Randomised trials in child health in developing countries 2011.

Abstract

This booklet (http://www.ichrc.org/RCT% 20child%20health/RCT20102011.pdf) is compiled annually to summarise the evidence on child health derived from randomised trials in developing countries over the previous year. The aim is to make this information widely available to paediatricians, child health nurses, midwives, researchers, students and administrators in places where up-to-date health information is hard to find. It is hoped that such information will be helpful in reviewing treatment guidelines, clinical practice and public health approaches, and in teaching about paediatrics and evidencebased medicine. The method of searching for studies to include uses PubMed, a search engine that is freely available and widely used in most countries throughout the world. The search strategy has been chosen to try to capture as many relevant studies as possible and can be undertaken by anyone with access to the Internet, through http://www.ncbi.nlm.nih. gov/sites/entrez Randomised controlled trials (RCTs) are far from the only valuable scientific evidence, and some RCTs, because of problems with design or implementation, are of limited value. However, the method of the randomised trial is the gold standard for determining attributable benefit or harm from clinical and public health interventions. When appropriately performed, they eliminate bias and confounding. Their results, however, should not be accepted uncritically and they should be evaluated for quality and validity. Before the result of an RCT can be applied in another setting, its wider applicability, feasibility and potential for sustainability must be considered. This year, 200 studies were identified. They were undertaken in all regions of the world, mostly by researchers in developing countries. Several trials in 2010/2011 will lead to significant changes in child health approaches or clinical recommendations. The web-link for papers that are freely available in full on the Internet is included. More importantly, through HINARI (http:// www.who.int/hinari/en/), a programme set up by WHO in collaboration with major publishers, the full-text versions of over 7000 journal titles are now available to health institutions in 109 countries. Institutions (medical schools, teaching hospitals, nursing schools, government offices) can register online. The booklet is for free distribution. Previous editions (2002/2010) are available at www.ichrc.org This year, four trials reported significant reductions in child mortality, as follows. In Kenya, South Africa and Burkina Faso, pregnant women who were infected with HIV were given a combination of three antiretroviral (ARV) drugs from the last trimester through to 6 months of breastfeeding, which, compared with zidovudine in pregnancy and single-dose nevirapine, reduced the risk of transmitting HIV to the baby and improved survival. In 11 centres in nine African countries, among more than 5000 children with severe malaria, artesunate substantially reduced mortality compared with quinine treatment. In rural China, iron and folic acid supplementation of pregnant women in the poorest households reduced neonatal mortality and reduced low birthweight. Standard iron and folic acid provided more protection against neonatal death than multiple micronutrient supplements. In a community-based programme involving over 46,000 households in Pakistan, Annals of Tropical Paediatrics (2011) 31, 283–285