TY - JOUR
T1 - Quality of stroke guidelines in low- and middle-income countries
T2 - A systematic review
AU - The Stroke Experts Collaboration Group
AU - Yaria, Joseph
AU - Gil, Artyom
AU - Makanjuola, Akintomiwa
AU - Oguntoye, Richard
AU - Miranda, J. Jaime
AU - Lazo-Porras, Maria
AU - Zhang, Puhong
AU - Tao, Xuanchen
AU - Ahlgren, Jhon Álvarez
AU - Bernabe-Ortiz, Antonio
AU - Moscoso-Porras, Miguel
AU - Malaga, German
AU - Svyato, Irina
AU - Osundina, Morenike
AU - Gianella, Camila
AU - Bello, Olamide
AU - Lawal, Abisola
AU - Temitope, Ajagbe
AU - Adebayo, Oluwadamilola
AU - Lakkhanaloet, Monkol
AU - Brainin, Michael
AU - Johnson, Walter
AU - Thrift, Amanda G.
AU - Phromjai, Jurairat
AU - Mueller-Stierlin, Annabel S.
AU - Perone, Sigiriya Aebischer
AU - Varghese, Cherian
AU - Feigin, Valery
AU - Owolabi, Mayowa O.
N1 - Publisher Copyright:
© 2021, World Health Organization. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - Objective To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. Methods We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. Findings We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. Conclusion Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
AB - Objective To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. Methods We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. Findings We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. Conclusion Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
UR - http://www.scopus.com/inward/record.url?scp=85115679424&partnerID=8YFLogxK
U2 - 10.2471/BLT.21.285845
DO - 10.2471/BLT.21.285845
M3 - Article
C2 - 34475601
AN - SCOPUS:85115679424
SN - 0042-9686
VL - 99
SP - 640-652E
JO - Bulletin of the World Health Organization
JF - Bulletin of the World Health Organization
IS - 9
ER -