatment. Networking among veterinary faculties is developing rapidly, but conferences and meetings can be difficult to attend because of time limitations and travel costs. The current study examines acceptance of synchronous online conferences, seminars, meetings, and lectures by veterinarians and students. First, an online survey on the use of communication technology in veterinary medicine was made available for 15 weeks to every German-speaking veterinary university and via professional journals and an online veterinary forum. A total of 1,776 persons (620 veterinarians and 1,156 students) participated. Most reported using the Internet at least once per day; more than half reported using instant messengers. Most participants used the Internet for communication, but less than half used Skype. Second, to test the spectrum of tools for online conferences, a variety of "virtual classroom" systems (netucate systems iLinc, Adobe Acrobat Connect Pro, Cisco WebEx, Skype) were used to deliver student lectures, veterinary continuing-education courses, and academic conferences at the University of Veterinary Medicine, Hannover (TiHo). Of 591 participants in 63 online events, 99.4% rated the virtual events as enjoyable, 96.1% found them useful, and 92.4% said that they learned a lot. Participants noted that the courses were not tied to a certain place, and thus saved time and travel costs. Online conference systems thus offer new opportunities to provide information in veterinary medicine.

Capacity building in global mental health research

Research-generated information about mental disorders is crucial in order to establish the health needs in a given setting, to propose culturally apt and cost-effective individual and collective interventions, to investigate their implementation, and to explore the obstacles that prevent recommended strategies from being implemented. Yet the capacity to undertake such research in low- and middle-income countries is extremely limited. This article describes two methods that have proved successful in strengthening, or that have the potential to strengthen, mental health research capacity in low-resource settings. We identify the central challenges to be faced, review current programs offering training and mentorship, and summarize the key lessons learned. A structured approach is proposed for the career development of research staff at every career stage, to be accompanied by performance monitoring and support. A case example from the Mental Health and Poverty Project in sub-Saharan Africa illustrates how this approach can be put into practice-in particular, by focusing upon training in core transferrable research skills.

Cardiovascular disease research in Latin America: a comparative bibliometric analysis

AIM

To investigate the number of publications in cardiovascular disease (CVD) in Latin America and the Caribbean over the last decade.

METHODS

We performed a bibliometric analysis in PubMed from 2001 to 2010 for Latin America and the Caribbean, the United States, Canada, Europe, China, and India.

RESULTS

Latin America published 4% of articles compared with 26% from the United States/Canada and 42% from Europe. In CVD, Latin America published 4% of articles vs 23% from the United States/Canada and 40% from Europe. The number of publications in CVD in Latin America increased from 41 in 2001 to 726 in 2010.

CONCLUSION

Latin America, while publishing more articles than previously, lags behind developed countries. Further advances in research infrastructure are necessary to develop prevention strategies for this region.

Medical education in sub-Saharan Africa: a literature review

OBJECTIVES

This review synthesises research published in the traditional and 'grey' literature to promote a broader understanding of the history and current status of medical education in sub-Saharan Africa (SSA).

METHODS

We performed an extensive review and analysis of existing literature on medical education in SSA. Relevant literature was identified through searches of five traditional medical databases and three non-traditional or grey literature databases featuring many African journals not indexed by the traditional databases. We focused our inquiry upon three themes of importance to educators and policymakers: innovation; capacity building, and workforce retention.

RESULTS

Despite the tremendous heterogeneity of languages and institutions in the region, the available literature is published predominantly in English in journals based in South Africa, the UK and the USA. In addition, first authors usually come from those countries. Several topics are thoroughly described in this literature: (i) human resources planning priorities; (ii) curricular innovations such as problem-based and community-based learning, and (iii) the 'brain drain' and internal drain. Other important topics are largely neglected, including: (i) solution implementation; (ii) programme outcomes, and (iii) the development of medical education as a specialised field of inquiry.

CONCLUSIONS

Medical education in SSA has undergone dramatic changes over the last 50 years, which are recorded within both the traditionally indexed literature and the non-traditional, grey literature. Greater diversity in perspectives and experiences in medical education, as well as focused inquiry into neglected topics, is needed to advance medical education in the region. Lessons learned from this review may be relevant to other regions afflicted by doctor shortages and inequities in health care resulting from inadequate capacity in medical education; the findings from this study might be used to inform specific efforts to address these issues.

