Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, 7505, South Africa.
Department of Medicine, Faculty of Clinical Sciences, University of Calabar, Cross River, Nigeria.
Bull World Health Organ. 2024 Oct 1;102(10):749-756. doi: 10.2471/BLT.24.291564. Epub 2024 Sep 2.
Many national child health guidelines in Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation.
In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses.
Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries.
National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making.
Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development.
马拉维、尼日利亚和南非的许多国家儿童健康指南已经过时，并且在严格的方法和利益相关者参与方面得分较低。
根据世界卫生组织（WHO）对地方指南本地化的强调，全球证据-地方适应（GELA）项目支持多利益攸关方进程，以适应马拉维、尼日利亚和南非儿童健康的循证建议。GELA 项目团队召集了国家指导小组，这些小组进行了结构化、迭代的优先事项设定练习，以确定优先主题。我们通过系统地搜索和筛选现有指南来确定适当的来源指南。然后，我们将潜在来源指南中的建议与相关问题进行匹配，并评估指南的及时性和质量。借鉴世卫组织的指南制定过程，我们应用 GRADE-ADOLOPMENT 过程从现有指南中制定本地化的建议。如果没有确定来源指南或审查，我们会进行新的证据综合。
马拉维、尼日利亚和南非是卫生重点和系统各不相同的国家，都在向全民健康覆盖过渡。指南结构因国家而异，各国卫生部门在很大程度上主导着这些进程。
在 GELA 研究人员和政府-学术合作伙伴的支持下，国家指南小组制定了五项符合国情的儿童健康建议。对于这些建议中的大多数，需要更多的证据来为国情提供信息。有针对性的能力建设和在职学习增强了国家贡献者和研究人员在循证决策方面的能力。
制定符合国情的建议需要大量的资源和时间。需要进一步投资加强地方能力，以可持续地制定国家指南。
