The document provides information about an upcoming training workshop on using evidence to accelerate progress towards universal health care coverage in Cotonou, Benin from February 17-18, 2022. The workshop objectives are to equip participants with skills in conducting literature reviews and writing policy briefs to contribute to progress towards universal health coverage in Benin. The training will use presentations, group work, and discussions. Sources of information will include participants, faculty from the Institute of Tropical Medicine in Belgium, and the facilitator's experience working in knowledge management in Benin.

1. WELCOME TO THE TRAINING
WORKSHOP ON USING EVIDENCE TO
ACCELERATE PROGRESS TOWARDS
UNIVERSAL HEALTH COVERAGE
Cotonou, 17-18 February 2022

2. Training workshop on using evidence to
accelerate progress towards universal
health coverage
Benin Royal Hotel, 17 to 18 February 2022
Objectives of the workshop

3. General
objective
Equipping participants to use evidence to
accelerate progress towards UHC

4. Specific
objectives
• Know the different steps of literature review and
policy brief writing
• Conducting a literature review and writing a
policy brief
• Using the achievements to contribute to
progress towards UHC in Benin

5. Methodology
DIRECT PRESENTATION
(COMMNICATIONS)
GROUP WORK PLENARY DISCUSSION

6. Sources of inspiration used
throughout the course
• Your input is part of this training
• Faculty members of the Institute of Tropical Medicine in
Antwerp, Belgium
– Prof. Vincent de Brouwere
– Prof. Dominique Roberfroid
– Ms Ildiko Bokros
• Personal experience
– Since 2008
– Daily activities at CERRHUD
– Some publications in peer-reviewed journals
– Presentations at international conferences
– Publications of research reports and literature reviews
– Co-Facilitator of the Benin CoP Hub - Knowledge Management
Network

7. Spirit of the workshop
• Inspired by the principles of Communities of
Practice
• Horizontal organisation of relations between
all
• Everyone is an expert: co-production of
knowledge

8. Training plan
• Introductory notes
– Typology of health knowledge needs
– Knowledge management
• Does English count?
• Typologies of health knowledge stocks
• Clarify the literature search question
• Using the Global Burden of Diseases
• Better use of Pubmed to consult Medline
• Evaluate the quality of the results of bibliographic
queries
• Other bibliographic reference databases
• Staying up to date in your field
• Save the results of your queries

9. Training plan
• Introduction to the automatic management of
bibliographic references in manuscripts
• Introduction to Mendeley Desktop
• Overcoming the language barrier
• Installing the software
• Understanding the interface
• Importing bibliographic references
• Inserting RBs into a word document in the
Vancouver format
• Update and correct the list of bibliographic
references
• Engaging in continuing education

10. Number of academic journals -Ulrich's
Periodicals Directory
Anglais
Allemand
Chinois (Mandarin)
Espagnol
Français
Japonais
Italien
Polonais
Portugais Neerlandais Russe
Adapted from
Lobachev,2008

11. Number of academic journals UPD
English and French only
Anglais
Français
Adapted from
Lobachev,2008

12. Typology of knowledge
needs

13. Exercise 1
• Discuss in pairs
• Fill in the following table, following the
example given
• Duration of the work in pairs: 5 minutes
• Discussion and synthesis in plenary

14. Need
Fundamenta
l to
What can
we use to
satisfy this
need?
Place of
production
Place of
storage and
distribution
Renewal
time
Feeding
yourself
Food
Drink
Agro-pastoral
production unit
(UP) - Water
UP, breweries
Attics
Household
kitchen
Water towers .
A few hours

15. Needs
Fundamentals
Place of production Storage location
Maximum
duration before
renewal
Feeding
yourself -Food
and drink
Agro-pastoral
production/processing units
Water collection/treatment
point
Attics
Household kitchen
A few hours
Housing-
Housing
Formal/informal real estate
companies
In living
environments
Several years
Clothes -
Clothing
Textile industries Sewing
room
Weaving workshop
Clothing shops
Sewing room
A few months
Caring for
yourself-Care
Houses
Modern/traditional care
facilities
Not applicable A few months
Learning-
Knowledge
Formal and informal, modern
and traditional research
Physical/virtual
libraries
In the memory of
the
?????