Strategies for capacity building for health research in Bangladesh: Role of core funding and a common monitoring and evaluation framework

Background

There is increasing interest in building the capacity of researchers in low and middle income countries (LMIC) to address their national priority health and health policy problems. However, the number and variety of partnerships and funding arrangements can create management problems for LMIC research institutes. This paper aims to identify problems faced by a health research institute in Bangladesh, describe two strategies developed to address these problems, and identify the results after three years of implementation.

Methods

This paper uses a mixture of quantitative and qualitative data collected during independent annual reviews of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) between 2006 and 2010. Quantitative data includes the number of research activities according to strategic priority areas, revenues collected and expenditure. Qualitative data includes interviews of researchers and management of ICDDR,B, and of research users and key donors. Data in a Monitoring and Evaluation Framework (MEF) were assessed against agreed indicators.

Results

The key problems faced by ICDDR,B in 2006 were insufficient core funds to build research capacity and supporting infrastructure, and an inability to direct research funds towards the identified research priorities in its strategic plan. Two strategies were developed to address these problems: a group of donors agreed to provide unearmarked pooled core funding, and accept a single common report based on an agreed MEF. On review after three years, there had been significant increases in total revenue, and the ability to allocate greater amounts of money on capacity building and infrastructure. The MEF demonstrated progress against strategic objectives, and better alignment of research against strategic priorities. There had also been changes in the sense of ownership and collaboration between ICDDR,B's management and its core donors.

Conclusions

The changes made to funding relationships supported and monitored by an effective MEF enabled the organisation to better align funding with research priorities and to invest in capacity building. This paper identified key issues for capacity building for health research in low and middle income countries. The findings have relevance to other research institutes in similar contexts to advocate and support research capacity strengthening efforts.

Representation of less-developed countries in Pharmacology journals: an online survey of corresponding authors

BACKGROUND

Scientists from less-developed countries (LDC) perceive that it is difficult to publish in international journals from their countries. This online survey was conducted with the primary aim of determining the opinion of corresponding authors of published papers in international Pharmacology journals regarding the difficulties in publications and their possible solutions.

METHODS

The titles of all Pharmacology journals were retrieved from Pubmed. 131 journals were included in study. The latest issue of all journals was reviewed thoroughly. An online survey was conducted from the corresponding authors of the published papers who belonged to LDC.

RESULTS

584 out 1919 papers (30.4%) originated from the LDC. 332 responses (response rate; 64.5%) were received from the authors. Approximately 50% the papers from LDC were published in journals with impact factor of less than 2. A weak negative correlation (r = -0.236) was observed between journal impact factor and the percentage of publications emanating from LDC. A significant majority of the corresponding authors (n = 254; 76.5%) perceived that it is difficult to publish in good quality journals from their countries. According to their opinion, biased attitude of editors and reviewers (64.8%) is the most important reason followed by the poor writing skills of the scientists from LDC (52.8%). The authors thought that well-written manuscript (76.1%), improvement in the quality of research (69.9%) and multidisciplinary research (42.9%) are important determinants that may improve the chances of publications.

CONCLUSIONS

The LDC are underrepresented in publications in Pharmacology journals. The corresponding authors of the published articles think that biased attitude of the editors as well as the reviewers of international journals and the poor writing skills of scientists are the major factors underlying the non-acceptance of their results. They also think that the improvement in the writing skills and quality of research will increase the chances of acceptance of their works in international journals.

Editorial bias in scientific publications

INTRODUCTION

Many authors believe that there are biases in scientific publications. Editorial biases include publication bias; which refers to those situations where the results influence the editor's decision, and editorial bias refers to those situations where factors related with authors or their environment influence the decision.

DEVELOPMENT

This paper includes an analysis of the situation of editorial biases. One bias is where mainly articles with positive results are accepted, as opposed to those with negative results. Another is latent bias, where positive results are published before those with negative results. In order to examine editorial bias, this paper analyses the influence of where the article originated; the country or continent, academic centre of origin, belonging to cooperative groups, and the maternal language of the authors. The article analyses biases in the editorial process in the publication of funded clinical trials.

CONCLUSIONS

Editorial biases exists. Authors, when submitting their manuscript, should analyse different journals and decide where their article will receive adequate treatment.

