Global research priorities for COVID-19 in maternal, reproductive and child health: Results of an international survey

PLoS ONE, Volume 16, No. 9 September, Year 2021

Interpretation

Background The World Health Organization’s “Coordinated Global Research Roadmap: 2019 Novel Coronavirus”outlined the need for research that focuses on the impact of COVID-19 on pregnant women and children. More than one year after the first reported case significant knowledge gaps remain, highlighting the need for a coordinated approach. To address this need, the Maternal, Newborn and Child Health Working Group (MNCH WG) of the COVID- 19 Clinical Research Coalition conducted an international survey to identify global research priorities for COVID-19 in maternal, reproductive and child health. Method This project was undertaken using a modified Delphi method. An electronic questionnaire was disseminated to clinicians and researchers in three different languages (English, French and Spanish) via MNCH WG affiliated networks. Respondents were asked to select the five most urgent research priorities among a list of 17 identified by the MNCH WG. Analysis of questionnaire data was undertaken to identify key similarities and differences among respondents according to questionnaire language, location and specialty. Following elimination of the seven lowest ranking priorities, the questionnaire was recirculated to the original pool of respondents. Thematic analysis of final questionnaire data was undertaken by the MNCH WG from which four priority research themes emerged. Results Questionnaire 1 was completed by 225 respondents from 29 countries. Questionnaire 2 was returned by 49 respondents. The four priority research themes which emerged from the analysis were 1) access to healthcare during the COVID-19 pandemic, 2) the direct and 3) indirect effects of COVID-19 on pregnant and breastfeeding women and children and 4) the transmission of COVID-19 and protection from infection. Conclusion The results of these questionnaires indicated a high level of concordance among continents and specialties regarding priority research themes. This prioritized list of research uncertainties, developed to specifically highlight the most urgent clinical needs as perceived by healthcare professionals and researchers, could help funding organizations and researchers to answer the most pressing questions for clinicians and public health professionals during the pandemic. It is hoped that these identified priority research themes can help focus the discussion regarding the allocation of limited resources to enhance COVID-19 research in MNCH globally. This project was undertaken between October 2020 and January 2021 using a modified Delphi method (Fig 1). A short online questionnaire was designed by the MNCH WG through collaborative discussions guided by the WHO’s “Coordinated Global Research Roadmap for the Novel Coronavirus” [2]. Questionnaire respondents were asked to provide demographic information including specialty and location, and to select the five most urgent research priorities among a list of 17 which had been generated by the MNCH WG through literature review and expert opinion (S1 File). Space was also provided within the questionnaire for respondents to include additional research priorities that were not included in the list. The questionnaire was translated from English into French and Spanish and disseminated electronically using the SurveyMonkey platform via affiliated networks of the MNCH WG members including: World Society for Pediatric Infectious Diseases (WSPID); European Society for Pediatric Infectious Diseases (ESPID); African Society for Pediatric Infectious Diseases (AfSPID), who forwarded to their respective in-country pediatric and obstetric associations; Honduran Pediatric Association; Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Paediatrics and Child Health (RCPCH), who forwarded to their global health membership; American College of Obstetricians and Gynecologists (ACOG) and International Federation of Gynecology and Obstetrics (FIGO), who also forwarded to all its country member organizations for further dissemination [10–16]. We also disseminated the Questionnaire 1 via the social media platforms Twitter and Facebook [17, 18]. Responses were collected electronically over a period of four weeks and data analysis was performed using Microsoft Excel. The frequency of selection of each research priority was calculated (with each research priority being equally weighted). Subgroup analysis of Questionnaire 1 data was performed to determine the frequency of selection of each research priority according to questionnaire language, respondent specialty and respondent location (continent). An overview of additional research priorities submitted by respondents was also undertaken by the MNCH WG to determine whether they were sufficiently distinct from the original listed priorities (no new priorities were added). Following this review, the seven least frequently selected research priorities by questionnaire respondents among the original list of 17 (as indicated by the seven lowest scores) were eliminated from the list, leaving ten research priorities which were reviewed and refined by the MNCH WG and recirculated to respondents to Questionnaire 1 who had consented to being recontacted (S2 File). Respondents were asked to rank these ten research priorities from most to least important (with 1 signifying the most important priority and 10 signifying the least important priority) and to comment on the relevance and comprehensibility of the research priorities. Responses to Questionnaire 2 were also collected over a period of four weeks. The mean ranking of each research priority was calculated by dividing the sum of the rankings for each research priority by the total number of respondents to Questionnaire 2. We subsequently performed a thematic analysis of the most frequently selected priorities from Questionnaire 1 and the highest ranked priorities among the responses to Questionnaire 2, through which four principal research priority themes emerged. The MNCH WG reconvened to define important research questions within each theme. Three key questions within each research priority theme were developed following literature review to identify persisting knowledge gaps. We then presented the research questions to OBGYN and pediatric specialists at virtual international meetings to ensure agreement among specialists within the field. This project was reviewed by the Public Health England Research Ethics and Governance Group. Given the consultative nature of the surveys, the project was deemed not to require full ethical review and was granted an exemption from the ethical approval process (https://www.gov.uk/government/organisations/public-health-england/about/research).

