Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
Free public child health Consultant, European Confederation of Primary Care Paediatricians, Lyon, France.
BMC Pediatr. 2021 Sep 8;21(Suppl 1):356. doi: 10.1186/s12887-021-02638-8.
Recommendations to prevent morbidity and mortality in children was a high priority for the editorial group of a WHO pocket book for primary health care in the European region. However, the benefit of preventive interventions is not always clear and recommendations differ across countries and institutions. Here, we summarize the existing recommendations and the most recent evidence on ten selected preventive interventions applied to children under five years to inform this group. In addition, we reflect on the process and challenges of developing these summaries.
For each intervention, we systematically searched for current recommendations from the WHO, the United States Preventive Services Task Force, the workgroup PrevInfad from the Spanish Association of Primary Care Pediatrics, the Centers of Disease Control and Prevention, and the National Institute for Health and Care Excellence. Then, we systematically searched the sources above and the Cochrane library for relevant systematic reviews. For each topic, we reported the recommendations and the strength of the recommendation when and as reported by the authors. We summarized the main findings of systematic reviews with the certainty of the evidence as reported. Categorising the ten preventive interventions in three groups allowed narrative comparisons between similar types of interventions and between groups.
For the single interventions of providing vitamins D and K and topical fluoride there is overall a high degree of consensus between institutions for the evidence of their effectiveness. For the multiple interventions to prevent sudden infant death syndrome and unintentional injuries consensus was more variable as evidence of effectiveness is harder to ascertain. For the screening interventions the summaries of recommendations and evidence varied too. While institutions generally agreed in recommending for vision screening and against universal screening for language and speech delay and iron deficiency, they had some differences for pulse oximetry and autism. The transparent and independent process shed light upon how institutions use existing evidence in their settings - common and different positions were accounted for and became visible. We also identified gaps and duplications of research. Our approach was a crucial starting point for developing the respective sections in the pocket book.
预防发病率和死亡率是世界卫生组织（WHO）欧洲地区初级卫生保健袖珍手册编辑小组的首要任务。然而，预防干预措施的益处并不总是明确的，并且各国和各机构的建议也存在差异。在这里，我们总结了现有的建议以及最近关于十种选定的预防干预措施的证据，这些措施适用于五岁以下儿童，为该群体提供信息。此外，我们还反思了制定这些总结的过程和挑战。
对于每一种干预措施，我们系统地从世界卫生组织、美国预防服务工作组、西班牙初级保健儿科学预防工作组 PrevInfad、疾病控制与预防中心和国家卫生与保健卓越研究所的建议中进行了搜索。然后，我们系统地搜索了上述来源和 Cochrane 图书馆中相关的系统评价。对于每个主题，我们按照作者报告的情况报告了建议和建议的强度。我们按照报告的证据确定性总结了系统评价的主要发现。将这十种预防干预措施分为三组，允许对相似类型的干预措施和组之间进行叙述性比较。
对于提供维生素 D 和 K 以及局部氟化物这两种单一干预措施，各机构之间总体上对其有效性的证据有高度共识。对于预防婴儿猝死综合征和意外伤害的多种干预措施，共识则更为多变，因为有效性的证据更难确定。对于筛查干预措施，建议和证据的总结也存在差异。虽然各机构普遍同意建议进行视力筛查，反对普遍筛查语言和言语延迟以及缺铁，但在脉搏血氧饱和度和自闭症方面存在一些分歧。透明和独立的过程揭示了各机构如何在其环境中使用现有证据——共同和不同的立场都得到了考虑并变得可见。我们还发现了研究的差距和重复。我们的方法是为袖珍手册编写相关章节的关键起点。