Case histories of infectious disease management in developing countries: Phnom Penh and Kabul

Healthcare in developing countries is affected by severe poverty, political instability and diseases that may be of lesser importance in industrialized countries. The aim of this paper was to present two cases and histories of physicians working in hospitals in developing countries and to discuss the opportunities for clinical investigation and collaboration. Cases of patients in Phnom Penh, Cambodia, with histoplasmosis, cryptococcal meningitis, crusted scabies, cerebral lesions and human immunodeficiency virus and of patients in Kabul, Afghanistan, with liver cirrhosis, nephrotic syndrome and facial ulcer are discussed. Greater developmental support is required from industrialized nations, and mutually beneficial cooperation is possible since similar clinical problems exist on both sides (e.g. opportunistic cardiovascular infections). Examples for possible support of hospital medicine include physician interchange visits with defined objectives (e.g. infection control or echocardiography training) and collaboration with clinical investigations and projects developed locally (e.g. epidemiology of cardiovascular diseases or nosocomial bloodborne infections).

Health research strengthening and operational research needs for improving child survival in India

Health research can be utilized to improve the policies, interventions and outputs of the health systems, and ultimately the health of individuals and population. This requires systematic evaluation of evidence and its integration into national policies and programs after suitable adoption at the local level. It has been noted that there has been limited focus upon strengthening health research in India, due to weak research systems or institutional mechanisms, lack of trained human resources and enabling environment, absence of well defined priorities, perceived low quality of research, and inadequate funding. Though various vertical and integrated health programs for improving child survival in the country have been introduced, the decline in child mortality has been excessively slow. Operational research, a sub theme of health research, which uses systematic research techniques to provide evidence to the policymakers and program managers, can be used to assess programmatic issues and improve their effectiveness. This article analyzes the current situation of health research in India, describes briefly the process of operational research, and summarizes the areas of programmatic concern and priority topics for future research in five key fields of child health (Newborn health, Immunization, Malnutrition, Disease prevention and control, health systems strengthening). Finally, it outlines the immediate need of strengthening health research system in the country for improving child survival through increased funding, development of institutional mechanisms, building pool of talented researchers and provision of an enabling environment, to facilitate health and operational research in a scientifically credible manner and to ensure wider dissemination of results.

Disparities in the contribution of low- and middle-income countries to palliative care research

CONTEXT

Important aspects of the palliative care needs of patients from low- and middle-income countries (LMIC) are largely unexplored. About 44 million of the 56 million annual deaths worldwide occur in developing countries, and it is estimated that more than 33 million of those concerned would benefit from palliative care. In this context, the understanding of specific social and cultural needs is fundamental to the development of appropriate health policy and clinical practice concerning palliative and end-of-life care.

OBJECTIVES

This study aims to answer the question: what are the contributions, in terms of generation of knowledge, of LMIC to the published palliative care literature?

METHODS

A bibliometric analysis was conducted in Medline and EMBASE (to June 2008). Articles were included when either the first author (institutional affiliation or contact address) or the data collection was derived from LMIC, as defined by criteria of the World Bank. Excluded were articles done in migrant and non-palliative care populations.

RESULTS

The literature search resulted in 845 references. In total, 245 articles coming from LMIC were identified, being published by 34 LMIC (27.3% of LMIC). The first publications appeared in 1982. The study shows a rather modest contribution of publications from LMIC. However, the volume of publications within LMIC is distributed unequally: upper-middle-income countries published almost half of the articles (46.9%), whereas only 11% of the publications came from low-income countries. In contrast, 104 LMIC (72.7% of LMIC) do not have any registered publications. Surprisingly, 25% of the articles with data from LMIC have been done and published by high-income countries. Reasons for the underrepresentation, as well a possible correction of this imbalance, are discussed.

CONCLUSION

Palliative care research should be a priority in LMIC, where many patients could benefit tremendously from it, and publication of findings in these countries should be encouraged.

The unequal world of health data

Peter Byass argues that less data are available on the health of the poor than of the rich, and discusses several alternative strategies to improve the representativeness of health data.

Accessing public health information: a preliminary comparison of CABI's GLOBAL HEALTH database and MEDLINE

BACKGROUND

Access to a comprehensive public health index or database has been identified as problematic for health professionals. Public health literature contains many varied sources including reports, journal articles, and grey literature. Traditional biomedical databases such as MEDLINE often do not meet the needs of public health workers and researchers.