16. What to remember from exercise
1?
• Knowledge is a basic need
• Which is produced in the research units
• Its explicit form is stored in the physical and virtual
libraries
• Its tacit form is stored in individual and collective
memories without transcription
• It is important to look for well-defined knowledge in
the right place
• It is essential to state clearly where definite knowledge
has been sought and found
• Knowledge is renewed. You need to know how often
knowledge is renewed in your field and make sure you
stay up to date

17. 17
The cycle of the search for the obvious
Formulating a
question
Search for
publications
Assessing the
quality of
publications
Store references to
publications
Contextualise and
synthesise
Recommend
Share
Decide
Combining with
existing

18. Typology of literature
review types

19. • There are several with different approaches
and objectives
• Some examples
– Systematic review of the literature
– Rapid assessment of evidence
– Scoping review
– Narrative review
– Realistic synthesis
19
What are the different types of
literature reviews

20. • To assess the effects (efficacy and tolerance) of an intervention
(often therapeutic, sometimes diagnostic), by critically synthesising
all studies that answer the question.
• To do this, it follows a systematic and rigorous methodology:
– Comprehensive search of all studies (published and
unpublished) that answer a specific question,
– Critical assessment of methodological quality;
– Summary
http://tutoriel.fr.cochrane.org/fr/revue-syst%C3%A9matique
20
What is a systematic review of the
literature?

21. • Question: limited, focused
• A review of journals and not necessarily a review
of all primary studies
• May focus on one type of study
• Extract only the precise data on the key aspects
What is a rapid evidence assessment
21

22. Systematic review Scoping review
Focused search with restricted parameters More vague research question
The inclusion/exclusion criteria are defined
at the outset
Inclusion/exclusion criteria can be
developed after
Quality assessment often applies to Quality assessment is not the priority
Data extraction is detailed May not require data extraction
A quantitative synthesis is often made The synthesis is not typically quantitative
Formally assesses the quality of
publications and makes a conclusion on a
specific issue
Often used to identify variables and gaps in
the literature on a topic
What is a scoping review?
22
Adapted from

23. Formulate the
literature search
question

24. Exercise 2
• Each participant formulates a research
question related to his or her daily practice
• Share this question with your buddy
• Put your partner's question in one of the 12
cells in the following table
• Argue the choice of this cell with your buddy
• Do this in turn
• Duration: 10 minutes

25. Describe/project/conce
ptualise an ideal health
situation
Develop the most
efficient solutions to a
problem
Describing/analysing/u
nderstanding a
problem
Methodology for
knowledge production
Pathogens -
Causes of
disease
Patients Populations
Types of needs of
knowledge
Large groups
of targets

26. Describe/project/conceptualise the
ideal situation
Develop the most efficient solutions
Is it efficient to invest in
the production of a vaccine
against Lassa virus
disease?
Is it effective to use the 5S
approach to reduce abuse
in maternity wards in
Benin?
How to improve the
implementation of
the national
postabortion care
policy in Benin?
Describe/analyse/understand the
problem
What is the viral cycle of
the Lassa virus?
What is the prevalence of
abuse of pregnant women
in maternity wards in
Benin?
What are the
determinants of
unsafe abortion
mortality in Benin?
Methodology for knowledge production
Which technological
approach is more cost
effective in isolating the
Lassa Virus?
How to measure the
influence of paternalism on
the quality of maternal
health care in Benin?
More appropriate
methodology for a
study on the extent
of unsafe abortion
in Benin
Pathogens - Causes of
disease
Patients Population
Types of needs of
knowledge
Large groups
of targets

27. Describe/project/conceptualise
the ideal situation
Is it possible to stop the
natural circulation of the
Lassa virus?
Should pregnant women in
Benin be given the right to
choose the position in
which they give birth?
What is the ideal
Total Fertility Rate
for Benin?
Develop the most efficient
solutions
Is it efficient to invest in
the production of a vaccine
against the Lassa virus?
Does calcium
supplementation have an
impact on the prevention
of pre-eclampsia?
How to improve the
implementation of
the national
postabortion care
policy in Benin?
Describe/analyse/understand
the problem
What is the viral cycle of
the Lassa virus?
What is the burden of
diarrhoeal disease in
Benin?
What are the
determinants of
unsafe abortion
mortality in Benin?
Methodology for knowledge
production
Which technological
approach is more cost
effective in isolating the
Lassa Virus?
How to measure the
influence of paternalism on
the quality of maternal
health care in Benin?
More appropriate
methodology for a
study on the extent
of unsafe abortion
in Benin
Pathogens - Causes
of disease
Patients Population
Types of needs of
knowledge
Large groups
of targets

