Article type
Year
Abstract
Background: The process of evidence synthesis began in a very informal process; three topics for which people felt there were gaps were chosen, namely: sickle cell disease, umbilical cord care and fluid therapy in children. Systematic reviews in these areas were conducted and published.
Objectives: To develop recommendations for newborn care.
Methods: A multi-disciplinary panel was selected jointly by Ministry of Health and Kenya Paediatric Association. The full systematic reviews, short summaries and GRADE (Grading of Recommendations Assessment, Development and Evaluation) 'Summary of findings' tables were sent to the panel four weeks before the meeting. At the meeting, the panel members were exposed to one day of training on the GRADE process. Evidence was presented for each of the three topics (one topic per day), followed by discussions facilitated by the panelists. The discussions mainly focused on, balance of benefits/harms, feasibility, costs, acceptability (local values), and equity of the proposed interventions. Consensus was developed through voting where necessary.
Results: The panels were able to come up with three recommendations that have been incorporated as policies by the Ministry of Health.
1. For sickle cell disease: Hydroxyurea should be considered for use in children under five years of age with a severe form of sickle cell disease where minimum monitoring conditions and appropriate formulation are available; this recommendation was based on low quality evidence.
2. For umbilical cord care: Chlorhexidine 4% should be applied to the umbilical cord immediately after birth, and thereafter daily until the cord separates in babies of > 1000 g (or > 28 weeks) born in facilities; recommendation based on moderate quality evidence.
3. For fluid therapy: In children with severe febrile illness and impaired circulation without signs of severely impaired circulation maintain hydration with appropriate maintenance fluids and do not give a rapid fluid bolus; recommendation based on high quality evidence.
Conclusions: The involvement of key stakeholders at the development of recommendations is key and possible even in low-resource settings.
Objectives: To develop recommendations for newborn care.
Methods: A multi-disciplinary panel was selected jointly by Ministry of Health and Kenya Paediatric Association. The full systematic reviews, short summaries and GRADE (Grading of Recommendations Assessment, Development and Evaluation) 'Summary of findings' tables were sent to the panel four weeks before the meeting. At the meeting, the panel members were exposed to one day of training on the GRADE process. Evidence was presented for each of the three topics (one topic per day), followed by discussions facilitated by the panelists. The discussions mainly focused on, balance of benefits/harms, feasibility, costs, acceptability (local values), and equity of the proposed interventions. Consensus was developed through voting where necessary.
Results: The panels were able to come up with three recommendations that have been incorporated as policies by the Ministry of Health.
1. For sickle cell disease: Hydroxyurea should be considered for use in children under five years of age with a severe form of sickle cell disease where minimum monitoring conditions and appropriate formulation are available; this recommendation was based on low quality evidence.
2. For umbilical cord care: Chlorhexidine 4% should be applied to the umbilical cord immediately after birth, and thereafter daily until the cord separates in babies of > 1000 g (or > 28 weeks) born in facilities; recommendation based on moderate quality evidence.
3. For fluid therapy: In children with severe febrile illness and impaired circulation without signs of severely impaired circulation maintain hydration with appropriate maintenance fluids and do not give a rapid fluid bolus; recommendation based on high quality evidence.
Conclusions: The involvement of key stakeholders at the development of recommendations is key and possible even in low-resource settings.