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Developing guidelines in low-income and middle-income countries: lessons from Kenya
  1. Mike English1,2,
  2. Grace Irimu3,
  3. Rachel Nyamai4,
  4. Fred Were5,
  5. Paul Garner6,
  6. Newton Opiyo7
  1. 1 Health Serviecs Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
  2. 2 Nuffield Department of Medicine, University of Oxford, Oxford, UK
  3. 3 Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
  4. 4 Maternal, Newborn, Adolescent and Child Health Unit, Ministry of Health, Nairobi, Kenya
  5. 5 Kenya Paediatric Association, Nairobi, Kenya
  6. 6 Centre for Evidence Synthesis for Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
  7. 7 Health Services Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
  1. Correspondence to Professor Mike English, KEMRI-Wellcome Trust Research Programme, P.O. Box 43640, Nairobi 00100 Kenya; menglish{at}kemri-wellcome.org

Abstract

There are few examples of sustained nationally organised, evidence-informed clinical guidelines development processes in Sub-Saharan Africa. We describe the evolution of efforts from 2005 to 2015 to support evidence-informed decision making to guide admission hospital care practices in Kenya. The approach to conduct reviews, present evidence, and structure and promote transparency of consensus-based procedures for making recommendations improved over four distinct rounds of policy making. Efforts to engage important voices extended from government and academia initially to include multiple professional associations, regulators and practitioners. More than 100 people have been engaged in the decision-making process; an increasing number outside the research team has contributed to the conduct of systematic reviews, and 31 clinical policy recommendations has been developed. Recommendations were incorporated into clinical guideline booklets that have been widely disseminated with a popular knowledge and skills training course. Both helped translate evidence into practice. We contend that these efforts have helped improve the use of evidence to inform policy. The systematic reviews, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approaches and evidence to decision-making process are well understood by clinicians, and the process has helped create a broad community engaged in evidence translation together with a social or professional norm to use evidence in paediatric care in Kenya. Specific sustained efforts should be made to support capacity and evidence-based decision making in other African settings and clinical disciplines.

  • Evidence Based Medicine
  • Paediatric Practice
  • Tropical Paediatrics
  • Guidelines

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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Footnotes

  • Contributors ME initiated the evidence to policy and practice strategy reported on here, participated in all evidence to policy rounds and wrote the first draft of this manuscript. NO was the team leader for much of the work on evidence synthesis and engagement. GI helped lead the development of the ETAT+ course and was the focal person for collaboration with local academic communities. RN ensured engagement through the Ministry of Health, and FW to engagement with academics and the professional association. PG has provided support to the efforts reported here since 2013. All these authors reviewed the draft manuscript and provided inputs to improve it before approving the final draft.

  • Funding Funds from Wellcome Trust (#076827, #097170) awarded to ME as Senior Fellowships together with additional funds from a Wellcome Trust core grant awarded to the KEMRI-Wellcome Trust Research Programme (#092654) supported this work. Support was also provided for the conduct of systematic reviews and guideline panel meetings in 2013 and 2015 from the Effective Heath Care Consortium funded by UK aid from the UK Government for the benefit of low-income and middle-income countries (Grant: 5242). The views expressed in this publication do not necessarily reflect UK government policy.

  • Competing interests None declared.

  • Patient consent Not applicable.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data sharing statement Not applicable.

  • Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ‘BMJ Publishing Group’. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.

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