Cochrane systematic reviews and global burden of disease in children under five: a challenge for developing countries

Tags: Oral
Sguassero Y, Cuesta C

Background: The Cochrane Collaboration is an international initiative dedicated to the production and dissemination of high quality systematic reviews as a step towards global health improvement. Every year, nearly 11 million children die before reaching their fifth birthday. Most of these deaths are in developing countries and more than half are due to acute respiratory infections, diarrhoea, measles, malaria, and HIV/AIDS. In addition, malnutrition underlies 54% of all child deaths. These conditions will continue to be major contributors to child deaths in 2020 unless significant efforts are made to control them. Much has been written about the relevance of systematic reviews of the effectiveness of interventions for health care decision-making, especially in settings with poor health resources. It is not surprising then that the importance of involving people from developing countries in the activities of the Collaboration is being recognized, and efforts being made to increase global health topics in the Cochrane database of systematic reviews with the creation of the Cochrane Developing Countries Network (CDCN) ( However, conducting Cochrane systematic reviews that address relevant health topics in children is a big challenge for review authors in developing countries.

Objectives: The main objectives were to: 1) identify the total number of Cochrane systematic reviews authored by people from developing countries; 2) identify the total number of these addressing child health relevant topics, 3) identify the number of these relevant to developing world regions aimed to improve child survival and reduce child morbidity; 4) to compare results among regions in the developing world.

Method: Systematic reviews from low, low-middle and high-middle income countries (according to the World Bank classification) were identified via the web page of the Cochrane Collaboration in March 2007. This information was gathered by browsing abstracts and summaries by country of author. The author extracted the total number of systematic reviews, including those focused on child health, for each country and region.

Results: In total, 331 systematic reviews were identified and 82 (25%) were linked to child health. Only 30 out of 82 aimed to prevent or treat major conditions that cause most of the global burden of morbidity and mortality in children under five in the developing world, as stated in the background section. When comparing main regions of the developing world, differences were also shown in terms of child health topics for systematic reviews.

Conclusions: In response to the challenges faced by global child health and survival in the developing world, more efforts are needed to promote and support the development of relevant Cochrane systematic reviews. The reasons for the estimated shortfall in the number of systematic reviews authored by people living in developing countries may be complex. Many countries continue to struggle with complex political and social situations, cultural and language barriers, lack of access to technical/research expertise, and deficiencies in their health system. Definition of priority-setting for both health care program actions and research could be considered as a first step to identify gaps in knowledge that need to be filled to reach one of the millennium goals: a two-thirds reduction in child mortality by 2015 (from the base year 1990).

Acknowledgment: Centro Rosarino de Estudios Perinatales, Argentina.