Table 2 Studies on WHO guideline uptake and use included in the review
From: Improving WHO’s understanding of WHO guideline uptake and use in Member States: a scoping review
Author | Year | Country | Study design | Health condition | Guideline | Barriers |
|---|---|---|---|---|---|---|
Chanda et al. | 2015 | Malawi | Case study | Malaria | WHO-recommended indoor residual spraying for malaria transmission control and elimination | Limited funding, cost of alternative insecticides and technical resource challenges |
Chinkonde et al. | 2010 | Malawi | Qualitative study | HIV and infant feeding | UNAIDS, WHO, UNFPA and UNICEF guidelines for HIV and infant feeding | Lack of consensus and general confusion regarding guidelines at all levels, need for resources, lack of up-to-date information, lack of contextualized and easy-to-follow guidelines |
Church et al. | 2015 | Kenya, Malawi, South Africa, Uganda, the United Republic of Tanzania and Zimbabwe | Mixed methods study | HIV | HIV testing and treatment guidelines | Lack of WHO explicit guidance around pre-ART CD4 monitoring intervals, rapid initiation of ART, task-shifting for ART initiation, drug resupply intervals, pill count recommendations, drug collection by designees, referral to peer support and home-based care |
Doherty et al. | 2007 | South Africa | Prospective cohort study | Infant feeding practices/HIV mothers | WHO/UNICEF guidelines on infant feeding for HIV-positive women. The guidelines recommend that HIV-positive women avoid all breastfeeding only if replacement feeding is acceptable, feasible, affordable, sustainable and safe | Within operational settings, the WHO/UNICEF guidelines were not being implemented effectively, leading to inappropriate infant feeding choices and consequent lower infant HIV-free survival |
Finocchario-Kessler et al. | 2016 | Kenya | Retrospective cohort study | HIV | Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach—2010 version | Inadequate and inconsistent training, less efficacious regimens, weak systems for patient follow-up and retention |
Govere and Chimbari | 2020 | Sub-Saharan Africa | Scoping review | HIV | WHO’s CD4-threshold ART initiation recommendations | Economic constraints, drug stock-outs, delays in obtaining baseline blood test results and staff shortages |
Hodges-Mameletzis et al. | 2018 | LMICs | Descriptive policy review | HIV | Pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) | Underlying cost of PrEP services, cost considerations include commodities, from the drug itself to the additional testing required to ensure PrEP is offered effectively and safely |
Jones-López et al. | 2011 | Uganda | Prospective cohort study | TB | Standard WHO-recommended retreatment regimen (category II) for TB | Lack of access to rapid diagnostics for TB drug resistance, second-line TB treatment, ART and limited guidance among the policy-makers and healthcare providers on using the tools available |
Lecher et al. | 2015 | Sub-Saharan African countries (Côte d’Ivoire, Kenya, Malawi, Namibia, South Africa, Tanzania, Uganda) | No design specified | HIV | Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach | Lack of trained laboratory personnel, no operating budget, difficulty transporting samples, delays in commodity procurement and distribution, inadequate laboratory information systems, insufficient trained human resources, equipment breakdown, delay in equipment repair, inadequate laboratory and storage space, insufficient viral load testing results management |
Nadjm et al. | 2010 | Tanzania | Observational study | Malaria | WHO manual Management of the child with severe infection or severe malnutrition: guidelines for care at first-referral level. This is the standard WHO guide for paediatric inpatient care and has been adopted as policy by the ministries of health of many resource-poor countries | In an area exposed to high transmission of malaria, current WHO guidelines failed to identify almost a third of children with invasive bacterial disease, and more than half of the organisms isolated were not susceptible to currently recommended antimicrobials. Improved diagnosis and treatment of invasive bacterial disease is needed to reduce childhood mortality |
Nasser et al. | 2015 | 20 LMICs in Africa and South-East Asia | Logistic regression analysis | HIV and TB guidelines | WHO HIV and TB guidelines | |
Ngoma et al. | 2015 | Zambia | Prospective observational cohort study | HIV | WHO guidelines recommend maternal combination antiretroviral therapy (cART) during pregnancy, throughout breastfeeding for 1 year and then cessation of breastfeeding (COB) | Maternal cART may limit mother-to-child transmission of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit |
Stanecki et al. | 2010 | No country specified | No design specified | HIV | WHO guidelines on ART for HIV infection in adults and adolescents | |
Stover et al. | 2014 | 24 LMICs | Modelling | HIV | WHO ART treatment guidelines | Mobilizing additional resources; expanding facilities, personnel and drug supply chains; and identifying HIV-infected people at higher CD4þ T-cell counts and those in serodiscordant partnerships; the large number of patients |
