World Health Organization Guideline Development: An Evaluation

This study explored experiences, perceptions and views among World Health Organization (WHO) staff about the changes, progress and challenges brought by the guideline development reforms initiated in 2007. Thirty-five semistructured interviews were conducted with senior WHO staff. Sixteen of the interviewees had in-depth experience with WHO’s formal guideline development process. Thematic analysis was conducted to identify key themes in the qualitative data, and these were interpreted in the context of the existing literature on WHO’s guideline development processes. First, the reforms were seen to have transformed and improved the quality of WHO’s guidelines. Second, independent evaluation and feedback by the Guidelines Review Committee (GRC) was described to have strengthened the legitimacy of WHO’s recommendations. Third, WHO guideline development processes are not yet designed to systematically make use of all types of research evidence needed to inform decisions about health systems and public health interventions. For example, several interviewees expressed dissatisfaction with the insufficient attention paid to qualitative evidence and evidence from programme experience, and how the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process evaluates the quality of evidence from non-randomised study designs, while others believed that GRADE was just not properly understood or applied. Fourth, some staff advocated for a more centralised quality assurance process covering all outputs from WHO’s departments and scientific advisory committees, especially to eliminate strategic efforts aimed at bypassing the GRC’s requirements. Overall, the ‘culture change’ senior WHO staff called for over 10 years ago appears to have gradually spread throughout the organisation. However, at least two major challenges remain: (1) ensuring that all issued advice benefits from independent evaluation, monitoring and feedback for quality and (2) designing guideline development processes to better acquire, assess, adapt and apply the full range of evidence that can inform recommendations on health systems and public health interventions.

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Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary

Hypertension ◽

10.1161/hypertensionaha.121.18192 ◽

2021 ◽

Author(s):

Akram Al-Makki ◽

Donald DiPette ◽

Paul K. Whelton ◽

M. Hassan Murad ◽

Reem A. Mustafa ◽

...

Keyword(s):

World Health Organization ◽

Pharmacological Treatment ◽

Treatment Guidelines ◽

Lifestyle Modification ◽

Guideline Development ◽

Pharmacological Therapy ◽

World Health ◽

Executive Summary ◽

The World ◽

Health Organization

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient’s values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

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Changes to the World Health Organization guideline on hormonal contraceptive eligibility for women at high risk of HIV: South African perspective and response

South African Medical Journal ◽

10.7196/samj.2018.v108i8.13160 ◽

2018 ◽

Vol 108 (8) ◽

pp. 629 ◽

Cited By ~ 2

Author(s):

Z Nene ◽

G J Hofmeyr ◽

M Patel ◽

M Panday ◽

H Rees ◽

...

Keyword(s):

High Risk ◽

World Health Organization ◽

South African ◽

Hormonal Contraceptive ◽

World Health ◽

The World ◽

African Perspective ◽

Health Organization ◽

World Health Organization Guideline

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Introducing 24-Hour Movement Guidelines for the Early Years: A New Paradigm Gaining Momentum

Journal of Physical Activity and Health ◽

10.1123/jpah.2019-0401 ◽

2020 ◽

Vol 17 (1) ◽

pp. 92-95 ◽

Cited By ~ 10

Author(s):

Mark S. Tremblay

Keyword(s):

South Africa ◽

World Health Organization ◽

Guideline Development ◽

Early Years ◽

World Health ◽

Movement Behavior ◽

Sedentary Behaviors ◽

New Paradigm ◽

The World ◽

Health Organization

Background: Emerging research shows that the composition of movement behaviors throughout the day (physical activities, sedentary behaviors, sleep) is related to indicators of health, suggesting previous research that isolated single movement behaviors maybe incomplete, misleading, and/or unnecessarily constrained. Methods: This brief report summarizes evidence to support a 24-hour movement behavior paradigm and efforts to date by a variety of jurisdictions to consult, develop, release, promote, and study 24-hour movement guidelines. It also introduces and summarizes the accompanying series of articles related specifically to 24-hour movement guidelines for the early years. Results: Using robust and transparent processes, Canada, Australia, New Zealand, South Africa, and the World Health Organization have developed and released 24-hour movement guidelines for the early years: an integration of physical activity, sedentary behavior, and sleep. Other countries are exploring a similar approach and related research is expanding rapidly. Articles related to guideline development in South Africa, the United Kingdom, Australia, and by the World Health Organization are a part of this special series. Conclusions: A new paradigm employing 24-hour movement guidelines for the early years that combines recommendations for movement behaviors across the whole day is gaining momentum across the globe.

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