Webinar: Pregnant Women & Vaccines Against Emerging Epidemic Threats: Ethics Guidance for Preparedness, Research, and Response, 5 March 2019by The Editorial Team
ORRCA (www.orrca.org.uk) is a free, online, searchable database of research around recruitment to Clinical Trials. It aims to help users identify promising recruitment interventions and inform the matching or tailoring of these interventions to specific recruitment challenges faced by different types of trial.
The workshop was attended by 120 total participants over two days, and here we provide a report of the workshop, as well as all the presentations from the day.
REPORT OF THE 2018 ONE DAY FREE WORKSHOP ON CLINICAL RESEARCH CAPACITY BUILDING FOR CLINICAL RESEARCH IN NIGERIAby Glory Oluwagbenga Ogunfowokan - Regional Faculty Lead, morenike Ukpong, AUGUSTINE ONYEAGHALA - Senior Contributor, ogundokun Olusegun - Senior Contributor, Regional Faculty Committee Member, Ekezie Ralueke Oluchukwu
This report details the workshop held on 7th July 2018 at the Nigerian Airforce Conference Centre, Abuja.
This Guide to Efficient Trial Management, published by the Trial Manager's Network (UK) and available freely online, is a must for all trial managers or coordinators. This link is for the 6th Edition (2018)
Update on GRN collaboration to provide research skills for nurses working in genomic medicine in Africaby GRN Coordinator
Forum for University Nursing Deans in South Africa (FUNDISA) meeting – 26-27 October 2017, University of Cape Town (UCT), Cape Town, South Africaby GRN Coordinator
Seminar presented by the EQUATOR Network's Dr Jen de Beyer from the Centre for Statistics in Medicine, University of Oxford - 11th Sept 2017by GRN coordinator
Introduction of GRN to nursing staff at hospitals, clinics and a nursing college in Mpumalanga Province, South Africa – 26/29 September 2017by GRN coordinator
Dr Elize Pietersen, GRN coordinator, delivers two presentations at the International Collaboration for Community Health Nursing Research (ICCHNR) – 20-22 Sept 2017by GRN coordinator
GRN workshop held with nurses from 4 African countries at Groote Schuur Hospital, Cape Town – 11 September 2017by GRN coordinator
Clinical research nurses are busy people! The Global Health Network Training Centre is therefore designed to offer snappy, practical 'how to' training courses that can be completed within 60-90 minutes, and more specialised modules can be taken over several sessions. However because some nurses don't find it easy to access a computer,
Joby George RN RM presents at the 66th Annual Conference of American Society of Tropical Medicine and Hygieneby GRN coordinator
Sr Cordelia Leisegang and Sr Brenda Wright from the University of Cape Town's Collaborating Centre for Optimising Antimalarial Therapy (CCOAT) star a video to explain to future healthy volunteers what they may expect from being in a phase 1 clinical trial.
The Cups or Cash for Girls (CCg) Trial is currently being conducted in Western Kenya. This trial is investigating whether giving school girls a menstrual cup, cash transfer, or both, has an impact on various deleterious outcomes. This trial offers a unique perspective on safety monitoring and this article discusses why safety monitoring is important in such a trial and how it is being tackled.
A continuous quality improvement intervention to improve the effectiveness of community health workers providing care to mothers and children: a cluster randomised controlled trial in South Africaby Horwood et al
Community health workers (CHWs) play key roles in delivering health programmes in many countries worldwide. CHW programmes can improve coverage of maternal and child health services for the most disadvantaged and remote communities, leading to substantial benefits for mothers and children. This is a cluster randomised controlled trial to investigate the effectiveness of a continuous quality improvement (CQI) intervention amongst CHWs providing home-based education and support to pregnant women and mothers. Findings suggest that improved training and CQI-based mentoring of CHWs can improve quantity and quality of CHW-mother interactions at household level, leading to improvements in mothers’ knowledge and infant feeding practices.
Summarizes evidence on the impact of community-based programs for improving reproductive, maternal, newborn, and child health (RMNCH) by (1) describing contextual factors affecting implementation; (2) considering issues of cost-effectiveness; and (3) highlighting research gaps, the challenges of scaling up, and the way forward.
Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic reviewby Gilmore et al
This review reports findings on a systematic review analysing effectiveness of preventive interventions delivered by Community Health Workers for Maternal and Child Health in low- and middle-income countries. Community Health Workers were shown to provide a range of preventive interventions for Maternal and Child Health in low- and middle-income countries with some evidence of effective strategies, though insufficient evidence is available to draw conclusions for most interventions and further research is needed.
This short film shows the impact of the CHAPAS trial on patient health and future possibilities of a small boy from Malawi.
This is a great video of a talk given at the Oxford Martin School by Professor Kevin Marsh.
In this podcast Dr Jacob McKnight talks about his experiences in neonatal nursing delivery and research in Kenya.
There has been steady progress in LMIC health research capacity, but major barriers to research persist and more empirical evidence on development strategies is required.
Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysisby Popova s et al
Alcohol use during pregnancy is the direct cause of fetal alcohol syndrome (FAS). The authors aimed to estimate the prevalence of alcohol use during pregnancy and FAS in the general population and, by linking these two indicators, estimate the number of pregnant women that consumed alcohol during pregnancy per one case of FAS. Alcohol use during pregnancy is common in many countries and as such, FAS is a relatively prevalent alcohol-related birth defect. More effective prevention strategies targeting alcohol use during pregnancy and surveillance of FAS are urgently needed.
Thought-provoking perspectives of becoming a clinical research nurse from South Africa and the United Kingdom
Become a Cochrane citizen scientist. Anyone can join their collaborative volunteer effort.
This book is a collection of fictionalised case studies of everyday ethical dilemmas and challenges, encountered in the process of conducting global health research in places where the effects of global, political and economic inequality are particularly evident.
It is time to revise the international Good Clinical Practices guidelines: recommendations from non-commercial North–South collaborative trialsby GHN Editors
The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs).
Around half of the clinical trials done on medicines we use today are not published; a tragic truth that needs to be changed.
The impact of occupational stress on nurses’ caring behaviors and their health related quality of lifeby Pavlos Sarafis, Eirini Rousaki, Andreas Tsounis, Maria Malliarou, Liana Lahana, Panagiotis Bamidis, Dimitris Niakas, Evridiki Papastavrou
A descriptive analysis of midwifery education, regulation and association in 73 countries: the baseline for a post-2015 pathwayby Sofia Castro Lopes, Andrea Nove, Petra ten Hoope-Bende, Luc de Bernis, Martha Bokosi, Nester T. Moyo, Caroline S. E. Homer
This video seminar describes research to develop a low-cost, field-based test to detect several slow-clearing ACT drug compounds from unprocessed fingerstick blood samples
Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countriesby Bizu Gelaye et al
This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.
Countdown to 2015 country case studies: what have we learned about processes and progress towards MDGs 4 and 5?by Moucheraud et al
This paper aims to identify cross-cutting themes on how and why these countries achieved or did not achieve MDG progress.
Please see this Sky News interview where we were asked by Sky News to comment on the announcement about this bold vision to tackle all diseases.
Launch of Mesh: a new online platform co-created by its users and aiming to improve Community Engagementby The Editorial Team
Today,The Global Health Network launches Mesh: a new online platform co-created by its users and aiming to improve Community Engagement with health in low and middle income countries.
How the war in Syria is decimating human resources for health and health systems.
The team interview panel members talking about the Novartis Access Initiative's work on NCDs.
Professor Sallie Lamb talks about the history of clinical trials, and explains important concepts such as randomisation, masking and minimisation of bias.
Professor Scheffler provided a conceptual framework that shows how pay for performance works in health, and discusses the results of selected case studies.
Retrospective analysis of pulse oximeter alarm settings in an intensive care unit patient populationby Krystal Landsdowne, David G Strauss, Christopher G Scully
The cacophony of alerts and alarms in a hospital produced by medical devices results in alarm fatigue. The pulse oximeter is one of the most common sources of alarms. One of the ways to reduce alarm rates is to adjust alarm settings at the bedside. This study is aimed to retrospectively examine individual pulse oximeter alarm settings on alarm rates and inter- and intra- patient variability.
Obstetric fistula is an important global health issue that negatively affects the lives of countless women, and the team highlight what can be done to prevent and treat fistula.
After the fall of the Taliban in 2001, Afghanistan experienced a tumultuous period of democracy overshadowed by conflict, widespread insurgency, and an inflow of development assistance. Although there have been several cross-sectional assessments of health gains over the last decade, there has been no systematic analysis of progress and factors influencing maternal and child health in Afghanistan. Despite conflict and poverty, Afghanistan has made reasonable progress in its reproductive, maternal, newborn, and child health indicators over the last decade based on contributions of factors within and outside the health sector. However, equitable access to health care remains a challenge and present delivery models have high transactional costs, affecting sustainability.
