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Africa Centre for Systematic Reviews and Knowledge
Translation“Africa Centre”
http://chs.mak.ac.ug/afcen/about-us
Prof. SEWANKAMBO, Nelson(Principal Investigator)
Dr. OBUKU, Ekwaro(Coordinator)
29th May, 2014Research Forum, Infectious Diseases Institute, College of Health Sciences
Makerere University, KAMPALA, UGANDA
OUTLINE OF SESSION
1. Use of evidence for decision making
2. What is Knowledge Translation
3. Systematic Reviews and decision making
4. The Africa Centre for Systematic Reviews and Knowledge Translation
Promising activities that increase research to policy uptake:
• Interaction between researchers and decision takers/policy makers.
• Building research to policy partnership networks and trust
• General climate: timing and timeliness of research evidence Innvaer et al. 2002
Barriers to research R2P include:
• Lack of perceived relevance of the research by decision takers/policy makers.
• Negative attitude towards use of research evidence by decision takers/policy makers.
• Lack of relevant skills by decision • find, read, appraise & interpret research evidence.
• Use of jargon in research evidence brief write ups.
• Power and budget struggles among decision takers/policy makers. Innvaer et al. 2002
Research NOT ALWAYS USED by decision makers*
Where am I?
You’re 30 metres above the
ground in a balloon
You must be a researcher
Yes. How did you know?
Because what you told me is absolutely
correct but completely useless
You must be a policy makerYes, how
did you know?
Because you don’t know where you are, you don’t know where you’re going, and now you’re blaming
me
The Trust Problem
Slide courtesy of Martin McKee
What is Knowledge Translation?
“KT is a dynamic and iterative process that includes the identification, synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, provide more effective health services and products and strengthen the healthcare system”
(Canadian Institute of Health Research, 2004)
Synonyms of KT:Implementation Science
Operations Research Knowledge Management Diffusion of Innovation
CPD/CME
Figure 2: Models of Linking Research To Action (Lavis et al, 2006)
NICE
MakCHS MoH
NARO & NAADS
Use of EVIDENCE to inform decision-making
Figure 3: Knowledge Pyramid (WHO, 2004)
NICE
-Scoping-Assessment
-Appraisal
BMRC
NAADS
NARO
What is a systematic review?
• Reviews prepared using a documented systematic approach, in order to minimize bias and random errors.
• (Chalmers and Altman, 1995)
-Protocol driven-Well defined question: PICOST-Eligibility criteria: explicit inclusion and exclusion-Outcomes: clear and a priori-Search strategy: comprehensive
Systematic Reviews & decision making
2007 2011
Issue of CDSR
CDSR: Cochrane Database of Systematic Reviews
Number and proportions (%) of Cochrane reviews by location of contact author in
developing/developed countries, 1997 to 2007
16%
0
500
1000
1500
2000
2500
3000
3500
Issue 3/97
Issue 3/98
Issue 3/99
Issue 3/00
Issue 3/01
Issue 3/02
Issue 3/03
Issue 3/04
Issue 3/05
Issue 3/06
Issue 3/07
Nu
mb
er o
f re
view
s
Developed countries
Developing countries
12%
9%
9%
8%
7%
8%
12%
10 %
7%
9%
CLOC, 2012: 21.9%
The Africa Centre for Systematic Reviews and Knowledge
Translation
OBJECTIVES
• Objective 1: Building capacity for conducting systematic review and utilization among researchers, health professionals and health decision makers in Uganda.
• Objective 2: Conducting high quality systematic reviews in the priority areas of Millennium Development Goals 4 (child health) or 5 (maternal health) and or 6 (infectious or non-communicable diseases) relevant to sub- Saharan Africa.
• Objective 3: Disseminating products of evidence synthesis and facilitating interaction between researchers and policy makers in Uganda to prioritize plan and deliberate on research evidence from systematic reviews.
• Objective 4: Assessing the extent to which existing published systematic reviews are informative and helpful in answering urgent policy makers’ needs (questions) handled by Rapid Response Mechanism in the four study countries.
• Objective 5: Planning for a systematic evaluation of the Rapid Response Mechanism in Uganda, Burkina Faso, Zambia and Cameroon.
Quasi Experimental
• Intervention– Training– Deliberatio
n workshops
– Seminar series
TIME: 36 months total
O1 O2 O3
T0 T5T4
BEFORE AFTER
T1
INTERVENTION INTERVENTION
T3
PHASE III
26 reviewers enrolled• 20 (77%) Completed phase I• 24 (92%) Completed phase II• 8 (31%) Women scientists
August 2013 – Jan 2015
2=Kenya1=Tanzania1=Cameroun1=Botswana19=Uganda
Phase III• Review production
– “Africa Centre”• “Priority setting
exercise”• Teams
– Cochrane Collaboration• Dr. Andy Oxman/EPOC
– Individual projects
• Individual projects– PhD students
• 2 questions: – KT platforms for MV in TZ– Antimicrobial self medication
– Non degree training• 4 questions
– Depression in DM– Breast Cancer in SSA– Integration of NCDs/HIV – Task shifting in surgery
• Cochrane collaboration– ?1 protocol update
– Integration of PHC
– ?1 new protocol– Anti-depressants in HIVChallenge 1
DEMAND: Participants suggestions: How to increase the visibility of the “Africa Centre”?
• Communication:– Group email– Website– Face book– Twitter– Newsletter
• Circulate Systematic Reviews Course training materials– Drop box
• Embed Systematic Reviews course in undergraduate & graduate training at university– Consider for Masters projects– PhD sub-projects
• Seminar series on Systematic Reviews:– Universities e.g. IHSU, MUST– Research institutions e.g. IDI
• Sense of belonging– Membership to the Africa CentreChallenge 2
"My fellow Americans, ask not what your country can do for you, ask what you
can do for your country."
John Fitzgerald KENNEDY, 35th President of the USA 1961 Inaugural Speech
THANK YOU!
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THANK YOU