28. What to remember from exercise
2?
• There are many different types of
(bibliographic) health research questions
• You must be able to clarify and situate your
bibliographic research question
• Knowing the type of research question guides
the stock of knowledge to be consulted:
Explicit knowledge? Implicit? Universal?
Contextualised? Etc.
• What are the quality criteria for the type of
knowledge sought?

29. Describe/project/conceptualise the
ideal situation
Is it possible to stop the
natural circulation of the
Lassa virus?
Should pregnant women in
Benin be given the right to
choose the position in
which they give birth?
What is the ideal
Total Fertility Rate
for Benin?
Develop the most efficient solutions
Is it efficient to invest in
the production of a vaccine
against the Lassa virus?
Does calcium
supplementation have an
impact on the prevention
of pre-eclampsia?
How to improve the
implementation of
the national
postabortion care
policy in Benin?
Describe/analyse/understand the
problem
What is the viral cycle of
the Lassa virus?
What is the burden of
diarrhoeal disease in the
Beninese population?
What are the
determinants of
unsafe abortion
mortality in Benin?
Methodology for knowledge production
Which technological
approach is more cost
effective in isolating the
Lassa Virus?
How to measure the
influence of paternalism on
the quality of maternal
health care in Benin?
More appropriate
methodology for a
study on the extent
of unsafe abortion
in Benin
Pathogens - Causes of
disease
Patients Population
Types of needs of
knowledge
Large groups
of targets

30. How do you assess the burden of disease
in a population?
• At the population level
– DALY=Measure of the total burden of disease
expressed as a cumulative number of years lost due to
illness, disability and also premature death

31. State
of
health
Years of life max
100%
0%
birth 0
HLY lost due
to an
accident and
permanent
disability
Years of life
max
0
0%
100%
HLY lost due
to a sudden
death
Years of life max
0
0%
100
%
HLY lost due to
an acute illness

32. Global Burden of Disease
Global Burden of Diseases
• http://www.healthdata.org/data-
visualization/gbd-compare

33. Exercise 3?
• Using the Global Burden of Disease website,
answer the following questions:
– Malaria was the leading cause of death among
children under 5 in Benin in 2013: True or False?
– In the general population in Benin, asthma was
responsible for:
• 5% of the total number of DALYs suffered by the
Beninese population in 2013
• 0.5% of the total number of DALYs suffered by the
Beninese population in 2013
• 0.05% of the total number of DALYs suffered by the
Beninese population in 2013

36. Describe/project/conceptualise the
ideal situation
Is it possible to stop the
natural circulation of the
Lassa virus?
Should pregnant women in
Benin be given the right to
choose the position in
which they give birth?
What is the ideal
Total Fertility Rate
for Benin?
Develop the most efficient solutions
Is it efficient to invest in
the production of a vaccine
against the Lassa virus?
Do LLINs have an impact on
the burden of malaria for
children under 5 in sub-
Saharan Africa?
How to improve the
implementation of
the national
postabortion care
policy in Benin?
Describe/analyse/understand the
problem
What is the viral cycle of
the Lassa virus?
What is the burden of
diarrhoeal disease in the
Beninese population?
What are the
determinants of
unsafe abortion
mortality in Benin?
Methodology for knowledge production
Which technological
approach is more cost
effective in isolating the
Lassa Virus?
How to measure the
influence of paternalism on
the quality of maternal
health care in Benin?
More appropriate
methodology for a
study on the extent
of unsafe abortion
in Benin
Pathogens - Causes of
disease
Patients Population
Types of needs of
knowledge
Large groups
of targets

37. Clarify the literature search
question
• Population/participants
• Intervention
• Comparison
• Outcome=Result

38. Population
• Sex
• Age
• Health status
• Country or region of the world
• Type of environment
• Ethnicity
• Socio-economic level
• Etc...
• Example: Children under 5

39. Intervention
• Intervention carried out: New practice under
study
– New drug
– New dosage or mode of administration
– New treatment duration
– Etc.
• Example: LLIN

40. Comparison
• Alternative approach to which the new one
under consideration is compared
– Old approach
– Placebo
– No intervention
– Etc.
• Example: Empty

41. Outcome=Effect
Focusing on an outcome
as clear as possible
• Onset of malaria?
• Onset of severe malaria?
• Occurrence of severe malaria in its anemic
form? In its neurological form
• Etc.

