Turner et al. BMC Public Health 2010, 10:170 http://www.biomedcentral.com/1471-2458/10/170 these were relevant to the section ‘Health and Nutrition’ which constitutes only approximately 20 percent of the content of the handbook. Very few Cochrane reviews were relevant to the rest of the content. There were no studies from developing settings in seven of the poten- tially relevant Cochrane reviews, and in another two reviews the setting of the included studies was unclear. The WHO “Manual for the health care of children in humanitarian emergencies”[9] aims to provide guidance on the care of children in the acute and chronic phases of an emergency, where there are no inpatient hospital facilities. The content included diarrhoea and dehydra- tion, cough or difficulty breathing, fever, malnutrition, anaemia, injuries, burns, poisoning, immunization and other public health measures, prevention of HIV Infec- tion in children, and mental health and psychosocial support. There were 56 Cochrane reviews and eight pro- tocols relevant to the content of this guideline, addres- sing much of the guideline content. However few reviews or protocols were found for topics on injury management, malnutrition, burns, or emergency assess- ment and triage. Research from developing settings was included in all but seven of the potentially relevant Cochrane reviews. Of the total of 198 Cochrane systematic reviews that were identified as being potentially relevant to the con- tent of the included guidelines, 18 (9.1%) have summa- ries in Evidence Aid. Links to the full text of the reviews are provided for a further twelve (6.1%). Discussion Echoing what has been found previously [1], we were unable to identify any explicitly evidence-based guide- lines to support decision-making around perinatal and child health care in crisis settings. The limited resources available and the enormous proportion of the burden of illness and death resulting from disasters borne by this portion of the population, mean that ensuring care delivery is evidence-based is vitally important for this setting. It is possible to imagine a world where guidelines in all areas of clinical practice would provide recommenda- tions based on systematic reviews of the best available evidence, integrated with clinical expertise and patient preferences. Cochrane reviews would be available to answer every clinical question, and after searching the Cochrane Database of Systematic Reviews, guidelines would be written, and we could be confident that the recommended care was based on a solid foundation of research evidence. However this ideal is unlikely to ever be achieved. Existing evidence-based guideline develop- ment methods are time-consuming and resource-inten- sive and often produce guidelines which are only applicable in a narrow range of contexts. Guideline Page 5 of 12 developers do not always search for the best available research evidence, or do not document the methods used so that the evidence base on which the guidelines are developed cannot be established. Cochrane systema- tic reviews are not available to cover every possible clin- ical question, and many do not address issues of applicability and generalisability. In many areas primary research is not available, or is not directly relevant to the guideline being developed. These problems are exa- cerbated by the fact that it is very difficult to carry out primary research in crisis settings, and that most health research is carried out in well resourced settings, to address the health concerns of well resourced popula- tions. As a result there is less primary research available relevant to crisis settings and potentially fewer relevant systematic reviews. In spite of the barriers to the production of systematic reviews relevant to crisis settings, our results demon- strate that there are Cochrane reviews available which have the potential to support health care decision-mak- ing in perinatal and child health in crisis settings. A large number of potentially relevant reviews were identi- fied. The great majority of the identified reviews include some studies that were undertaken in resource-poor set- tings, however very few, if any, were conducted in crisis settings. The contribution Cochrane reviews can make in the crisis setting is further limited in a number of important ways. The Cochrane Database of Systematic Reviews includes few reviews on health system issues, focusing more on reviews of clinical interventions. While we only included guidelines that addressed at least one area of clinical practice, several of the included guidelines had substantial sections addressing establishing, prioritising or evaluating healthcare programs, and there is a clear need for evidence to support decision-making in these areas. The Cochrane Collaboration’s contribution to synthesising research about health care delivery systems is currently limited, though may increase through the work of the Effective Practice and Organisation of Care group within the Collaboration. The critical need for this kind of evidence was also identified in our inter- views with potential users of Evidence Aid as part of the broader Evidence Aid evaluation. The large number of protocols for systematic reviews that are potentially relevant to the included guidelines suggests that the Cochrane Collaboration’s contribu- tion to the evidence-base of guidelines for perinatal and child health in crisis settings is likely to grow into the future. However the majority of these protocols address areas similar to those addressed in existing reviews, and the reviews arising from these protocols will not address the gap in evidence relating to health care delivery systems. This gap might be addressed by