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

Abstract

Background Low and middle-income countries remain disproportionately affected by high rates of childhood mortality, often caused by preventable conditions. Clinical practice guidelines (CPGs) are essential policy tools in supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based CPGs play a key role in improving clinical management aiming to impact child mortality. We aimed to identify and assess the quality of CPGs for newborn and child health published in South Africa, Nigeria and Malawi.Methods We searched relevant websites (June–July 2022), for publicly available national and subnational de novo or adapted CPGs, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible CPGs (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised CPG quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument.Results We identified 40 CPGs from the three countries. Of these, 8/40 reported being adopted from a parent CPG. More CPGs (n = 19) provided guidance on communicable diseases than on non-communicable diseases (n = 8). CPGs were most often developed by national health ministries and professional societies. Eighteen CPGs reported on stakeholder consultation; with Nigeria (10/11) and Malawi (3/6) faring better than South Africa (5/23) in reporting this activity. GRADE was used in 1/7 CPGs that reported assessing certainty of evidence. Overall CPGs 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).Conclusion Topics covered by the identified CPGs did not always match country level burden of disease likely representing substantial gaps in available guidance for healthcare providers, parents, caregivers, and patients. Our study found low AGREE II scores for CPG development processes, possibly undermining the credibility of the available CPGs to provide evidence-informed care. Our findings highlight the importance of ongoing efforts to strengthen capacity and support CPG development with collaboration between policymakers, researchers and the public.