The WHO E-Library for Nutrition Programmes Guidance: Recommendations, Evidence and Best Practices

2. The Rationale Need of guidance on: Evidence-based nutrition policy making Best practices for implementation Programme experiences repository Where it is implementing � lessons learned Cost-effective nutrition interventions They want/need to know NOW "More research is needed" is not helpful

3. WHO NUTRITION GUIDELINESDifferent formats, Different locations

4. How do you know which WHO Guideline is current?

5. List of Publicationsis an alternative but may not be complete

6. Supplements in peer-reviewed journals:are these WHO guidelines?

7. WHO RECOMMENDATIONS PROCESS CRITICIZED IN 2007WHO guidelines are insufficiently transparent and not evidence based Lack of use of systematic reviews Lack of transparency about judgements Too much dependence on expert opinion Lack of emphasis on adapting global guidelines to end users' needs Tension between time taken and when advice needed Lack of resources The GRC was only established recently, and it was in response to a problem identified in 2007 by Oxman in Lancet Conducted a review that examined the use of evidence in recommendations developed by WHO departments. And found: WHO guidelines are insufficiently transparent and not evidence based Lack of use of systematic reviews Lack of transparency about judgements Too much dependence on expert opinion Lack of emphasis on adapting global guidelines to end users' needs Tension between time taken and when advice needed Lack of resources The GRC was only established recently, and it was in response to a problem identified in 2007 by Oxman in Lancet Conducted a review that examined the use of evidence in recommendations developed by WHO departments. And found: WHO guidelines are insufficiently transparent and not evidence based Lack of use of systematic reviews Lack of transparency about judgements Too much dependence on expert opinion Lack of emphasis on adapting global guidelines to end users' needs Tension between time taken and when advice needed Lack of resources

8. Solution 2007 - Effective as of 2008 Development of a Guidelines Review Committee Minimum standards for: Reporting Processes Use of evidence Revised WHO Handbook for Guideline Development Different processes for documents to fit different purposes Rapid advice guidelines Standard guidelines Full guidelines A solution was found soon afterwards A review committee was established � GRC (terms of reference Information Note 16/2007) Internal and external representation Meets monthly and reviews proposals for development of guidelines and final guideline products Minimum standards were set for: Reporting Processes Use of evidence Revised WHO guidelines for guidelines, 2003 version updated, describes WHO standards and methods for guideline-development process Different processes for documents to fit different purposes: Depending on scope and urgency of advice needed Rapid advice eg- avian influence guideline, response to acute problem Standard � most frequent case Full � comprehensive, covering whole disease/policy area Also: 'Books' � synthesis of recommendations from other sources, not necessarily new treatment recommendations and evidence syntheses but still requiring full referencing Joint guidelines � sometimes, of WHO with other groups A solution was found soon afterwards A review committee was established � GRC (terms of reference Information Note 16/2007) Internal and external representation Meets monthly and reviews proposals for development of guidelines and final guideline products Minimum standards were set for: Reporting Processes Use of evidence Revised WHO guidelines for guidelines, 2003 version updated, describes WHO standards and methods for guideline-development process Different processes for documents to fit different purposes: Depending on scope and urgency of advice needed Rapid advice eg- avian influence guideline, response to acute problem Standard � most frequent case Full � comprehensive, covering whole disease/policy area Also: 'Books' � synthesis of recommendations from other sources, not necessarily new treatment recommendations and evidence syntheses but still requiring full referencing Joint guidelines � sometimes, of WHO with other groups

9. WHO standards for guidelines Principles Initial definition of scope and target audience Development of 'questions' Systematic and comprehensive evidence retrieval and synthesis Development of recommendations based on interpretation of evidence Management of conflicts of interest Standards for reporting Plan for implementation and update Following principles of guideline development need to be followed Initial definition of scope and target audience Development of 'questions' guideline wants to address Questions: phrase researchable questions using PICO criteria � Outcomes � not surrogate but patient-important outcomes or public Health outcomes. - Question important because these are questions that sys review is trying to answer, From elements of your questions, search strategy will be defined, Systematic and comprehensive evidence retrieval and synthesis this also includes quality appraisal of the evidence, standard to use GRADE system Development of recommendations based on interpretation of this evidence Here also GRADE, provides systematic approach of moving from evidence to recommendations Management of conflict of interest Standards for reporting Plan for implementation and update Following principles of guideline development need to be followed Initial definition of scope and target audience Development of 'questions' guideline wants to address Questions: phrase researchable questions using PICO criteria � Outcomes � not surrogate but patient-important outcomes or public Health outcomes. - Question important because these are questions that sys review is trying to answer, From elements of your questions, search strategy will be defined, Systematic and comprehensive evidence retrieval and synthesis this also includes quality appraisal of the evidence, standard to use GRADE system Development of recommendations based on interpretation of this evidence Here also GRADE, provides systematic approach of moving from evidence to recommendations Management of conflict of interest Standards for reporting Plan for implementation and update

