Methodological quality assessment of guidelines for surveillance and clinical management of dengue and chikungunya

Abstract: The study aimed to assess the methodological quality of guidelines by the Brazilian Ministry of Health, Pan American Health Organization (PAHO), and World Health Organization (WHO) on surveillance and clinical management of dengue and chikungunya. This was a descriptive study in which the tool Appraisal of Guidelines for Research & Evaluation Reporting Checklist II (AGREE II) was applied by four evaluators in independent and masked fashion for six guidelines. Each evaluator assigned a score from 1 (disagree completely) to 7 (agree completely) to the 23 items in the AGREE II domains: scope and purpose; stakeholder involvement; rigor in the development; clarity of presentation; applicability; and editorial independence. The dengue guidelines by PAHO (mean = 5.2, SD = 0.8) and WHO (mean = 4.5, SD = 0.5) obtained the highest overall scores and were recommended with modifications by all the evaluators, while the Brazilian Ministry of Health guidelines (mean = 2.7, SD = 0.4) were not recommended by any of them. Meanwhile, the chikungunya guidelines scored low (means from 2.2 to 3.0) for all three agencies. The domains with the greatest conformity were “clarity of presentation” (median 84.7%) and “scope and purpose” (77.1%), while those with the lowest conformity were “editorial independence” (5.2%) and “rigor in development” (9.1%). The study identified gaps in the guidelines’ methodological quality, mainly in transparency of the work processes, selection of scientific evidence, and formulation of recommendations, besides lack of clarity in financing and possible conflicts of interest.

摘要：本研究旨在评估巴西卫生部、泛美卫生组织（Pan American Health Organization, PAHO）与世界卫生组织（World Health Organization, WHO）发布的登革热及基孔肯雅热监测与临床管理指南的方法学质量。本研究为描述性研究，由4名评价者采用独立盲法，应用《指南研究与评价报告清单II》（Appraisal of Guidelines for Research & Evaluation Reporting Checklist II, AGREE II）对6份指南开展评价。每名评价者需针对AGREE II六大领域下的23个条目进行评分，评分区间为1分（完全不同意）至7分（完全同意），六大领域分别为："范围与目的"、"利益相关方参与"、"制定严谨性"、"呈现清晰度"、"适用性"及"编撰独立性"。

泛美卫生组织登革热指南（平均得分5.2，标准差（standard deviation, SD）0.8）与世界卫生组织登革热指南（平均得分4.5，SD 0.5）整体得分最高，所有评价者均建议经修改后采用该两份指南；而巴西卫生部发布的登革热指南（平均得分2.7，SD 0.4）未获得任何一名评价者的推荐。与此同时，三家机构发布的基孔肯雅热指南得分均较低（平均分区间为2.2至3.0）。

各领域中一致性最高的为"呈现清晰度"（中位数84.7%）与"范围与目的"（77.1%），一致性最低的领域则为"编撰独立性"（5.2%）与"制定严谨性"（9.1%）。本研究发现现有指南在方法学质量上存在多处短板，主要集中在工作流程透明度、科学证据遴选及推荐意见制定环节，此外还存在经费说明模糊、潜在利益冲突未明确等问题。