title: Appraisal of guidelines developed by the World Health Organization.
abstract: OBJECTIVE
  To appraise the quality of guidelines developed by the World Health Organization (WHO) that were approved by its Guidelines Review Committee (GRC) and identify strengths and weaknesses in the guideline development process.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Three individuals independently assessed GRC-approved WHO guidelines using the Appraisal of Guidelines for Research and Evaluation II instrument (AGREE II). Scores were standardized across domains and overall quality was determined through consensus.
  
  
  RESULTS
  124 guidelines met inclusion criteria and were assessed. 58 guidelines were recommended for use, 58 were recommended with modifications and eight were not recommended. The highest scoring domains across guidelines were scope and purpose, and clarity of presentation. The recommended guidelines had higher rigor of development and applicability domain scores in comparison to other guidelines. 77% of the guidelines referenced an underlying evidence review and 49% used GRADE to assess the body of evidence or the strength of the recommendation. The domains in need of improvement included stakeholder engagement, editorial independence, and applicability. Guidelines not recommended for use were generally insufficient in their rigor of development.
  
  
  CONCLUSIONS
  WHO guidelines need further improvement, most importantly in the rigor of their development (i.e., use of evidence reviews). Other areas for improvement include increased stakeholder engagement, a more explicit process for recommendation formulation and disclosure of interests, discussion of the facilitators, barriers, resource implications, and criteria for monitoring the outcomes of guideline implementation. WHO guidelines can improve through increased transparency, adherence to the WHO Handbook for Guideline Development, and better oversight by the GRC.
authors.affiliation: Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave., Portland, OR 97227, United States. Electronic address: Brittany.U.Burda@kpchr.org.
authors.forename: B U
authors.initials: BU
authors.lastname: Burda
authors.affiliation: School of Professional Psychology, Pacific University, 190 SE 8th Ave., Forest Grove, OR 97123, United States.
authors.forename: A R
authors.initials: AR
authors.lastname: Chambers
authors.affiliation: Hatfield School of Government, Portland State University, 506 S.W. Mill Street, Suite 650, Portland, OR 97201, United States.
authors.forename: J C
authors.initials: JC
authors.lastname: Johnson
mesh_terms: D026683:Advisory Committees; D019985:Benchmarking; D015331:Cohort Studies; D032921:Consensus; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine / Q000592:standards; D014943:Global Health; D006291:Health Policy; D006801:Humans; D008370:Manuals as Topic; D015233:Models, Statistical; D017410:Practice Guidelines as Topic / Q000592:standards*; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards*; D014944:World Health Organization
keywords: Clinical practice guidelines; Global health; Quality assessment