This paper finds that none of 35 doctors in an Ethiopian referral hospital use the Cochrane Library in their clinical practice. This begs the question: How important is it that individual health professionals use the Cochrane Library directly? It could be argued that the key audience for Cochrane and other systematic reviews is the developer of clinical guidance (at global and national levels). Should the emphasis be on translating guidance into policy and practice? Or should it be expected that health professionals routinely refer to Cochrane evidence directly? Also, this study appeared to show a modest level of understanding of evidence-based medicine as a concept, although this was self-reported. It would be interesting to know the actual level of understanding/knowledge about evidence-based medicine.
CITATION: Abdulwadud O, Tadesse F, Yilma G, Midekssa M, Ibraghimova I.
Knowledge and experience with Cochrane and evidence based medicine among health professionals in Debreberhan Referral Hospital in Ethiopia: a cross-sectional survey.
The Pan African Medical Journal. 2018;30:162. doi:10.11604/pamj.2018.30.162.14667
Introduction: Cochrane generates and disseminates high-quality systematic reviews through the Cochrane Library. We surveyed Ethiopian health professionals' knowledge and experience with cochrane, the Cochrane Library and Evidence Based Medicine (EBM).
Methods: a cross-sectional survey was conducted using a convenient sample of health professionals in DebreBerhan Referral hospital in Ethiopia. Participants completed a pre-tested self-administered survey before EBM training. Data were analyzed using Fisher's exact or Chi-Squared test with Yates' correction. The strength of association between variables was quantified using odds ratios with 95% confidence intervals.
Results: the response rate was 71.4% (35/49). Over half (54.3%) of the sample were males; 68.6% aged ≤ 30 years; 54.3% were physicians and 37.1% were nurses. Up to 65.7% had heard about Cochrane and only two knew cochrane South Africa as their reference centre. Nearly 48.6% were aware of the Cochrane Library, of whom 46% accessed it however; none used it for lacking awareness, search skills, access to internet and time constraints. Majority had a positive attitude towards EBM; 45.7% had heard of EBM; 74.3% rated their EBM knowledge as low; 74.3% lacked EBM training; and 88.6% were keen to attend EBM course. Adequate EBM knowledge was correlated with prior training (OR = 3.7, 95% CI 1.9-6.9, P<0.001], high self-assessment of EBM knowledge (OR = 0.27, 95% CI 0.14-0.51, P<0.001), male gender (P = 0.04), a positive attitude towards EBM (P = 0.001) and awareness of Cochrane (P = 0.004).
Conclusion: Ethiopian health professionals have unmet training needs and want support through professional development workshops and an improved education system to provide high-quality evidence-based healthcare.
'The use of evidence-based resource helps to inform clinical practice. In Ethiopia, although the Cochrane Library is free, less than half were aware of the resource. Strikingly, none of those who accessed it have used it in practice either. This is not surprising given similar observations have been reported before [30-34]. In Nigeria, doctors' use of the Cochrane Library was reported as 10%  and 7% . Equally, 8.5% of Sri Lankan doctors  and 4.3% of Jordanian family doctors  use it.'
The authors conclude: 'Awareness sensitization campaign, in-service training and upgrading the health infrastructure, including the internet service are critical to promote the use of Cochrane Library among clinical staff. The set up of EBM journal club in hospitals also helps an increased awareness and use of evidence, as well as assist clinical staff to keep up-to-date with the medical literature.'
Best wishes, Neil
Coordinator, HIFA Project on Evidence-Informed Policy and Practice
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