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Mthethwa M, Mbeye NM, Effa E, Arikpo D, Blose N, Brand A, Chibuzor M, Chipojola R, Durao S, Esu E, Kallon II, Kunje G, Lakudzala S, Naude C, Leong TD, Lewin S, Mabetha D, McCaul M, Meremikwu M, Vandvik PO, Kredo T. Newborn and child health national and provincial clinical practice guidelines in South Africa, Nigeria and Malawi: a scoping review. BMC Health Serv Res 2024; 24:221. [PMID: 38374031 PMCID: PMC10877834 DOI: 10.1186/s12913-024-10682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Low and middle-income countries remain disproportionately affected by high rates of child mortality. Clinical practice guidelines are essential clinical tools supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based guidelines play a key role in improving clinical management to impact child mortality. We aimed to identify and assess the quality of guidelines for newborn and child health published in South Africa, Nigeria and Malawi in the last 5 years (2017-2022). METHODS We searched relevant websites (June-July 2022), for publicly available national and subnational de novo or adapted guidelines, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible guidelines (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised guideline quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. RESULTS We identified 40-guidelines from the three countries. Of these, 8/40 reported being adopted from a parent guideline. More guidelines (n = 19) provided guidance on communicable diseases than on non-communicable diseases (n = 8). Guidelines were most often developed by national health ministries (n = 30) and professional societies (n = 14). Eighteen guidelines reported on stakeholder consultation; with Nigeria (10/11) and Malawi (3/6) faring better than South Africa (5/23) in reporting this activity. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used in 1/7 guidelines that reported assessing certainty of evidence. Overall guidelines scored well on two AGREE II domains: scope and purpose median (IQR) score 68% (IQR 47-83), and clarity of presentation 81% (67-94). Domains critical for ensuring credible guidance scored below 20%: rigour of development 11% (4-32) and editorial independence 6% (0-27). CONCLUSION National ministries and professional societies drive guideline activities in Malawi, Nigeria and South Arica. However, the methods and reporting do not adhere to global standards. We found low AGREE II scores for rigour of guideline development and editorial independence and limited use of GRADE or adaptation methods. This undermines the credibility of available guidelines to support evidence-informed care. Our findings highlight the importance of ongoing efforts to strengthen partnerships, capacity, and support for guideline development.
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Affiliation(s)
- Mashudu Mthethwa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nyanyiwe Masingi Mbeye
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Emmanuel Effa
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ntombifuthi Blose
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Moriam Chibuzor
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roselyn Chipojola
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Solange Durao
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ekpereonne Esu
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Idriss Ibrahim Kallon
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Gertrude Kunje
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Suzgika Lakudzala
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Celeste Naude
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Trudy D Leong
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simon Lewin
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Denny Mabetha
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Michael McCaul
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Agula C, Bawah AA, Asuming PO, Kyei P, Biney A. Impact of health system strengthening interventions on child survival in sub-Saharan Africa: a systematic review protocol. Syst Rev 2024; 13:15. [PMID: 38178219 PMCID: PMC10768431 DOI: 10.1186/s13643-023-02397-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/22/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Strengthening healthcare systems is a practical approach to enhance healthcare delivery and services. Although there has been a rise in the number of health systems strengthening (HSS) interventions in sub-Saharan Africa (SSA), there is limited evidence on the causal effect of these activities on child survival. Furthermore, the findings reported so far have been varied, and how they relate to each other remains unclear. This systematic review study aims to assess all available evidence to understand the impact of HSS activities on child survival in SSA. METHODS We developed a search strategy to retrieve all relevant studies from electronic databases such as PubMed/MEDLINE, Web of Science, and African Journals Online. We will use a combination of search terms such as "under-five mortality," "child mortality," "infant mortality," "neonatal mortality," "child survival," and "health systems strengthening." The review will include studies that establish a causal relationship between HSS interventions and child survival. This will include studies with designs such as randomized controlled trials and quasi-experimental and methods like difference-in-difference. Two reviewers will independently screen all citations, abstracts, and full-text data and a third reviewer will act as a tiebreaker in case of disagreements. The primary outcome of interest is the impact of HSS activities on under-five survival. We will evaluate the quality of each study using the Bradford Hill criteria for causation. DISCUSSION Our systematic review will identify and evaluate all relevant evidence that establishes a causal relationship between HSS activities and the survival of children under five years in SSA. The review's findings regarding the impact of HSS activities on child survival could be of significant interest to the donor community and policy actors in the region. We also anticipate that the review's conclusions could serve as a valuable guide for the development of future health system interventions and strategies in SSA. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022333913.