Preparing for Genomic Medicine Nurse Training in Africa : A special report by Victoria Nembaware, Nicola Mulder and Raj Ramesar from H3ABioNet and the University of Cape Town Division of Human Genetics on
Reproductive, maternal, newborn, and child health: key messages from Disease Control Priorities 3rd Editionby Black et al
As part of Disease Control Priorities 3rd Edition, the World Bank will publish a volume on Reproductive, Maternal, Newborn, and Child Health that identifies essential cost-effective health interventions that can be scaled up to reduce maternal, newborn, and child deaths, and stillbirths. This Review summarises the volume's key findings and estimates the effect and cost of expanded implementation of these interventions. Recognising that a continuum of care from the adolescent girl, woman, or mother to child is needed, the volume includes details of preventive and therapeutic health interventions in integrated packages: Maternal and Newborn Health and Child Health (along with folic acid supplementation, a key reproductive health intervention).
Preparing for and Executing a Randomised Controlled Trial of Podoconiosis Treatment in Northern Ethiopiaby Henok Negussie, Thomas Addissie, Adamu Addissie, Gail Davey
This study highlights the utility of rapid ethical assessment prior to clinical trials involving complex procedures and concepts.
U.S. efforts to combat the Zika virus in the US and abroad
Travel Medicine and Infectious Diseases have evolved rapidly in recent decades as outbreaks such as SARS, Avian Influenza, Ebola, MERS, Chikungunya, and Zika virus have demonstrated how quickly infections can cross international borders.
Public Health Degrees.org is a comprehensive search engine designed for students who are interested in learning more about Public Health and Health Sciences programs around the United States.
Global Research Nurses is proud to announce skills sharing workshops at Mumbai and Gujarat, India in March 2016
Greg Martin talks about four areas of competencies needed to be effective in public health and global health. He places particular importance on management, leadership and governance.
Abstract The luncheon for research nurses, supported by the Global Health Trials’ South African faculty and Global Research Nurses, was held at the University of Cape Town on 6 November 2015. The purpose of the event, which attracted 65research nurses, was to provide face to face interaction for research nurses and a platform for sharing challenges and triumphs for both UK and South African research nurses.
The Zika virus is another wild card dealt to us by nature. It was first discovered in 1947.
Video seminar by Chelsea McMullen, Operational Support Officer, International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), presented at the University of Oxford, 21st October 2015
Quality of care assessment is one of the ways of evaluating what the health system is providing, however, such monitoring depends on an ability to measure quality with the availability of high quality data.
This Week in Global Health or TWiGH presents Global Health Out Loud with Sulzhan Bali & Jessica Taaffe. This week they discuss Zika virus.
Call for Papers: Special issue on strengthening tuberculosis diagnostic networks in Africa - African Journal of Laboratory Medicine
Malaria remains a major global health threat. In the last fifteen years there has been remarkable progress in reducing cases and deaths due to malaria.
Deployed in April 2015, we have established proof-of-principle for real-time genomic surveillance by generating over 40 genome sequences in as little as 48 hours from obtaining a patient sample and feeding the information back to the Ebola central coordination team.
A cluster-randomised controlled trial integrating a community-based water, sanitation and hygiene programme, with mass distribution of albendazole to reduce intestinal parasites in Timor-Leste: the WAby Vaz Nery et al 2016
There is limited evidence demonstrating the benefits of community-based water, sanitation and hygiene (WASH) programmes on infections with soil-transmitted helminths (STH) and intestinal protozoa. Our study aims to contribute to that evidence base by investigating the effectiveness of combining two complementary approaches for control of STH: periodic mass administration of albendazole, and delivery of a community-based WASH programme.
This talk covers several research projects we are undertaking to assess the Electronic Health Record landscape in Kenya and current large-scale projects to roll out Open Source EHR systems to public hospitals.
Building on the concept of rapid learning health systems, Dr. Peek’s seminar focuses on the use of health information technology to address epidemiological and public health questions and to accelerate the translation of research findings to clinical practice.
A seminar presented by Dr Jalemba Aluvaala in the Centre for Tropical Medicine and Global Health, University of Oxford
From our colleagues at the African Society for Laboratory Medicine (ASLM) - The Role of Public Health Institutes in Achieving Public Health Goals
Looking for a job in global health? A 4 part series that takes a look at what you need to do to get your career in global health off to a good start.
Damalie Nakanjako (MBChB, MMED, PhD) is an internist whose work focuses on optimizing HIV treatment outcomes and reducing HIV-associated morbidity and mortality in sub-Saharan Africa.
eSeminar: Research papers that make a difference: discussing research waste, reproducibility and impactby Iveta Simera, the EQUATOR Network
Dr Iveta Seimer, Deputy Director of the UK EQUATOR Centre, discusses research waste, reproducibility, and how to use reporting guidelines to make an impact. Poor reporting seriously affects the integrity of health research literature and critically limits the use and impact of published studies.
Video of Professor Peter Horby, the University of Oxford, on how he and his team set up clinical trials in the heart of the Ebola outbreak.
East African Leaders Join Together to Develop Country-Specific Plans for Point-of-Care Testing.
Two great articles from the African Society for Laboratory Medicine looking at the increasing risk posed by antimicrobial resistance.
Professor Lang talks about doing difficult trials in difficult places - including malaria and ebola trials.
Difficulties in behaviour and communication are core problems in children with neurodevelopmental disorders, and often cause the most stress to parents and families living in resource poor areas of Africa.
Community based reproductive health interventions for young married couples in resource-constrained settings: a systematic reviewby Sarkar et al
This paper presents a review of the available evidence on the effectiveness of community-based health interventions to improve the reproductive health status of young married couples in LMICs. Review suggests that multi-layered community-based interventions, targeting young married women, their families and the health system can improve utilization of reproductive health services among young couples in resource-constrained settings. The paper emphasizes the need for further research to fill the knowledge gaps that exist about improving utilization of reproductive healthcare services, especially safe abortion care among young married women in LMICs.
The articles in this collection examine the evidence and the thinking that form the basis of the new global strategy.
Scientific title: Effectiveness of Malaria Rapid Diagnostic Tests in fever patients attending primary health care facilities in Zanzibar. Over the past decade, Zanzibar has adopted artemisinin-based combination therapy (ACT), long lasting insecticide treated nets and indoor residual spraying
This study focuses on reduction of needle stick injuries in Indraprstha Apollo Hospitals, Delhi.
The "South African Social Science and HIV Programme' - or SASH Programme - is a collaboration between the University of Cape Town (UCT) and Brown University aimed at strengthening the place of HIV social science teaching and research in the Division of Social and Behavioural Sciences at UCT's School of Public Health and Family Medicine For more details see link to the left
This article provides a helpful introduction to statistics as it relates to clinical research, explaining common terms and theories with examples and case studies. Powerpoint presentation also attached for further explanation.
Healthcare associated infections (HAI) are of important concern in patient care. This talk discusses Visual Analytics techniques which have been developed to help detect, monitor, analyse and understand trends, clusters and outbreaks of HAI.
The SWAT and SWAR programme is identifying issues about the methods of trials and systematic reviews about which there is sufficient uncertainty to justify research to support well-informed decision making about future designs and choices.
Schistosomiasis, is a chronic, debilitating disease. Uganda began a National Control Programme in 2003 with annual MDA of praziquantel. MDA on this scale provides strong selective pressures on the parasite population with an associated risk of drug resistance developing.
Girls' and women's health is in transition and, although some aspects of it have improved substantially in the past few decades, there are still important unmet needs. Population ageing and transformations in the social determinants of health have increased the coexistence of disease burdens related to reproductive health, nutrition, and infections, and the emerging epidemic of chronic and non-communicable diseases (NCDs). Simultaneously, worldwide priorities in women's health have themselves been changing from a narrow focus on maternal and child health to the broader framework of sexual and reproductive health and to the encompassing concept of women's health, which is founded on a life-course approach.
What is the optimal rate of caesarean section at population level? A systematic review of ecologic studiesby Betran et al
The authors conducted a systematic review to identify, critically appraise and synthesize the analyses of the ecologic association between CS rates and maternal, neonatal and infant outcomes. The findings suggest that at CS rates below this threshold, socio-economic development may be driving the ecologic association between CS rates and mortality. On the other hand, at rates higher than this threshold, there is no association between CS and mortality outcomes regardless of adjustment. The ecological association between CS rates and relevant morbidity outcomes needs to be evaluated before drawing more definite conclusions at population level.
