Identifying guideline needs for newborn and child health in South Africa, Malawi and Nigeria: a priority-setting exercise
2Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Nigeria
3Kamuzu University of Health Sciences, Malawi
4Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
5Health Systems Research Unit, South African Medical Research Council, South Africa
Sub-Saharan Africa (SSA) has the highest under-five mortality rate globally. Evidence-informed guidelines are key in supporting healthcare decision-making. The GELA (Global Evidence, Local Adaptation) project aims to enhance the capacity to use global research to develop locally relevant guidelines for newborn and child health in three SSA countries, either de novo or through adaptation of existing guidelines. To achieve this, we first carried out a priority-setting exercise.
Objectives: To identify priority newborn and child health topics in South Africa (SA), Malawi, and Nigeria that require guidelines.
Methods: We followed good practice for priority-setting, including stakeholder engagement, online surveys, and consensus meetings. We established national Steering Groups (SGs) to help prioritise topics and advise on the process. Members represented government, health professionals, academia, and NGOs; all declared their interests. A variety of stakeholders were engaged via online surveys to rate the importance of topics. Survey results informed national consensus meetings with SGs, in which final priorities were identified. Non-participant observations of SG consensus meetings were conducted to gain insights into processes, dynamics, and contexts.
Results: Initial priority topics were identified and added to online surveys, which were open for 3-4 weeks in 2022. Surveys were completed by 37, 23, and 78 people in SA, Malawi, and Nigeria, respectively; similar proportions of participants completed all sections (SA 66%, Malawi 61%, Nigeria 68%). The surveys identified 9, 10, and 8 topics in SA, Malawi, and Nigeria, respectively; these informed several SG consensus meetings. Through voting or discussion at these meetings and scoping guidelines, the top three priorities, per country, were identified. SG meeting observations revealed similar and different capacity gaps (e.g., guideline development process), stakeholder dynamics (e.g., certain dominant voices), and procedural challenges (e.g., voting resistance). These may have impacted the priority setting process and outcomes.
Conclusions: Dynamic and iterative stakeholder engagement enabled identification of priority topics for guideline development on newborn and child health. Contextualised priority-setting, though highly recursive and time-intensive, is essential, as shown by the limited overlap in topics prioritised. Patient and stakeholder involvement: Civil society organisations were invited to contribute to the priority setting survey.