Context-Informed Clinical Practice Guidelines for Fever With Neutropenia Management Among Sub-Saharan African Children With Cancer: A GRADE-Based Approach.

Abstract

Fever with neutropenia (FN) is a common complication of cancer treatment in children and is associated with high morbidity and mortality. Evidence-based clinical practice guidelines (CPGs) for FN aim to standardize care and thereby improve it, prioritize resources, and influence national policies. Despite the significant burden of childhood cancer in sub-Saharan Africa, current CPG fail to explicitly address certain conditions critical for our context. We developed a FN management CPG for pediatric cancer patients in sub-Saharan African countries. The clinical guideline development process involved training of panelists (oncology specialists) in 10 sub-Saharan African countries on guideline development. The guideline was developed following the Grading of Recommendations, Assessment, Development and Evaluation approach. Question development by panelists, systematic review to evaluate evidence for itemized questions, and in-person voting for each recommendation were conducted. Classification of the decision to "recommend" or "not recommend" and the strength of recommendation (strong versus conditional) was decided by a simple majority among (>50%) the CPG panel members. Fifty-eight respondents representing 19 countries in the region participated in the question prioritization exercise. Fifteen panelists received training in evidence synthesis and guideline development. Twenty-five recommendations and two definitions intended for practice settings in sub-Saharan Africa were developed to address the management of pediatric FN. This FN guideline developed by a multidisciplinary team incorporates regional considerations in treatment of FN and can serve as a tool for policymaking. The performance of guideline recommendations and associated outcomes should be monitored to improve FN outcomes in the region. The CPG development also highlights the need for more research efforts on the continent to generate evidence tailored to the local context.