Independent Consultant, Geneva, Switzerland.
Department of Maternal, Newborn, Child and Adolescent Health, WHO, Geneva, Switzerland.
BMJ Glob Health. 2020 Nov;5(Suppl 1). doi: 10.1136/bmjgh-2019-002060.
Significant global gains in sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) will be difficult unless conflict settings are adequately addressed. We aimed to determine the amount, scope and quality of publically available guidance documents, to characterise the process by which agencies develop their guidance and to identify gaps in guidance on SRMNCAH&N promotion in conflicts.
We identified guidance documents published between 2008 and 2018 through English-language Internet sites of humanitarian response organisations, reviewed them for their scope and assessed their quality with the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) tool. Additionally, we interviewed 22 key informants on guidance development, dissemination processes, perceived guidance gaps and applicability.
We identified 105 conflict-relevant guidance documents from 75 organisations. Of these, nine were specific to conflicts, others were applicable also to other humanitarian settings. Fifteen documents were technical normative guidelines, others were operational guides (67), descriptive documents (21) or advice on legal, human rights or ethics questions (2). Nutrition was the most addressed health topic, followed by communicable diseases and violence. The documents rated high quality in their 'scope and purpose' and 'clarity of presentation' and low for 'rigour of development' and 'editorial independence'. Key informants reported end user need as the primary driver for guideline development and WHO technical guidelines as their main evidence base. Insufficient local contextualisation, lack of inter-agency coordination and lack of systematic implementation were considered problems in guideline development. Several guidance gaps were noted, including abortion care, newborn care, early child development, mental health, adolescent health beyond sexual and reproductive health and non-communicable diseases.
Organisations are motivated and actively producing guidance for SRMNCAH&N promotion in humanitarian settings, but few documents address conflicts specifically and there are important guidance gaps. Improved inter-organisation collaboration for guidance on SRMNCAH&N promotion in conflicts and other humanitarian settings is needed.
除非冲突地区得到妥善处理，否则全球在性健康、生殖健康、母婴健康、新生儿健康、儿童健康和青少年健康以及营养方面取得的重大进展将难以实现。我们旨在确定现有的公共指导文件的数量、范围和质量，描述机构制定指导意见的过程，并确定冲突中促进性健康、生殖健康、母婴健康、新生儿健康、儿童健康和青少年健康及营养方面的指导意见存在的差距。
我们通过人道主义应对组织的英文互联网网站确定了 2008 年至 2018 年期间发布的指导文件，评估了它们的范围，并使用 AGREE II（评估研究和评估指南 II）工具评估了它们的质量。此外，我们还采访了 22 名关键知情者，了解指导意见的制定、传播过程、认为的指导意见差距和适用性。
我们从 75 个组织中确定了 105 份与冲突相关的指导文件。其中，9 份专门针对冲突，其他则也适用于其他人道主义环境。15 份文件是技术性规范指南，其他则是操作性指南（67 份）、描述性文件（21 份）或关于法律、人权或道德问题的建议（2 份）。营养是最受关注的健康议题，其次是传染病和暴力。这些文件在“范围和目的”和“表述清晰”方面的评分较高，而在“制定的严谨性”和“编辑独立性”方面的评分较低。主要知情者报告说，最终用户的需求是制定准则的主要驱动力，世卫组织技术准则是其主要的证据基础。准则制定方面存在的问题包括地方情况缺乏针对性、机构间协调不足以及系统实施不足。还注意到了一些指导意见方面的差距，包括堕胎护理、新生儿护理、儿童早期发展、心理健康、性健康以外的青少年健康以及非传染性疾病。
组织有动机并积极为促进人道主义环境中的性健康、生殖健康、母婴健康、新生儿健康、儿童健康和青少年健康及营养制定指导意见，但很少有文件专门针对冲突，而且存在重要的指导意见差距。需要加强组织间在冲突和其他人道主义环境中促进性健康、生殖健康、母婴健康、新生儿健康、儿童健康和青少年健康及营养方面的指导意见方面的合作。