42. Outcome=Effect
Focus on the clearest possible outcome
• Measured how?
– Dichotomous variable
• Relative risk
• Odd-ratio
– Continuous variable
• Average (with confidence interval)
– Etc.

43. What to look for?

44. Place of publication Examples of publications -
Explicit evidence -
Refereed journals
Lancet
http://www.thelancet.com/lancet/information-for-authors/article-types-
manuscript-requirements
• Original article
• Editorial
• Comment
• Correspondence
• Reviews
• Series
Explicit evidence not
published in peer-
reviewed journals
• Books
• Research reports
• Experts' opinions
• Seminar reports
• Blogs
• Newsletters etc...
Tacit evidence "An old man dying is a burning library".
• Therapeutic practices in religious convents
• Influence of religious conceptions on administrative management
practices in health 44

45. What to look for?
Adapted from Lomas et al (2005)

46. Where to look?

47. Where to look?
• PEDro: http://www.pedro.org.au/ (Physiotherapy)
• Cinahl: http://www.ebscohost.com/cinahl/ (Infirmary)
• Medion: http://www.mediondatabase.nl/ (Diagnostic studies & reviews)
• PsycInfo: http://www.apa.org/pubs/databases/psycinfo/index.aspx
(psychology)
• POPLINE: http://www.popline.org/ (Reproductive health)
• LILACS: http://www.bireme.br/bvs/I/ibd.htm
• Citation Indexes (e.g. ISI Web of Knowledge)

48. Using PubMed better to
search Medline

49. Where to look?
• Pubmed<National Center for Biotechnology
Information<National Library of Medicine
(Medline)
– > 6000 newspapers;
– 20 million items
– Free
– 65% randomised clinical trials
– Mainly English-speaking (91%)
• http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed

50. Search MEDLINE with Pubmed
• Objectives
– Understanding MeSH vocabulary and how to use
it
– Build a search strategy using MeSH vocabulary
and PubMed search tools
– Import the results to your computer
– Find the complete free articles

51. Search strategy
= fishing strategy
CAUTION!!!
In the immensity of the water, where you can't see the
bottom:
• Catch as many sea bodies as possible (Sensitivity)
• Catch as few unwanted objects as possible among these

52. Boolean logic
AND GOLD NOT
CAUTION!!!

53. MeSH
• MeSH =Medical Subject Headings
• Organised and structured set of key concepts found in
the biomedical literature
– Arranged hierarchically (16 key branches)
– > 25000 descriptors = key themes
– >172000 words
https://www.nlm.nih.gov/mesh/intro_record_types.html
• Searching for a key theme automatically includes all
sub-themes classified under that keyword

55. MeSH
• For each publication indexed in Medline,
Medline assigns descriptors (key theme)
• These key themes are relative:
– Subject of the publication
– Age group
– Human vs. animal study
– Male vs. female
– Type of publication

56. The MeSH Directory
• Find a medical concept you want to research
• Find its definition and other relevant information about this
concept
• Building a Pubmed search strategy
• Adjust the level of precision you wish to have for a search
• Bibliographic databases that use this MeSH vocabulary:
– Medline
– Cochrane Bookshop
– CRD database
– Etc.

57. Exercise 4?
• Discuss with your buddy
• Reformulate the research question on LLINs
and malaria with the PICO approach;
• Open the MeSH directory of Pubmed;
• Select the most appropriate key themes for
each of the 4 aspects of the PICO question
formulated;
• Duration: 15 minutes

58. Key MeSH search topics
• Population
– Child, Preschool: A child between the ages of 2 and 5.
(OR)
– Infant: A child between 1 and 23 months of age.
• Intervention
– Insecticide-Treated Bednets :
Lightweight meshwork fabric made of cotton, silk, polyester, nylon (polyamides), or other material
impregnated with insecticide, having openings too small to allow entry of mosquitoes or other insects,
thereby offering protection against insect bite and insect-borne diseases
• Comparison:
– Vacuum
• Outcome:
– Malaria, Falciparum
Malaria caused by PLASMODIUM FALCIPARUM. This is the severest form of malaria and is associated with the
highest levels of parasites in the blood. This disease is characterized by irregularly recurring febrile paroxysms
that in extreme cases occur with acute cerebral, renal, or gastrointestinal manifestations.

