Naude Celeste E, McCaul Michael, de Polnay Kirrily, Bendabenda Jaden, Weise Prinzo Zita, Daniel Allison I
Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland.
BMJ Glob Health. 2025 Aug 13;10(Suppl 5):e017223. doi: 10.1136/bmjgh-2024-017223.
The 2023 has a broad scope aligned with WHO's responsibility to develop a comprehensive guideline as part of the Global Action Plan on Child Wasting. A WHO technical team consisting of the WHO Steering Committee for this guideline, supported by a consultant and two independent methodologists, coordinated guideline development according to WHO's standards and methods. The guideline contains 21 recommendations and 12 good practice statements on prevention and management across four focus areas. As can be expected from a broad guideline covering many new areas, we faced complexities. As a technical team involved throughout the 3-year process, we reflected on the challenges and our experiences in addressing these. In this paper, we summarise selected elements of processes and methods and our key reflections and learnings relevant to three challenging areas that may be useful to other guideline developers and groups addressing complex needs across contexts. Key reflections included (1) implementing comprehensive and systematic prioritisation was time well spent, allowing the most pressing guidance gaps to be addressed first, while also identifying possible future gaps; (2) evidence syntheses and evidence-to-decision approaches for broad and composite guideline questions required careful planning and coordination, which helped streamline Guideline Development Group discussions and consensus during decision-making and (3) putting steps in place aimed at ensuring consistency and rigour across multiple questions, reviews and meetings improved transparent and systematic guideline development processes.
《2023年指南》范围广泛，与世界卫生组织制定全面指南的职责相一致，该指南是《全球儿童消瘦行动计划》的一部分。一个由该指南的世界卫生组织指导委员会组成的世界卫生组织技术团队，在一名顾问和两名独立方法学家的支持下，按照世界卫生组织的标准和方法协调指南的制定工作。该指南包含了关于四个重点领域预防和管理的21项建议和12项良好实践声明。正如一份涵盖众多新领域的广泛指南所预期的那样，我们面临着复杂性。作为参与整个三年过程的技术团队，我们反思了所面临的挑战以及应对这些挑战的经验。在本文中，我们总结了过程和方法的选定要素，以及与三个具有挑战性的领域相关的关键反思和经验教训，这些可能对其他指南制定者以及应对不同背景下复杂需求的团体有用。关键反思包括：（1）实施全面而系统的优先排序很值得投入时间，这使得最紧迫的指导空白能够首先得到解决，同时也能识别未来可能出现的空白；（2）针对广泛且综合的指南问题进行证据综合和证据到决策的方法需要仔细规划和协调，这有助于在决策过程中简化指南制定小组的讨论并达成共识；（3）采取措施确保多个问题、审查和会议的一致性和严谨性，改善了透明且系统的指南制定过程。
