Table 4 IMC-SAM (2015) AGREE domains support quotations

2. Stakeholder involvement

Quote 4a: “When we did work in the Eastern Cape we did not seek public opinion, I don’t know whether before the national guidelines were developed whether they did [involve the public]” (Informant 1, Academic)

3. Rigour of development

Quote 4b: “Under the deputy director of the ministry of health, the development of a national guideline was spearheaded with the content highly dependent on WHO guidelines developed in 2013… its content as well as the IMCI are South Africa-specific by modifying the antibiotic step due to high prevalence of HIV” (Informant 1, Academic)

5. Applicability

Quote 4c: “With step 10 [of SAM care] on rehabilitation we followed a sub-sample of discharged and found most of them had not gained much weight because they had limited amount and range of food, were not receiving enough money and were not accessing child grants which have just been introduced. On the basis of that, we did a lot of advocacy work, including a TV programme; this had a very big impact nationally which caused the minister to visit the next day and there were stuff in the Sunday Times [local newspaper]. That influenced the inclusion of [a slogan saying] ‘make sure all children with SAM in the hospital are linked to social services’ in South Africa’s version of 10 steps of SAM care” (Informant 1: Academic). Quote 4d: “The ingredients were not mostly stored by facilities but the main problem was the mineral micronutrient mix because it did not appear in the EDL thus not accessible through normal channels thus it has to be made up so we found a friendly pharmacist in East London who made it up for the whole province [pilot site-Eastern Cape Province], however he could not keep up with the demand” (Informant 1, Academic)

6. Editorial independence

Quote 4e: “There was a dispute from certain doctors on whether antibiotic should be given routinely (ampicillin). For F75 some doctors pushed very strongly for infant formulas since they were easier to get than rely on hospitals to make feeds; because of the issue of not binding on iron they cannot absorb thus likely to cause septicaemia and since F75 has no iron present it was endorsed around 2007” (Informant 1, Academic)