Healthcare interventions for consumers/public
The Cochrane Collaboration, is a not for profit organisation which produces systematic reviews on the effects of healthcare interventions. These reviews are published in an online database, The Cochrane Library monthly.
What is a systematic review?
A systematic review asks a specific research question about a particular healthcare intervention in a clearly defined group of people with a health condition or problem. These reviews summarise the results of healthcare studies and provides the evidence on the effectiveness of the interventions. Systematic reviews are complex and depend on what clinical trials have been conducted, the quality of the trials and the health outcomes that were measured. The review authors combine the numerical data about the effects of the treatment and the authors assess the benefits and harms for the specific treatment.1
For more information about what consumers can and cannot get from systematic reviews, please visit the Cochrane Consumer website.
The South African Cochrane Centre which is part of the Cochrane Collaboration, will publish consumer summaries monthly as listed below. Should you require information for a specific health condition please go to http://summaries.cochrane.org/ and search for the information you require or alternatively contact firstname.lastname@example.org
1. Cochrane Consumer Network (www.consumers.cochrane.org). Accessed 17 August 2012
Antibiotics for people with sore throats
This review sought to determine whether antibiotics are effective for treating the symptoms and reducing the potential complications associated with sore throats.
Sore throats are infections caused by bacteria or viruses. People usually recover quickly (usually after three or four days), although some develop complications. A serious but rare complication is rheumatic fever, which affects the heart and joints. Antibiotics reduce bacterial infections but they can cause diarrhea, rash and other adverse effects and communities build resistance to them.
The review is current to July 2013 and included 27 trials with 12,835 cases of sore throat. All of the included studies were randomised, placebo-controlled trials which sought to determine if antibiotics helped reduce symptoms of either sore throat, fever and headache or the occurrence of more serious complications. Studies were conducted among both children and adults.
The review found that antibiotics shorten the duration of pain symptoms by an average of about one day and can reduce the chance of rheumatic fever by more than two-thirds in communities where this complication is common. Other complications associated with sore throat are also reduced through antibiotic use.
Quality of evidence
The quality of the included studies was moderate to high. However, there were very few recent trials included in the review (only three since 2000), hence it is unclear if changes in bacterial resistance in the community may have affected the effectiveness of antibiotics.
Citation: Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database of Systematic Reviews 2013, Issue 11. Art. No.: CD000023. DOI: 10.1002/14651858.CD000023.pub4.
Artemisinin-based combination therapy (ACT) for treating non-severe malaria due to Plasmodium vivax
What is P. vivax malaria and how do ACTs work?
P. vivax is one of five species of the malaria parasite known to cause clinical illness. It is a common cause of malaria in Asia, South America and Oceania. Unlike P. falciparum (the commonest cause of malaria in Africa), P. vivax has a liver stage which is not treated by most common antimalarial drugs. This liver stage can become active and cause a relapse of clinical illness weeks or even years after the initial illness.
The standard treatment for vivax malaria has been chloroquine to treat the clinical illness, and a 14-day course of primaquine to clear the liver stage. In some parts of Oceania the P. vivax parasite in now highly resistant to chloroquine, which makes this treatment ineffective.
Artemisinin-based combination therapies (ACTs) are now the recommended treatment for P. falciparum malaria worldwide. As the effectiveness of chloroquine for P. vivax declines, alternative therapies are needed. If ACTs are also effective against P. vivax they could become the standard treatment for all forms of malaria.
Current ACT combinations do not contain drugs effective against the liver stage of P. vivax so primaquine would still be necessary to achieve complete cure.
What the research says about the effect of using ACTs
We examined the research published up to 28 March 2013.
Compared to chloroquine
People who are treated with an ACT are probably less likely to have another episode of P. vivax malaria during the next six to eight weeks than those treated with chloroquine (only dihydroartemisinin-piperaquine, artesunate plus sulphadoxine-pyrimethamine, and artesunate-pyronaridine have been compared with chloroquine). It is not clear whether this advantage is still present when primaquine is given to achieve a complete cure.
