Schizophrenia trials conducted in African countries: a drop of evidence in the ocean of morbidity?

International Journal of Mental Health Systems

Corrado Barbui²  Clive Adams¹  Marianna Purgato² 

[1] Division of Psychiatry, University of Nottingham, Nottingham, UK;Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Verona, Italy

关键词: Schizophrenia;    Africa;    Clinical trials;   

Others  :  801905
DOI  :  10.1186/1752-4458-6-9

 received in 2012-05-15, accepted in 2012-06-07,  发布年份 2012

【 摘 要 】

Objective

To quantify schizophrenia trialling activity in African countries and to describe the main features of these trials.

Methods

We searched the Cochrane Schizophrenia Group Register, which contains 16,000 citations to 13,000 studies relating only to people with schizophrenia or schizophrenia-like illness, to identify schizophrenia trials conducted in Africa without time limitation.

Results

A total of 38 trials met the inclusion criteria and were included in our analysis. Of the 54 countries of Africa, only 8 produced at least one trial: South Africa produced the majority of trials (20 out of 38 trials, 53%), followed by Nigeria (7 out of 38 trials, 18%) and Egypt (4 out of 38 trials, 11%). The majority of studies investigated the efficacy of pharmacological interventions, were short in duration, and employed a double-blind design. The quality of reporting was generally poor. We found six trials comparing antipsychotics from the WHO Essential List of Medicine versus new generation antipsychotics. In terms of efficacy and acceptability, these studies failed to show any advantage of newer antipsychotics over first-generation agents.

Conclusions

We observed an impressive mismatch between the number of individuals with schizophrenia living in African countries, estimated to be around 10 million, and the overall number of patients included in African trials, which is less than 2,000. These few trials were of low quality and appeared not to reflect the real needs of the population. We argue that the concept of pragmatism should be introduced into the design of randomized trials in African countries. Pragmatic trials should investigate whether treatments, given in real-world circumstances, really have clinically meaningful effects.

【 授权许可】

   
2012 Purgato et al.; licensee BioMed Central Ltd.

【 图 表 】

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