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Randomised trials in developing countries
  1. James A Berkley
  1. Correspondence to Dr James A Berkley, KEMRI/Wellcome Trust Research Programme, PO Box 230, Kilifi 80108, Kenya; Centre for Clinical Vaccinology & Tropical Medicine, University of Oxford, Old Road, Headington, Oxford OX3 7LJ, UK; jberkley{at}kemri-wellcome.org

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Professor Trevor Duke and colleagues at the Centre for International Child Health, University of Melbourne, have made a remarkable contribution to international child health. Over the past 11 years, they have undertaken annual structured searches for published reports of controlled trials of interventions addressing child health in developing countries, and assembled summaries in a compendium that is easily accessible to clinicians, policymakers and research funders. They present an analysis of the controlled trials that have been included in these annual compendia.1

The results are encouraging: there has been a sevenfold increase in the number of trials published each year, providing a significant expansion in the evidence base for many common conditions, most notably the prevention and treatment of malaria. New knowledge of effective interventions from these trials has been generated alongside political will arising from the Roll Back Malaria initiative. Over the last 11 years, many endemic regions have experienced a decline in disease due to falciparum malaria.

The greatest number of published trials were on nutrition. Perhaps this is unsurprising given that recent estimates suggest that undernutrition causes 45% of childhood mortality, principally by increasing the likelihood of common life-threatening infectious diseases. Nearly three-quarters of nutritional intervention trials were of micronutrients. However, in the 2013 Lancet series on maternal and child nutrition, of the five nutrition-related interventions …

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