Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015

  • Journal of Global Health, Volume 2, No. 1, Year 2012

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Study Justification:
The aim of this study was to identify health research priorities that could help reduce global neonatal mortality from preterm birth and low birth weight (PB/LBW) by 2015, in line with the UN’s Millennium Development Goal 4. The study used the Child Health and Nutrition Research Initiative (CHNRI) methodology to determine the most important research areas.
Highlights:
– The study identified the top 10 research priorities for reducing neonatal mortality from PB/LBW.
– Health systems and policy research questions dominated the priorities, including identifying LBW infants born at home for additional care, improving quality of care for LBW infants in health facilities, and addressing barriers to optimal home care practices.
– Other priorities included improving existing interventions such as early initiation of breastfeeding and improved cord care, as well as developing new interventions for providing thermal care to LBW infants.
– The study emphasized the need for short-term solutions to rapidly reduce mortality, focusing on improving access, coverage, effectiveness, deliverability, and acceptance of existing interventions.
Recommendations:
– Prioritize health systems and policy research to improve access and coverage of existing interventions, as well as to address barriers to optimal care practices.
– Conduct further research to improve the effectiveness, deliverability, and acceptance of existing interventions.
– Focus on epidemiological research to fill key knowledge gaps, particularly in identifying LBW infants who need hospital care.
– Develop new simple and effective interventions for providing thermal care to LBW infants, if Kangaroo Mother Care is not feasible.
Key Role Players:
– Researchers and experts in child, maternal, and newborn health.
– World Health Organization (WHO) for coordination and guidance.
– Health policymakers and program managers.
– Health facility staff and community health workers.
– Non-governmental organizations (NGOs) working in maternal and child health.
Cost Items for Planning Recommendations:
– Research funding for health systems and policy research, epidemiological research, and development of new interventions.
– Training and capacity building for healthcare providers.
– Implementation costs for improving access and coverage of existing interventions.
– Communication and awareness campaigns to promote optimal care practices.
– Monitoring and evaluation of interventions and their impact on neonatal mortality.
Please note that the cost items provided are general categories and not actual cost estimates. The actual budget would depend on the specific context and resources available.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used the Child Health and Nutrition Research Initiative (CHNRI) methodology, which involved 21 researchers with expertise in child, maternal, and newborn health. They suggested 82 research ideas and assessed them based on various criteria. The top 10 research priorities were identified, including health systems and policy research questions, improvement of existing interventions, and development of new interventions. However, the abstract does not provide specific details about the methodology used to assess the research questions, and it does not mention the sample size or demographics of the researchers involved. To improve the strength of the evidence, the abstract could include more information about the CHNRI methodology, such as how the criteria for answerability, effectiveness, deliverability, maximum potential for mortality reduction, and equity were determined. Additionally, providing information about the sample size and demographics of the researchers would enhance the transparency and generalizability of the findings.

Aim This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN’s Millennium Development Goal 4. Methods We applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007-2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method. Results The top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24-48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of new simple and effective interventions for providing thermal care to LBW infants, if KMC is not acceptable to the mother. Conclusion The context for this exercise was set within the MDG4, requiring an urgent and rapid progress in mortality reduction from low birth weight, rather than identifying long-term strategic solutions of the greatest potential. In a short-term context, the health policy and systems research to improve access and coverage by the existing interventions, coupled with further research to improve effectiveness, deliverability and acceptance of existing interventions, and epidemiological research to address the key gaps in knowledge, were all highlighted as research priorities.

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Some innovations for the recommendations mentioned in the research paper include:

1. Identifying low birth weight (LBW) infants born at home within 24-48 hours of birth for additional care: One innovation could be the use of mobile health technology to enable community health workers to identify and track LBW infants born at home. This could involve the use of smartphone applications or text messaging systems to collect data and provide real-time alerts for follow-up care.

2. Improving the quality of care for LBW infants in health facilities: Innovations could include the implementation of standardized protocols and guidelines for the care of LBW infants, the use of technology such as electronic health records to improve documentation and communication among healthcare providers, and the training of healthcare workers in specialized neonatal care.

3. Identifying barriers to optimal home care practices: Innovations could involve community-based interventions such as home visits by trained healthcare providers or community health workers to educate and support mothers in implementing optimal home care practices for LBW infants. This could also include the use of educational materials or multimedia tools to provide information and guidance to mothers.

