Evaluating policy guidelines for the prevention and management of anaemia in pregnancy in Africa: a systematic scoping review of practices and recommendations

BACKGROUND: Anaemia in pregnancy (AiP) remains a major public health concern in Africa, contributing substantially to maternal and neonatal morbidity. However, variability in the quality and content of clinical and policy guidelines may hinder effective prevention and management. METHODS: This scoping review followed the Arksey and O'Malley framework. We searched PubMed, Scopus, ScienceDirect, Google Scholar, Embase, CINAHL, LILACS, and grey literature sources (WHO-AFRO, WHO-IRIS, and UNICEF) from 7 April 2025. Only guidelines published in English were included. Two reviewers independently screened records using Rayyan software based on predefined inclusion and exclusion criteria. The methodological quality of included guidelines was appraised by three appraisers using the AGREE II instrument. RESULTS: Twenty-one guidelines were included (18 from databases and 3 from web searches). Overall, the guidelines clearly described their objectives and recommendations; however, important differences were observed in their methodological quality and usability. Most guidelines performed well in describing their purpose and presenting recommendations, but many lacked detailed information on evidence review methods, involvement of relevant stakeholders, practical implementation strategies, and processes to ensure independence. Based on AGREE II assessment, six guidelines (28.6%) were recommended as high quality, six (28.6%) were recommended with modifications, and nine (42.8%) were not recommended due to major quality limitations. Preventive strategies were widely endorsed, although variations existed in diagnostic thresholds, iron-folic acid supplementation regimens, and integration with malaria interventions. A key limitation was the restriction to English-language documents, which may have excluded relevant context-specific guidelines. CONCLUSIONS: AiP guidelines across Africa show notable variability in screening, diagnostic criteria, treatment regimens, and implementation, alongside gaps in methodological rigour and applicability. These inconsistencies hinder comparability and effective practice. Strengthening future guidelines will require harmonized yet context-sensitive approaches, clearer evidence-based standards, and better integration of implementation tools addressing feasibility, cost, and sociocultural factors. Improving both quality and contextual relevance is essential for advancing maternal health outcomes and progress towards SDG 3.