Suchergebnisse

Background Mycobacterium Tuberculosis (TB) poses a substantial burden in sub-Saharan Africa and is the leading cause of death amongst infectious diseases. Randomised controlled trials (RCTs) are regarded as the gold standard for evaluating the effectiveness of interventions. We aimed to describe published TB treatment trials conducted in Africa. Methods This is a cross-sectional study of published TB trials conducted in at least one African country. In November 2019, we searched three databases using the validated Africa search filter and Cochrane's sensitive trial string. Published RCTs conducted in at least one African country were included for analysis. Records were screened for eligibility. Co-reviewers assisted with duplicate data extraction. Extracted data included: the country where studies were conducted, publication dates, ethics statement, trial registration number, participant's age range. We used Cochrane's Risk of Bias criteria to assess methodological quality. Results We identified 10,495 records; 175 trials were eligible for inclusion. RCTs were published between 1952 and 2019. The median sample size was 206 participants (interquartile range: 73–657). Most trials were conducted in South Africa (n = 83) and were drug therapy trials (n = 130). First authors were from 30 countries globally. South Africa had the most first authors (n = 55); followed by the United States of America (USA) (n = 28) and Great Britain (n = 14) with fewer other African countries contributing to the first author tally. Children under 13 years of age eligible to participate in the trials made up 17/175 trials (9.71%). International governments (n = 29) were the most prevalent funders. Ninety-four trials provided CONSORT flow diagrams. Methodological quality such as allocation concealment and blinding were poorly reported or unclear in most trials. Conclusions By mapping African TB trials, we were able to identify potential research gaps. Many of the global north's researchers were found to be the lead authors in these African trials. Few trials tested behavioural interventions compared to drugs, and far fewer tested interventions on children compared to adults to improve TB outcomes. Lastly, funders and researchers should ensure better methodological quality reporting of trials.

AbstractBackgroundWell‐conducted systematic reviews contribute to informing clinical practice and public health guidelines. Between 2008 and 2018 Cochrane authors in sub‐Saharan Africa were publishing progressively fewer Cochrane Reviews, compared to non‐Cochrane reviews. The objective of this study was to determine what motivated trained Cochrane authors in sub‐Saharan Africa to conduct and publish non‐Cochrane reviews over Cochrane Reviews.MethodsWe conducted a mixed‐methods exploratory sequential study. We purposely selected 12 authors, who had published at least one Cochrane‐ and one non‐Cochrane review, for in‐depth, semi‐structured interviews. We manually coded and analysed the qualitative data using Grounded Theory approach and used the results to inform the survey questions. Subsequently we surveyed 60 authors with similar publishing experience. We analysed the quantitative data using descriptive and inferential statistics.ResultsFacilitators to publish with Cochrane were a high‐impact factor, rigorous research, and visibility. From barriers, the main categories were protracted time to complete Cochrane Reviews, complex title registration process, and inconsistencies between Cochrane Review groups regarding editorial practices. From the survey, authors confirmed rigorous research and reviewing process (84%), high impact factor (77%), and good mentorship (73%). The major barriers included Cochrane's long reviewing process (70%) and Cochrane's complicated title registration (50%). Authors with publishing experience in the previous 10 years at <95 percentile of systematic review publications, there was no significant difference between the medians for publishing with Cochrane (1) and non‐Cochrane (0) reviews, p = 0.06. Similarly, for those with publishing experience of ≥95 percentile of systematic review publication there was no significant difference between the medians for publishing with Cochrane (4) and non‐Cochrane (6), p = 0.344.ConclusionAuthors considered the visibility and relevance of Cochrane research as a trade‐off point. They continued publishing with Cochrane despite the barriers that they encountered. However, the concerns raised by many authors are worth addressing.