AIM/METHODS

The aim of the study was to examine the unique content of the GLOBAL HEALTH database, by comparing it to the MEDLINE database. Pre-determined terms were used as baseline comparators where controlled vocabulary definitions in each database were sufficiently matched. Retrieved results were stored and compared using EndNote libraries.

RESULTS

Results obtained from the terms used in the comparison study protocol suggest that the GLOBAL HEALTH database holds a high proportion of unique records in comparison to MEDLINE. The largest overlap of duplicates from the GLOBAL HEALTH database perspective came from the coccidiomycosis results set which contained 70.5% of references retrieved from both databases. Analyzing the results from a MEDLINE perspective, the subject with the largest overlap was dengue, with a 43% overlap.

CONCLUSION

The results of this study show that the GLOBAL HEALTH database is complimentary to MEDLINE in the subject areas of public health and global health.

Information needs of health care workers in developing countries: a literature review with a focus on Africa

Health care workers in developing countries continue to lack access to basic, practical information to enable them to deliver safe, effective care. This paper provides the first phase of a broader literature review of the information and learning needs of health care providers in developing countries. A Medline search revealed 1762 papers, of which 149 were identified as potentially relevant to the review. Thirty-five of these were found to be highly relevant. Eight of the 35 studies looked at information needs as perceived by health workers, patients and family/community members; 14 studies assessed the knowledge of health workers; and 8 looked at health care practice. The studies suggest a gross lack of knowledge about the basics on how to diagnose and manage common diseases, going right across the health workforce and often associated with suboptimal, ineffective and dangerous health care practices. If this level of knowledge and practice is representative, as it appears to be, it indicates that modern medicine, even at a basic level, has largely failed the majority of the world's population. The information and learning needs of family caregivers and primary and district health workers have been ignored for too long. Improving the availability and use of relevant, reliable health care information has enormous potential to radically improve health care worldwide.

African HIV/AIDS trials are more likely to report adequate allocation concealment and random generation than North American trials

Background

Adherence to good methodological quality is necessary to minimise bias in randomised conrolled trials (RCTs). Specific trial characteristics are associated with better trial quality, but no studies to date are specific to HIV/AIDS or African trials. We postulated that location may negatively impact on trial quality in regions where resources are scarce.

Methods

1) To compare the methodological quality of all HIV/AIDS RCTs conducted in Africa with a random sample of similar trials conducted in North America; 2) To assess whether location is predictive of trial quality. We searched MEDLINE, EMBASE, CENTRAL and LILACS. Eligible trials were 1) randomized, 2) evaluations of preventive or treatment interventions for HIV/AIDS, 3) reported before 2004, and 4) conducted wholly or partly (if multi-centred) in Africa or North America. We assessed adequacy of random generation, allocation concealment and masking of assessors. Using univariate and multivariate logistic regression analyses we evaluated the association between location (Africa versus North America) and these domains.

Findings

The African search yielded 12,815 records, from which 80 trials were identified. The North American search yielded 13,158 records from which 785 trials were identified and a random sample of 114 selected for analysis. African trials were three times more likely than North American trials to report adequate allocation concealment (OR = 3.24; 95%CI: 1.59 to 6.59; p<0.01) and twice as likely to report adequate generation of the sequence (OR = 2.36; 95%CI: 1.20 to 4.67; p = 0.01), after adjusting for other confounding factors. Additional significant factors positively associated with quality were an a priori sample size power calculation, restricted randomization and inclusion of a flow diagram detailing attrition. We did not detect an association between location and outcome assessor masking.

Conclusions

The higher quality of reporting of methodology in African trials is noteworthy. Most African trials are externally funded, and it is possible that stricter agency requirements when leading trials in other countries and greater experience and training of principal investigators of an international stature, may account for this difference.

Assessment of an undergraduate psychiatry course in an African setting

BACKGROUND

International reports recommend the improvement in the amount and quality of training for mental health workers in low and middle income countries. The Scotland-Malawi Mental Health Education Project (SMMHEP) has been established to support the teaching of psychiatry to medical students in the University of Malawi. While anecdotally supportive medical educational initiatives appear of value, little quantitative evidence exists to demonstrate whether such initiatives can deliver comparable educational standards. This study aimed to assess the effectiveness of an undergraduate psychiatry course given by UK psychiatrists in Malawi by studying University of Malawi and Edinburgh University medical students' performance on an MCQ examination paper.