59. Exercise 5
• Using the "key themes" identified above, build
a bibliographic search strategy using the
Pubmed "Builder" advanced search tool
• Work 2 by 2
• Duration: 15 minutes

60. Exercise 5
Research strategy - Phase 1
Step 2 - Insert
keywords
Step 1 - Choose
the specific search
base here
Step 3-Add to history
Step 4-Repeat this for all key
PICO themes

61. Exercise 5
Research strategy - combination
Step 3- Add the intervention
Step 1 - Click in
this field
Step 2-Add the population
Step 4- Add the result
Step 5- Add to history
Step 6- Open in a new
tab to read the results

62. Exercise 5
Research strategy
Details of the search strategy
and automatic mapping by
Pubmed

63. Exercise 5
Research strategy
• (("child, preschool"[MeSH Terms] OR ("child"[All Fields]
AND "preschool"[All Fields]) OR "preschool child"[All Fields]
OR ("child"[All Fields] AND "preschool"[All Fields]) OR
"child, preschool"[All Fields]) OR ("infant"[MeSH Terms] OR
"infant"[All Fields])) AND ("insecticide-treated
bednets"[MeSH Terms] OR ("insecticide-treated"[All Fields]
AND "bednets"[All Fields]) OR "insecticide-treated
bednets"[All Fields] OR ("insecticide"[All Fields] AND
"treated"[All Fields] AND "bednets"[All Fields]) OR
"insecticide treated bednets"[All Fields]) AND ("malaria,
falciparum" [MeSH Terms] OR ("malaria" [All Fields] AND
"falciparum" [All Fields]) OR "falciparum malaria" [All
Fields] OR ("malaria" [All Fields] AND "falciparum" [All
Fields]) OR "malaria, falciparum" [All Fields])

64. Automatic term mapping
• Words that are not in the MeSH directory of key topics are
transformed:
– For topics following a table of conversion of words into key topics
– For a newspaper or magazine based on the correct name of the
newspaper
– For one author's name according to the correct author's name
• Words that don't match any key topic will be searched in the
"All Fields" section
• Several individual words are combined with the linking word
"AND
• Ex: When you enter pressure point in the search field
("pressure" [MeSH Terms] OR "pressure" [All Fields]) AND point [All Fields])

65. Exercise 5
Search strategy - Finding the details
Details of the search strategy
and automatic mapping by
Pubmed

66. Exercise 5
Search strategy - Filtering
Using different types of filters

67. Exercise 5
Search strategy - Filtering
Select references with free full
articles

68. Exercise 5
Results filter free full articles

69. Get the free items

70. Exercise 5
Adding new filters - e.g. language

71. Exercise 5
Result French filter - 1/72 and it's not free

72. Caution!
• When you put keywords in "" or square
brackets, there is no automatic mapping
• Search with key topics - "MeSH excludes
publications that are not (yet) indexed in the
"MeSH" directories

73. Search for sentences
• PubMed searches for phrases in the following
conditions:
– The phrase corresponds to a MeSH theme, a journal name,
an author or is found in the researchers' directory or is
indexed in the automatic term mapping process.
– The phrase is entered with a specific search marker: kidney
allograft [tw] or kidney transplant
– The sentence is put in inverted commas "kidney allograft".
– There is a hyphen between the words: first-line
– The term is cut off: kidney allograft*.

