South African Cochrane Centre, South African Medical Research Council, Cape Town, Western Cape, South Africa.
Health Res Policy Syst. 2012 Jan 5;10:1. doi: 10.1186/1478-4505-10-1.
Reducing 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.
We 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.
We 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.
This 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.
减少疾病负担依赖于提供基于证据的临床实践指南（CPGs）。在南部非洲发展共同体（SADC）中，关于指南的可用性、质量和内容的数据有限。这项评估旨在填补这一知识空白，并为区域指南制定提供建议。
我们优先考虑了五种疾病：成人 HIV、儿童和成人疟疾、子痫前期、儿童腹泻和初级保健中的高血压。我们在 2010 年 6 月至 10 月期间进行了全面的电子搜索以查找指南，并通过电子邮件联系了 SADC 卫生部以补充搜索。独立审查员使用 AGREE II 工具对六个质量领域进行评分，报告指南制定过程。通过将指南的内容与具有内容专家确定的公认参考指南的关键建议进行比较，评估了指南证据基础的一致性，并计算了百分比得分。
我们从 13 个国家确定了 30 份指南，出版日期从 2003 年至 2010 年不等。总体而言，AGREE II 工具的“范围和目的”和“清晰度和表述”领域得分最高，中位数分别为 58%（范围 19-92%）和 83%（范围 17-100%）。“利益相关者参与”紧随其后，中位数为 39%（范围 6-75%）。“适用性”、“开发严谨性”和“编辑独立性”得分较低，均低于 25%。成员国之间的证据一致性存在差异，得分最低的情况出现在较旧的指南中，或者正在评估的指南是更广泛的初级保健 CPG 的一部分，而不是特定疾病的指南。
这项审查确定了南部非洲发展共同体五个优先疾病的现有指南中存在的质量差距和与最佳证据的不一致性。未来南部非洲发展共同体的指南制定过程应更好地遵守全球报告规范，要求更广泛地征求利益相关者的意见并提高过程透明度。区域指南支持委员会可以利用当地能力来支持适合国情的指南制定。