METHODS

An undergraduate psychiatry course followed by an MCQ exam was delivered by the SMMHEP to 57 Malawi medical students. This same MCQ exam was given to 71 Edinburgh University medical students who subsequently sat their own Edinburgh University examination.

RESULTS

There were no significant differences between Edinburgh students' performance on the Malawi exam and their own Edinburgh University exam. (p = 0.65). This would suggest that the Malawi exam is a comparable standard to the Edinburgh exam. Malawi students marks ranged from 52.4%-84.6%. Importantly 84.4% of Malawi students scored above 60% on their exam which would equate to a hypothetical pass by UK university standards.

CONCLUSION

The support of an undergraduate course in an African setting by high income country specialists can attain a high percentage pass rate by UK standards. Although didactic teaching has been surpassed by more novel educational methods, in resource poor countries it remains an effective and cost effective method of gaining an important educational standard.

Promoting Collaborations Between Biomedical Scholars in the U.S. and Sub-Saharan Africa

The premise of this piece is that a priority of international health should be to increase the number of investigators in the US and other developed countries who engage in research and other kinds of scholarly work in underdeveloped parts of the world, particularly sub-Saharan Africa where the overall disease burden is the highest and the gap in biomedical research infrastructure is the widest. The author’s aim is to encourage medical students, resident doctors, and medical school faculty to devote a part of their career to teach, acquire clinical skills, or participate in research with health professionals at teaching hospitals in Africa. After briefly describing the thinking that led the author to Nigeria 30 years ago to teach and study biochemical aspects of health problems in rural and urban areas, he discusses some of the factors one needs to consider before entering into an international partnership, including identifying the right foreign collaborators, selecting a suitable research site, setting realistic goals, learning the local culture and indigenous language, and defining a theme for your program. Lastly, the piece points out potential pitfalls and problems that are often overlooked or underestimated in the early phases of planning an international partnership, including lukewarm institutional support at home, inflexible institutional review boards, dominance of the program by the US partner, maintaining continuity, and striking the right balance between scholarly work and humanitarian efforts. My hope is that US students and faculty in the health professions who read this piece will be stimulated and encouraged to consider how they might integrate into their curriculum or academic life visits lasting several months or more each year during which they would teach or train others or engage in research at a teaching hospital in some country in Africa.

Relation between the global burden of disease and randomized clinical trials conducted in Latin America published in the five leading medical journals

Background

Since 1990 non communicable diseases and injuries account for the majority of death and disability-adjusted life years in Latin America. We analyzed the relationship between the global burden of disease and Randomized Clinical Trials (RCTs) conducted in Latin America that were published in the five leading medical journals.

Methodology/Principal Findings

We included all RCTs in humans, exclusively conducted in Latin American countries, and published in any of the following journals: Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine. We described the trials and reported the number of RCTs according to the main categories of the global burden of disease. Sixty-six RCTs were identified. Communicable diseases accounted for 38 (57%) reports. Maternal, perinatal, and nutritional conditions accounted for 19 (29%) trials. Non-communicable diseases represent 48% of the global burden of disease but only 14% of reported trials. No trial addressed injuries despite its 18% contribution to the burden of disease in 2000.

Conclusions/Significance

A poor correlation between the burden of disease and RCTs publications was found. Non communicable diseases and injuries account for up to two thirds of the burden of disease in Latin America but these topics are seldom addressed in published RCTs in the selected sample of journals. Funding bodies of health research and editors should be aware of the increasing burden of non communicable diseases and injuries occurring in Latin America to ensure that this growing epidemic is not neglected in the research agenda and not affected by publication bias.

Current access to health information in Zambia: a survey of selected health institutions

OBJECTIVE

To assess the current situation of access to information by health staff at selected central, provincial, district hospitals and health centres in Zambia.

METHODS

Government and non-governmental institutions were visited in the Lusaka Urban District and nine rural districts in the North-Western, Western and Central Provinces of Zambia in 2001. Thirty interviews were held with provincial and district health directors, medical doctors, nurses and clinical officers in district hospitals and rural and urban health centres. In 2006, a follow-up visit was undertaken to the health centres in the Lusaka Urban District in Lusaka Province and the Sesheke District in the Western Province.