Research Nurse Jerome Ackeneck discusses what's involved in his role on a Cameroonian HIV Study
Consulting research stakeholders in Kenya on fair practice in research data sharing: Findings and Policy Implications - Dr Vicki Marsh
In this video, Professor Theonest Mutabingwa discusses the two key challenges that face developing countries to progress their malaria research.
In this video of a seminar delivered at the University of Oxford in June 2014, Professor Nicholas White talks about the challenge of antimalarial resistance.
Anders Björkman is Professor of Infectious Disease at the Karolinska Institute. In this video, Anders talks about how the efficacy of antimalarials is a major obstacle in the path towards full malaria elimination.
Efficacy of Handwashing with Soap and Nail Clipping on Intestinal Parasitic Infections in School-Aged Children: A Factorial Cluster Randomized Controlled Trialby Mahmud et al
Intestinal parasitic infections are highly endemic among school-aged children in resource-limited settings. To lower their impact, preventive measures should be implemented that are sustainable with available resources. The aim of this study was to assess the impact of handwashing with soap and nail clipping on the prevention of intestinal parasite reinfections.
Joby George discusses his role as a research nurse based in India; what is involved, educational oprtions available, and what's important to him.
Are you a research scientist working in Global Health? Or an institution looking for partners to run a clinical trial? Site Finder is for you.
The progress in key maternal health indicators in the Eastern and Southern Africa Region (ESAR) over the past two decades has been slow. This paper analyzed available information on nutrition programs and nutrition-specific interventions targeting maternal nutrition in the ESAR and proposes steps to improve maternal nutrition in this region. Findings from the review suggest that multiple nutrition programs are in place in the ESAR; including programs that directly address nutrition indicators and those that integrate corresponding sectors like agriculture, health, education, and water and sanitation. However, their scale and depth differ considerably. These programs have been implemented by a diverse range of players including respective government ministries, international agencies, non government organisations and the private sector in the region. Most of these programs are clustered in a few countries like Kenya, Uganda and Ethiopia while others e.g. Comoros, Somalia and Swaziland have only had a limited number of initiatives.
In this seminar from January 2014, Dr Jane Crawley talks about clinical standardisation in PERCH (Pneumonia Etiology Research for Child Health), a large case-control study of the causes of and risk factors for severe pneumonia.
Job interviews can be intimidating, but simply preparing well can make the difference between succeeding or failing, regardless of how nervous you are. In this article we pull together advice on how to prepare for job interviews and how to know what questions you’ll be asked.
Dr Nat Segaren - Medical Director of the Caris Foundation, presents on 'The Haiti National Early Infant Diagnosis of HIV Program'
Determinants of unmet need for family planning among currently married women in Dangila town administration, Awi Zone, Amhara regional state; a cross sectional studyby Genet et al
Evidences about unmet need for family planning and associated factors are not enough in Dangila town. Therefore, this study was done to assess the magnitude and determinants of unmet need for family planning among currently married women in Dangila town. Findings suggest that the level of unmet need for family planning in the study area is still high compared to the target set (10 %) in the national family planning guide plan of Ethiopia to be achieved by the end of 2015. Therefore, it is important to strengthen counseling and partner involvement in Dangila town to reduce unmet need for family planning.
Birth preparedness and complication readiness among recently delivered women in chamwino district, central Tanzania: a cross sectional studyby Bintabara et al
Birth Preparedness and Complication Readiness is among the key interventions that can reduce maternal mortality. Despite this, its status in Tanzania is not well documented. The authors assessed the practice and determinants of Birth preparedness and complication readiness among recently delivered women in Chamwino district, Central Tanzania. Findings suggest that the proportion of women who prepared for birth and its complications were found to be low. District reproductive and child health coordinator should emphasis on early and frequent antenatal care visits, since they were among predictors of birth preparedness and complication readiness.
New Public Management (public sector reforms which draw on business ideology) are increasingly seen in African ministries of health. This talk concentrates on the effects of NPM reform on Ethiopian hospitals and how efforts to be 'more business-like' have many unintended consequences for hospitals and patients.
Professor Bongani M Mayosi from the Department of Medicine, Groote Schuur Hospital & University of Cape Town describes the transofmation of the science cohort in South Africa.
In this seminar Professor Kevin Marsh describes how knowledge of immunity to malaria in humans has developed over the past thirty years and what impact this has for future research.
Professor Mike English explains how KEMRI-Wellcome are ''working with government to generate patient level data from a network of Kenyan hospitals as a platform for research'.
A birthday message for GHT and all its members from Mr Joby George, research nurse, India.
ABRAID, new website of infectious diseases risk maps
Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation in Wakiso district, Ugandaby Atuyambe et al
Adolescents are frequently reluctant to seek sexual and reproductive health services (SRH). In Uganda, adolescent health and development is constrained by translation of the relevant policies to practice. This study aimed to assess the sexual reproductive health needs of the adolescents and explored their attitudes towards current services available. Adolescents in Uganda have multiple sexual and reproductive health needs that require special focus through adolescent friendly services. This calls for resource support in terms of health provider training, information education and communication materials as well as involvement of key stakeholders that include parents, teachers and legislators.
Hypertension Education Intervention with Ugandan Nurses Working in Hospital Outpatient Clinic: A Pilot Studyby Nicola McHugh
This pilot study demonstrated that nurses’ knowledge, skills, and attitudes could be significantly improved with a multimodal education program implemented in a low resource environment.
Despite the close interrelation between these infections and nutrition conditions, key nutrition interventions for prevention of childhood diarrhea and pneumonia have not received deserved attention, especially in low- and middle-income countries. Several interventions and strategies can effectively address these issues but are not available to those in need. This article discusses in detail the burden and trends of global under-5 mortality, infections, and nutrition conditions; etiology and associated risk factors; biological plausibility and the interrelation between infections, nutrition, and growth; and existing interventions and strategies to reduce major childhood infections and improve nutrition and growth and implications.
The nine-article special issue, titled Newborn Health in Uganda, details results of a community randomized trial, the Uganda Newborn Study (UNEST), which evaluated an integrated care package linking homes, clinics and hospitals and involving visits during pregnancy and the postnatal period at home by a designated member of the village health team. The UNEST results demonstrate that these home visits in pregnancy and soon after delivery were possible to achieve, and that life-saving behaviors could be improved by this interaction. UNEST was influenced by the previously published neonatal survival series in the Lancet which identified cost-effective interventions that could prevent the majority of deaths in the newborn period.
Levels, trends and reasons for unmet need for family planning among married women in Botswana: a cross-sectional studyby Letamo et al
The objectives of this study were to estimate the prevalence of unmet need for family planning among married women using Botswana Family Health Survey 2007 data and to identify risk factors for unmet need for family planning among married women.Findings suggest that the prevalence of unmet need for family planning was low in Botswana compared to other sub-Saharan African countries. The findings from this study reemphasise the importance of women's empowerment and men's involvement in women's sexual and reproductive healthcare needs and services. Different approaches are needed to satisfy the demand for family planning for spacing and limiting.
Links to resources provided by iRIM (the Initiative on Research and Innovation Management) - free online presentations and tutorials relating to how to manage grants and perform administration of clinical research projects effectively.
Supporting adolescent girls to stay in school, reduce child marriage and reduce entry into sex work as HIV risk prevention in north Karnataka, India: protocol for a cluster randomised controlled trialby Beattie et al
Low caste adolescent girls living in rural northern Karnataka are at increased risk of school drop-out, child marriage, and entry into sex-work, which enhances their vulnerability to HIV, early pregnancy and adverse maternal and child health outcomes. This protocol describes the evaluation of Samata, a comprehensive, multi-level intervention designed to address these structural drivers of HIV risk and vulnerability.
Associations between parental BMI, socioeconomic factors, family structure and overweight in Finnish children: a path model approachby Parikka et al
The aim of this study was to assess the less studied interrelationships and pathways between parental BMI, socioeconomic factors, family structure and childhood overweight. The observed pathways between parental BMI and education and childhood overweight emphasize a need for evidence-based health promotion interventions tailored for families identified with parental overweight and low level of education.
Managing clinical trials, of whatever size and complexity, requires efficient trial management. Trials fail because tried and tested systems handed down through apprenticeships have not been documented, evaluated or published to guide new trialists starting out in this important field.
