Bringing ‘Yotkom’ to northern Uganda: translating ‘health’ for those who need it most through a synthesis of clinical practice guidelines

Abstract

In resource-poor settings, like northern Uganda, a shortage of trained medical staff and reduced access to evidence-based education or guidelines often leads to an inconsistent approach to medical practice and prescription, and consequent poor patient outcomes. Within this context the application of clinical practice guidelines developed in high-income countries has variable success. Due to the impractical resource and skill requirements of internationally developed guidelines, clinicians in resource-poor contexts are often left depending on traditional practices that are not evidence-based. In this practice paper, we describe the integrated knowledge translation-informed approach to developing a context-specific synthesis of clinical practice guidelines in a northern Ugandan hospital. Using the Knowledge Creation element of the Knowledge to Action cycle as a guide, and strategies from the Expert Recommendations for Implementing Change framework, we identified the most common conditions relevant to our health context and summarised the current best-practice guidelines for each. These recommendations were then further distilled through the context funnel of (1) health system resources, (2) clinician resources, (3) cultural implications, and (4) patient resources. This has resulted in a synthesis of clinical practice guidelines that are relevant to our context in terms of need and available resources and easy for clinicians to navigate during patient management. We wish to share this experience with clinicians and researchers working in similar resource-limited contexts, and provide a thinking framework for distilling best practice through the context funnel to develop pragmatic recommendations for low-middle income countries.