Evidence Aid provides systematic reviews and evidence summaries to aid decision making in humanitarian crises and disasters. They conducted a survey that found most respondents feel systematic reviews are useful and practical for disaster response. While few trials have been done in disaster settings, it is possible to conduct them and summarize the evidence systematically. Evidence Aid aims to identify relevant systematic reviews and prioritize new reviews to address aid workers' most pressing evidence needs and improve the effectiveness of humanitarian interventions.

1. Evidence Aid
Systematic reviews and trials:
The what and the how and the why in
challenging circumstances
Bonnix Kayabu (Co-ordinator) and Claire Allen (Knowledge Manager)

2. Outline of presentation
• Background to Evidence Aid.
• The Evidence Aid team.
• The what, the why and the how of systematic
reviews.
• Reflections about systematic reviews from
those preparing for and responding to natural
disasters, humanitarian crises and major
healthcare emergencies.
• Conclusion.

3. Evidence Aid – why?
• Established after Indian Ocean tsunami - December
2004.
• Uses knowledge from systematic reviews (SRs) to
provide reliable, up-to-date evidence for disasters,
humanitarian crises and other major healthcare
emergencies.
• Provides urgent response, by bundling together brief
summaries of the findings of SRs.
• Improves access to SRs on the effects of interventions
and actions of relevance, so as to improve health-
related outcomes in major healthcare emergencies.

4. Who are we?
Claire Allen Mike Clarke Bonnix Kayabu
Knowledge Manager Project Lead Co-ordinator
Oxford, UK Dublin, Ireland Dublin, Ireland
Belfast, UK
We make up the equivalent of 1.5 full-time staff

5. Questions
Do decision makers need this evidence?
Do decision makers want this evidence?
What are their priorities?
Do relevant studies exist?
Do relevant systematic reviews exist?
How should we deliver this knowledge?
Can we get the job done?

6. Do decision makers need the evidence?

7. What is a systematic review?
• A review of a clearly formulated question that
uses systematic and explicit methods to
identify, select, and critically appraise relevant
research, and to collect and analyse data from
the studies that are included in the review.
Statistical methods (meta-analysis) may or
may not be used to analyse and summarise
the results of the included studies.
(from: http://www.cochrane.org/glossary/5#letters)

8. Why is a Systematic Review
different?
• Explicitly different from traditional literature
reviews or expert commentaries in that they
are transparent, rigorous and replicable.

9. Have trials been done in
challenging circumstances?
Few trials have been done in disaster settings. However, some
have been carried out, e.g.:
• Onder et al randomized 103 adults to one of three different drugs to treat
post traumatic stress disorder (PTSD) after the 1999 Turkish earthquake.
• Catani et al randomized 31 children with a preliminary diagnosis of PTSD in
a refugee camp in north-eastern Sri Lanka to six sessions of Narrative Exposure
Therapy for children, called KIDNET, or six sessions of meditation-relaxation
after the Indian Ocean tsunami.
• Habib et al in Pakistan in 2006 allocated 200 children affected by an
earthquake to take zinc in suspension form or as tablets as a treatment for
diarrhoea.
We need to bring together the trials in a systematic way to
present the overall results of all the trials.

11. Systematic review process
• A relevant research question developed in
consultation with users.
• A search strategy to find all the available studies,
including journals, grey literature and
unpublished studies.
• A set of inclusion and exclusion criteria to select
the studies for review.
• A quality appraisal strategy.
• Methods for synthesising the studies.

12. Why are systematic reviews
important?
• To help understand risks, benefits and consequences of
decision making.
• To establish whether an intervention works, does not
work, or has the potential to cause harm.
• To present a clearer and more consistent picture of the
body of evidence.
• To avoid decision-making on the basis of a single study.
• To ensure decisions are based on information that is
transparent, rigorous and replicable.

13. Reflections about
systematic reviews
• 83% of respondents said SRs are useful in disasters.
• “Evidence from SRs could have a positive role in
humanitarian interventions “ 69% “strongly agreed”
and 29% “agreed”.
• “SRs are not practical in decision-making about
humanitarian interventions” 50% “disagreed”, 20%
“strongly disagreed”.

14. Reflections about
systematic reviews
• Humanitarian interventions should be based on reliable
knowledge of which interventions work, which don’t
work and which are potentially harmful (‘agreed’ 25%;
‘strongly agreed’ 71%).
• SRs could be used to assess the likely effects of
interventions before providing funding (83% of those
who have worked with donor agencies agreed).
• Improved access to SRs would improve responses to
natural disasters (82%).

15. Conclusion
• Opinions on the potential role of SRs were positive.
• Trials and SRs can be done in challenging
circumstances, but more needs to be done to help.
• Humanitarian aid workers and donors need SRs to
improve their interventions and assess impact of their
efforts.
• They have many uncertainties for which they need
research evidence.
• Evidence Aid is engaging with aid workers to prioritise
their needs on systematic reviews.

16. Thank you for listening!
Contact us using:
Website: www.evidenceaid.org
Twitter: @evidence Aid
Facebook: Evidence Aid
E-mail: callen@evidenceaid.org