Smoking in pregnancy is known to be associated with a range of adverse pregnancy outcomes, yet there is a high prevalence of smoking among pregnant women in many countries, and it remains a major public health concern. The authors have conducted a systematic review and meta-analysis to provide contemporary estimates of the association between maternal smoking in pregnancy and the risk of stillbirth. The review findings confirm a dose-response effect of maternal smoking in pregnancy on risk of stillbirth. To minimise the risk of stillbirth, reducing current smoking prevalence in pregnancy should continue to be a key public health high priority.
This paper is published in BioMedCentral, with link provided in this article. Building research capacity in health services has been recognised internationally as important in order to produce a sound evidence base for decision-making in policy and practice.
Demonstrating the Efficacy of the FoneAstra Pasteurization Monitor for Human Milk Pasteurization in Resource-Limited Settingsby Mageshree Naicker, Anna Coutsoudis, Kiersten Israel, Rohit Chaudhri, Noah Perin, Koleka Mlisana
Rubella remains an important pathogen worldwide, with roughly 100 000 cases of congenital rubella syndrome estimated to occur every year. This seminar present results regarding rubella control, elimination, and eradication policies, and a brief review of new laboratory diagnostics.
26 studies were reviewed to identify barriers and facilitators for Research Utilisation in nursing practice.
Motor development following in utero exposure to organochlorines: a follow-up study of children aged 5–9 years in Greenland, Ukraine and Polandby Hoyer et al
Study findings suggest that In utero exposure to CB-153 and p,p′-DDE was not associated with parentally retrospectively assessed developmental milestones in infancy or parentally assessed motor skills at young school age. The use of a more sensitive outcome measure may be warranted if subtle effects should be identified.
Incidence and severity of childhood pneumonia in the first year of life in a South African birth cohort: the Drakenstein Child Health Studyby Dr David M le Roux, Landon Myer, Mark Nicol, Heather Zar
Hypertension Education Intervention with Ugandan Nurses Working in Hospital Out Patient Clinic: A Pilot Studyby Godfrey Katende, Sara Groves, Kathleen Becker
Conclusion: After 3 months of implementing the nurses’ hypertension management educative interventions program, knowledge, skills, and attitudes regarding prevention, detection, risk assessment, patient education, and HBP management increased significantly. The pilot study demonstrated the feasibility of implementing a multimodal evidence-based educational intervention in a low resource environment.
Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysisby Liu et al 2015
Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000–13, and cause-specific mortality scenarios to 2030 and 2035. The authors in this study estimated the distributions of causes of child mortality separately for neonates and children aged 1–59 months
100 days, 100% hospital acquired pressure ulcer-free campaign at a Saudi Arabian rehabilitation facilityby Marilou Mendoza, Joanne Jovera, Maricar Agbuya, Tiffany Tan
The success of reducing the incidence of HAPU does not rely merely on nurses checking the skin and turning the patient, but needs an interdisciplinary approach with a positive attitude to prevention by maintaining both the patients' and health care professionals' awareness of cause and prevention.
Smoking doubles the risk of death for people with HIV. Read more here.
The increase in childhood obesity is a serious public health concern. Several studies have indicated that breastfed children have a lower risk of childhood obesity than those who were not breastfed, while other studies have provided conflicting evidence. The objective of this meta-analysis was to investigate the association between breastfeeding and the risk of childhood obesity. Results of our meta-analysis suggest that breastfeeding is a significant protective factor against obesity in children.
Protective efficacy of prolonged co-trimoxazole prophylaxis in HIV-exposed children up to age 4 years for the prevention of malaria in Uganda: a randomised controlled open-label trialby Dr Jaco Homsy
WHO recommends daily co-trimoxazole for children born to HIV-infected mothers from 6 weeks of age until breastfeeding cessation and exclusion of HIV infection. We have previously reported on the effectiveness of continuation of co-trimoxazole prophylaxis up to age 2 years in these children. We assessed the protective efficacy and safety of prolonging co-trimoxazole prophylaxis until age 4 years in HIV-exposed children.
Internet-based systems for epidemiological studies have advantages overtraditional approaches as they can potentially recruit and monitor a wider range of individuals in a relatively inexpensive fashion. We studied the association between communication strategies used for recruitment (offline, online, face-to-face) and follow-up participation in nine Internet-based cohorts: the Influenzanet network of platforms for influenza surveillance which includes seven cohorts in seven different European countries, the Italian birth cohort Ninfea and the New Zealand birth cohortELF. Follow-up participation varied from 43% to 89% depending on the ohort.Although there were heterogeneities among studies, participants who became aware of the study through an online communication campaign compared with those through traditional offline media seemed to have a lower follow-up participation in 8 out of 9 cohorts. There were no clear differences in participation between participants enrolled face-to-face and those enrolled through other offline strategies. An Internet-based campaign for Internet-based epidemiological studies seems to be less effective than an offline one in enrolling volunteers who keepparticipating in follow-up questionnaires. This suggests that even for Internet-based epidemiological studies an offline enrollment campaign would be helpful in order to achieve a higher participation proportion and limit the cohort attrition.
Maternal and perinatal health research priorities beyond 2015: an international survey and prioritization exerciseby Souza JP et al
Maternal mortality has declined by nearly half since 1990, but over a quarter million women still die every year of causes related to pregnancy and childbirth. Maternal-health related targets are falling short of the 2015 Millennium Development Goals and a post-2015 Development Agenda is emerging. In connection with this, setting global research priorities for the next decade is now required. The authors in this paper adapted the methods of the Child Health and Nutrition Research Initiative (CHNRI) to identify and set global research priorities for maternal and perinatal health for the period 2015 to 2025.
A workshop on “Recent Trends and Career Development in Clinical Research –INDIA”, was organized at Bhaskara Auditorium on 19th November 2014 by SAMSKARA, a Non Profit Organization based at Hyderabad and The Global Health Network for the first time in Telangana.
Respiratory tract infections (RTIs) are an important cause of death in children, and often contribute to the terminal decline in children with chronic conditions. RTIs are often underrecorded as the underlying cause of death; therefore the overall contribution of RTIs to child deaths and the potential preventability of RTI-related deaths have not been adequately quantified. The authors in this study conclude that RTI-related deaths have not declined in the last decade among children in England, except in infants. Targeted strategies to prevent the winter excess of RTIs and to treat RTIs in children, particularly children with chronic conditions, may reduce RTI-related deaths.
Hepatitis B vaccination status and Needle-stick and Sharps-related Injuries among medical school students in Nepal: a cross-sectional studyby Suraj Bhattarai, Smriti KC, Pranil MS Pradhan, Sami Lama, Suman Rijal
Background Hepatitis B is a dreadful infectious disease and a major global health problem. Health-care workers including clinical students are more vulnerable to such infections and non-sterile occupational exposures as their daily activities are closely related to patient's blood and body fluids.
Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Databaseby Kozhimannil et al
The authors in this study used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Findings suggest that variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses.
Professor Peter Piot, LSHTM, talks about Ebola and implications for Africa and understanding future epidemics at the Martin School, University of Oxford, 16th October 2014.
Treatment of Infections in Young Infants in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Accessby Lee ACC et al
Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (<2 months) in low- and middle-income countries (LMICs). This study aimed to address three questions regarding access to treatment for young infant infections in LMICs: (1) Can frontline health workers accurately diagnose possible bacterial infection (pBI)?; (2) How available and affordable are antibiotics?; (3) How often are antibiotics procured without a prescription?
Ebola PPE guidelines - urgent need to revise WHO and CDC guidelines. This video shows an excerpt from keynote address 'The fuss about face masks', Professor Raina MacIntyre from the School of Public Health and Community Medicine, UNSW Australia.
Collaborative nursing research across academic and practice settings is imperative to generate knowledge to improve patient care. Models of academic/practice partnerships for nursing research are lacking. This paper reports data collected before and during a one-day retreat for nurse researchers and administrators from local universities and health care organizations designed to establish a regional nursing research partnership. Read the article here.
Intermittent Preventive Treatment of Malaria in Pregnancy with Mefloquine in HIV-Negative Women: A Multicentre Randomized Controlled Trialby González et al
Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended by WHO to prevent malaria in African pregnant women. The spread of SP parasite resistance has raised concerns regarding long-term use for IPT. Mefloquine (MQ) is the most promising of available alternatives to SP based on safety profile, long half-life, and high efficacy in Africa. This study evaluated the safety and efficacy of MQ for IPTp compared to those of SP in HIV-negative women. Women taking MQ IPTp (15 mg/kg) in the context of long lasting insecticide treated nets had similar prevalence rates of low birth weight as those taking SP IPTp. MQ recipients had less clinical malaria than SP recipients, and the pregnancy outcomes and safety profile were similar. MQ had poorer tolerability even when splitting the dose over two days. These results do not support a change in the current IPTp policy.