AI Digest

Study Justification:

The study aimed to address significant knowledge gaps regarding the impact of COVID-19 on pregnant women and children. The World Health Organization’s research roadmap highlighted the need for research in this area. The study aimed to identify global research priorities for COVID-19 in maternal, reproductive, and child health to guide funding organizations and researchers in answering the most pressing questions for clinicians and public health professionals during the pandemic.

Highlights:

– The study used a modified Delphi method and an international survey to identify research priorities.
– 225 respondents from 29 countries completed the first questionnaire, and 49 respondents completed the second questionnaire.
– Four priority research themes emerged from the analysis: access to healthcare during the pandemic, direct and indirect effects of COVID-19 on pregnant and breastfeeding women and children, and transmission of COVID-19 and protection from infection.
– The study found a high level of concordance among continents and specialties regarding priority research themes.
– The identified priority research themes can help focus the discussion on allocating limited resources to enhance COVID-19 research in maternal, newborn, and child health globally.

Recommendations:

– Allocate resources to address the identified priority research themes: access to healthcare during the pandemic, direct and indirect effects of COVID-19 on pregnant and breastfeeding women and children, and transmission of COVID-19 and protection from infection.
– Prioritize research that addresses the identified knowledge gaps within each research theme.
– Foster collaboration among healthcare professionals, researchers, and funding organizations to address the research priorities and enhance COVID-19 research in maternal, newborn, and child health globally.

Key Role Players:

– Healthcare professionals specializing in maternal, reproductive, and child health
– Researchers in the field of COVID-19 and maternal, reproductive, and child health
– Funding organizations supporting research in this area
– International and national health organizations and agencies
– Policy makers and government officials responsible for public health

Cost Items for Planning Recommendations:

– Research grants and funding for studies addressing the priority research themes
– Research infrastructure and equipment
– Data collection and analysis tools
– Research personnel salaries and training
– Collaboration and networking activities
– Dissemination of research findings through publications and conferences
– Monitoring and evaluation of research projects
– Knowledge translation and implementation activities to ensure research findings inform policy and practice

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong as it presents the methodology used, the number of respondents, and the key research themes that emerged. However, to improve the evidence, it would be helpful to provide more specific details about the questionnaire, such as the number of questions and the response options. Additionally, including information about the demographics of the respondents, such as their specialties and locations, would provide further context.

