Les principaux défis de la médecine fondée sur les preuves dans les pays en développement

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 internationalesEnglish Title: Key challenges of evidence-based medicine in developing countriesEnglish AbstractObjective: 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 standard

Neurological and neurosurgical manifestations of human immunodeficiency virus (HIV) infection in Africa

No Abstrac

Report (East and Central African Journal of Surgery) The Malawi “hybrid” medical graduates (1992-1998)

In April 1991, the Malawi College of Medicine opened its doors to Malawi medical students who had undertaken all but the final year of their undergraduate training in the United Kingdom. The first batch qualified with the MB BS degrees of the University of Malawi in September 1992. Since then and up to July 1998, 112 doctors have been produced. They are all Malawians, 90 males and 22 females, 29%, 31% and 40% respectively come from the Northern, Central and Southern regions of Malawi. Seventy-one per cent of the graduates had passed through Chancellor College, Zomba, and 27% had attended the Kamuzu Academy, Kasunga, Malawi. So far, most of these graduates have remained in Malawi, working in various locations in government and mission hospitals and at the University of Malawi. Many have shown encouraging interest in pursuing postgraduate education. In September 1994 the epoch of hybridisation was brought to a close with the admission of the first set of students who will train fully here in Malawi and become our first batch of home-grown doctors

HTTP man-in-the-middle code execution

As the Internet continues to mature, users are faced with an increasingly hostile environment on the World Wide Web. Additionally, public WiFi networks continue to become more popular, hackers infiltrate corporate networks with regularity, and oppressive governments continue to intercept and modify their citizens\u27 web traffic. The concept of using an untrusted network is becoming more familiar. Accordingly, it is no longer acceptable to design and build systems under the assumption that they will only operate in trusted environments, or that they are not important enough to warrant basic security measures. This thesis describes a relatively basic HTTP man-in-the-middle attack that results in arbitrary code execution. It demonstrates the ease with which users can be exploited when using systems that do not attempt to ensure their safety, and details the methods attackers can use to avoid detection. The goal of this methodology is twofold - to illustrate the consequences of such an attack, and to discover methods for mitigating such attacks using existing technologies and best practices

Hydranencephaly in Malawian children

Objective: To show that not all big heads in children are due to hydrocephalus.Setting: The Queen Elizabeth Central Hospital (QECH), Blantyre, the teaching hospital of Malawi College of Medicine. It is the biggest and leading hospital in Malawi and the major referral centre for the whole country.Design: A prospective study was made of all children who presented at QECH, Blantyre with the diagnosis of hydrocephalus during the study period.Subjects: Fifteen cases of hydranencephaly were encountered.Intervention: All cases of abnormally large heads were investigated with cranial ultrasonography, a few children had air ventriculography and CT scan of the brain. All patients had ventricular aspiration of cerebral spinal fluid (CSF) to verify the colour and condition of the fluid before performing ventriculo-peritoneal shunting for which our locallymade Malawi unishunt was used.Results: In hydranencephaly, the brain was found replaced by large fluid-filled cavity in contrast to hydrocephalus where brain was present and ventricular dilatation was encountered. Ventriculo-peritoneal shunting benefited children with hydrocephalus but not those with hydranencephaly.Conclusion: Hydranencephaly is one of the causes of abnormal head enlargement in children often confused with hydrocephalus. It is important to recognise hydranencephaly to avoid unnecessary operation which does not help the patient

The Place of the Church in Equitable Distribution of Nigerian Commonwealth

Equitable distribution of the nation’s wealth is believed to be one of the bases for peaceful co-existence among various groups in a country. Nigeria is blessed with lots of resources ranging from crude oil, gas, mines, bitumen, timber, cocoa, cotton, coal and the likes. It is however unfortunate that most Nigerians are living in abject poverty because these resources are under the control of few privilege individuals who are either on the corridor of power or born with silver spoon. While the rich in the country are becoming richer and monopolizing the nation’s wealth, the poor are becoming poorer. The aim of this study therefore is to investigate the roles of the church in addressing this uneven distribution of Nigerian wealth knowing full well that some of these wealthy people are in the church. The phenomenology and historical research methods were adopted for this study. The study focused on how the church today can be a model example in fair sharing of national wealth taking a clue from the apostles in the early church who ensured the people that complained of neglect in daily distribution of food were justly treated. It therefore recommended that the church (the Assembly of God’s children) should be involved in sharing the national wealth and preach always against injustice in the land. This would help in bridging the gap of inequity between the rich and the poor and promoting peaceful co-existence in Nigeria