Compared to alternative ACTs
People who are treated with dihydroartemisinin-piperaquine are probably less likely to have another episode of P. vivax malaria during the next six weeks than those treated with alternative ACTs (only artemether-lumefantrine, artesunate plus sulphadoxine-pyrimethamine and artesunate plus amodiaquine have been compared). This advantage may be present even when additional primaquine is given to achieve a complete cure.
Citation: Gogtay N, Kannan S, Thatte UM, Olliaro PL, Sinclair D. Artemisinin-based combination therapy for treating uncomplicated Plasmodium vivax malaria. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD008492. DOI: 10.1002/14651858.CD008492.pub3.
Micronutrient supplementation for children with HIV infection
This review includes 11 trials that tested the effectiveness and safety of various micronutrient supplements in children with HIV infection in a diversity of settings. All except one trial were conducted in African children. The primary outcomes were mortality, morbidity, and HIV-related hospitalisations, and secondary outcomes were HIV disease progession, measures of growth, and adverse effects of supplementation.
The review found that vitamin A supplements are beneficial and safe, and halved mortality overall in an analysis of three trials in different African countries. Zinc appeared to be safe and reduced diarhoeal morbidity in one trial. Multiple micronutrient supplements reduced the duration of hospital admissions, and improved appetite and short-term growth in poorly nourished hospitalised children.
Further research is needed on single supplements other than vitamin A, and on the long-term effects, optimal composition and dosing of multiple supplements.
Citation: Irlam JH, Siegfried N, Visser ME, Rollins NC. Micronutrient supplementation for children with HIV infection. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD010666. DOI: 10.1002/14651858.CD010666.
Physical fitness training for stroke patients
Physical fitness is important to allow people to carry out everyday activities such as walking and climbing stairs. However, physical fitness is often reduced in stroke patients and may limit their ability to perform everyday activities and also worsen any stroke-related disability. For this reason fitness training has been proposed as a beneficial approach for stroke patients. In January 2013 this review identified 45 trials involving 2188 participants, which tested different forms of fitness training after stroke.
Studies of fitness training can be difficult to carry out. This means most of the studies were small and of moderate quality. However, some consistent findings did emerge. We found that some types of fitness training, particularly those involving walking, can improve exercise ability, walking and balance after stroke. However, there was not enough information to draw reliable conclusions about the impact of fitness training on quality of life or mood.
There was no evidence that any of the different types of fitness training caused injuries or other health problems; exercise appears to be a safe intervention.
Citation: Saunders DH, Sanderson M, Brazzelli M, Greig CA, Mead GE. Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003316. DOI: 10.1002/14651858.CD003316.pub5.
Mothers' position during the first stage of labour
There is little doubt that women should be encouraged to utilise positions which give them the greatest comfort, control and benefit during first stage labour. As women in most western societies now lie in bed for the entire duration of their labour, it is important that they understand the risks and benefits of the positions they choose.
This review included 25 studies (involving 5218 women). Although many studies were not of high quality, and most of the women were low risk, they did show that the first stage of labour may be approximately one hour and twenty minutes shorter for women who are upright or walk around. As every contraction is potentially painful, and prolonged labour can be an overwhelming and exhausting process resulting in an increased need for medical intervention, this is a meaningful outcome for women. Indeed other important outcomes for women who were upright and mobile compared with lying down in bed included a reduction in the risk of caesarean birth, less use of epidural as a method of pain relief, and less chance of their babies being admitted to the neonatal unit. More research of better quality is still needed to validate these results for all women in labour. However, based on the results of this review we recommend that wherever possible, women should be encouraged and supported to use upright and mobile positions of their choice during first stage labour, as this may enhance the progress of their labour and may lead to better outcomes for themselves and their babies.
Citation: Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003934. DOI: 10.1002/14651858.CD003934.pub4
|For more information, contact the South African Cochrane Centre on (021) 938 0834 or email Joy.Oliver@mrc.ac.za.