Comparative Effectiveness Research (CER) in Nigeria: the Milestones and the Millstones.

Abstract

Background: The relevance of empirical evidence in healthcare decision making is well acknowledged. Within any setting constrained by a lean resource base, stronger premium should be placed on evidence which informs policy; as ever so often in such climes, multiplicity of healthcare needs outstrip available resources. Thus, the outstanding challenge is how to best serve the most compelling needs of the teeming populace by a fair balance of evidence and resource outlay within the complex imperatives of the overarching socio-cultural context. Familiar poor development indices underscore most developing countries; peculiarities also exist with respect to national priorities, resource base, available technologies and infrastructure, philosophies and cultures, and penchant for adaptation. Nigeria is one such complex society, trying to address healthcare needs of her citizens while concurrently addressing competing needs from other sectors by a very delicate balancing act. This study aims to provide an overview of the state and turnover of Comparative Effectiveness Research (CER) in Nigeria between the years 1975 and 2009, and the extent to which key health problems are addressed within study imperatives. Methods: Studies were selected by running searches in PubMed and Cochrane databases. Search terms such as Compar*, effectiv*, research, study, and Nigeria were used. The Cochrane Library was searched using a listing of Nigerian authors provided by the South African Cochrane Centre. Studies were selected both by study design (experimental studies - Randomized Control Trials, Controlled Clinical Trial, analytic studies or full systematic reviews on these designs) and by study setting which in this instance was Nigeria. Data extraction was done using a checklist designed to capture priority areas apparent within the studies reviewed and as enunciated by the National Health Policy. Results: The overall volume of intervention studies was low. A greater proportion of studies, 48.5%, investigated treatment options for infectious and parasitic diseases; 24.2% investigated reproductive health interventions. Approximately 62.6 % of interventions aimed to achieve cure, and 29.3% aimed for prevention. Study endpoints were efficacy (95.9%), adverse effects/tolerability (60.6%), treatment failure (28.6%) and cost (6.1%). Study patterns were similar in different geopolitical zones of the country. No stable funding structure could be identified for these studies. Conclusion: CER does reflect the pattern of need and the dominant type of healthcare in Nigeria. Interventions oriented to achieve cure dominate the CER landscape in Nigeria. Keywords: comparative effectiveness research, healthcare, Nigeria