Breastfeeding Progression in Preterm Infants Is Influenced by Factors in Infants, Mothers and Clinical Practice: The Results of a National Cohort Study with High Breastfeeding Initiation Ratesby Maastrup et al
Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim of this study was to analyse postmenstrual age at breastfeeding milestones in different preterm gestational age groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. The study concludes that breastfeeding competence is not developed at a fixed postmenstrual age, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding.
This series of five papers assesses and summarizes information from relevant systematic reviews on the impact of various approaches to improve the quality of care for women and newborns.
Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Healthby Vogel JP et al
Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. The authors in thsi study analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice.
Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trialby Priest P et al
The potential for transmission of infectious diseases offered by the school environment are likely to be an important contributor to the rates of infectious disease experienced by children. This study aimed to test whether the addition of hand sanitiser in primary school classrooms compared with usual hand hygiene would reduce illness absences in primary school children in New Zealand. The authors found that the provision of hand sanitiser in addition to usual hand hygiene in primary schools in New Zealand did not prevent disease of severity sufficient to cause school absence.
Incidence of Road Traffic Injury and Associated Factors among Patients Visiting the Emergency Department of Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopiaby Bewket Tadesse Tiruneh, Berihun Assefa Dachew, Berhanu Boru Bifftu
Breastfeeding practice and associated factors among female nurses and midwives at North Gondar Zone, Northwest Ethiopia. A Cross sectional institution based study.by Berihun Assefa Dachew, Behanu Boru Bifftu
Worldwide, 250,000–280,000 women die during pregnancy and childbirth every year and an estimated 6.55 million children die under the age of five. The majority of maternal deaths occur during or immediately after childbirth, while 43% of child death occurs during the first 28 days of life. However, the progress in limiting these has been slow and sporadic. In this supplement of five papers, teh authors aim to systematically assess and summarize essential interventions for reproductive, maternal, newborn and child health from relevant systematic reviews.
Developing a Culture to Facilitate Research Capacity Building for Clinical Nurse Consultants in Generalist Paediatric Practiceby Lesley Wilkes, Joanne Cummings, Nicola McKay
The Ebola virus epidemic may well spread out of Africa. Dr Greg Martin takes a look at some of the variables that contribute to this risk and discusses some steps that should be taken.
On the 8th of July 2014 The Global Health Network launched the Global Health Research Process Map, the first digital toolkit designed to enable researchers anywhere in the world to conduct rigorous global health research.
Seven principles for strengthening research capacity in low- and middle-income countries: simple ideas in a complex worldby ESSENCE on Health Research Initiative
This good practice document of the ESSENCE on Health Research initiative is designed to provide broad guidance on how best to strengthen research capacity with the maximum possible benefit.
Intrauterine growth restriction (IUGR) is responsible for the higher rates of fetal, perinatal, and neonatal morbidity and mortality. This review details the IUGR risk factors, its short and long-term sequel, themechanism underlying the long-term consequences, and the strategies to tackle IUGR burden.
A retrospective study of the health profile of neonates of mothers with anemia in pregnancy and pregnancy induced hypertension in Lagos, Nigeriaby Olusola Funmilayo Sotunde, Silifat Ajoke Sanni, Oluseye Olusegun Onabanjo, Ibiyemi O. Olayiwola, Mure Agbonlahor
AuthorAid is a great online tool whose aim is to support developing country researchers in publishing their work.
Comparison of Nurses' and Families' Perception of Family Needs in Critical Care Unit at Referral Hospitals in Malawi.by Rodwell Gundo, Feggie Bodole, Edoly Lengu, Alfred Maluwa
Maternal Overweight and Obesity and Risks of Severe Birth-Asphyxia-Related Complications in Term Infants: A Population-Based Cohort Study in Swedenby Jai K Das
Maternal overweight and obesity increase risks of pregnancy and delivery complications and neonatal mortality, but the mechanisms are unclear. The objective of this study was to investigate associations between maternal body mass index (BMI) in early pregnancy and severe asphyxia-related outcomes in infants delivered at term (≥37 weeks).
Methods for Specifying the Target Difference in a Randomised Controlled Trial: The Difference ELicitation in TriAls (DELTA) Systematic Reviewby Jai K Das
Randomised controlled trials (RCTs) are widely accepted as the preferred study design for evaluating healthcare interventions. When the sample size is determined, a (target) difference is typically specified that the RCT is designed to detect. This provides reassurance that the study will be informative, i.e., should such a difference exist, it is likely to be detected with the required statistical precision. The aim of this review was to identify potential methods for specifying the target difference in an RCT sample size calculation.
Food fortification is safe and cost-effective in the prevention of micronutrient deficiencies and has been widely practiced in developed countries for well over a century. The findings in this report clearly support the utilization of food fortification strategies at scale, which could build on the recent success of the iodized salt programme. Given the widespread prevalence in Pakistan of deficiencies in iron and in vitamins A and D, food fortification strategies offer a tangible option for delivering these micronutrients on a large scale.
Effects of postnatal interventions for the reduction of vertical HIV transmission on infant growth and non-HIV infections: a systematic reviewby Moleen Zunza, Gareth D Mercer, Lehana Thabane, Monika Esser, Mark F Cotton
Rates and determinants of seasonal influenza vaccination in pregnancy and association with neonatal outcomesby Jai K Das
There is growing evidence that seasonal influenza vaccination in pregnancy has benefits for mother and baby. The authors in this paper determined influenza vaccination rates among pregnant women during the 2 nonpandemic influenza seasons following the 2009 H1N1 pandemic, explored maternal factors as predictors of influenza vaccination status and evaluated the association between maternal influenza vaccination and neonatal outcomes. This study and others have shown an association between maternal influenza vaccination and improved neonatal outcomes, which supports stronger initiatives to promote vaccination during pregnancy.
Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trialby Jai K Das
Delayed cord clamping allows for the passage of blood from the placenta to the baby and reduces the risk of iron deficiency in infancy. To hold the infant for more than 1 min at the level of the vagina (as is presently recommended), on the assumption that gravity affects the volume of placental transfusion, is cumbersome, might result in low compliance, and interferes with immediate contact of the infant with the mother. This study aimed to assess whether gravity affects the volume of placental transfusion.
Musculo-skeletal disorder risk factors among nurses in low resource settings: a cross sectional case study in Ugandaby Ian Munabi, William Buwembo, David L Kitara, Joseph Ochieng, Erisa S Mwaka
This article explains how to write a cover letter for a research job, tailored for each job and to maximise your chances of securing an interview. Examples and templates are given.
This article describes how to seek research jobs which will suiit you, and how to work out from the job description the best ways to apply and secure an interview.
This article gives practical advice about how to create an excellent research CV, and has links to many templates and advice articles from around the world, as well as information about how to use the Professional Membership Scheme to create a free, formatted GCP-standard CV for you which can be used for site files and job applications.
Factors associated with non-utilization of child immunization in Pakistan: evidence from the Demographic and Health Survey 2006-07by Jai K Das
The proportion of incompletely immunized children in Pakistan varies from 37-58%, and this has recently resulted in outbreaks of measles and polio. The aim of this paper is to determine the factors associated with incomplete immunization among children aged 12-23 months in Pakistan.
Can food vouchers improve nutrition and reduce health inequalities in low-income mothers and young children: a multi-method evaluationby Jai K Das
Good nutrition is important during pregnancy, breastfeeding and early life to optimise the health of women and children. It is difficult for low-income families to prioritise spending on healthy food. Healthy Start is a targeted United Kingdom (UK) food subsidy programme that gives vouchers for fruit, vegetables, milk, and vitamins to low-income families. This paper reports an evaluation of Healthy Start from the perspectives of women and health practitioners.
The latest report by 'Save the Children' highlights that the world has made remarkable progress in the fight to end child mortality in recent years. Since 1990, we have almost halved the number of children who die every year before the age of five – from 12.6 million to 6.6 million. And yet, in spite of this progress, child mortality remains one of the great shames of our modern world. Every day, 18,000 children under five die, and most from preventable causes. See the attach report to discover how 2 million newborn babies who could be saved each year if we end preventable newborn mortality.
Accumulating evidence implicates early life factors in the aetiology of non-communicable diseases, including asthma/wheezing disorders. We undertook a systematic review investigating risks of asthma/wheezing disorders in children born preterm, including the increasing numbers who, as a result of advances in neonatal care, now survive very preterm birth.
