Agreement and alignment: Current status of clinical practice guidelines within the Southern African Development Community

Tags: Poster
Kredo T1, Gerritsen A2, van Heerden J3, Conway S4, Siegfried N1
1South African Cochrane Centre, South Africa, 2Epi Result, South africa, 3Benguela health, South Africa, 4Southern African Regional Programme for Access to Medicines, South Africa

Background: 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 to provide recommendations for regional guideline development.

Methods: 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, supported by email contact with SADC Ministries of Health was used to locate guidelines. The AGREE II tool was applied by independent reviewers to evaluate 6 quality domains reporting the guideline development process. Individual domains were scored and percentages calculated. Alignment of the evidence-base of the guidelines was evaluated by comparing content with key recommendations from accepted reference guidelines, identified with a content expert, and percentage scores were calculated.

Results: We identified 30 guidelines from 13 countries, between June and October 2010. Publication dates ranged from 2003 to 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). '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.

Conclusion: 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.