Key challenges of evidence-based medicine in developing countries

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.