Tlhajoane et al. | 2018 | Zimbabwe | Longitudinal study | HIV | WHO recommendations on HIV testing services, prevention of mother-to-child transmission (PMTCT) of HIV, and provision of ART | Limited availability of different regimen choices posed challenges in the provision of ART stock-outs; laboratory monitoring remained confined to larger hospitals |
Tudor Car et al. | 2013 | LMICs | Systematic review | HIV | 1. WHO (2010) PMTCT strategic vision 2010–2015: preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals 2. Technical consultation on the integration of HIV interventions into maternal, newborn and child health services 3. WHO (2005) Glion consultation on strengthening the linkages between reproductive health and HIV/AIDS: family planning and HIV/AIDS in women and children | Late admission, unknown HIV status, fear of stigma, the policy context |
Van Deun et al. | 2020 | LMICs | Review | TB | WHO treatment guidelines for multidrug- and rifampicin-resistant TB. 2018 update | The drug susceptibility testing capacity, long regimen |
Downs et al. | 2015 | India | Mixed-methods | NCDs | WHO recommends virtually eliminating trans fat from the global food supply | |
Dzudie et al. | 2020 | Cameroon | Survey | NCDs/CVD | WHO’s 25 × 25 goal is aimed at achieving a 25% reduction in the number of premature deaths (occurring before 70 years of age) due to NCDs by 2025 | Availability of essential medicines for CVD was 33%, much lower than the 80% recommended by the WHO Global Action Plan for Prevention of NCDs |
Kaltenbrun et al. | 2020 | South Africa | Qualitative | NCDs and nutrition | WHO recommends that countries adopt a fiscal policy to reduce the consumption of sugar-sweetened beverages | Political will, limited delivery capacity, legislation restrictions and competing government priorities |
Pati et al. | 2020 | India | Narrative review | NCDs | NCD Global Monitoring Framework | Challenges in the identification of eligible beneficiaries, shortage and poor capacity of frontline health workers, poor functioning of community groups and poor community knowledge on NCD risk factors were key gaps at the community level. Challenges at the facility level such as poor facility infrastructure, lack of provider knowledge on standards of NCD care and subpar quality of care led to poor management of NCDs. At the health system level, organization of care, programme management and monitoring systems were not geared up to address NCDs. Multisectoral collaboration and coordination were proposed at the policy level to tackle NCDs; however, gaps remained in implementation of such policies |
Abebe et al. | 2019 | Ethiopia | Cross-sectional study | MNCH/neonatal | Integrated Management of Neonatal Childhood Illness (IMNCI) strategy | Shortage of essential drugs and supplies, inadequate trained staff, time-consuming nature of the protocol, lack of supervision, lack of knowledge about the strategy and lack of good attitude among healthcare workers/professionals towards the IMNCI strategy |
Ansah Manu et al. | 2014 | Ghana | Cluster-randomized trial | MNCH | Home visits for the newborn child: a strategy to improve survival: WHO/UNICEF joint statement | Poor facility, poor health worker attitudes |
Braddick et al. | 2016 | Uganda | Mixed methods | MNCH | WHO PPH guideline: adherence to AMTSL guidelines according to WHO PPH recommendations | Healthcare system issues; current knowledge, awareness, and use of clinical guidelines; and healthcare practitioner attitudes towards updating their clinical practice |
Chang et al. | 2020 | Bangladesh | Mixed methods | MNCH | WHO’s 2016 standards for improving quality of maternal and newborn care in health facilities | The volume of existing indicators |
Chu et al. | 2012 | LMICs | Review | MNCH | Misoprostol use to prevent and treat PPH | Research evidence does not support misoprostol use in home and community settings in LMICs for PPH prevention. WHO should rethink its recent decision to include misoprostol on the essential medicines list |
Colvin et al. | 2013 | Lower- and middle-income countries | Systematic review | MNCH | WHO recommendations: optimizing health worker roles to improve access to key maternal and newborn health interventions through task-shifting guidelines | Lack of legal protection and liabilities and the regulatory framework for task-shifting |
Doku and Neupane | 2017 | 57 LMICs | Cross-sectional Demographic and Health Survey | MNCH–ANC | WHO recommendations for ANC (first visit within the first trimester and at least four visits during pregnancy) | |
Downe et al. | 2019 | South Africa, Indonesia, United Kingdom, Papua New Guinea, Australia, Peru, Uganda, Ghana, United States, Brazil, Ethiopia, Mozambique, Nigeria, Bangladesh, Argentina, Kenya, Iran, Viet Nam, India, Tanzania, Canada, Ireland, Lebanon, Pakistan, Australia, New Zealand, Sweden, Colombia, Romania, Lao People’s Democratic Republic, Zimbabwe, Cambodia, Peru, Georgia, South Sudan, Afghanistan, Iraq, Nepal, Gambia, Swaziland, France, Burkina Faso | Review | MNCH | WHO recommendations on ANC for a positive pregnancy experience | Inconvenience of clinic attendance, lack of accessibility and availability of local transport, indirect costs, potential loss of income, lack of privacy, lack of medicine and equipment, medical jargon |
Khosla et al. | 2017 | Global | Review | MNCH | WHO developed the 2016 guidelines on the management of health complications from FGM | Lack of national legislation |
