ReviewThe Lancet. Global health2021
The injustice of unfit clinical practice guidelines in low-resource realities.
Review in The Lancet. Global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT07751432 (Pregnancy in the Context of Climate Change), which is not on this map. Cited by 61 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Pregnancy in the Context of Climate Change: Co-creating Climate-responsive Antenatal Care for Urban Tanzania (the CC-ANC Project).
Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Anesthesia Trauma Guidelines: A Systematic Review of Global Accessibility and Quality.Anesthesia and analgesia · 2025Pooled it
- Global guidelines for emergency general surgery: systematic review and Delphi prioritization process.BJS open · 2022Pooled it
- The Dilemmas and Opportunities of Co-Creating Health Interventions to Fit Local Contexts: An Ethnographic Study on the Adaptation of Clinical Guidelines in Tanzania.Health expectations : an international journal of public participation in health care and health policy · 2024Trial
- The PROMISE study: protocol for a community-based cohort study and co-creation of a reproductive health intervention in Somaliland.Global health action · 2026Article
- Physical Exercise in Obesity and Metabolic Bariatric Surgery: The First Latin American Consensus.Obesity surgery · 2026Article
- Toward Labour-Care Tools That Survive Low-Resource Realities: Reflections From the PartoMa Group on the WHO Labour Care Guide Implementation Strategy.Birth (Berkeley, Calif.) · 2026Article
- Article
- WHO recommendations for pregnancy and postpartum care should include hypertensive disorders of pregnancy.Bulletin of the World Health Organization · 2026Article
- Article
- Developing an assessment tool to measure health equity considerations of guideline development handbooks.International journal of technology assessment in health care · 2026Article
- Coadaptation and implementation of intrapartum clinical guidelines to save lives during childbirth: Protocol for an adapted PartoMa intervention in Eastern Ethiopia.BMC health services research · 2026Article
- Caesarean section Robson classification, complications, and lessons learned in a rural hospital in Walikale, North Kivu, Democratic Republic of Congo: a cross-sectional study.AJOG global reports · 2026Article
- Emergency, critical and operative care in Afghanistan: pathways to overcoming fragmentation and strengthening access in a post-conflict setting-a mixed-method study.BMJ public health · 2026Article
- Article
- Article
- Addressing health information inequities: making evidence-based clinical content more accessible in low- and middle-income primary care.BMJ global health · 2025Article
- Protocol to Assess the Knowledge, Attitude, and Practices of Midwives in the Implementation of Maternal Healthcare Guidelines in a Selected District, Limpopo Province, South Africa.Nursing reports (Pavia, Italy) · 2025Article
- Designing clinical practice guidelines for equitable, inclusive, and contextualised care.BMJ (Clinical research ed.) · 2025Article
- Compliance with the national and WHO antibiotic treatment guidelines for respiratory tract infections and their association with clinical and economic outcomes in Vietnam: an observational study.JAC-antimicrobial resistance · 2025Article
- Malawi newborn and child health national clinical practice guidelines: a landscape analysis.International health · 2025Review
1 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.