Abstract

This project was undertaken between October 2020 and January 2021 using a modified Delphi method (Fig 1). A short online questionnaire was designed by the MNCH WG through collaborative discussions guided by the WHO’s “Coordinated Global Research Roadmap for the Novel Coronavirus” [2]. Questionnaire respondents were asked to provide demographic information including specialty and location, and to select the five most urgent research priorities among a list of 17 which had been generated by the MNCH WG through literature review and expert opinion (S1 File). Space was also provided within the questionnaire for respondents to include additional research priorities that were not included in the list. The questionnaire was translated from English into French and Spanish and disseminated electronically using the SurveyMonkey platform via affiliated networks of the MNCH WG members including: World Society for Pediatric Infectious Diseases (WSPID); European Society for Pediatric Infectious Diseases (ESPID); African Society for Pediatric Infectious Diseases (AfSPID), who forwarded to their respective in-country pediatric and obstetric associations; Honduran Pediatric Association; Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Paediatrics and Child Health (RCPCH), who forwarded to their global health membership; American College of Obstetricians and Gynecologists (ACOG) and International Federation of Gynecology and Obstetrics (FIGO), who also forwarded to all its country member organizations for further dissemination [10–16]. We also disseminated the Questionnaire 1 via the social media platforms Twitter and Facebook [17, 18]. Responses were collected electronically over a period of four weeks and data analysis was performed using Microsoft Excel. The frequency of selection of each research priority was calculated (with each research priority being equally weighted). Subgroup analysis of Questionnaire 1 data was performed to determine the frequency of selection of each research priority according to questionnaire language, respondent specialty and respondent location (continent). An overview of additional research priorities submitted by respondents was also undertaken by the MNCH WG to determine whether they were sufficiently distinct from the original listed priorities (no new priorities were added). Following this review, the seven least frequently selected research priorities by questionnaire respondents among the original list of 17 (as indicated by the seven lowest scores) were eliminated from the list, leaving ten research priorities which were reviewed and refined by the MNCH WG and recirculated to respondents to Questionnaire 1 who had consented to being recontacted (S2 File). Respondents were asked to rank these ten research priorities from most to least important (with 1 signifying the most important priority and 10 signifying the least important priority) and to comment on the relevance and comprehensibility of the research priorities. Responses to Questionnaire 2 were also collected over a period of four weeks. The mean ranking of each research priority was calculated by dividing the sum of the rankings for each research priority by the total number of respondents to Questionnaire 2. We subsequently performed a thematic analysis of the most frequently selected priorities from Questionnaire 1 and the highest ranked priorities among the responses to Questionnaire 2, through which four principal research priority themes emerged. The MNCH WG reconvened to define important research questions within each theme. Three key questions within each research priority theme were developed following literature review to identify persisting knowledge gaps. We then presented the research questions to OBGYN and pediatric specialists at virtual international meetings to ensure agreement among specialists within the field. This project was reviewed by the Public Health England Research Ethics and Governance Group. Given the consultative nature of the surveys, the project was deemed not to require full ethical review and was granted an exemption from the ethical approval process (https://www.gov.uk/government/organisations/public-health-england/about/research).

Materials

Innovations

Based on the provided description, the innovations for potential recommendations to improve access to maternal health include:

1. Telemedicine and virtual consultations: Utilizing technology to provide remote healthcare services, including prenatal check-ups, consultations, and postnatal care. This can help overcome geographical barriers and increase access to healthcare for pregnant women, especially in remote or underserved areas.

2. Mobile health applications: Developing mobile applications that provide information, education, and support for pregnant women, such as tracking pregnancy progress, providing health tips, and connecting with healthcare professionals. These apps can enhance self-care and empower women to make informed decisions about their health.

3. Community-based healthcare models: Implementing community-based programs that bring healthcare services closer to pregnant women, such as mobile clinics or community health workers. This can improve access to maternal health services, particularly in areas with limited healthcare infrastructure.

4. Task-shifting and training programs: Expanding the roles of healthcare workers, such as nurses and midwives, through training programs to provide comprehensive maternal healthcare services. This can help address the shortage of skilled healthcare professionals and improve access to essential maternal health services.

5. Public-private partnerships: Collaborating with private sector organizations to improve access to maternal health services, including leveraging their resources, expertise, and technology. This can help bridge gaps in healthcare delivery and expand access to quality maternal healthcare.

