Summary of the development process for the guideline on the prevention and treatment of wasting

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Background

The World Health Organization (WHO), in collaboration with UNICEF, the United Nations High Commissioner for Refugees (UNHCR), the Food and Agriculture Organization (FAO) and the World Food Programme (WFP) convened a technical consultation in Geneva in December 2019 on the prevention and treatment of wasting in children. Bringing together international experts in the fields of undernutrition and child health, the meeting aimed to review the technical framing of wasting, to discuss how to identify children at highest risk of morbidity and mortality and to identify the key gaps in the guidance on preventing and treating wasting in children. The meeting highlighted among other things the importance of understanding what defines nutritional vulnerability and risk of death (not only anthropometric but functional recovery). The discussions were also the basis for the development of the Global Action Plan (GAP) Framework on child wasting.¹

In collaboration with UNICEF, UNHCR, FAO and WFP, WHO released the GAP Framework on child wasting in February 2020, highlighting priority actions on the prevention and treatment of child wasting, with emphasis on preventing low birthweight, advancing child health, improving infant and young child feeding and strengthening treatment as well as the importance of a systems-approach involving health, food, water, sanitation and hygiene (WASH) and social protection. The GAP framework reiterated WHO’s mandate to update and develop guidelines on wasting.

WHO Guideline development process on wasting prevention and treatment

In November 2020, WHO created the Guideline Development Group (GDG) consisting of 26 members including researchers, clinicians and programme managers in the areas of infant and child health and nutrition and treatment and prevention of child wasting with representation from all the world regions. The first step in a guideline development process is the scoping of the guideline and the development of the PICO questions. The following scoping reviews to map the available evidence on the prevention and treatment of wasting were commissioned and completed at the end of November:

1)  Growth failure in infants under six months of age

2)  Severe wasting and oedema in children aged six months and older

3)  Moderate wasting in children aged six months and older

4)  Prevention of wasting

A GDG scoping meeting was held 8-11 December 2020 to discuss the four scoping reviews and to prioritise questions in each of the topics. Key areas/questions were identified for the first three topics. There was not enough time to discuss the topic of prevention of wasting in detail and what questions would be relevant for the WHO guideline development process in this area.  More discussion is also needed on how to address the area of risk stratification when it comes to wasting in children.

To complete the scoping process (the development and prioritisation of the questions), small working groups will be established for each of the four topics to develop the questions identified during the meeting. The GDG will be asked to prioritise the questions as well as rank the outcomes for each of the priority questions. Once the information is available, WHO will commission systematic reviews and additional methods as appropriate to examine the available evidence for each of the questions.  It is expected that the reviews will be completed in 2021 and the final guideline meeting be held at the end of 2021 to formulate the recommendations.

Key research gaps will be highlighted and a research agenda developed in parallel.

Guideline on wasting/country action

WHO recommendations can be implemented in, and adapted to, local setting and contexts.  Guideline ‘derivatives’ such as implementation guidelines, policy briefs and training courses will be developed in in 2021/2022 to help countries with the appropriate implementation based on their context. The involvement of key multisector stakeholders will be important for this.

For more detailed information on the guideline development process, watch this webinar co-hosted by WHO and ENN to improve understanding of the WHO guideline development process in general as well as the layout of specific considerations and timelines for the new wasting guidelines. https://www.ennonline.net/mediahub/video/whowebinaronwastingguidelinesanddevelopment

For more detailed information on WHO’s guideline development process: WHO Handbook for Guideline Development: https://apps.who.int/iris/handle/10665/145714

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