Doctor: Lee Aymar Ndounga Diakou
Title: Randomized trials conducted in Sub-Saharan Africa: epidemiology, methodology and description of interventions
Supervisors: Isabelle Boutron, Francine Ntoumi
Doctoral school: ED 393 Epidemiology and Biomedical Information Sciences, Université Paris Cité
Date of thesis defense: 17/11/2017
Jury: François Dabis, Gonzague Jourdain, Michel Cot, Bruno Giraudeau, Francine Ntoumi, Isabelle Boutron
Sub-saharan Africa (SSA) is characterized by a high population growth and a significant poverty. In addition, this area deals with a burden of disease due to traditional infection diseases and to the emerging chronic diseases. Randomized controlled trials (RCTs) taking into account the local context are needed to strength health policy and to improve the population health. However, because of constraint research capacities, RCTs performed in SSA must investigate relevant research questions, biases must be avoided in methods, and health interventions evaluated must be reported completely for easing implementation in current clinical practice. Such efforts help to avoid waste of research.
Our objectives were to describe the epidemiology of SSA RCTs, and then to evaluate the methodological quality as well as the reporting of evaluated interventions. On the one hand, our works highlighted that SSA RCTs mainly focused on diseases of the highest burden in that area, although they were frequently funded by high-income countries, and most of the corresponding authors were affiliated to those countries. In the other hand, we have shown that methods at high risk of bias can be avoided through simple methodological adjustments of minor cost, and adequate reporting of interventions can be improved via the adherence to reporting guidelines including the CONSORT statement.
Improving the methodological quality of SSA RCTs implies a large dissemination of available methods at low risk of bias and guidelines on the complete reporting of interventions. Furthermore, understanding barriers and facilitators to the uptake of those methods and guidelines is equally required.