Evidence-based medicine in low-income and middle-income countries

Evidence-based medicine is the backbone of modern medicine. Any newly proposed therapy needs to be tested in high-quality randomised controlled trials (RCTs) before being considered for approval. Nepal a low-income country south Asia. Researchers have been contributing global health by doing RCTs high-altitude and infectious diseases like typhoid. Infectious such as tuberculosis, typhus, leptospirosis, non-infectious hypertension, diabetes, atherosclerotic diseases, cancers, liver kidney autoimmune are also present Nepal. However, so far, no studies done patients with these country. Thus, clinicians manage per international guidelines that based on from other populations—usually high-income countries—but modifications their experiences expertise, rather findings local RCTs. Most drugs weight-based dosing. The average weight adults middle-income countries lower than countries.1Walpole SC Prieto-Merino D Edwards P Cleland J Stevens G Roberts I nations: an estimation adult human biomass.BMC Public Health. 2012; 12: 1-6Crossref PubMed Scopus (410) Google Scholar Doctors hypothesise this difference might why often do not tolerate guideline-recommended doses many drugs. As result, doctors tend prescribe recommended. For example, cirrhosis ascites, furosemide commenced at 40 mg spironolactone 100 mg, maximum limits 160 400 spironolactone.2Runyon BA Introduction revised American Association Study Liver Diseases practice guideline management ascites due 2012.Hepatology. 2013; 57: 1651-1653Crossref (453) Nepalese can develop electrolyte disturbances doses; thus, started 20 50 mg. In my experience, tolerated up usual recommended dose intravenous pulse methylprednisolone most disease flares 500–1000 once day.3Sinha A Bagga Pulse steroid therapy.Indian Pediatr. 2008; 75: 1057-1066Crossref (67) countries, sceptical prescribing drug because, addition low body weight, fear hidden infection tuberculosis remains. Hence, range 250–500 preferred. Patients atrial fibrillation need oral anticoagulants prevent stroke. International guidelines4January CT Wann LS Calkins H et al.2019 AHA/ACC/HRS focused update 2014 fibrillation: report College Cardiology/American Heart Task Force clinical Rhythm Society.J Am Coll Cardiol. 2019; 74: 104-132Crossref (669) now recommend direct over warfarin because risk life-threatening bleeding coagulation profile does monitored. expensive contrast, warfarin, which cheaper anticoagulants, introduces substantial living mountainous remote places, regular monitoring almost impossible. Without monitoring, end hospital bleeding. With mind, undergoing receive antiplatelet agent aspirin alone. Asian population known higher cardiovascular even body-mass index populations countries. Hence cutoff overweight obesity has modified population. About 150 min brisk walking week diseases,5Volgman AS Palaniappan Aggarwal NT al.Atherosclerotic Asians United States: epidemiology, factors, treatments: scientific statement Association.Circulation. 2018; 138: e1-e34Crossref (124) but Nepal, who live regions, normal weekly activity far exceeds recommendation. This disconnect indicates further regarding evaluation Such could provide more specific lifestyle recommendations patients. High patient burden doctor, poor technological advancement, data recording, insufficiency funding or grants, absence research-friendly government institutional policies all factors contributed research culture Additionally, researchers able afford required article processing charges publish Open Access, high impact factor journals, unaware option request fee waiver. experts get little recognition, invited professional communities during preparation guidelines, means experience expertise usually represented guidelines. Funders should focus activities involving researchers. Promoting positive first step improve people truly benefit evidence-based services. declare competing interests.