South Asian health: what is to be done?

Editor—A paradigm shift in clinical practice towards evidence based medicine can be embraced even in the poorest countries, where constraints to implementing effective health care may include lack of financial resources, and political will.1 Practising evidence based medicine requires using information and communication technologies to access relevant guidelines, reviews, primary literature, and relevant critical appraisal skills, which need to be taught separately.2 We conducted a survey of medical practitioners in Dhaka, Bangladesh, to investigate views, attitudes, and practice concerning evidence based medicine and information and communication technologies, as part of a European Union funded project.3 Of the 226/300 (75%) who responded to the survey, 118 (52%) owned a computer, 95 (42%) had never used email communication, and 111 (49%) had never accessed the internet to search for information. Among the types of material that the respondents read to find information about clinical evidence, the most popular source was textbooks (152; 73%) and the second most popular was review articles (134; 64%). Electronic resources, such as professional guidelines (24; 11%), the Cochrane Library (14; 6.8%), and hospital intranet protocols (11; 5.3%) were the least popular sources of information. The practitioners showed a positive attitude towards evidenced based medicine and strongly acknowledged the need for further training. However, the respondents' confidence in assessing research evidence did not reflect their ability to evaluate medical literature critically. In developing countries, actions are needed to improve free access to journals and teach the skills of evidence based medicine and information and communication technologies, bearing in mind local constraints and limitations of the healthcare system.