4. Increasing the use of antenatal corticosteroids in preterm labor: Innovations could include the development of strategies to improve the availability and accessibility of antenatal corticosteroids in low-resource settings, such as the use of simplified treatment protocols, training of healthcare providers, and the integration of antenatal corticosteroids into existing maternal health programs.

5. Improving existing interventions such as early initiation of breastfeeding, improved cord care, and alternative methods to Kangaroo Mother Care (KMC) for keeping LBW infants warm in community settings: Innovations could include the development of culturally appropriate educational materials and interventions to promote early initiation of breastfeeding and proper cord care. Alternative methods to KMC could involve the use of innovative devices or technologies to provide thermal care to LBW infants, such as specially designed warmers or wraps.

It is important to note that these are just examples of potential innovations and further research and development would be needed to implement and evaluate their effectiveness.
AI Innovations Description
The recommendation from the research paper titled “Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015” is to focus on health policy and systems research to improve access to maternal health. This includes identifying low birth weight (LBW) infants born at home within 24-48 hours of birth for additional care, improving the quality of care for LBW infants in health facilities, identifying barriers to optimal home care practices, and increasing the use of antenatal corticosteroids in preterm labor. Other priorities include improving existing interventions such as early initiation of breastfeeding, improved cord care, and alternative methods to Kangaroo Mother Care (KMC) for keeping LBW infants warm in community settings. Additionally, there is a need for the development of new simple and effective interventions for providing thermal care to LBW infants if KMC is not acceptable to the mother. The research emphasizes the importance of addressing these priorities to improve access to maternal health and reduce mortality rates.
AI Innovations Methodology
To simulate the impact of the main recommendations from the research paper on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that can measure the impact of the recommendations on improving access to maternal health. These indicators could include the percentage of LBW infants identified and receiving additional care within 24-48 hours of birth, the quality of care provided to LBW infants in health facilities, the percentage of mothers practicing optimal home care practices, the utilization rate of antenatal corticosteroids in preterm labor, the rate of early initiation of breastfeeding, the effectiveness of alternative methods to Kangaroo Mother Care (KMC) in keeping LBW infants warm in community settings, and the availability and utilization of new interventions for providing thermal care to LBW infants.

2. Data collection: Collect baseline data on the identified indicators. This could involve conducting surveys, interviews, or reviewing existing data sources such as health facility records, birth registries, and community health worker reports. Ensure that the data collected is representative and covers a wide range of settings.

3. Intervention implementation: Implement the recommendations outlined in the research paper in selected settings. This could involve training healthcare providers on identifying and providing additional care to LBW infants, improving the quality of care for LBW infants in health facilities, implementing interventions to address barriers to optimal home care practices, and promoting the use of antenatal corticosteroids in preterm labor. Additionally, interventions to improve existing practices such as early initiation of breastfeeding, improved cord care, and alternative methods to KMC can be implemented. New interventions for providing thermal care to LBW infants can also be developed and implemented if KMC is not acceptable to the mother.

4. Monitoring and evaluation: Continuously monitor and evaluate the implementation of the interventions. Collect data on the identified indicators at regular intervals to assess the impact of the recommendations on improving access to maternal health. This could involve conducting follow-up surveys, reviewing health facility records, and conducting interviews with healthcare providers and mothers.

5. Data analysis: Analyze the collected data to assess the impact of the recommendations. Compare the baseline data with the data collected after the implementation of the interventions to determine any changes in the indicators. Use statistical methods to analyze the data and identify any significant improvements in access to maternal health.

6. Reporting and dissemination: Prepare a report summarizing the findings of the simulation study. Present the results in a clear and concise manner, highlighting the impact of the recommendations on improving access to maternal health. Disseminate the findings to relevant stakeholders, including policymakers, healthcare providers, and researchers, to inform decision-making and further research efforts.

By following this methodology, it would be possible to simulate the impact of the main recommendations from the research paper on improving access to maternal health and provide valuable insights for future interventions and policies.


Statistics:
Citations: 37
Identifiers:
DOI: 10.7189/jogh.02.010403
ISSN: 20472978
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
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