The Cochrane Collaboration is a leader in the preparation of high-quality systematic reviews, but they are prepared and available mainly in the English language. This alone greatly undermines the potential of Cochrane Reviews as building blocks for decision-making in many low- and middle-income countries, including those in Africa, where evidence about the benefits and harms of healthcare interventions is needed urgently.
There are two main reasons why more efforts should be steered towards translating Cochrane Reviews into the French language. Firstly, if Cochrane Reviews aim to alleviate disease burden, their efforts should be directed at the region with the highest burden – Africa. Secondly, Africa has the highest number of French speakers, with approximately 115 million people spread across 31 countries. Also, although there are many French public health publications available, they seem to respond to the health needs of France and not the developing French-speaking countries.
This disparity in knowledge availability, use, and generation is particularly evident in countries where both English and French are spoken. In Cameroon, where French and English are the official languages, English speakers make up only a fifth of the Cameroonian population, and it is likely that the English-speaking researchers are more likely to read, use, and prepare Cochrane Reviews numbers. Those who would like to benefit from accessing the content in The Cochrane Library, such as researchers, policy-makers, and clinicians, are obliged to upgrade their English. This situation does not fit well with approaches to evidence dissemination initiatives that prefer the "push and pull" approach, in which evidence is pushed forward in response to the "pull" from end users. How can we access the pull from end users who don't speak English? This might be challenging, but there is evidence to suggest that translating reviews into native languages increases the number of people using them; for example, in 2005 there were 1,635,211 Cochrane Review abstracts accessed in La Biblioteca Cochrane Plus, the Spanish language version of The Cochrane Library, while 2,181,701 were accessed in The Cochrane Library. Also, combining the translation of key article information (e.g. titles) into specific languages with the development of search interfaces that allow someone to search for content in one of the languages, as used in Health Systems Evidence, can facilitate the "pull" of information.
In Cameroon, the Centre for the Development of Best Practices in Health (CDBPH), Yaoundé, initiated a dialogue with key staff from the Ministry of Health to identify priority areas in which evidence for decision-making was lacking and where policy briefs were needed. The CDBPH, in collaboration with the Effective Health Care Research Consortium (EHCRC), initiated a door-to-door priority-setting activity with researchers, policy-makers, clinicians, and other stakeholders in Cameroon to identify a short list of eight topics (child health, maternal health, primary health care, and organisation of health care, health financing, health regulation, health promotion, and evidence assessment). The next step was to match the topics with Cochrane systematic reviews that provided the most up-to-date evidence, and provide them in their most concise (abstracts) and understandable (plain language summary) form. Each of the abstracts and plain language summaries required translation into French, and this time-consuming process is undertaken by CDBPH staff with assistance from a special systematic review translation dictionary prepared by the French Cochrane Centre. The CDPBH became aware of the demand for these translations when, at first, they were only available as paper versions directly from the CDBPH office, and many people were making a special trip to collect a copy. With permission, the translations were then posted on the CDBPH website, and since this time these translated summaries have become the most popular content available on the website. This work is ongoing and French translations for the CDBPH and others are now being conducted in collaboration with the French Cochrane Centre.
For native French speakers in Cameroon who are interested in high-quality evidence, the future seems bright, but what about translations into other languages? There are a range of translation initiatives taking place around the world and across The Cochrane Collaboration, and the aim is to provide Cochrane Review content in at least all the six designated World Health Organization languages. The Collaboration is committed to increasing the accessibility of Cochrane Reviews to non-English language speakers and, as stated in its recent strategic session report, is "developing a translation strategy for Cochrane Reviews that focuses on translating key sections of Cochrane Reviews, signposting the translated content, exploring the capacity of web-based translation services, and developing search interfaces for other languages". The output of the enormous translation efforts are starting to become visible in The Cochrane Library, with translations of abstracts and plain language summaries of some Cochrane Reviews already available in traditional Chinese and French (including those prepared by the CDBPH). Over the coming months, content in simplified Chinese, Japanese, and Spanish will also be available. These translation activities will be complemented by changes in The Cochrane Library website to make it easier for readers to locate and search the translated content.
The importance of translations into French is clear in Cameroon, and the demand for translated Cochrane Reviews will be repeated for many other languages.
The Cochrane Collaboration's commitment to including translated Cochrane Review content in The Cochrane Library is positive, but reaching this goal will take time and will hold challenges along the way. In the meantime, in Cameroon, the CBDPH will continue to prepare policy-briefs based on translations of Cochrane Reviews and provide the opportunity for the results of high-quality systematic reviews to be considered by healthcare decision-makers.
1Lawrence Mbuagbaw & 2Harriet MacLehose
1Lawrence Mbuagbaw (email@example.com), Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Avenue Henri Dunant, Messa, PO Box 87, Yaoundé, Cameroon; and Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Canada; 2Harriet MacLehose (firstname.lastname@example.org), Senior Editor, The Cochrane Library, Cochrane Editorial Unit, 13 Cavendish Square, London, W1G 0AN, UK
We would like to acknowledge Professor Paul Garner who proposed this editorial and supported its development.
How to cite: Mbuagbaw L, MacLehose H. Why should we translate Cochrane Reviews into French? A view from Cameroon [editorial]. Cochrane Database Syst Rev. 2012 June13;7:ED000043. http://www.thecochranelibrary.com/details/editorial/2069959/Why-should-we-translate-Cochrane-Reviews-into-French-A-view-from-Cameroon.html
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The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request) and declare (1) no receipt of payment or support in kind for any aspect of the article; (2) that LM is part of the translations team described in this paper, which is funded by the EHCRC, and that HM is employed by The Cochrane Collaboration as Senior Editor for The Cochrane Library, and between 2001 and 2009 she was employed by the EHCRC in an editorial role with the Cochrane Infectious Diseases Group, but otherwise they have no financial relationships with any entities that have an interest related to the submitted work; (3) that the authors/spouses/children have no financial relationships with entities that have an interest in the content of the article; and (4) that there are no other relationships or activities that could be perceived as having influenced, or giving the appearance of potentially influencing, what was written in the submitted work.
Image credit: CrazyPhunk (source: http://commons.wikimedia.org/wiki/File:Francophone_Africa.svg)
Image caption: Map highlighting Francophone Africa (17 May 2007)
Dark blue: Countries normally considered Francophone
Aqua blue: Countries sometimes considered Francophone
Green: Non-Francophone countries that have joined the Organisation internationale de la Francophonie in a process to adopt French
Contact the Editor in Chief, Dr David Tovey (email@example.com): Feedback on this editorial and proposals for future editorials are welcome.