Pathway to developing paediatric non-communicable disease guidelines in Malawi: a scoping review

Abstract

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.

Keywords: Guidelines review; Malawi; Paediatric non-communicable diseases; Quality of care.

Fig. 1

PRISMA flowchart

Fig. 2

Heatmap - Coverage for the 10 child NCDs with the highest burden of disease (DALYs) in sub-saharan Africa within the reviewed guidelines*# *: Reviewed diseases in the respective category: (1) depression, autism spectrum disorders (2), sickle cell disease, anaemia (3), leukemia, lymphoma, other malignancies (4), rheumatic heart disease, cardiomyopathies #: Assessment grading - green: the disease(s) is (are) covered with focus on children, yellow: the disease(s) is (are) covered but without focus on children or is (are) partly covered, red: the disease(s) is (are) not covered §: figure in brackets – year of publication; figure in square brackets – reference number