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Main Article Content
Les principaux défis de la médecine fondée sur les preuves dans les pays en développement
Abstract
Objectif: la médecine fondée sur les preuves est progressivement en train de remodeler la conduite de la recherche médicale dans les pays en développement. Avec l'augmentation du nombre d'études originales menées dans divers milieux locaux, des experts mondiaux de la santé ont cherché un moyen de combiner systématiquement ces petites études afin de synthétiser les résultats qui ont un sens, logique, réalisable, et également le représentant d'un plus grand groupe de population la région considérée. Médecine fondée sur les preuves insiste sur l'utilisation de la meilleure preuve de bien conçu et mené la recherche médicale visant à fournir les meilleures données disponibles pour éclairer la prise de décisions de santé. Dans de nombreux milieux à revenu faible et moyen cependant, synthèses de preuves ne sont pas sans certains défis fondamentaux. L'étude est d'identifier les défis clés dans la synthèse de preuves dans les pays en développement et de fournir des moyens pratiques pour y remédier.
Méthodes: Une recherche de la littérature de cadrage exploratoire a été menée sur PubMed et Google Scholar pour les études pertinentes sur la synthèse des preuves dans les pays à faible revenu et à revenu intermédiaire.
Résultats: la normalisation et de la base de preuves insuffisantes ont été identifiés comme les deux principaux défis de la synthèse des éléments de preuve dans le monde en développement. Les normes et directives utilisées dans la collecte de données et d'informations, la synthèse des résultats et des rapports varient grandement à travers de nombreux paramètres de recherche, ce qui rend la combinaison des éléments de preuve recueillis presque impossible. La base de données pour la recherche médicale dans de nombreux pays en développement est une portée trop limitée pour évaluer la question de la recherche de l'intérêt, et la distribution de l'étude révèle souvent un modèle géographique caractérisée par des petits groupes de zones urbaines bien documentés entourées de vastes zones rurales sous-étudié. Amélioration dans les dossiers et les données de santé au niveau des pays à travers la création d'un système national d'information de gestion de la santé a été identifié comme un moyen important et souhaitable avant, avec ce qui nécessite le soutien organisationnel, technique et financier robuste.
Conclusion: Avec un potentiel d'amélioration dans la gestion des données dans les pays en développement, les chercheurs doivent tenir strictement aux normes et directives internationales de fournir des preuves qui peuvent éclairer les décisions ensemble de la population équilibrés et équitables.
Mots-clés: La médecine fondée sur les preuves, la recherche médicale, les normes internationales
English Title: Key challenges of evidence-based medicine in developing countries
English Abstract
Objective: Evidence-based medicine is gradually re-shaping the conduct of medical research in developing countries. With increase in the number of original studies conducted across various local settings, global health experts have looked for a way to systematically combine these smaller studies in order to synthesize results that are meaningful, logical, feasible, and also representative of a larger population group in the region under consideration. Evidence-based Medicine emphasizes the use of the best evidence from well designed and conducted medical research aimed at providing the best available evidence to inform health decision making. In many low- and middle-income settings however, evidence syntheses are not without some basic challenges. The study aims to identify the key challenges in evidence synthesis in developing countries and provide practical ways to address these.
Methods: An exploratory scoping literature search was conducted on PubMed and Google Scholar for relevant studies on evidence synthesis in low- and middle-income countries.
Results: Standardization and Limited Evidence Base were identified as the two main challenges of evidence synthesis in the developing world. The standards and guidelines employed in the collation of data and information, synthesis of results, and reporting vary widely across many research settings, making the combination of evidence gathered almost impossible. The evidence base for medical research in many developing countries is too limited in scope to evaluate the research question of interest, and study distribution often reveals a geographical pattern characterized by small clusters of well-researched urban areas surrounded by large under-researched rural areas. Improvement in country level health records and data through the establishment of a national health management information system was identified as an important and desirable way forward, with this requiring robust organizational, technical and financial backing.
Conclusion: With a potential improvement in data management in developing countries, researchers need to keep strictly to international standards and guidelines to provide evidence that can inform balanced and equitable population-wide decisions.
Keywords: Evidence-based medicine, medical research, international standards
