A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist

To maximize the efficiency of resources and reduce redundancy, organizations and countries may decide to adapt an existing practice guideline rather than developing a new one. The RIGHT (Reporting Items for practice Guidelines in HealThcare) statement currently informs the reporting of the guideline development; however, it does not cover reporting of steps that are specific to guideline adaptation.

A scientific workgroup, filled this gap and developed a new reporting tool designed to improve standardization and transparency of adapted health care guidelines. Called the RIGHT-Ad@pt Checklist, the tool focuses on improving the clarity and explicitness of recommendations that have been adapted for use in different health care systems, and of the guideline development process.

The RIGHT-Ad@pt Checklist was developed as an extension of the RIGHT statement through a multi-step process involving literature reviews and consensus building involving a range of stakeholders including guideline adaptation experts, users, journal editors, and policy makers. The checklist was designed to be used to guide the reporting of adapted guidelines, including adaptation process and the adapted recommendations. It can also be applied to assess the completeness of reporting and, in combination with available adaptation frameworks, to inform adaptation processes. Different audiences may use the RIGHT-Ad@pt checklist for different purposes:

  • Guideline developers could use the checklist to report their adapted guidelines;
  • Journal editors and reviewers could use the checklist to ensure the completeness and transparency of the reporting in the publication of adapted guidelines;
  • Clinicians could accurately identify and apply adapted recommendations to their clinical practice based on detailed and clear reporting; and
  • Policymakers could evaluate the feasibility of adapted recommendations for local implementation based on the reporting contents suggested by the checklist.

The checklist was published in Annals of Internal Medicine and is available here

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Packed red cells versus whole blood transfusion for severe paediatric anaemia, pregnancy‐related anaemia and obstetric bleeding: an analysis of clinical practice guidelines from sub‐Saharan Africa & evidence underpinning recommendations

In sub‐Saharan Africa (SSA) and other low‐ and middle‐income regions, the majority of blood transfusions are given as whole blood. High‐income countries use preparations of red cell concentrates for transfusions rather than whole blood, which is in line with international recommendations. This involves removing the majority of plasma from donated whole blood by centrifugation and adding an additive solution. Red cell preparations are being increasingly promoted in sub‐Saharan Africa, but whether the exclusive use of packed red cell transfusions, which for the purposes of this study we define as any preparation of red blood cells derived from one unit of whole blood, is necessary or beneficial in SSA vs. whole blood, is unclear. Understanding why packed red cells are recommended, and the evidence to support these recommendations, is important to ensure the most appropriate use of packed red cells and whole blood for clinical use in SSA.

Read the analysis of clinical practice guidelines from sub‐Saharan Africa and evidence underpinning recommendations, published in Tropical Medicine and International Health.

Quality of WHO guidelines on snakebite: the neglect continues

Snakebite remains a major public health challenge in many parts of rural Africa, Asia and South America. Available estimates suggest that there are about 94 000 deaths across the world annually due to snakebites; a conservative estimate as many deaths in low and middle-income countries are not reported.The burden on health systems due to snakebite is much higher than what is indicated by the mortality, because even non-venomous snakebite victims visit healthcare facilities for assessment and the morbidity due to snakebite has been scarcely documented. The social and economic consequences of snakebite are known to be high in communities with high prevalence.


Despite its consequences, snakebite has largely been neglected in global health. The WHO readded snakebite to the list of neglected tropical diseases in 2017—potentially implying more attention and funding for disease control programmes and treatment access initiatives. Such initiatives and programme planning are informed by recommendations in practice guidelines. WHO guidelines are highly influential in South Asia, South-East Asia and sub-Saharan Africa (countries with high burden of snakebite) where the lack of in-country capacity for guideline development means WHO guidelines are used as it is or are being adapted .

Read the full article by Dr. Soumyadeep B and colleagues which presents the evaluation of WHO guidelines on snakebite at BMJ Global Health.  (open access)