1 Aboubaker S, et al. BMJ Global Health 2020;5:e002060. doi:10.1136/bmjgh-2019-002060 The availability of global guidance for the promotion of women’s, newborns’, children’s and adolescents’ health and nutrition in conficts Samira Aboubaker, 1 Egmond Samir Evers, 2 Loulou Kobeissi, 3 Lauren Francis, 2 Robinah Najjemba, 1 Nathan P Miller, 4 Steve Wall, 5 Daniel Martinez, 6 Joseph Vargas, 7 Per Ashorn , 8 and members of the BRANCH steering committee Original research To cite: Aboubaker S, Evers ES, Kobeissi L, et al. The availability of global guidance for the promotion of women’s, newborns’, children’s and adolescents’ health and nutrition in conficts. BMJ Global Health 2020;5:e002060. doi:10.1136/ bmjgh-2019-002060 Handling editor Seye Abimbola ► Additional material is published online only. To view, please visit the journal online (http://dx.doi.org/10.1136/ bmjgh-2019-002060). Received 7 October 2019 Revised 24 October 2020 Accepted 29 October 2020 For numbered affliations see end of article. Correspondence to Dr Per Ashorn; per.ashorn@tuni.f © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. ABSTRACT Background Signifcant global gains in sexual, reproductive, maternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) will be diffcult unless confict settings are adequately addressed. We aimed to determine the amount, scope and quality of publically available guidance documents, to characterise the process by which agencies develop their guidance and to identify gaps in guidance on SRMNCAH&N promotion in conficts. Methods We identifed guidance documents published between 2008 and 2018 through English-language Internet sites of humanitarian response organisations, reviewed them for their scope and assessed their quality with the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) tool. Additionally, we interviewed 22 key informants on guidance development, dissemination processes, perceived guidance gaps and applicability. Findings We identifed 105 confict-relevant guidance documents from 75 organisations. Of these, nine were specifc to conficts, others were applicable also to other humanitarian settings. Fifteen documents were technical normative guidelines, others were operational guides (67), descriptive documents (21) or advice on legal, human rights or ethics questions (2). Nutrition was the most addressed health topic, followed by communicable diseases and violence. The documents rated high quality in their ‘scope and purpose’ and ‘clarity of presentation’ and low for ‘rigour of development’ and ‘editorial independence’. Key informants reported end user need as the primary driver for guideline development and WHO technical guidelines as their main evidence base. Insuffcient local contextualisation, lack of inter-agency coordination and lack of systematic implementation were considered problems in guideline development. Several guidance gaps were noted, including abortion care, newborn care, early child development, mental health, adolescent health beyond sexual and reproductive health and non-communicable diseases. Interpretation Organisations are motivated and actively producing guidance for SRMNCAH&N promotion in humanitarian settings, but few documents address conficts specifcally and there are important guidance gaps. Improved inter-organisation collaboration for guidance on SRMNCAH&N promotion in conficts and other humanitarian settings is needed. INTRODUCTION Women and children represent the majority of populations affected by conflicts world- wide. According to an international estimate, 368 million children aged under 18 years (16% of all children in the world) and 265 million adult women (7%) were living in the proximity of armed conflict at the end of Key questions What is already known? ► Addressing the health needs of women, newborns, children and adolescents in conficts and other hu- manitarian emergencies is recognised as an import- ant global health priority. ► Signifcant global gains in sexual, reproductive, ma- ternal, newborn, child and adolescent health and nutrition (SRMNCAH&N) require interventions that specifcally address affected populations in confict settings. What are the new fndings? ► SRMNCAH&N guidance for confict settings exists from different organisations. However, there are important gaps in areas such as emergency con- traception, newborn health, child development and adolescent health beyond sexual and reproductive health and non-communicable disease. ► There are weaknesses in the documented rigour of development and the adaptability of guidance to lo- cal contexts. What do the new fndings imply? ► There is need for adaptable, rigorously developed guidance that is coordinated from the development phase onwards for SRMNCAH&N in confict settings. on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from on December 4, 2021 by guest. Protected by copyright. http://gh.bmj.com/ BMJ Glob Health: first published as 10.1136/bmjgh-2019-002060 on 22 November 2020. Downloaded from