Chapter 2.6 The current state of the evidence: Mapping the evidence and systematic reviews
Authors: Shaikh IA, Davies P, Man A.
Chapter 2.6 describes the importance of the following when considering the current state of the evidence and systematic reviews as a source of information for research in health emergency and disaster risk management (Health EDRM):
- The essential elements of Health EDRM as they pertain to various stages of the emergency management continuum.
- The current level of research and available evidence to standardize the application and practice of these essential elements in Health EDRM.
- The optimal modalities for generating additional evidence for elements currently deemed deficient.
- The barriers and difficulties in conducting systematic reviews and research during emergencies and disasters.
What is this chapter about?
Optimal application of sound and effective interventions in disasters and other health emergencies requires reliable and robust evidence from research. Systematic reviews of good quality research can help decision-makers identify efficient and effective practices for use during different phases of the disaster management cycle.
This chapter describes three main types of systematic review: statistical meta-analysis, narrative systematic reviews and qualitative synthesis that might be used to improve the evidence base for Health EDRM. It describes the steps and tools used for preparing systematic reviews and outlines how Cochrane reviews can be used for various aspects of decision-making about health and health care. There are also case studies presenting the findings of a systematic review and discussing the evidence base from systematic reviews for specific topics related to Health EDRM.
Case studies presented in the chapter
- Cochrane and the Cochrane Database of Systematic Reviews (CDSR).
- A systematic review and meta-analysis of the impact of mental health and psychosocial support interventions on people affected by humanitarian emergencies.
- Existing evidence from systematic reviews on violence in disasters.
What are the key messages of this chapter?
- Many challenges hamper the generation of evidence and its accurate and consistent application in Health EDRM. Practitioners who are aware of evidence limitations may not have the necessary training or skills to design, plan, implement and evaluate their programmes. They may also lack the training to discern programmatic and practice-based problems that could be turned into research questions for new studies (see Chapter 3.5).
- People in low-income, resource-poor countries and settings may disproportionately suffer from the ‘double jeopardy’ of lacking the critical mass of trained researchers and practitioners, coupled with limited or non-existent opportunities for interaction between researchers and practitioners in Health EDRM.
- Strong leadership will be required from global and regional entities, including donors, with a strong stake in Health EDRM to bring together the main groups required for the generation and use of evidence: the Health EDRM practice community to identify needs and problems requiring research; the academic sector to conduct high quality research; and agencies and donors to bridge the science into practice and application gaps.
- Systematic reviews provide the means to bring together existing evidence to inform these processes and to place the findings of new studies in the context of the totality of the evidence. They will allow decision makers in Health EDRM to make use of the best available evidence.
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