In 2013, the WHO released a new set of guidelines on the prevention of mother to child transmission (PMTCT) of HIV/AIDS. The new guidelines suggests that all pregnant women who test positive for HIV should immediately begin a course of triple ARVs, regardless of CD4 cell levels.
Perceived family support regarding condom use and condom use among secondary school female students in Limbe urban city of Cameroonby Jai K Das
In this cross sectional survey it is hypothesized that adolescents' perceptions of family support for condom use, would encourage condom use among female students in Limbe urban city of Cameroon.
The current difficulties in keeping systematic reviews up to date leads to considerable inaccuracy, hampering the translation of knowledge into action. Incremental advances in conventional review updating are unlikely to lead to substantial improvements in review currency. A new approach is needed. The authors propose living systematic review as a contribution to evidence synthesis that combines currency with rigour to enhance the accuracy and utility of health evidence.
Planning, Monitoring and Evaluation Framework for Capacity Strengthening in Health Research - ESSENCE Good Practiceby ESSENCE on Health Research Initiative
The ESSENCE on Health Research initiative has created a good practice document on Planning, Monitoring and Evaluation Framework for Capacity Strengthening in Health Research.
A Risk Prediction Model for the Assessment and Triage of Women with Hypertensive Disorders of Pregnancy in Low-Resourced Settings: The miniPIERS Multi-country Prospective Cohort Studyby Jai K Das
Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). The authors developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.
Moleen Zunza is a member of the Global Research Nurses' network and is part of the team that has published this systematic review.
Dissemination and Implementation Research: Intersection between Nursing Science and Health Care Deliveryby Vincent D
The editorial in Nursing Research and Practice discusses facilitators and barriers to knowledge and implementation of research findings in nursing.
Managing health worker migration: a qualitative study of the Philippine response to nurse brain drainby Roland M Dimaya, Mary M McEwan, Leslie A Currie, Elizabeth H Bradley
A qualitative study investigating causes and effects of nurse migration in the Philippines.
ESSENCE on Health Research have created a good practice document on research costing. It includes a review of the funding practices related to the definition and funding of direct and indirect costs.
This guide, developed by the WHO and released in December 2013, aims to facilitate implementation research in LMICs.
Black ethnic groups have a higher breast cancer mortality than Whites. American studies have identified variations in tumour biology and unequal health-care access as causative factors. This study compared tumour pathology, treatment and outcomes in three ethnic groups in young breast cancer patients treated in the United Kingdom and concluded that despite equal access to health care, young Black women in the United Kingdom have a significantly poorer outcome than White patients. Black ethnicity is an independent risk factor for reduced DRFS particularly in ER-positive patients.
E-health has become a burgeoning field in which health professionals and health consumers create and seek information. E-health refers to internet-based health care and information delivery and seeks to improve health service locally, regionally and worldwide. E-sexual health presents new opportunities to provide online sexual health services irrespective of gender, age, sexual orientation and location. This paper used the dimensions of the RE-AIM model (reach, efficacy, adoption, implementation and maintenance) as a guiding principle to discuss potentials of E-health in providing and accessing sexual health services.
This report and brief is based on the study 'The Political Economy of Under-Nutrition in Pakistan'. The authors highlight challenges faced for mainstreaming nutrition as an inter-sectoral development priority and provide strategic recommendations using Acosta and Fanzo’s nutrition governance framework.
The recent BMC Public Health supplement “The Lives Saved Tool in 2013: new capabilities and applications” has been published. The series comprise of 30 papers focusing on various domains of maternal child health with a special focus on the interventions reviewed for the prevention and management of childhood diarrhea and penumonia.
This systematic review of the current evidence assessed the effectiveness of food fortification with single micronutrients (iron, folic acid, vitamin A, vitamin D, iodine, zinc) as well as MMN when compared with no fortification on the health and nutrition of women and children.
A qualitative study exploring factors associated with mothers’ decisions to formula-feed their infants in Newfoundland and Labrador, Canadaby Jai K Das
The primary aim of this qualitative study was to examine individual factors that shaped mothers’ decisions to formula-feed their infants.
Opportunities for Africa's newborns: Practical data, policy and programmatic support for newborn care in Africaby Jai K Das
Each year at least 1.16 million newborns die in Sub-Saharan Africa. The African region has the highest rates of neonatal mortality in the world, and has shown the slowest progress so far in reducing neonatal deaths. However there is hope. Under the umbrella of the Partnership for Maternal, Newborn and Child Health (PMNCH), 9 organizations, 60 authors and over 40 reviewers, drawn from policymakers and programme leaders for MNCH in Africa, have been involved and contributed to this publication. The book provides an overview of the continuum of care through the lifecycle and opportunities to address gaps at all levels - family and community care, outreach services and health care facilities.
Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trialby Jai K Das
Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. This study hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam.
Risk of Early-Onset Neonatal Infection with Maternal Infection or Colonization: A Global Systematic Review and Meta-Analysisby Jai K Das
Neonatal infections cause a significant proportion of deaths in the first week of life, yet little is known about risk factors and pathways of transmission for early-onset neonatal sepsis globally. This review aimed to estimate the risk of neonatal infection (excluding sexually transmitted diseases [STDs] or congenital infections) in the first seven days of life among newborns of mothers with bacterial infection or colonization during the intrapartum period.
Effect of Household-Based Drinking Water Chlorination on Diarrhoea among Children under Five in Orissa, India: A Double-Blind Randomised Placebo-Controlled Trialby Jai K Das
Boiling, disinfecting, and filtering water within the home can improve the microbiological quality of drinking water among the hundreds of millions of people who rely on unsafe water supplies. However, the impact of these interventions on diarrhoea is unclear. The aim of this study was to measure the effect of in-home water disinfection on diarrhoea among children under five.
India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010); and adolescent (aged 15–19) mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG)–5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15–19) in India during 1990–2006.
The authors propose four arguments for why cervical cancer screening and treatment should be included when it comes to operationalizing these two goals and thus to improving reproductive and maternal health outcomes. Each of the four arguments is illustrative of a larger framework that has equity and socioeconomic, gender, public health, and health services dimensions.
Factors Affecting the Delivery, Access, and Use of Interventions to Prevent Malaria in Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysisby Jai K Das
Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization–recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. This systematic review explores factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women
Recent research has established linkages of preconception interventions with improved maternal, perinatal and neonatal health outcomes and it has been suggested that several proven interventions recommended during pregnancy may be even more effective if implemented before conception. The authors in this report have collated and synthesized relevant information on interventions available during the preconception period by using standard methods.
Risk Prediction for Breast, Endometrial, and Ovarian Cancer in White Women Aged 50 y or Older: Derivation and Validation from Population-Based Cohort Studiesby Jai K Das
Breast, endometrial, and ovarian cancers share some hormonal and epidemiologic risk factors. While several models predict absolute risk of breast cancer, there are few models for ovarian cancer in the general population, and none for endometrial cancer. Using data on white, non-Hispanic women aged 50+ y from two large population-based cohorts, the authors estimated relative and attributable risks and combined them with age-specific US-population incidence and competing mortality rates.
Presentations from D Groups
The Effect of Intermittent Antenatal Iron Supplementation on Maternal and Infant Outcomes in Rural Viet Nam: A Cluster Randomised Trialby Jai K Das
Intermittent antenatal iron supplementation is an attractive alternative to daily dosing; however, the impact of this strategy on infant outcomes remains unclear. This study compared the effect of intermittent antenatal iron supplementation with daily iron supplementation on maternal and infant outcomes in rural Viet Nam.
The World Health Organization’s recommendations on optimizing the roles of health workers aim to help address critical health workforce shortages that slow down progress towards the health-related Millennium Development Goals. These recommendations are intended for health policy-makers, managers and other stakeholders at a regional, national and international level.
This study suggests that to achieve a substantial reduction in maternal mortality, a comprehensive approach to emergency care, and overall improvements in the quality of maternal health care will be needed.
Changes in Association between Previous Therapeutic Abortion and Preterm Birth in Scotland, 1980 to 2008: A Historical Cohort Studyby Jai K Das
The authors in this study hypothesized that the association between previous abortion and the risk of preterm first birth changed in Scotland between 1 January 1980 and 31 December 2008.
Health data include many gaps, particularly relating to poorer areas of the world, so complex estimation techniques are needed to get overall global pictures. Estimates of population health, however, carry their own uncertainties and may be flawed in some instances. Here we present a range of reflections on the Global Burden of Disease 2010 estimates, highlighting their strengths as well as challenges for potential users. In the long term, there can be no substitute for properly counting and accounting for all the world's citizens, so that complex estimation techniques are not needed.
