South Asian Cochrane Network

The SACN input to the EHCRPC:
The national provision for The Cochrane Library was helped by to a consortium funded workshop for the ICMR held at New Delhi in October 2006; attempts to influence health policy continued with the protocol development workshop at Vellore in June 2007 that was partly funded by the EHCRPC. The Cochrane review on ‘Pimaquine for preventing relapses in P. vivax malaria’ (CDSR, Issue 1, 2007) was an EHCRPC effort, as was another review by Srividya Adinarayan from the Vector Control and Research Center, Pondicherry, and colleagues on ‘Diethylcarbamazine (DEC)- medicated salt for community-based control of lymphatic filariasis’ (CDSR, Issue 1, 2007) that concluded that low dose DEC-medicated salt is an effective intervention when maintained at 90% coverage for at least 6 months.
Forthcoming EHCRPC sponsored reviews with authors from the SACN include:

An example of an EHCRPC sponsored Cochrane Systematic Review changing health care policy in the region
Malaria is a major public health problem in many parts of the world, including South Asia. Infection with Plasmodium vivax causes a relapsing type of malaria since, in addition to the pre-erythrocytic and erythrocytic stages found in P. falciparum and P. malariae, there is a stage in the liver called the hypnozoite. These dormant forms can be activated weeks to years after the initial infection and cause relapses of the infection. A combination of chloroquine and primaquine is used to treat P. vivax malaria. Chloroquine acts on the blood stages of the parasite and primaquine eliminates the liver forms.
For many years, there had been a discrepancy in the treatment guidelines for radical cure of P. vivax malaria between those issued by the National Malaria Control Programmes in the region, such as in India and Sri Lanka that recommend 5 days of primaquine following chloroquine, and those from the World Health Organization that recommends a 14-day course of primaquine as the standard treatment for preventing relapses.
Gawrie Galappaththy, from the Anti-malaria campaign, Ministry of Health, Sri Lanka, and others published a Cochrane Review in issue 1, 2007 of The Cochrane Library on Primaquine for preventing relapses in people with Plasmodium vivax malaria, that included 9 randomized controlled trials of over 3400 people from the region. The review showed that giving 5 days of primaquine (15 mg/kg) after chloroquine is no better in preventing relapses than using chloroquine alone. Primaquine (15 mg/kg/day) for 14 days plus chloroquine was more effective in preventing relapses of P. vivax malaria than chloroquine alone or primaquine for 5 days plus chloroquine.
Within 6 months of publication of this review, the Revised Malaria Treatment Guidelines issued by the National Vector Borne Diseases Control Programme, Ministry of Health and Family Welfare, Government of India, and the 2007 guidelines of the National Anti Malaria campaign Directorate, Ministry of Health in Sri Lanka had both changed recommendations for the use of primaquine for preventing relapses in P. vivax malaria from 5 days to the WHO recommended 14 days treatment regimen.
For this evidence based policy recommendation to affect practice, attention now needs to be given to improving compliance with the longer primaquine regimen. Primaquine resistance is also increasing in the region and higher doses of primaquine (30 mg/kg) for 14 days and other drugs that eliminate the liver forms of P. Vivax need to be evaluated in systematic reviews.

Evidence Update
The SACN is also involved in disseminating and evaluating Evidence Update, two-page summaries of Cochrane reviews of interventions relevant to health care in low and middle-income countries. There are about 50 such summaries available and these have been disseminated to over 400 primary care practitioners and to medical colleges in India.