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  • Inclusion criteria for information products: We examined information products issued by WHO for four recent public health emergencies: outbreaks of avian influenza A—H1N1 virus (2009), avian influenza A—H7N9 virus (2013), Middle East respiratory syndrome coronavirus (MERS-CoV) (2013) and Ebola virus disease (EVD) (2014 to 2016). There were other outbreaks, humanitarian emergencies, and natural disasters between 2009 and 2016 that were graded by the Global Emergency Management Team [3], however we selected these four emergencies as purposeful sample as they all focused on infectious diseases outbreaks, and involved a significant response by WHO including the production of a large number of information products. All occurred after the institution of the GRC so that a standard approach to develop guidelines in the non-emergency context was in place at WHO. We included all information products published in any language that were specifically developed or adapted by WHO for the four selected emergencies. We excluded testimonials, media releases, situation reports and meeting reports. Two independent reviewers assessed each document against study inclusion criteria. As per WHO’s definition [2], we classified an information product as a guideline based on the content of that document (i.e., whether it contained a specific recommendation for the end-user), rather than by the process for development. Guidelines included products that contained recommendations and did not reference an underlying, source guideline. These covered a wide range of topics including clinical care [4], water and sanitation [5], and occupational health and safety [6], among many other topics. All other information products were classified as non-guidelines, which included, for example, publications derived from existing guidelines [7], assessments of preparedness in countries[8], and tools for assessment or response [9]. Non-guidelines are not expected to contain detailed methods and other types of information that is expected in a high-quality guideline. Identification of included information products: We identified eligible information products available on 24 April 2016, from lists of technical documents related to each emergency assembled by the WHO Department of Communicable Disease Surveillance and Response. We had difficulty identifying relevant documents and therefore searched multiple potential sources such as WHO's global digital library (Institutional Repository for Information Sharing (IRIS)), hand-searched WHO websites, consulted key WHO staff in technical units and reviewed WHO resource toolkits. Two independent reviewers extracted information product characteristics and publication format, and identified translations. For guidelines, we extracted data on standard WHO guideline development processes (e.g., based on a systematic review of the evidence, involved external experts in the formulation of recommendations) and had two independent reviewers appraise each guideline using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument[10]. This instrument, the most widely-used guideline quality appraisal tool, is comprised of 23 items, six quality domains and a 7-point Likert-like response scale. We report the prevalence of key characteristics for information products in each emergency. For continuous data, we report the mean and standard deviation (SD). We summarize AGREE II scores for each domain (scaled to a percentage of the maximum score) across guidelines using the median value and the interquartile range, as scores were not normally distributed and sample sizes were small for some emergencies. All statistical analyses were conducted using Stata 12.1 (StataCorp LP, College Station, Texas, USA).
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