In 2010 Pakistan experienced the worst floods recorded in its history; millions of people were affected and thousands lost their lives. Nutrition assessment surveys led by UNICEF were conducted in flood-affected areas of Punjab and Sindh provinces to assess the nutrition status of children between 6–59 months while Aga Khan University (AKU) undertook a parallel assessment including micronutrient status in their project areas within Balochistan, Sindh and Punjab.
Little is known about factors contributing to inequities in antenatal care use in Ethiopia. This study aimed to assess inequities in the use of antenatal care on the basis of area of residence, administrative region, economic status and education.
The Lancet publishes a special themed issue to coincide with the third Women Deliver conference in Kuala Lumpur, Malaysia on May 28–30, 2013. Women Deliver brings together voices from around the world to generate political commitment and resource investments to improve the health and well-being of girls and women and achieve universal access to reproductive health. The studies published in The Lancet's themed issue use different methods to show the multidimensional nature of reproductive health and the influence of social determinants and health systems.
Pedagogy is a US provider of Continuing Education for Nurses. They have produced posters that can be downloaded, showing recent guidlines in the management of Intra Venous therapy.
Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatmentby Jai K Das
Pneumonia remains a major cause of child death globally, and improving antibiotic treatment rates is a key control strategy. The third paper in the PLOS series of 'Measuring Coverage in MNCH', the authors show that the performance of survey tools could be improved by increasing the survey recall period or by improving either overall discriminative power or specificity.
The PLOS Medicine “Measuring Coverage in MNCH” Collection of research studies and reviews presents systematic assessments of the validity of health intervention coverage measurement based on household surveys, the primary method for estimating population-level intervention coverage in low- and middle-income countries. This is the second paper of the collection. It focuses on the development of the indicators and standard measurement tools that are needed to measure coverage of key newborn interventions.
The PLOS Medicine “Measuring Coverage in MNCH” Collection of research studies and reviews presents systematic assessments of the validity of health intervention coverage measurement based on household surveys, the primary method for estimating population-level intervention coverage in low- and middle-income countries. This is the first paper of the collection
Over the last decade, a number of influential organisations have called for the integration of mental, neurological and substance use (MNS) disorders into large scale public health programmes. Although progress at the implementation level has been slow, the development of a number of evidence-based, potentially scalable interventions in the MNS field provides new impetus to develop strategies for integration with broader programmes. Integrating maternal mental health care will help advance maternal and child health (MCH) status.
Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysisby Jai K Das
In 2006, Brazil began routine immunization of infants <15 wk of age with a single-strain rotavirus vaccine. The authors in this paper evaluated whether the rotavirus vaccination program was associated with declines in childhood diarrhea deaths and hospital admissions by monitoring disease trends before and after vaccine introduction in all five regions of Brazil with varying disease burden and distinct socioeconomic and health indicators.
Women with preeclampsia (PEC) and gestational hypertension (GH) exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance. The authors in this paper aim to determine whether women with PEC or GH during pregnancy have an increased risk of developing diabetes after pregnancy, and whether the presence of PEC/GH in addition to gestational diabetes (GDM) increases the risk of future (postpartum) diabetes.
An account of 3 skills sharing workshops in South India.
The Lancet Series on Childhood Pneumonia and Diarrhoea, led by Aga Khan University, Pakistan, provides evidence for integrated control efforts for childhood pneumonia and diarrhoea.The series of four papers assesses the global burden of these two illnesses and identifies a set of highly cost-effective interventions that can prevent most diarrhoea deaths and nearly two thirds of pneumonia deaths by 2025, if delivered at scale. It also highlights the findings from consultations with several hundred frontline workers in high-burden countries and explores the barriers and enablers they face in dealing with these two diseases and potential ways forward. The final paper represents a call to action and discusses the global and country-level remedies needed to eliminate preventable deaths from these illnesses by 2025.
Despite published guidance on writing the abstract in the PRISMA Statement guiding the reporting of systematic reviews in general and elsewhere, evaluations show that reporting of systematic reviews in journal and conference abstracts is poor. Teh authors developed consensus-based reporting guidelines as an extension to the PRISMA Statement on good reporting of systematic reviews and meta-analyses in abstracts.
Young Children's Probability of Dying Before and After Their Mother's Death: A Rural South African Population-Based Surveillance Studyby Jai K Das
There is evidence that a young child's risk of dying increases following the mother's death, but little is known about the risk when the mother becomes very ill prior to her death. We hypothesized that children would be more likely to die during the period several months before their mother's death, as well as for several months after her death. Therefore the authors in this paper investigated the relationship between young children's likelihood of dying and the timing of their mother's death and, in particular, the existence of a critical period of increased risk.
In this article, the authors illustrate five basic statistical concepts that can significantly impact the interpretation of the medical literature and its application to the care of patients, drawing examples from the vaccine literature: (i) consider clinical and statistical significance separately, (ii) evaluate absolute risks rather than relative risks, (iii) examine confidence intervals rather than p values, (iv) use caution when considering isolated significant p values in the setting of multiple testing, and (v) keep in mind that statistically nonsignificant results may not exclude clinically important benefits or harms.
There have been significant improvements in the performance of the Expanded Programme on Immunization (EPI) in Africa since its inception in 1974. However, there exist wide inter- and intra-country differences.
Vitamin D insufficiency together with high serum levels of vitamin A increases the risk for osteoporosis in postmenopausal womenby Jai K Das
This is a cross-sectional study to evaluate the association between vitamin D deficiency/insufficiency and excess of vitamin A intake as an osteoporosis risk factor in healthy postmenopausal women.
Vitamin K Supplementation in Postmenopausal Women with Osteopenia (ECKO Trial): A Randomized Controlled Trialby Jai K Das
Vitamin K has been widely promoted as a supplement for decreasing bone loss in postmenopausal women, but the long-term benefits and potential harms are unknown. This study was conducted to determine whether daily high-dose vitamin K1 supplementation safely reduces bone loss, bone turnover, and fractures.
It is estimated that 41.8% of pregnant women worldwide are anaemic. Approximately 60% of these cases in non-malarious areas, and 50% in malaria-endemic settings, are assumed to be due to iron deficiency. We share the WHO guideline providing global, evidence-informed recommendations on the use of multiple micronutrient powders for home fortification of foods consumed by pregnant women.
Critical issues in conducting non-commercially sponsored clinical research in South Africa: Meeting report 1st Feb 2013by Elizabeth Allen - Regional Faculty Lead, Lesley Workman - Senior Contributor, Cordelia Reddy
On 1st February 2013, Global Health Trials Southern African Regional Faculy held the first of its Clinical Trials Skills-Sharing Workshops in South Africa, hosted by the University of Cape Town. Here you can find the presentations from the day.
Helminth infections impose a great burden on poor populations in the developing world – yet robust, low-cost and effective public health interventions are available to relieve that burden and provide a better quality of life for people in poor settings. We share the WHO Guidleines for the Preventive chemotherapy in human helminthiasis.
Report on a one-day skills sharing workshop for improved clinical trials and research in East Africa, hosted by UVRI/MRC, EACCR and Global Health Trials and held on 15th February 2013.
In response to the unacceptable maternal health situation, WHO has developed the Pilot Edition of the Safe Childbirth Checklist, to support the delivery of essential maternal and perinatal care practices. The WHO Safe Childbirth Checklist contains 29 items addressing the major causes of maternal death (namely, haemorrhage, infection, obstructed labour and hypertensive disorders), intrapartum-related stillbirths (namely, inadequate intrapartum care), and neonatal deaths (namely birth asphyxia, infection and complications related to prematurity) in low-income countries. It was developed following a rigorous methodology and tested for usability in ten countries across Africa and Asia. Please have a look at the below link:
Translating Coverage Gains into Health Gains for All Women and Children: The Quality Care Opportunityby Jai K Das
The health outcomes of women and children have not matched expectations from the gains in the coverage of care. Robust evidence exists for one explanatory factor: the poor–rich gaps in coverage found along the continuum of care for women and children, and particularly for the crucial period around childbirth. The more-neglected explanation for the mismatch between coverage and health outcomes is the quality of the care provided to women and children. The following paper is structured around a key cause and a consequence of the neglect of quality—weak measurement and poor evidence for action—and concludes with priorities for seizing the quality care opportunity.
These guidelines help address the urgent need to develop tests that can work in children, ideally using non-sputum based samples. It is vital that these reference standards are endorsed and implemented by the major donors, researchers and diagnostic developers.
Women of reproductive age are at increased risk of anaemia because of chronic iron depletion during the menstrual cycle. It is estimated that worldwide there are 469 million anaemic women of reproductive age. At least half of the cases are attributed to iron deficiency. We share the WHO guidleines for Intermittent iron and folic acid supplementation in menstruating women.
