Local input 'essential' to improve childhood treatment in low-income countries, researchers argue

9 December 2008

Guidelines for childhood illness should have more local input, instead of relying on generic data from organisations such as the World Health Organization (WHO), say Trust-funded experts.

In an essay published in ‘PLoS Medicine’, Mike English and Anthony Scott from the KEMRI-Wellcome Trust Research Programme in Kenya propose a framework for national surveillance, monitoring and research that could help shape better treatment guidelines for low-income countries.

They say the input of local data and decision-making will improve the management of childhood diseases such as malaria, pneumonia and diarrhoea.

English and Scott argue that no universal guideline can capture the differences that exist between countries in the patterning of disease, health system capacity and the uptake and acceptance of new health technologies.

As low-income countries develop they will benefit from local data on the burden of disease, the effectiveness of treatments and their costs, and the way people make use of healthcare. This information can be combined with other data from international organisations and collaborations and fed into new guidelines and policy.

The authors say that the WHO has an important role to play in assisting low-income countries in the increasingly devolved process of decision-making. But they add that their proposed framework may help overcome limitations in the way the WHO develops its guidelines - particularly the lack of a comprehensive process for evaluation, revision or refinement when a new guideline is introduced. This is despite the fact that WHO guidelines are meant to be applied to the care and treatment of vast numbers of children each year.

“We will need appropriate evidence to adapt treatment guidelines for these millions of children,” say English and Scott, “so that the guidelines are optimally effective at regional or country, not continental, level.”

Image: A medical checkup in India; Ray Witlin/World Bank.

References

English M and Scott JAG. What is the Future for Global Case Management Guidelines for Common Childhood Diseases? PLoS Med. 2008;DOI:10.1371/journal.pmed.0050241 [Epub ahead of print]