Scope, quality and reporting of clinical practice guidelines for newborn and child health in South Africa, Nigeria, and Malawi.
2Kamuzu University of Health Sciences, Malawi
3Cochrane Nigeria, University of Calabar, Nigeria
4Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
5Kamuzu University of Health Sciences, Malawi
6Western Norway University of Applied Sciences, Norway
7Norwegian University of Science and Technology, Norway
8MAGIC Evidence Ecosystem Foundation, Norway
9Cochrane South Africa & Health Systems Research Unit, South African Medical Research Council, South Africa
Low- and middle-income countries are disproportionately affected by high rates of under-5-year-old mortality, often caused by preventable conditions. High-quality, evidence-based clinical practice guidelines (CPGs) may play a key role in improving clinical management and quality of care and, thus, in reducing child mortality. However, limited availability or poor accessibility, inadequate reporting and low-quality methodologies of available CPGs may undermine their utility and expected impact in improving quality of care and outcomes.
Objectives: To conduct a scoping review to identify CPGs for newborn and child health published in South Africa, Nigeria, and Malawi and to assess their quality.
Methods: We searched key websites (June-July 2022) for published national and subnational de novo or adapted CPGs addressing newborn and child health in the three countries. Pairs of reviewers screened for eligibility, extracted information from included CPGs (scope, condition or topic, target population and end users, developers, methods), and appraised their quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. Data were analysed descriptively in Microsoft Excel and STATA-17.
Results: We included 40 CPGs. Most provided guidance on communicable diseases (19/40), whilst eight on non-communicable diseases. The majority of CPGs did not report on methods for assessing the certainty of evidence (7/40), of which one CPG reported using GRADE. Overall, CPGs scored well on clarity of presentation (median 81%, IQR 67-94), and scored poorly on AGREE II domains rigour of development (median 11%, IQR 4-32) and editorial independence (median 6%, IQR 0-27). Similar trends in AGREE II domain scores were observed across all countries.
Conclusions: We highlight gaps in methodological and reporting quality of CPGs for newborn and child health across the three countries, which may impact our credibility of recommendations. Gaps in guidance were identified as the topics of CPGs often did not align with country-specific disease burdens. CPGs specifically addressing malnutrition, neonatal disorders, and trauma related-mental health disorders need to be considered. We further highlight a lack of regional and national CPG repositories which may impact on access to and use of CPGs. Patient, public, and/or healthcare consumer involvement: No direct patient involvement in the conduct of our research.