| dc.description.abstract | Introduction: Prehospital care is integral in addressing sub-Saharan Africa's (SSA) high injury and illness burden.
Consequently, robust, high-quality prehospital guidance documents are needed to inform care. These guidance
documents include, but are not limited to, clinical practice guidelines (CPGs), protocols and algorithms that are
contextually appropriate for SSA. However, SSA prehospital guidance mostly originates from the ‘Global North,’
with limited guidance for Africa by Africans. To strengthen prehospital clinical practice in SSA, we described and
appraised all prehospital SSA guidance documents informing clinical decision making.
Methods: We conducted a scoping review of prehospital-relevant guidance documents, including CPGs, algorithms, protocols and position statements originating from SSA. We performed a comprehensive literature search
in various databases (PUBMED and SCOPUS), guideline clearing houses (Scottish Intercollegiate Guidelines
Network, Trip, and Guidelines International Network), journals, various forms of grey literature and contacted
experts. Guidance document screening and data extraction was done independently, in duplicate and reviewed
by a third author. Guidance quality was then determined using the AGREE II tool and data were analysed using
simple descriptive statistics.
Results: We included 51 guidance documents from 13 countries across SSA after screening 2320 potential
documents. The majority of guidance documents lacked an evidence foundation, made recommendations based
on expert input, and were predominantly end-user presentations such as algorithms or protocols. Overall, reporting quality was poor, specifically for critical domains such as rigour of development; however, clarity of
presentation was generally strong. Guidance topics were focused around resuscitation and common diseases
(both communicable and non-communicable) with major gaps identified across a variety of topics; such as
mental health for example.
Conclusion: The majority of prehospital clinical guidance from SSA provides clinicians with excellent ready to
use end-user material. Conversely, most of the guidance documents lack an appropriate evidence foundation and
fail to transparently report the guidance development process, highlighting the need to strengthen and build
guideline development capacity to promote the transition from eminence-based to evidence-based guidance for
prehospital care in SSA. Guideline developers, professional societies and publishers need to be aware of international and local guidance document development and reporting standards in order to produce guidance we
can trust. | |
