Lack of local evidence in LMIC

26 June, 2019

Dear HIFA Colleagues:

As a country representative from Honduras, I will like to share with all of you an experience that I believe is relevant for the discussions that we share in this media. I currently work in a Cancer Center “Emma Romero de Callejas” in Tegucigalpa, Honduras. As part of the management of thyroid carcinoma, we send our patients of lower incomes to a surgical brigade that visits our country from the US. Most of these patients undergo a hemi thyroidectomy (HT) even though the Oncologist has ordered a total thyroidectomy (TT). Biopsy results of the patients that undergo HT usually report: compromised surgical borders and thyroid capsule infiltration. This obliges the patient to undergo a new surgery since radioactive iodine is not indicated if there is remaining thyroid tissue.

At the light of this situation, we decided to discuss this problem with the US colleagues. We presented them all the cases that needed reoperation but couldn’t afford it or that were missed in the follow up due to patients’ scarce resources. We also presented a paper of Chinese authors that discussed the issue TT vs HT in LMIC and that in this context, TT was the wisest choice for patients in which follow up may be troublesome. Our American Colleagues pointed out that they couldn’t act against the American Thyroid Association Management Guidelines for Adult patients with Thyroid nodules and differentiated Thyroid cancer, which recommend HT for lesions lower than 1 cm. As reasonable as this statement is, the patients´ problem is not solved.

This situation raises the discussion that in LMIC medical practice is still empirical and in several occasions decisions are taken based on evidence made in high income countries. The only way to know how to approach a local health problem is through randomized controlled trials and other experimental designs developed and implemented locally.

Implementation Research (IR) is a type of research, that through rigorous designs and practical research questions, aims to uptake interventions that have proven effective under controlled settings and turn them into routine practices that benefit a wider population. IR might be an important tool to enhance quality research and to boost research practice in LMIC, so that local evidence guides health decisions and practices.

Dr. Carlos Fajardo

General Practitioner and Epidemiologist

Country Representative from Honduras

HIFA profile: Carlos Jose Fajardo Flores is a Physician at the Honduran Health Secretary/ UNAH. Professional interests: Neurology, new lines of Investigation for Dementia, Methodology of investigation. he is a HIFA Country Representative.

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