RESULTS

There is limited access to health information for health workers in Zambia. In hospitals and health centres, where there is access, it is usually provided in an ad hoc manner without a central policy from the government. In all the places visited, there was also an overwhelming expressed need for different types of information relating to the professional or personal needs of health care workers.

CONCLUSIONS

The study found that access to information was very poor. There were some excellent examples of local initiatives showing that, even under difficult financial and infrastructural circumstances, it was feasible to improve health workers' access to information by using low technology, information access initiatives. These existing local initiatives deserve to be scaled up, while new initiatives should be adopted to improve access to information in a much more structured way. Of paramount importance is the formulation and implementation of an information policy that will guarantee the provision of health information to Zambian health workers.

Open access for the non-English-speaking world: overcoming the language barrier

This editorial highlights the problem of language barrier in scientific communication in spite of the recent success of Open Access Movement. Four options for English-language journals to overcome the language barrier are suggested: 1) abstracts in alternative languages provided by authors, 2) Wiki open translation, 3) international board of translator-editors, and 4) alternative language version of the journal. The Emerging Themes in Epidemiology announces that with immediate effect, it will accept translations of abstracts or full texts by authors as Additional files.

Editorial note:

In an effort towards overcoming the language barrier in scientific publication, ETE will accept translations of abstracts or the full text of published articles. Each translation should be submitted separately as an Additional File in PDF format. ETE will only peer review English-language versions. Therefore, translations will not be scrutinized in the review-process and the responsibility for accurate translation rests with the authors.

Geography of Africa biomedical publications: an analysis of 1996-2005 PubMed papers

Background

Scientific publications play an important role in scientific process providing a key linkage between knowledge production and use. Scientific publishing activity worldwide over the past decades shows that most countries in Africa have low levels of publication. We sought to examine trends and contribution of different Africa subregions and individual countries as represented by the articles indexed by PubMed between 1996 and 2005.

Results

Research production in Africa is highly skewed; South Africa, Egypt, and Nigeria make up a striking 60% of the total number of articles indexed by PubMed between 1996 and 2005. When adjusted for population size smaller countries, such as The Gambia, Gabon and Botswana, were more productive than Nigeria and Kenya. The Gambia and Eritrea had better records when total production was adjusted for gross domestic product. The contribution of Africa to global research production was persistently low through the period studied.

Conclusion

In this study, we found that most populous and rich countries (such as South Africa, Egypt, and Nigeria) have correspondingly higher research production; but smaller countries can be productive. We noted continuous increases and reassuring trends in the production of research articles from all African subregions during the period 1996 – 2005. However, contribution of Africa to global research production was limited.

Planning health education: Internet and computer resources in southwestern Nigeria. 2000-2001

The use of the Internet as a health education tool and as a resource in health education planning is widely accepted as the norm in industrialized countries. Unfortunately, access to computers and the Internet is quite limited in developing countries. Not all licensed service providers operate, many users are actually foreign nationals, telephone connections are unreliable, and electricity supplies are intermittent. In this context, computer, e-mail, Internet, and CD-Rom use by health and health education program officers in five states in southwestern Nigeria were assessed to document their present access and use. Eight of the 30 organizations visited were government health ministry departments, while the remainder were non-governmental organizations (NGOs). Six NGOs and four State Ministry of Health (MOH) departments had no computers, but nearly two-thirds of both types of agency had e-mail, less than one-third had Web browsing facilities, and six had CD-Roms, all of whom were NGOs. Only 25 of the 48 individual respondents had computer use skills. Narrative responses from individual employees showed a qualitative difference between computer and Internet access and use and type of agency. NGO staff in organizations with computers indicated having relatively free access to a computer and the Internet and used these for both program planning and administrative purposes. In government offices it appeared that computers were more likely to be located in administrative or statistics offices and used for management tasks like salaries and correspondence, limiting the access of individual health staff. These two different organizational cultures must be considered when plans are made for increasing computer availability and skills for health education planning.

