Abstract
BackgroundReducing the burden of disease relies on availability of evidence-based clinical practice guidelines (CPGs). There is limited data on availability, quality and content of guidelines within the Southern African Development Community (SADC). This evaluation aims to address this gap in knowledge and provide recommendations for regional guideline development.MethodsWe prioritised five diseases: HIV in adults, malaria in children and adults, pre-eclampsia, diarrhoea in children and hypertension in primary care. A comprehensive electronic search to locate guidelines was conducted between June and October 2010 and augmented with email contact with SADC Ministries of Health. Independent reviewers used the AGREE II tool to score six quality domains reporting the guideline development process. Alignment of the evidence-base of the guidelines was evaluated by comparing their content with key recommendations from accepted reference guidelines, identified with a content expert, and percentage scores were calculated.FindingsWe identified 30 guidelines from 13 countries, publication dates ranging from 2003-2010. Overall the 'scope and purpose' and 'clarity and presentation' domains of the AGREE II instrument scored highest, median 58%(range 19-92) and 83%(range 17-100) respectively. 'Stakeholder involvement' followed with median 39%(range 6-75). 'Applicability', 'rigour of development' and 'editorial independence' scored poorly, all below 25%. Alignment with evidence was variable across member states, the lowest scores occurring in older guidelines or where the guideline being evaluated was part of broader primary healthcare CPG rather than a disease-specific guideline.ConclusionThis review identified quality gaps and variable alignment with best evidence in available guidelines within SADC for five priority diseases. Future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders and transparency of process. A regional guideline support committee could harness local capacity to support context appropriate guideline development.
Highlights
Clinical practice guidelines bridge the gap between policy and practice and should be based on up-to-date, high quality research findings [1,2]
This review identified quality gaps and variable alignment with best evidence in available guidelines within Southern African Development Community (SADC) for five priority diseases
Future guideline development processes within SADC should better adhere to global reporting norms requiring broader consultation of stakeholders and transparency of process
Summary
Clinical practice guidelines bridge the gap between policy and practice and should be based on up-to-date, high quality research findings [1,2]. Reducing the burden of disease in resource-poor settings relies on the availability of such evidence-based clinical practice guidelines [3] Gaps in these guidelines may impact on the health of the public they are meant to serve. There is little data regarding the quality and content of guidelines in Southern Africa, a region facing serious health issues including poorly contained communicable diseases, increasing non-communicable diseases and under-resourced, often poorly managed health systems. This demands increasing attention from both development agencies and researchers to support research aimed at strengthening guidelines and policy [9].
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