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Abstract：
To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.
摘要：
结束低收入和中等收入国家可预防死亡的国际危机，迫切需要有证据和成本效益的医疗保健，和情境化的临床实践指南至关重要。然而,由于适应不良的COVID-19指南的间接后果而暴露出来，据报告，国际建议和现实的最佳做法之间仍然存在根本差距。为了解决这种长期存在的不公正现象，即医疗服务提供者没有有用的指导，我们借鉴了孕产妇健康和COVID-19大流行的例子。我们提出了一个框架，用于全球指南开发人员如何更有效地对低资源设置的建议进行分层，并考虑可预测的实施背景障碍（例如，人力资源)以及收益和损失(例如，成本效率)。在全球一级制定更现实的临床实践指南将为地方一级更简单和可实现的适应铺平道路。我们还敦促通过与最终用户共同创建，在低收入和中等收入国家的国家和国家以下各级制定和调整高质量的临床实践指南，我们鼓励全球分享这些经验。
