Putting evidence into practice in low-resource settings.

There is growing recognition of the need to maximize efforts to bring evidence into practice in low-resource settings, following realization that the gap between evidence and practice in developing countries results in ineffective treatments that drain their health systems (1). In health systems with few resources, putting evidence into practice is proving exceedingly challenging for reasons that are only partially understood. Some of these challenges are highlighted by two papers in this issue of the Bulletin. From Mali (935–941), Mahé et al. propose that simply translating evidence into user-friendly clinical management algorithms, together with a one-off training session, can bring about substantial improvement in the diagnosis and management of common dermatological conditions. They argue that improvements can be sustained over a prolonged period, even if resources are lacking to provide refresher training. Noticeably, rapid staff turnover in Mali meant that nearly half the health-care workers initially trained were replaced by new members of staff, underlining the need for some form of induction or continuing education. The second paper, by Tita et al. from Cameroon (895–903), demonstrates that only a small proportion of health-care workers is abreast of current evidence on maternal and child health care. Moreover, only a few of those who are aware of the evidence apply it to their clinical practice. The authors identify a number of reasons, including limited access to educational resources, poor formal training and lack of continuing medical education. They suggest these barriers can be overcome using traditional approaches such as seminars, refresher courses, ward rounds and lectures. Both papers identify the need for a comprehensive approach, consisting