Kraft et al. | 2018 | Ethiopia and Senegal | Qualitative study | MNCH/family planning | WHO’s evidence-based family planning guidance and tools (i.e. materials) that support the provision of quality family planning services | Resource constraints |
Kumar et al. | 2016 | India | Quasi-experimental observational study | MNCH | WHO Safe Childbirth Checklist (SCC): the SCC targets high-impact best practices around four pause points that occur in almost every delivery: admission, pushing, just after delivery and pre-discharge | High-quality care provision at institutions is still a challenge |
Mchenga et al. | 2019 | Malawi | Retrospective study | MNCH | 2001 Focused Antenatal Care (FANC) programme | Unsupportive spouse, time lag |
Nsabagasani et al. | 2015 | Uganda | Qualitative study | MNCH | WHO recommends the inclusion of child-appropriate dosage formulations in the essential medicines lists of member countries | Lack of resources |
Ritchie et al. | 2016 | LMICs | Comparative study | MNCH | WHO guidelines on maternal, reproductive and women’s health | Lack of material and human resources, problems with communication and information sharing, policy issues, inadequate training, inadequate knowledge and skills, lack of access to evidence, lack of awareness of evidence, providers’ attitudes and beliefs, lack of financial resources, patients’ knowledge and beliefs, lack of communication, resultant lack of trust between providers and policy-makers, lack of accountability |
Roberts et al. | 2017 | Malawi | Qualitative study | MNCH-A | 2011 WHO statement on antenatal care | Beliefs, attitudes, control beliefs, and significant others; cultural beliefs adhered to by the mothers and providers, too many required antenatal care visits, travel distance |
Samnani et al. | 2017 | developing countries | Systematic review | MNCH | Inclusion of misoprostol in its essential medicines list model in March 2011 | Inconsistency in supplies and distribution; inadequate staffing; lack of knowledge of providers and end users, absence of the registration of drug, and fear and apprehension related to its use at the provider and policy levels. Leadership, governance and policy-related issues are substantial barriers to successful implementation of misoprostol in developing countries; fear and confusion among implementers, policy-makers and government officials; lack of awareness about existing policy; lack of integration of misoprostol in basic health service package |
Shilton et al. | 2019 | Ethiopia | Mixed methods | MNCH | WHO guidelines on preventing early pregnancy and poor reproductive health outcomes among adolescents in developing countries | Knowledge, national agenda, laws, resources, culture, cooperation |
Straus et al. | 2013 | Kosovo | Mixed methods | MNCH | WHO PPH guidelines | Lack of communication between clinicians and ministry representatives, substantial mistrust between clinicians and policy-makers, lack of communication across clinical groups that provide obstetric care and a lack of integration across the entire healthcare system, including rural and urban centres, inability to monitor quality of care, inability to consistently access required medications and to smoothly transfer patients from rural to urban centres |
Vogel et al. | 2016 | Four LMICs—Myanmar, Uganda, Tanzania and Ethiopia | Mixed methods | MNCH | WHO maternal and perinatal health guidelines | Health system-level factors, including health workforce shortages and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation and to improve the knowledge and skills of healthcare providers were also identified |
Xue et al. | 2020 | LMICs | No design specified | MNCH/cervical | WHO calls for global action towards the elimination of cervical cancer; one of the main strategies is to screen 70% of women between the ages of 35 and 45 years and 90% of women managed appropriately by 2030, in order to achieve reduction to less than four new cases per 100,000 women | Shortage of experienced colposcopists, consummate colposcopy training courses, and uniform diagnostic standard and strict quality control |
Zhang et al. | 2017 | 74 Countdown countries | Modelling | MNCH | 1. Guidelines for the management of common illnesses with limited resources 2. Community health worker manual, Facilitator notes 3. Guidelines for the management of common childhood illnesses, 2nd edition | NR |
Ziegler et al. | 2020 | Democratic Republic of the Congo | Demographic and Health Surveys | MNCH | WHO recommendations on antenatal care for a positive pregnancy experience | Conflicts |
Hossain et al. | 2017 | LMICs | Systematic review | Nutrition—severe acute malnutrition (SAM) in children | WHO’s facility-based guideline for the reduction of under-five SAM child mortality | High rates of poverty, malnutrition, severe comorbid conditions, lack of resources and differences in treatment practices |
Mejia et al. | 2019 | The Americas: Chile, Costa Rica and Guatemala; Africa: Malawi, Uganda and Zambia; South Asia: Bangladesh; and the Western Pacific Region: China and the Philippines | Review | Nutrition | WHO recommends public health interventions to provide vitamins and minerals | Lack of regulatory frameworks, lack of safety measures |