74. Manage the display of results with -
Display settings
• Display options Sort by

76. How to select publications?
Studies included
Sorting by TITLE
Sorting by RESUMES
Sorting after reading the FULL
TEXTS
Query results
Depart
ure
Sorting
process

77. References identified after
database search
(n = )
Sorting
Inclusion
Eligibility
Identification
Other references identified by
other sources
(n = )
References retained after deletion
of duplicates (n = )
Sort by title and
abstract
(n = )
Excluded references
(n = )
Sorting after reading
the full texts (n = ) Full texts excluded -
Specify reasons
(n = )
Studies included in
the qualitative
synthesis
(n = )
Studies included in the
quantitative synthesis
(n = )
PRISMA

78. Exercise 6
• Starting with the list of the first 20 references
found, sort according to the titles of the
references
• Briefly justify why you have eliminated each
item
• Work 2 by 2
• Duration: 10 minutes

79. Exercise 7
• Read the summaries of Articles 21 or 22
• Should they be included in our review?
• Briefly justify why you have eliminated each
item
• Work 2 by 2
• Duration: 10 minutes

80. Send the results to my computer
• Send to
Maximum 500 references

81. Other important databases
• Base (Europe)
http://www.info.embase.com/
• Cochrane library: Directory of systematic
reviews by Cochrane
http://www.thecochranelibrary.com/view/0/ind
ex.html
• DRB baselines
http://www.crd.york.ac.uk/crdweb/

82. Other bases
• PEDro: http://www.pedro.org.au/ (Physiotherapy)
• Cinahl: http://www.ebscohost.com/cinahl/ (Infirmary)
• Medion: http://www.mediondatabase.nl/ (Diagnostic studies
& reviews)
• PsycInfo:
http://www.apa.org/pubs/databases/psycinfo/index.aspx
(psychology)
• POPLINE: http://www.popline.org/ (Reproductive health)
• LILACS: http://www.bireme.br/bvs/I/ibd.htm
• SUMSearch: http://sumsearch.uthscsa.edu/
• TRIP Database: http://www.tripdatabase.com/
• Citation Indexes (e.g. ISI Web of Knowledge)

83. Other sources Public Health
• Public Health Interventions Cost Effectiveness Database
(PHICED): http://www.yhpho.org.uk/nphl/nphlresults.asp
• Database of Promoting Health Effectiveness Reviews
(DoPHER):
http://eppi.ioe.ac.uk/webdatabases/Intro.aspx?ID=2
• Canadian Institutes of Health Research (CIHR): http://health-
evidence.ca/articles/search
• Public Health + (National Collaborating Centre for Methods
and Tools, NCCMT):
http://www.nccmt.ca/tools/public_health_plus-eng.html

84. Registers of ongoing studies
• Clinical trial registries:
– www.clinicaltrials.gov
– www.controlled-trial.com
– http://apps.who.int/trialsearch/
– www.trialscentral.org
– http://eudract.emea.europa.eu
• Systematic reviews:
– Prospero:

85. Assessing the quality of the
publication. Why do you want to do
this?
• It is not necessarily of good quality because:
– It is published in a major journal: The Lancet, Nature, etc..
– This is a study by a great professor who has written many
books
– This is a study done in Europe or America, etc.
– It's a study that everyone quotes...
– This is a study that looked at 50 million cases etc.
• Quality = Rigour in the methodological approach and
assessment of the validity of the results and/or
conclusions of the study
• Differences in the quality of the study may explain the
differences in the results of two similar studies
• Guides the interpretation of results and gives weight to
conclusions and recommendations

86. Type of bias Description
Selection bias Systematic differences between the baseline
characteristics of the groups being compared
Performance Bias Systematic differences in the quality of
interventions carried out in the study groups
Detection bias Systematic differences in the way the dependent
variable (the outcome) is measured
Attribution bias Systematic differences in the number of
losses/withdrawals in each group
Documentation bias Systematic differences in documented and
undocumented information
Some quality elements of RCTs
86
Source: Cochrane handbook: http://handbook.cochrane.org/

87. • AMSTAR checklist (Assessing the
Methodological Quality of Sytematic Reviews)
http://amstar.ca/Amstar_Checklist.php
Quality of systematic reviews
87

88. • Observational studies: SIGN checklist
http://www.sign.ac.uk/methodology/checklists.html
• Qualitative research: NICE checklist
http://publications.nice.org.uk/methods-for-the-
development-of-nice-public-health-guidance-
third-edition-pmg4/appendix-h-quality-appraisal-
checklist-qualitative-studies
• Cost-effectiveness studies: SIGN or NICE checklists
Quality of the...
88

89. Keeping up to date

90. Feedly - Backing up websites and
blogs to stay up to date

91. 91
Communities of Practice

92. Slideshare - Professional Power-
Points