Newborn and child health national and provincial clinical practice guidelines in South Africa, Nigeria and Malawi: a scoping review

Low and middle-income countries remain disproportionately affected by high rates of child mortality. Clinical practice guidelines are essential clinical tools supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based guidelines play a key role in improving clinical management to impact child mortality. We aimed to identify and assess the quality of guidelines for newborn and child health published in South Africa, Nigeria and Malawi in the last 5 years (2017-2022).We searched relevant websites (June-July 2022), for publicly available national and subnational de novo or adapted guidelines, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible guidelines (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised guideline quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument.We identified 40-guidelines from the three countries. Of these, 8/40 reported being adopted from a parent guideline. More guidelines (n = 19) provided guidance on communicable diseases than on non-communicable diseases (n = 8). Guidelines were most often developed by national health ministries (n = 30) and professional societies (n = 14). Eighteen guidelines reported on stakeholder consultation; with Nigeria (10/11) and Malawi (3/6) faring better than South Africa (5/23) in reporting this activity. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used in 1/7 guidelines that reported assessing certainty of evidence. Overall guidelines scored well on two AGREE II domains: scope and purpose median (IQR) score 68% (IQR 47-83), and clarity of presentation 81% (67-94). Domains critical for ensuring credible guidance scored below 20%: rigour of development 11% (4-32) and editorial independence 6% (0-27).National ministries and professional societies drive guideline activities in Malawi, Nigeria and South Arica. However, the methods and reporting do not adhere to global standards. We found low AGREE II scores for rigour of guideline development and editorial independence and limited use of GRADE or adaptation methods. This undermines the credibility of available guidelines to support evidence-informed care. Our findings highlight the importance of ongoing efforts to strengthen partnerships, capacity, and support for guideline development.

低收入及中等收入国家儿童死亡率居高不下，对此问题影响尤为严重。临床实践指南作为支持有效、安全且经济的医疗保健实施的必要临床工具，发挥着至关重要的作用。高质量的证据基础指南在改善临床管理、降低儿童死亡率方面扮演着关键角色。本研究旨在识别和评估南非、尼日利亚和马拉维在过去五年（2017-2022年）发表的新生儿及儿童健康指南的质量。我们于2022年6月至7月期间在相关网站上进行了搜索，以获取这三个国家公开可用的国家和次国家级原创或改编的指南，内容涉及新生儿及儿童健康。由成对审阅人员独立从符合条件指南中提取信息（范围、主题、目标人群和用户、负责开发者、利益相关者咨询过程、改编描述、证据确定性评估）。我们使用《指南研究及评估的评估》（AGREE II）工具对指南质量进行了评估。我们从这三个国家共确定了40份指南。其中，8/40份报告称其源自母版指南。提供传染病指导的指南（n = 19）数量多于提供非传染性疾病指导的指南（n = 8）。指南最常由国家卫生部门（n = 30）和专业协会（n = 14）编制。18份指南报告了利益相关者咨询情况；在报告此项活动中，尼日利亚（10/11）和马拉维（3/6）的表现优于南非（5/23）。在报告评估证据确定性的7份指南中，有1份采用了《推荐、评估、开发与评价分级》（GRADE）方法。总体而言，指南在AGREE II的两个关键领域得分较高：范围与目的的中位数（四分位数间距）得分分别为68%（IQR 47-83），以及呈现的清晰度得分为81%（67-94）。确保可信指导的关键领域得分均低于20%：发展严谨性得分为11%（4-32），编辑独立性得分为6%（0-27）。马拉维、尼日利亚和南非的国家部门和专业协会推动了指南活动。然而，方法和报告并不符合全球标准。我们发现，在指南发展的严谨性和编辑独立性方面AGREE II得分较低，以及GRADE或改编方法的使用有限。这削弱了现有指南支持循证护理的可信度。我们的研究结果突显了持续加强合作伙伴关系、能力建设和指南发展的支持的重要性。