Promoting Evidenced-Based Public Health

October 1, 2004

Heather Heilman
Phone: (504) 865-5714

Many public health interventions are based on good ideas and good intentions but not enough concrete data," said Pierre Buekens, dean of the School of Public Health and Tropical Medicine.

publichealthRandomized trials are standard in medical research, but are more complicated to do and therefore relatively rare in the realm of public health.

But when interventions are left unevaluated, time and resources may be wasted. But Tulane can help remedy that.

When Buekens arrived at Tulane two years ago, he initiated a period of strategic planning in which it was determined that the promotion of evidence-based global health would be the focus of the school.

That vision took form with the official opening on Sept. 8 of the new Center for Evidence-Based Global Health. Tulane is already internationally recognized for its expertise in evaluating the effectiveness of public health interventions. Buekens hopes to build on that, making Tulane the undisputed leader in this area.

Buekens serves as director of the center. Frederique Jacquerioz, assistant professor of tropical medicine, has been named assistant director. Program coordinator Andrea Lee Meyer is the center's first full-time employee. The center is meant to foster collaboration among departments and across the university.

Faculty from all schools and departments are eligible to become fellows. The group is already very active and has been meeting almost every week and planning a lecture series.

"We want to foster an intellectual community that is thinking about new ways to make public health more evidence-based," Buekens said. "We hope to encourage cross fertilization."

The center will help faculty receive and manage grants to design, conduct and analyze randomized trials and other scientifically valid studies of health interventions.

"There are a lot of new technologies and methodologies to do that," Buekens said. "In the last five years we've seen more randomized community trials, which compare villages, hospitals, health centers or households."

Recent studies have shown, for example, that monthly antibiotic treatments for Kenyan sex workers don't reduce the incidence of HIV in that population. Another showed that household handwashing does prevent diarrhea in infants, but that antibacterial soap is no more effective than plain soap. Health systems and services could also be evaluated in such a way.

The first grant to be funded through the center will test the effi- cacy of episiotomies and active management of the third stage of labor on childbirth outcomes in 18 hospitals in Argentina and Uruguay. Buekens is principal investigator of this study, which is funded by the National Institutes of Health. The unfortunate irony is that sometimes interventions that are supported by evidence are not practiced. In those cases, what needs to be tested are methods of encouraging such practices.

The term "global" indicates that this work makes the link between domestic and international interventions. Multicenter studies work best when they include sites in many countries in as many regions as possible, allowing researchers to get a good grasp on what can be generalized and what is specific to certain locations or situations.

Sometimes interventions that are effective in industrialized countries don't work as well in developing nations. But sometimes they do, and sometimes careful adjustments can make them effective. Finding out means testing them in practice. "It's not easy, but it's worth the effort," Buekens said.

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