Scope and purpose
In 2015, the world committed to eliminating all forms of malnutrition by 2030 as part of the Sustainable Development Goals (SDGs). To achieve this, the SDGs incorporated the 65th World Health Assembly targets to reduce the proportion of children suffering from wasting to <5% by 2025 and <3% by 2030. Yet, since these targets were adopted, the proportion of children with wasting in the many parts of the world has remained unchanged. Today, an estimated 7.3% (50 million) of all children under five suffer from wasting at any given time. Three-quarters of these children live in low-income settings, while the remainder are affected by humanitarian crisis. Wasting affects children in virtually every continent on the planet, with the largest number living in South Asia.
On 14 July 2019, the Principals of the UN agencies (FAO, UNHCR, UNICEF, WFP, and WHO issued a joint statement calling for greater action to prevent and treat wasting in children; and a Global Action Plan (GAP) framework was developed highlighting the key actions. As part of the GAP, WHO committed to reviewing the science and examining programmatic experience to produce a comprehensive guideline on the prevention and treatment of wasting by the end of 2021.
The Department of Nutrition and Food Safety, in collaboration with the Department of Maternal, Child, Adolescent Health and Ageing, has started the process of developing a comprehensive guideline on the prevention and treatment of wasting in infants and children. The goal is to provide guidance on the following broad topics:
- The identification, diagnosis and management of growth failure in infants aged less than 6 months;
- The management of wasting in children aged 6 months or older:
- Identification and diagnosis of moderate and severe wasting;
- Community-based management of moderate and severe wasting;
- Hospital-based management of severe wasting with medical complications;
- The prevention of wasting.
For this purpose, WHO is establishing a WHO guideline development group on the prevention and treatment of wasting in infants and children. The guideline development group is a multidisciplinary group of experts encompassing a range of technical and programmatic skills as well as diverse perspectives, aiming at having geographical representation and gender balance. The WHO guideline development group will support WHO’s 13th General Programme of Work on various areas and will advise WHO on the following:
- Providing input into the scope of the guidelines and assisting the steering group in developing the key questions in Population, Intervention, Comparator, and Outcomes (PICO) format;
- Choosing and ranking priority outcomes that will guide the evidence reviews and focus the recommendations;
- Examining the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profiles or other assessments of the quality of the evidence used to inform the recommendations and provide input;
- Interpreting the evidence, with explicit consideration of the overall balance of benefits and harms;
- Formulating recommendations and determining their strength taking into account benefits, harms, values and preferences, feasibility, equity, ethics, acceptability, resource requirements and other factors, as appropriate;
- Defining implications for further research and gaps;
- Discussing implementation and evaluation considerations of the guideline.
WHO is convening the first meeting of the WHO guideline development group on the prevention and treatment of wasting in infants and children on 8 – 11 December, 2020 from 15h00–18h00 Central European Time (via a virtual platform). The main objectives of this meeting are to:
- Introduce members of the guideline development group to the WHO guideline development process, including Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology;
- Agree on the decision-making process and decision rules;
- Develop and prioritise PICO questions;
- Agree on the next steps and timeframe for the guideline development process.