Is evidence-based medicine relevant to the developing world? Systematic reviews have yet to achieve their potential as a resource for practitioners in developing countries

Although there is still some resistance to the evidence-based medicine movement, evidence-based health care has now become widely accepted and adopted. Systematic reviews of the effectiveness of health care interventions are the engine room of evidence-based health care; much has been written about how these reviews should be conducted and what they can achieve [1,2]. If the case for the use of systematic reviews is good in developed countries-and we think it is-then the case is even stronger in the developing world. Wherever health care is provided and used, it is essential to know which interventions work, which do not work, and which are likely to be harmful. This is especially important in situations where health problems are severe and the scarcity of resources makes it vital that they are not wasted [3]. But are the systematic reviews that have so far been published relevant and of practical use to those who provide health care in "the majority world" (i.e., in developing countries? In our view, the relevance of systematic reviews to frontline health care workers in developing countries has so far been limited, for a number of reasons.