Profile of Published Cochrane Systematic Reviews in Child Health From Low- and Middle-Income Countries

Objective: Setting priorities in health research is a challenge at the global and national levels.Use of evidence-based approach is uncommon and needs to be promoted in low-and middle-income countries (LMIC). We describe profile of Cochrane systematic reviews focussing onparticipation from LMIC. Methods:We searched six Cochrane review groups producingreviews relevant to child health in low- and middle-income countries for published Cochranesystematic reviews from 1 March, 2009 till 18 March, 2015 in the Cochrane Library. Results:A total of 669 Cochrane systematic reviews from six review groups were found. Lowproportion of lead authors from low- and middle-income countries was found in 4 out of 6review groups. About 50% of the reviews showed inconclusive evidence. 101/669 (15%)empty reviews were found needing more primary studies. Conclusions:The proportion ofCochrane authors from low- and middle-income countries is low. Capacity-building insystematic reviews and good quality primary research in these countries is warranted.

Building Capacity of Indian Scientists to Conduct Systematic Reviews in Child Health: An ICMR Initiative.

Knowledge and training in evidence-based medicine is essential for informed clinical decision-making and treatment choices. Systematic reviews identify, appraise and synthesize research-based evidence and present it in accessible format. The Indian Council of Medical Research has promoted evidence-based medicine in India by establishing an Advanced Center for evidence based medicine that hosted the South Asian Cochrane Network and Center at the Christian Medical College, Vellore; procuring a national subscription to The Cochrane Library making it accessible to all Indian scientists; and establishing a Center for Advanced research on evidence-based child health at Post Graduate Institute of Medical Education and Research, Chandigarh. This article informs about a national level initiative by ICMR that aims to harness the translational potential of secondary research, by funding systematic reviews aligned to national health priorities selected through a national competitive process; and to provide training, mentoring, and quality assurance. A continuing scheme of funding high-quality systematic reviews on priority areas of Child Health may follow.

Case Report of Rupture of Splenic Artery Aneurysm during Pregnancy with Poor Outcomes.

Aims: To highlight the importance of considering non-obstetrical etiologies for acute abdominal pain in gravid patients with risk factors for vasculopathies including diabetes and hypertension. Specifically, we report a tragic case of splenic artery aneurysm (SAA) rupture during the third trimester in a diabetic patient resulting in maternal-fetal mortality. Traumatic vascular events during pregnancy may be associated with a high rate of maternal and fetal morbidity or mortality. Therefore early and rapid intervention is critical to the obstetrical outcome. Presentation of Case: A 35 year old multiparous hypertensive diabetic patient presented with acute abdominal pain at 33 weeks of gestation. The presumptive diagnosis was concealed placental abruption with diabetic ketoacidosis. Although nonobstetrical diagnoses were not initially considered, postmortem analysis revealed a nonobstetrical etiology of SAA rupture with catastrophic consequences for the patient and fetus. Discussion: The likelihood of aneurysm rupture of SAA is heightened due to vasculopathic medical comorbidities such as hypertension and diabetes. The vascular congestion of pregnancy increases flow through arteries, leading to increased likelihood of aneurysm rupture without warning or preceding symptoms. Preconception screening and imaging modalities to confirm splenic artery aneurysms and elective repair are also discussed. Early consideration and accurate identification of SAA rupture is critical to saving the lives of both mother and fetus. Conclusion: SAA rupture, in the differential diagnosis of acute abdominal pain in pregnancy, should be considered more likely in multiparous patients and in the presence of comorbidities such as diabetes and hypertension.

Costs of illness due to typhoid fever in an Indian urban slum community: implications for vaccination policy.

Data on the burden of disease, costs of illness, and cost-effectiveness of vaccines are needed to facilitate the use of available anti-typhoid vaccines in developing countries. This one-year prospective surveillance was carried out in an urban slum community in Delhi, India, to estimate the costs of illness for cases of typhoid fever. Ninety-eight culture-positive typhoid, 31 culture-positive paratyphoid, and 94 culture-negative cases with clinical typhoid syndrome were identified during the surveillance. Estimates of costs of illness were based on data collected through weekly interviews conducted at home for three months following diagnosis. Private costs included the sum of direct medical, direct non-medical, and indirect costs. Non-patient (public) costs included costs of outpatient visits, hospitalizations, laboratory tests, and medicines provided free of charge to the families. The mean cost per episode of blood culture-confirmed typhoid fever was 3,597 Indian Rupees (US$ 1=INR 35.5) (SD 5,833); hospitalization increased the costs by several folds (INR 18,131, SD 11,218, p<0.0001). The private and non-patient costs of illness were similar (INR 1,732, SD 1,589, and INR 1,865, SD 5,154 respectively, p=0.8095). The total private and non-patient ex-ante costs, i.e. expected annual losses for each individual, were higher for children aged 2-5 years (INR 154) than for those aged 5-19 years (INR 32), 0-2 year(s) (INR 25), and 19-40 years (INR 2). The study highlights the need for affordable typhoid vaccines efficacious at 2-5 years of age. Currently-available Vi vaccine is affordable but is unlikely to be efficacious in the first two years of life. Ways must be found to make Vi-conjugate vaccine, which is efficacious at this age, available to children of developing-countries.