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Pathway to developing paediatric non-communicable disease guidelines in Malawi: a scoping review
Dominic Moyo1, Megumi Nagase2, Amos Msekandiana1
1Kamuzu University of Health Sciences, Blantyre, Malawi.
Insights
Existing African pediatric clinical practice guidelines for non-communicable diseases (NCDs) show gaps in prevention and health promotion. Developing new guidelines for Malawi will address these critical areas to improve child health outcomes.
Area of Science:
- Pediatric Health
- Public Health
- Clinical Practice Guidelines
Background:
- Non-communicable diseases (NCDs) are a growing global health concern in children, impacting low- and middle-income countries.
- Evidence-based, locally relevant interventions and standardized clinical practice guidelines are crucial for improving pediatric care quality.
- This review assesses existing African pediatric guidelines to inform the development of NCD guidelines for children in Malawi.
Purpose of the Study:
- To scope, content, and structure of existing pediatric clinical practice guidelines in Africa.
- To identify gaps in current guidelines, particularly concerning non-communicable diseases (NCDs) in children.
- To inform the development of comprehensive pediatric NCD guidelines for Malawi.
Main Methods:
- Searched PubMed, Scopus, and Cochrane databases for African pediatric NCD guidelines (2003-2022).
- Conducted manual searches of grey literature and contacted experts across Africa.
- Analyzed 19 guidelines from 13 African countries using a standardized framework.
Main Results:
- Included 19 guidelines from 13 African countries; 6 were pediatric-specific, and the rest were integrated for adults and children.
- No specific pediatric NCD guidelines were found, but common NCDs covered included injuries, developmental, mental, respiratory, cardiovascular, endocrine, renal, rheumatological, and hemato-oncological disorders.
- Significant heterogeneity existed, with integrated guidelines offering less detail. Most guidelines lacked prevention and health promotion aspects.
Conclusions:
- The review identified substantial gaps in pediatric guideline content, especially in health promotion and prevention, across African countries.
- Developing new pediatric NCD guidelines for Malawi will integrate insights from African peers and address identified content deficiencies.
- Addressing these gaps is vital for reducing the burden of pediatric NCDs in Malawi and potentially other African nations.
Background:
Non-communicable diseases (NCDs) in children are becoming the leading cause of morbidity and mortality globally. Low- and middle-income countries have not been spared. To improve the quality of care, there is need to use evidence-based and locally relevant interventions. Clinical practice guidelines are essential to provide recommendations that optimise and standardise care. This scoping review was performed to assess the scope, content, and structure of existing paediatric clinical practice guidelines in Africa that can inform the development of paediatric guidelines for NCDs in Malawi.
Methods:
Pubmed, Scopus, and Cochrane databases were searched to identify paediatric NCDs guidelines from Africa published between 2003 and 2022 in English. In addition, a manual search of grey literature was conducted online and experts from centres around Africa were contacted. Four independent reviewers analysed the guidelines by answering five specific questions on their scope, structure, content, recommendations and implementation.
Results:
A total of 19 guidelines from 13 African countries were included, seven from East Africa, four from Southern Africa and two from West Africa. There were six guidelines specifically for children while the rest were integrated guidelines for both adults and children. There were no specific guidelines for NCDs. However, common NCDs that were covered included non-accidental injuries, developmental disorders, mental health, respiratory, cardiovascular, endocrine, renal, rheumatological and haemato-oncological disorders. There was heterogeneity in how these topics were covered in that the specific paediatric guidelines had more detailed content for children than the integrated guidelines. Most guidelines lacked aspects of prevention and health promotion.
Conclusion:
This review evaluated paediatric guidelines from Malawi and the African region to support the development of national paediatric NCD guidelines. The findings highlighted significant gaps in addressing comprehensive aspects, particularly in health promotion and prevention measures, across the 19 reviewed guidelines. Moving forward, the development of paediatric NCD guidelines for Malawi will incorporate insights from African colleagues and address identified content gaps. Addressing these gaps presents an opportunity to tackle the burden of paediatric NCDs.
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