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June 2, 2004

Evidence-Based Global Health

JAMA. 2004;291(21):2639-2641. doi:10.1001/jama.291.21.2639

The effectiveness of many interventions to improve health in poor populations in the developing world remains untested and therefore unproven. It is sometimes assumed that what works is known and that the only challenge is to make interventions widely available to underserved populations worldwide, the so-called know-do gap. However, other than vaccination, few global health interventions are evidence-based.

Evidence-based global health requires use of the evidence from randomized controlled trials and other scientifically valid studies to evaluate global health interventions and to measure progress in improving global health. Randomized controlled trials of global public health interventions are often cluster trials, randomizing groups or communities.1,2 When evidence from randomized trials is not available or is difficult to generalize, observational studies provide useful information but must be carefully interpreted.2 Global health needs assessment and monitoring also rely on observational studies. This issue of THE JOURNAL illustrates the different approaches used in evidence-based global health research, with 1 individual and 3 cluster randomized controlled trials conducted in resource-poor communities to evaluate essential interventions aimed at preventing diseases and disorders prevalent in the developing world,3-6 and 4 observational studies measuring or estimating the frequency of specific health problems and associated risk factors for a number of important worldwide public health concerns.7-10