10. Minimum standards for reporting in WHO guidelines Who was involved and their declaration of interests How the guideline was developed, including How the evidence was identified How the recommendations were made Use by date (review by date) Minimum requirements, in place in this starting period of GRC and related processes Valid until end of the year After that: more stringent criteria according to the WHO guidelines for guidelines Criteria are:�Minimum requirements, in place in this starting period of GRC and related processes Valid until end of the year After that: more stringent criteria according to the WHO guidelines for guidelines Criteria are:�

11. Standards for evidencePrinciples For recommendations: Synthesis of all available evidence Evidence summaries for group meetings using standard template Formal assessment of quality of evidence Consideration of resource use and costs Linked evidence to recommendations, explaining reasons for judgements System for assessing evidence for interventions: GRADE

12. The WHO E-Library for Nutrition Programmes Guidance: Recommendations, Evidence and Best Practices ELECTRONIC RESOURCE With link to documents and tools (i.e. M&E framework, implementation guidelines) TARGET AUDIENCE: Policy Makers Program implementers and others WHO CURRENT RECOMMENDATIONS

13. The WHO E-Library for Nutrition Programmes Guidance: Recommendations, Evidence and Best Practices

14. Biological and Behavioural Basis for the Intervention One page "plain English" summary of causal associations and mechanisms by which intervention would be biologically and conceptually plausible in resulting in the expected outcome By biology experts and/or program planners on the for the intervention Considers physiological aspects of the population group(s) being targeted variety of contexts where this intervention may be particularly beneficial or harmful (i.e. deplete or replete populations; premature infants; etc)

15. Systematic Reviews of Evidence Various levels of evidence on the effects of the intervention for specific outcomes By nutrition experts together with methodologists, epidemiologists and program experts. Systematic reviews from the Cochrane Library as well as those published in peer reviewed journals A specific methodology to assure a standardized approach review of efficacy, effectiveness and safety of interventions in different contexts Formal consultative process on definition of questions and methods are considered early in the process

16. Commentaries/Practical Aspects By nutrition experts, program implementers, or field staff, especially from developing countries revised when the corresponding systematic reviews are updated Includes discussion of practical aspects that need consideration before scaling up the intervention Commentaries selected for publication are edited for technical accuracy and compliance with WHO language style and sent to author(s) for final clearance

17. Commentaries/Practical Aspects Evidence Summary (summary of systematic review of evidence) Relevance to Under-Resourced Settings Magnitude of the problem Applicability of the results Safety Aspects Research Gaps References Practical Aspects Economic Considerations Logistics for Implementation of the intervention Inter-sectoral Aspects and Social Participation Sustainability Implications for Practice First Contact (Primary Care Level) Referral Hospital (Secondary Care Level) At Home or in The Community National Programs About the Authors. Short Bio of the Reviewers/Commentators

18. Best Practices for Implementation By established Working Group consisting mostly program implementers and field staff Includes documents or guidelines (with links) related to: Successful implementation: evaluation of various delivery options (when recommended, to be consistent) Monitoring and Evaluation guidelines Factors affecting impact Types of compounds/supplements micronutrient analysis and dosages Compliance Implementation (How best to? question) Experiences in integration to existing programs in other areas (database with countries where program is /has implemented) Lessons Learned Additional sources of information (link to partners and to existing documents)

19. Commentaries/Practical Aspects By nutrition experts, program implementers, or field staff, especially from developing countries revised when the corresponding systematic reviews are updated Include a discussion of the practical aspects that need consideration before scaling up the intervention . Commentaries selected for publication are edited for technical accuracy and compliance with WHO language style and sent to author(s) for final clearance.