Maternal, newborn, and child health indices in Nigeria vary widely across geopolitical zones and between urban and rural areas, mostly due to variations in the availability of skilled attendance at birth. To improve these indices, the Midwives Service Scheme (MSS) in Nigeria engaged newly graduated, unemployed, and retired midwives to work temporarily in rural areas. This paper describes the structure, processes, challanges and the outcomes acheived through MSS.
Severe acute malnutrition remains a major killer of children under five years of age. Until recently, treatment has been restricted to facility-based approaches, greatly limiting its coverage and impact. New evidence suggests, however, that large numbers of children with severe acute malnutrition can be treated in their communities without being admitted to a health facility or a therapeutic feeding centre. We share the guidleines of for the management of children with SAM
Use of multiple micronutrient powders for home fortification of foods consumed by infants and children 6–23 months of age-The Guidelinesby Jai K Das
Comprehensive Approach to Improving Maternal Health and Achieving MDG 5: Report from the Mountains of Lesothoby Jai K Das
The emerging consensus is that improvement in women's health cannot be made through simple, vertical strategies; rather, it requires broad-based health system strengthening at every level of care, from the community to the clinic to the hospital. This paper reports experience in rural Lesotho, where a pilot program was implemented that provided comprehensive care of pregnant women from the community to the health center level, linking key primary care services (include HIV testing and treatment) to antenatal care (ANC) and facility-based delivery.
Post Partum Haemorrhage (PPH) is generally defined as blood loss greater than or equal to 500 ml within 24 hours after birth, while severe PPH is blood loss greater than or equal to 1000 ml within 24 hours. PPH is the most common cause of maternal death worldwide. We share the WHO guidelines for the mangement of PPH. It recommends that active management at the third stage of labour should include: (i) administration of a uterotonic soon after the birth of the baby; (ii) clamping of the cord following the observation of uterine contraction (at around 3 minutes); and (iii) delivery of the placenta by controlled cord traction, followed by uterine massage.
We share the WHO 2009 guideline that provides a framework for integrating nutrition support into the routine care of HIV-infected children (6 months-14 years). HIV-infected children deserve special attention because of their additional needs to ensure growth and development and their dependency on adults for adequate care including nutrition care and support for treatment. Vertical implementation of HIV programmes, such as PMTCT and ART, have resulted in missed opportunities to gain synergy with other existing services.
Contraception matters: Indicators of poor usage of contraception in sexually active women attending family planning clinics in Victoria, Australiaby Jai K Das
Unintended pregnancy remains an important health issue for women. This cross sectional survey recruited women from family planning clinics to determine the prevalence of and factors associated with risk of unintended pregnancy in Victoria, Australia.
Comparing HIV prevalence estimates from prevention of mother-to-child HIV transmission programme and the antenatal HIV surveillance in Addis Abababy Jai K Das
Currently multiple vertical and integrated programs are running concurrently to provide estimates for HIV prevalances in epidemic areas. These programs require careful evaluations and comparisons.This study was conducted in Addis Ababa to compare HIV prevalence estimates from routine PMTCT programme and antenatal surveillance with the aim to come up with evidence based recommendation.
Repository on maternal child health: Health portal to improve access to information on maternal child health in Indiaby Jai K Das
This article describes a health portal developed in India aimed at providing one-stop access to efficiently search, organize and share maternal child health information relevant from public health perspective in the country.
Half the developing world population lack access to flush toilets and other forms of improved sanitation; 1.1 billion people defecate in the open. An estimated 750 million people still live without improved water sources. There are serious adverse health consequences of poor access to water, sanitation and hygiene (WASH), particularly in children, including diarrhoea, respiratory illness, trachoma, and death. Access to safe drinking-water is essential to health, a basic human right and a component of effective policy for health protection. We share the guidelines for Drinking water quality and water safety manual.
Previously we have shared the guidelines pertaining to the early initiation and continuation of breast feeding and complementary feeding for newborns and infants. However there are concerns regarding breast feeding for women living with HIV. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This evidence has major implications for how women living with HIV might feed their infants, and how health workers should counsel these mothers. In light of this, the World Health Organization (WHO) commenced a guideline development process, culminating in a Guideline Development Group meeting in Geneva on 22–23 October 2009. We share here the revised guidelines by WHO for principles and recommendations for infant feeding inthe context of HIV.
Kangaroo mother care to reduce morbidity and mortality and improve growth in low birth weight infants-The Guidelinesby Jai K Das
For many small preterm infants, receiving prolonged medical care is important. However, kangaroo mother care (KMC) is an effective way to meet baby’s needs for warmth, breastfeeding, protection from infection, stimulation, safety and love. Kangaroo mother care is care of preterm infants carried skin-to-skin with the mother. It is a powerful, easy-to-use method to promote the health and well-being of infants born preterm as well as full-term. We share the WHO guidleines regarding KMC.
Low birth weight (LBW) has been defined by the World Health Organization (WHO) as weight at birthless than 2500 g. LBW infants are at higher risk of early growth retardation, infectious disease, developmental delay and death during infancy and childhood. Experience from developed and low- and middle-income countries has clearly shown that appropriate care of LBW infants, including feeding, temperature maintenance, hygienic cord and skin care, and early detection and treatment of complications, can substantially reduce mortality in this highly vulnerable group. Interventions to improve feeding are likely to improve the immediate and longerterm health and well-being of the individual infant and have a significant impact on neonatal and infant mortality levels in the population. We share the WHO guidelines for feeeding in LBW infants.
About one third of deaths in children under 5 years of age are due to underlying undernutrition, which includes stunting, severe wasting, deficiencies of vitamin A and zinc, and suboptimum breastfeeding. Childhood malnutrition is prevalent in low and middle income countries (LMICs). According to an estimate, 19.4% of children <5 years of age in these countries are underweight (weight-for-age Z score <-2) and about 29.9% are stunted in the year 2011 (height-for-age Z score <-2). The prevalence of both underweight and stunting was highest in Africa and South-Central Asia and stunting and wasting along with intrauterine growth restriction (IUGR) are responsible for about 2.1 million deaths worldwide in children <5 years of age. It is well recognized that the period of 6-24 months of age is one of the most critical time periods in the growth of the infant. The incidence of stunting is the highest in this period as children have high demand for nutrients and there are limitations in the quality and quantity of available foods, especially after exclusive breastfeeding.
Whether breast cancer screening does more harm than good has been debated extensively. The main questions are how large the benefit of screening is in terms of reduced breast cancer mortality and how substantial the harm is in terms of overdiagnosis, which is defined as cancers detected at screening that would not have otherwise become clinically apparent in the woman's lifetime.
Research reporting guidelines are standard statements that provide guidance on how to report research methodology and findings. These are in the form of checklists, flow diagrams or texts. Most of the biomedical journals require authors to comply with these guidelines. Guidelines are available for reporting various study designs:
- CONSORT Statement (reporting of randomized controlled trials)
- STARD (reporting of diagnostic accuracy studies)
- STROBE (reporting of observational studies in epidemiology)
- PRISMA (reporting of systematic reviews)
- MOOSE (reporting of meta-analyses of observational studies)
This article is an introduction to cluster randomised trials.
One fundamental ethical principle underpinning research ethics is that of respect for persons. It requires that researchers respect research participants’ autonomy, interests, and wishes, and act on the presumption that participants are the best judges of what their interests are (Nuffield Council on Bioethics 2002). This presumption obliges us to design consent processes for research that facilitate prospective participants’ free and informed decisions as to whether or not to participate in a study.
This editorial describes the work of the WOMAN trial about post partum bleeding, and invites the participation of obstetricians, midwives and nurses from around the world to join an international collaborative effort to identify safe and effective treatments for post partum haemorrhage.
We present this clinical trial as a gold standard example. This study addressed a key question in the management of severely ill children. It was conducted to a very high standard across 3 African countries. This article links to a short film that explains how this trial can be an example to all researchers in resource-limited settings and shows that research can and should be done.
A set of 4 consent templates for clinical trials, interview studies, observation studies and sampling only studies.
This article was written by a researcher from Sri Lanka and presents a very helpful overview on Biomedical Ethics. This article will be helpful to all levels of research staff and others who might want an accessible overview
Considerations for pharmacovigilance and safety reporting.
What is the definition of a clinical trial? Is there an international consensus? Read on to find out.
Community sensitisation is a fundamental aspect of clinical trial operations anywhere in the world but is of particular relevance in the developing world. Share your experiences with other developing country researchers.