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Context-Informed Clinical Practice Guidelines for Fever With Neutropenia Management Among Sub-Saharan African
Motunrayo Adekunle1, Esther Majaliwa2, Tea Reljic3
1Department of Pediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria.
Insights
A new clinical practice guideline (CPG) for managing fever with neutropenia (FN) in pediatric cancer patients was developed for sub-Saharan Africa. This guideline addresses regional needs to improve care and inform policy.
Area of Science:
- Pediatric Oncology
- Clinical Practice Guidelines
- Evidence-Based Medicine
Background:
- Fever with neutropenia (FN) is a critical complication of pediatric cancer treatment, leading to significant morbidity and mortality.
- Existing clinical practice guidelines (CPGs) for FN often lack specific considerations for sub-Saharan African contexts.
- Childhood cancer burden is substantial in sub-Saharan Africa, necessitating context-specific management strategies.
Purpose of the Study:
- To develop a novel, evidence-based clinical practice guideline (CPG) for the management of fever with neutropenia (FN) tailored to pediatric cancer patients in sub-Saharan Africa.
- To address critical gaps in current FN management protocols within the region.
- To provide a standardized framework for FN care, resource prioritization, and national policy influence.
Main Methods:
- A multidisciplinary panel of oncology specialists from 10 sub-Saharan African countries was trained in guideline development.
- The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was employed.
- Systematic reviews, question development, and consensus-based voting were used to formulate recommendations.
Main Results:
- The guideline development process involved 58 respondents from 19 countries and training for 15 panelists.
- Twenty-five specific recommendations and two definitions for FN management were established.
- The developed CPG incorporates regional considerations crucial for sub-Saharan African healthcare settings.
Conclusions:
- The newly developed FN CPG offers a vital tool for policymaking and standardizing care in sub-Saharan Africa.
- Monitoring the implementation and outcomes of these recommendations is essential for improving pediatric FN management.
- The guideline development underscores the urgent need for localized research to generate context-specific evidence in Africa.
Purpose:
Fever with neutropenia (FN) is a common complication of cancer treatment in children and is associated with high morbidity and mortality. Evidence-based clinical practice guidelines (CPGs) for FN aim to standardize care and thereby improve it, prioritize resources, and influence national policies. Despite the significant burden of childhood cancer in sub-Saharan Africa, current CPG fail to explicitly address certain conditions critical for our context. We developed a FN management CPG for pediatric cancer patients in sub-Saharan African countries.
Methods:
The clinical guideline development process involved training of panelists (oncology specialists) in 10 sub-Saharan African countries on guideline development. The guideline was developed following the Grading of Recommendations, Assessment, Development and Evaluation approach. Question development by panelists, systematic review to evaluate evidence for itemized questions, and in-person voting for each recommendation were conducted. Classification of the decision to "recommend" or "not recommend" and the strength of recommendation (strong versus conditional) was decided by a simple majority among (>50%) the CPG panel members.
Results:
Fifty-eight respondents representing 19 countries in the region participated in the question prioritization exercise. Fifteen panelists received training in evidence synthesis and guideline development. Twenty-five recommendations and two definitions intended for practice settings in sub-Saharan Africa were developed to address the management of pediatric FN.
Conclusion:
This FN guideline developed by a multidisciplinary team incorporates regional considerations in treatment of FN and can serve as a tool for policymaking. The performance of guideline recommendations and associated outcomes should be monitored to improve FN outcomes in the region. The CPG development also highlights the need for more research efforts on the continent to generate evidence tailored to the local context.
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