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he grading of the strength of the inal recommendations, in addition to the quality of evidence, were inluenced by the balance between risks and beneits, acceptability
values and preferences, and cost and feasibility implementation in low-resource settings.
All of the inal recommendations were reached by consensus without the need for voting. he panel also provided advise on strategies to support implementation of the
recommendations through the Pocket Book and other quality-of-care tools. In deciding on the strength of the recommendations, the panel was guided by the
agreed-on assessment criteria described in Table 2.2
. he decisions were made by consensus or, where necessary, by vote.
he inal, graded recommendations and remarks made by the panel were also circulated to external reviewers, including WHO regional and country child health
staf, for comments; the results of these comments were posted on the SharePoint for discussion. Where the panel requested more information, the Secretariat provided
the information to all panel members for agreement.
2.4 Review and update of the recommendations
hese recommendations will be regularly updated as more evidence is collated and analysed on a continuous basis with major reviews and updates at least every 3 to 5
years. However, reviews of evidence will be ongoing and where new data requires update of the recommendations, online interim updates will be produced. hese
recommendations will also form part of a technical series of the evidence behind several guidelines to be produced by the Department of Maternal, Newborn, Child
and Adolescent Health over the coming years. he next major update will be done in 2014.
TABLE 2.2
Assessment criteria for the strengths of recommendations
STRENGTH OF RECOMMENDATION RATIONALE
Strong The panel is confident that the desirable effects of adherence to the
recommendation outweigh the undesirable effects. ConditionalWeak
The panel concludes that the desirable effects of adherence to a recommendation probably outweigh the undesirable effects. However:
the recommendation is only applicable to a specific group, population or setting OR where the new evidence may result in changing the
balance of risk to benefit OR where the benefits may not warrant the cost or resource requirements in all settings.
No recommendation Further research is required before any recommendation can be made.
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3. Implementation of the recommendations
3.1 Proposed subsidiary products
Although these recommendations were developed in the context of updating the Pocket Book of Hospital Care for Children used at the referral level, they will also be
used to update the IMCI guidelines and other subsidiary child health implementation tools. Key tools to assist countries in the revision and update of national paediatric
guidelines that are to be updated or developed include, but are not limited to:
n
Pocket Book training CD-ROM
n
Hospital and self assessment tools
n
A manual for clinical use of oxygen
n
Integrated Management of Childhood Illiness clinical algorithms. he recommendations will be disseminated through various tools for improving
quality of care and capacity building. he Pocket Book training CD-ROM used for in-service and pre-service training will be updated and widely distributed. he
recommendations and the Pocket Book will be made available electronically as part of the quality of care improvement CD-ROM resource package, which will include
quality assessment tools, a framework for quality improvement, and self-assessment tools to support managers and clinicians with improving quality of hospital care.
3.2 Implementation of the recommendations
In addition to publishing the recommendations as a stand alone reference document, they will be incorporated into various products mentioned above. hey will mainly
be circulated through the Pocket Book of Hospital Care for Children, which is the standard guideline used at irst-referral level. he updated second edition of the
Pocket Book will be translated into French, Spanish, and Russian in collaboration with regional oices for wider circulation and readership. he Pocket Book will be
linked to the recommendations and the evidence used.
To increase its accessibility to the evidence used as the basis for the recommen- dations, it will also be made available for download from all of the WHO websites
headquarters, regional oices, and country oices and select WHO Collaborating Centres websites in various electronic formats. While wider dissemination will
continue through the Pocket Book sales in the WHO Bookshop, as well as through
