Describing the new CDCF project for tagging Systematic reviews - synergistic plan with the MASCOT (Multilateral Association for Studying Health Inequalities and Enhancing North-South And South-South Cooperation – is funded by the European Commission under the Seventh Framework Programme for Research and Technological Development (FP7).f7th project

1. Welcome to the CDCF meeting
20th Cochrane Collaboration Colloquium / Auckland - New Zealand
Tuesday 2 October 2012 - 15:30 - 17:00
Location: 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

2. 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.

3. 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.

4. 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

5. This year 2012…

6. 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.

7. Tagging Systematic Reviews for low
and middle income countries
Image taken from => http://dcf.cochrane.org/current-state-and-2012-module

8. 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

9. First, we need to make us visible …
We are now in …
LINK: https://www.facebook.com/CochraneDCF
LINK: https://twitter.com/CochraneDCF

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

11. And we have BLOG
LINK: http://Cochranedevelopingcountriesfield.wordpress.com

12. The rationale for tagging
systematic reviews:
Responding the needs of LOW and
MIDDLE income countries burden of
diseases.

13. “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.

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

15. 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.

16. 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.

17. 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.

18. 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

19. T he 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…

20. 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

21. 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.
…”

22. Examples of tagged (2)
Systematic reviews
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.

23. OTHER TAGGED SR ON RELATED TOPICS
ANTIBIOTICS AND CHILD AND MATERNAL HEALTH TAGGED SYSTEMATIC REVIEWS
REVIEW GROUP EVIDENCE QUALITY AND RELAVANCE FOR LMIC LAST UPDATE
POWER FOR MAIN
OUTCOME
Antibiotic adjuvant therapy for Cochrane Cystic Fibrosis and LOW MODERATE Published Online: 6 OCT 2010
pulmonary infection in cystic fibrosis Genetic Disorders Group Assessed as up-to-date: 8 SEP 2010
Antibiotic regimens for the empirical Cochrane Neonatal Group LOW HIGH Published Online: 15 AUG 2012
treatment of newborn infants with . Assessed as up-to-date: 18 FEB 2012
necrotising enterocolitis
Antibiotic prophylaxis for cesarean Cochrane Pregnancy and LOW HIGH Published Online: 20 JAN 2010
section Childbirth Group Assessed as up-to-date: 4 MAR 2002
Antibiotic prophylaxis for operative Cochrane Pregnancy and Published Online: 21 JAN 2009
vaginal delivery Childbirth Group Assessed as up-to-date: 30 AUG 2008
Antibiotic prophylaxis for third- and Cochrane Pregnancy and LOW HIGH Published Online: 10 NOV 2010
fourth-degree perineal tear during Childbirth Group Assessed as up-to-date: 3 OCT 2010
vaginal birth
Antibiotic regimens for endometritis Cochrane Pregnancy and HIGH HIGH Published Online: 21 JAN 2009
after delivery Childbirth Group Assessed as up-to-date: 22 MAY 2002
Antibiotic regimens for management of Cochrane Pregnancy and OUTDATED HIGH Publication status and date: Edited (no change
intraamniotic infection Childbirth Group to conclusions), published in Issue 9, 2011.
Review content assessed as up-to-date: 22 May
2002.
Antibiotics for meconium-stained Cochrane Pregnancy and OUTDATED HIGH Publication status and date: Edited (no change
amniotic fluid in labour for preventing Childbirth Group to conclusions), published in Issue 9, 2011.
maternal and neonatal infections Review content assessed as up-to-date: 22 May
2002
Antibiotics for preterm rupture of Cochrane Pregnancy and LOW HIGH Publication status and date: New search for
membranas Childbirth Group studies and content updated (conclusions
changed), published in Issue 8, 2010. Review
content assessed as up-to-date: 6 July 2010.

24. Doing synergy: Stakeholders and allies
tagging SR for child and maternal health
Taken from => http://www.mascotfp7.eu/

25. MASCOT - F7
partners in developing countries
FUNDACION INSTITUTO CENTROAMERICANO DE
SALUD INTERNACIONAL (COSTA RICA)
http://www.ihcai.org
Dr. Mario Tristan – mtristan@ihcai.org
CENTRE FOR HEALTH POLICY – UNIVERSITY OF
THE WITWATERSRAND JOHANNESBURG (SOUTH
AFRICA)http://www.wits.ac.za/chp
Prof. Matthew Chersich –
matthew.chersich@wits.ac.za
NATIONAL INSTITUTE FOR MEDICAL RESEARCH
(TANZANIA)
http://www.nimr.or.tz
Dr. Michael Munga – michaelmunga@yahoo.com

26. MASCOT-F7
partners in developing countries… (contd.)
SCHOOL OF PUBLIC HEALTH – UNIVERSITY OF GHANA
(GHANA) http://sph.ug.edu.gh
Dr. Patricia Akweongo – akweongo@gmail.com
HOPITAL FARHAT HACHED DE SOUSSE (TUNISIA)
http://www.epidemiologie-sousse.org
Prof. Hassen Ghannem – hassen.ghannem@rns.tn
UNIVERSIDAD CATOLICA DE LA SANTISIMA CONCEPCION
(CHILE)
http://www.ucsc.cl
Dr. Patricia Marcela Cortes Jofre – p.cortes@ucsc.cl
INSTITUTO NACIONAL DE SALUD PUBLICA (MEXICO)
http://www.insp.mx
Dr. Victor Becerril Montekio – victor.becerril@insp.mx

27. 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 HERE
OR EMAIL US TO
Cochrane Developing Countries Field Secretariat
cdcf@cochrane.ihcai.org>

28. Questions, comments and
suggestions