6. Innovative financing models: Developing innovative financing mechanisms, such as microinsurance or community-based health financing, to make maternal healthcare more affordable and accessible for vulnerable populations. This can help overcome financial barriers and ensure that all women have access to essential maternal health services.

These innovations can contribute to improving access to maternal health by addressing various barriers, including geographical, financial, and resource limitations.

AI Innovations Description

The recommendation that can be developed into an innovation to improve access to maternal health based on the research described is to prioritize and allocate resources for research on the identified priority themes. These priority themes include:

1. Access to healthcare during the COVID-19 pandemic: This theme focuses on understanding and addressing the challenges faced by pregnant women and children in accessing healthcare services during the pandemic. Innovations could include telemedicine solutions, mobile health applications, and community-based outreach programs to ensure that maternal health services are accessible and available.

2. Direct and indirect effects of COVID-19 on pregnant and breastfeeding women and children: This theme aims to investigate the impact of COVID-19 on the health and well-being of pregnant and breastfeeding women, as well as their children. Innovations could involve developing strategies for early detection and management of COVID-19 in pregnant women, ensuring safe delivery practices, and providing support for breastfeeding mothers.

3. Transmission of COVID-19 and protection from infection: This theme focuses on understanding the transmission dynamics of COVID-19 in the context of maternal health and developing strategies to prevent infection. Innovations could include the development of infection control protocols for healthcare facilities, the use of personal protective equipment, and the promotion of hygiene practices among pregnant women and healthcare providers.

By prioritizing research and innovation in these areas, it will be possible to generate evidence-based solutions and interventions that can improve access to maternal health during the COVID-19 pandemic and beyond. These innovations can help address the specific challenges faced by pregnant women and children, ensuring their health and well-being are protected.

AI Innovations Methodology

The study described in the provided text aimed to identify global research priorities for COVID-19 in maternal, reproductive, and child health. The methodology used was a modified Delphi method, which involved the following steps:

1. Questionnaire Design: The Maternal, Newborn and Child Health Working Group (MNCH WG) designed a short online questionnaire. The questionnaire included demographic information, such as specialty and location, and a list of 17 research priorities generated by the MNCH WG through literature review and expert opinion.

2. Dissemination: The questionnaire was translated into multiple languages (English, French, and Spanish) and distributed electronically using the SurveyMonkey platform. It was shared with clinicians and researchers through affiliated networks of the MNCH WG, including professional associations and global health organizations. Social media platforms like Twitter and Facebook were also used for dissemination.

3. Data Collection: Responses to the questionnaire were collected electronically over a period of four weeks. Microsoft Excel was used for data analysis.

4. Data Analysis: The frequency of selection for each research priority was calculated, with equal weighting given to each priority. Subgroup analysis was performed to determine the frequency of selection based on questionnaire language, respondent specialty, and respondent location (continent).

5. Refinement of Research Priorities: Based on the analysis of Questionnaire 1 data, the seven least frequently selected research priorities were eliminated from the list. The remaining ten research priorities were reviewed and refined by the MNCH WG. These refined priorities were then presented to the respondents of Questionnaire 1 for ranking.

6. Thematic Analysis: The highest ranked priorities from Questionnaire 2 and the most frequently selected priorities from Questionnaire 1 were subjected to thematic analysis. This analysis led to the identification of four principal research priority themes.

7. Development of Research Questions: Within each research priority theme, three key research questions were developed by the MNCH WG. These questions were reviewed by OBGYN and pediatric specialists at virtual international meetings to ensure agreement within the field.

It is important to note that this methodology was used specifically for identifying research priorities and not for simulating the impact of recommendations on improving access to maternal health. Simulating the impact of recommendations would require a different methodology, such as modeling or simulation techniques, which involve creating mathematical or computational models to simulate the effects of different interventions or recommendations on access to maternal health.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1371/journal.pone.0257516

Research Areas:

COVID, Disparities, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Design:

Cross Sectional Study

Study Approach:

Mixed-methods, Qualitative, Quantitative, Systematic Review

Participants Gender:

Female