In an editorial published this week in PLOS Medicine, the editors discuss the critical need for improved health information, particularly clear, accessible reference materials that enable health care providers to put the best evidence into practice and bolster health care in low and middle income countries. In their discussion of the critical need for high quality reference and educational materials, the authors single out the issue of postpartum hemorrhage.
From the editorial:
It is in the poorest settings where basic health information may prove most valuable. For example, postpartum hemorrhage (PPH) is a leading cause of maternal death worldwide; yet despite being recommended by the WHO and other professional bodies, active management of the third stage of labor to prevent PPH was found to be correctly used in only 0.5% to 32% of observed deliveries in seven developing countries . Worryingly, six of the seven countries were found to have multiple guidelines and conflicting recommendations for active management of the third stage of labor.
The authors go on to point out that while important sources of knowledge, expanding dissemination of the sort of evidence published in medical journals alone is not sufficient. Instead, the most critical resources may be those that translate evidence into forms that can be readily applied:
Medical journals remain a key part of the knowledge translation process, almost exclusively dealing with the final stages of knowledge creation (primary research), distillation (systematic reviews and guidelines), and commentary (editorializing and contextualizing by experts) via peer review and finally dissemination. Although making research openly available to be both read and reused is an essential step toward a vision of wider access to healthcare knowledge, disseminating information on its own is not enough to ensure evidence is used in decision-making. In many settings it is access to secondary reference and educational materials based on the best available evidence that is severely lacking yet probably more crucial for clinical practice than the most recent observational study or clinical trial findings.