Publications of plastic surgery research 1972 through 2004: a longitudinal trend analysis of three international journals

BACKGROUND AND PURPOSE OF STUDY

Assessment and benchmarking of research output is becoming a necessity in the quest for research funds and grants. However, reports on the trends in international research output by plastic surgeons over the years are lacking. We longitudinally analysed plastic surgery publications over the last three decades.

MATERIALS AND METHODS

Data on the topic of surgical interest and the anatomical region of research, the country of origin, and the origin and number of collaborating clinics were noted for each original article published in Plastic and Reconstructive Surgery, the British Journal of Plastic Surgery, and the European Journal of Plastic Surgery in 1972, 1980, 1988, 1996, and 2004.

MAIN FINDINGS AND CONCLUSIONS

The number of articles in three international plastic surgery journals has more than doubled over the last three decades. Reconstruction of acquired defects remained the most important topic in all three journals, but an interest in rejuvenation or aesthetic surgery seems to replace that in basic research. The head and neck area remains the anatomical region of most interest to date, but this interest has decreased substantially. Most articles still originate from the USA, but the absolute and relative number of articles originating from Europe and Asia is rapidly increasing. Also, the published output of multi-national scientific collaboration is increasing. Even though authors from larger countries, in general, contribute more publications in absolute numbers, authors from small countries have a more efficient output relative to the number of inhabitants and GDP of their country.

A case study of research ethics capacity development in Africa

Debates about cross-cultural research have sparked growing interest in international research ethics and have initiated collaborative efforts addressing international ethical concerns. This is a case study describing the attempt of the Johns Hopkins Fogarty African Research Ethics Training Program (JHF), recipient of a National Institutes of Health Fogarty International Center (FIC) award, to strengthen research ethics capacity in Africa. The aim of this article is to identify critical elements of an effective research ethics capacity development process through a case study of this particular training program. More specifically, this article describes the JHF program in detail, assesses its outputs during four years, and analyzes its implications of the current model for further growth of this and similar FIC programs. This article assesses the JHF program using materials produced in the first four years of its existence (2001-2004): curriculum materials; application records; informal progress notes and evaluations; transcripts from the trainees' coursework; resumes; and formal progress reports submitted by trainees. The framework used to assess the program is a systems approach, which explores inputs, processes, outputs, and outcomes of the program. The nature and types of inputs changed over time as experience was gained in the program and a continuous improvement in specific processes was implemented. The JHF program has been successful in providing research ethics education and motivating trainees to contribute in the field of research ethics in their countries. How this translates to changes in research ethics in Africa remains to be seen.

Ethics in public health research: minding the gaps: a reassessment of the challenges to safe motherhood

Maternal and perinatal mortality reduction has remained a priority on the international health agenda for nearly 2 decades. During this time, strategies for achieving these goals have shifted in emphasis from prevention of pregnancies to provision of care. Robust evidence is limited, particularly regarding what works best in delivering care in specific health system settings and at the population level. We describe the limited evidence base using a framework that highlights the consequences of the major gaps in measurement, evidence, and action, and we discuss existing opportunities for bridging these gaps at the policy level. Capitalizing on current global policy interests and generating demand-driven evidence is a priority for enabling documentation of progress toward reaching the United Nations Millennium Development Goals for 2015.

Access to electronic health knowledge in five countries in Africa: a descriptive study

Background

Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives.

Methods

Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externally funded research institution in The Gambia. Survey with postgraduate doctors and research scientists to determine Internet access patterns, reported awareness of on-line medical information and free access initiatives; semi structured interviews with a sub-sample of survey participants to explore factors influencing use.

Results

In the four African teaching hospitals, 70% of the 305 postgraduate doctors reported textbooks as their main source of information; 66% had used the Internet for health information in the last week. In two hospitals, Internet cafés were the main Internet access point. For researchers at the externally-funded research institution, electronic resources were their main source, and almost all had used the Internet in the last week. Across all 333 respondents, 90% had heard of PubMed, 78% of BMJ on line, 49% the Cochrane Library, 47% HINARI, and 19% BioMedCentral. HINARI use correlates with accessing the Internet on computers located in institutions. Qualitative data suggested there are difficulties logging into HINARI and that sometimes it is librarians that limit access to passwords.

Conclusion

Text books remain an important resource for postgraduate doctors in training. Internet use is common, but awareness of free-access initiatives is limited. HINARI and other initiatives could be more effective with strong institutional endorsement and management to promote and ensure access.