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Affiliation(s)
- Caesar Agula
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
| | - Ayaga A Bawah
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana.
| | - Patrick O Asuming
- University of Ghana Business School (UGBS), University of Ghana, Accra, Ghana
| | - Pearl Kyei
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
| | - Adriana Biney
- Regional Institute for Population Studies (RIPS), University of Ghana, Accra, Ghana
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Chilot D, Shitu K, Gela YY, Getnet M, Mulat B, Diress M, Belay DG. Factors associated with healthcare-seeking behavior for symptomatic acute respiratory infection among children in East Africa: a cross-sectional study. BMC Pediatr 2022; 22:662. [PMID: 36380283 PMCID: PMC9664707 DOI: 10.1186/s12887-022-03680-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although there has been promising progress in the reduction of child mortality from ARI, the magnitude is high yet, especially in East Africa. Since mothers/guardians decide upon the type and frequency of healthcare services for children, their good healthcare-seeking behavior could prevent acute respiratory infections (ARI) related mortality and morbidity. This study aimed to investigate the pooled prevalence and factors associated with healthcare-seeking behavior of children younger than five years with ARI symptoms by using data from nationally representative surveys of East Africa. Methods We analyzed secondary data based on the eleven East African Demographic and Health Survey data. Both Individual and community level variables were considered for this study and a multilevel binary logistic regression model was fitted to identify associated factors of children’s healthcare-seeking behavior for ARI symptoms. STATA V.14 software was used to clean, recode and analyze the data. All variables with a p-value = 0.2 in the bi-variable analysis were considered for the multivariable multilevel analysis. Adjusted OR (AOR) with 95% CI was reported to reveal significantly associated factors in the multivariable multilevel analysis. Result The overall prevalence of healthcare-seeking behavior of under-five children for ARI symptoms was 64.4% in East Africa. In the multilevel analysis, the following characteristics were found to be the most important factors of children healthcare seeking behavior for ARI symptoms (P < 0.05): Rural residence [AOR = 0.51, 95% CI (0.37–0.65)], high community level media usage [AOR = 1.63, 95% CI (1.49–1.79)], high community level women education [AOR = 1.51, 95% CI (1.39–1.66)], primary education [AOR = 1.62, 95% CI (1.45–1.82)], secondary education and above [AOR = 1.99, 95% CI (1.71–2.32)], working mother [AOR = 1.33, 95% CI (1.20–1.48)], unmarried women [AOR = 1.15, 95% CI (1.04–1.27)], media access [AOR = 1.43, 95% CI (1.20–1.58)], richest [AOR = 1.39, 95% CI (1.29–1.51)], distance to health facility not a big problem [AOR = 1.11, 95% CI (1.02–1.21)], Place of delivery at health facilities [AOR = 1.77, 95% CI (1.60–1.95)], age of child 7–23 months [AOR = 1.59, 95% CI (1.39–1.82)], age of child 24–59 months [AOR = 1.24, 95% CI (1.09–1.41)] in comparison with children aged 0–6 months, family size > 10 [AOR = 1.53, 95% CI (1.22–1.92)]. Conclusions and recommendations The overall prevalence of children’s healthcare-seeking behavior for ARI symptoms was found relatively low in East Africa, ARI symptoms were determined by individual-level variables and community-level factors. Targeted interventions are needed to improve socioeconomic and health systems to overcome the problem of acute respiratory infection in children. Special attention is required to empower local health staff and health facilities to provide proper diagnosis and management of ARI cases in East Africa.
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Amoah A, Asamoah MK. Child's survival: the role of a mother's education. Heliyon 2022; 8:e11403. [PMID: 36406711 PMCID: PMC9668681 DOI: 10.1016/j.heliyon.2022.e11403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/16/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022] Open
Abstract
In developing countries, children are considered as social and human capital needed for growth and development. However, the ability of uneducated parents to provide basic services to keep a child alive has always been in doubt. This has resulted in the avoidable deaths of children. This study seeks to examine the role of a mother's education in keeping a child alive. This is achieved by using the Ghana Demographic and Health Survey (DHS) Dataset (1988–2014) with 33,896 observations. This study uses the negative binomial model and finds an inverse and statistically highly significant relationship between a mother's education and the survival of her child in Ghana. Further robustness checks confirm that the result is consistent across gender of child and years of data collection. In line with the finding, this study recommends women's education from the basic education level as it drives the probability of saving a life. Globally, we suggest that education, especially at the basic level, should include health education to address numerous health concerns.
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Affiliation(s)
- Anthony Amoah
- School of Sustainable Development, University of Environment and Sustainable Development, Ghana
- Corresponding author.
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