Evaluation of Clinical Protocols and Guidelines for Leprosy Management Using the AGREE II Instrument

Abstract

Leprosy is a tropical, socially determined disease with high prevalence in countries such as India, Brazil, Indonesia and the Americas. Clinical guidelines are documents that bring together recommendations to improve patient care. Ideally, they should be rigorously prepared and follow the principle of evidence-based healthcare, so that they promote assertive recommendations, contributing to the quality of care. The objective of this article is to evaluate the quality of protocols and guidelines for the management of leprosy. The search for guidelines and protocols was carried out in the PubMed, Cochrane and BVS databases. The guidelines were selected based on previously defined inclusion and exclusion criteria. Twenty guidelines were found, and the guidelines of the World Health Organization, Brazil, India, Paraguay and Colombia were selected. These were evaluated using the AGREE II instrument, which addresses variability in the quality and transparency of guidelines through scores for six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability and editorial independence. The overall assessment showed that the World Health Organization guideline had the highest average percentage (93%), and the Paraguayan guideline had the lowest average (47%). The guidelines presented discrepancies mainly in relation to the rigor of their development and editorial independence, and these findings are also described in the literature. Therefore, improvements are suggested in relation to the methodological rigor in the development of guidelines and in the management of conflicts of interest and possible biases.