Newborn Health and Birth Outcomes

Setting Research Priorities for

2013-2025
Sachiyo Yoshida WHO Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland WHO, Saving the Newborn Lives, Save the Children, US and UNICEF

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TITLE fromNewborn VIEW and SLIDE MASTER | April 17, 2013 Global Conference, South Africa, April 2013

Why we are setting research priorities?

Proposal for health research funding exceeds available resources

Funding does not always correspond to the disease burden Donor's attention on newborn health has increased, but not commensurate with 3 million newborn deaths (43% share of U5MR)
There is a need to guide the limited research capacity and funding to get maximum impact on maternal, newborn and child health
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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Successful examples of setting research priorities

WHO coordinated a set of 5 prioritization exercises for the major causes of U5 mortality in 2008 using CHNRI methods There is an encouraging association with action after the previous exercise; more investment, more scientific papers published, and more RFPs in the priority areas Expanded mandate of the Department; need to articulate the research agenda beyond 2015 on survival, growth and development

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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Our scope for research priorities

Motivation Improving newborn health and birth outcomes for the next 10 years beyond the MDG Domains new interventions (discovery), improved interventions (development), delivery of existing interventions (delivery) Population Newborns (and stillbirths) Focus Improving survival and health, and growth and development Time frame 2013-2025 Audience Governments, researchers in low and middleincome countries, and international donors
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| April TITLE fromNewborn VIEW and SLIDE MASTER 17, 2013 Global Health Conference, Conference, South Africa, South April Africa, 2013 April 2013

CHNRI methodology
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Working group established

Top researchers and programme experts identified

600 experts identified and contacted 132 responded

Expert group meeting held 205 research questions finalized 15 first scores received

Context and prioritization criteria defined

390 research questions generated

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Finalization Dissemination of results Priority list finalized Research Priority Score synthesized

Scoring by the extended experts

All experts contacted

77 additional scores received

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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Characteristics of the 132 experts who contributed research questions

Background of respondents*
100% 90% 80% 70% 60% 50% 40%

Institution/organization of respondents*

*multiple choices allowed

60% research 40% programme

30%
20% 10% 0%
Researcher Health professional Programme manager Donor Policy maker representative

Academic or research institution

NGO

International organisation

Donor organisation

Consultant

Geographical distribution of the respondents

50% based in LMIC in Africa, Asia and South America

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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Characteristics of the 92 experts who scored the final list of research questions
Background of scores
100% 90% 80% 70% 60% 50%

Institution/organization of scores

2/3 research 1/3 programme

40%
30% 20% 10% 0% Researcher Program manager Health Policy maker Donor professional representative
Academic or research institution NGO Government Donor Oganization Consultant International Organization

Geographical distribution of the scores 40% based in LMICs in Africa, Asia and South America
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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Scoring criteria based on CHNRI methods

In this exercise five criteria were used:
Criterion 1. Answerability?
Can the research question be answered ethically?

Scores
Yes = 1 point

Criterion 2. Efficacy
Can the new knowledge lead to an efficacious intervention or programme?

No = 0 points Informed but undecided answer = 0.5 points Insufficiently informed = missing input

Criterion 3. Deliverability and acceptability

Is that proposed intervention or programme deliverable and acceptable?

Criterion 4. Maximum potential for disease burden reduction

Can the intervention or program improve newborn health substantially?

Criterion 5. Effect on equity

Can the intervention or program reach the most vulnerable groups?
Scoring questions adapted from CHNRI methods, Details in Rudan et al

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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Research priority scores

Each research question received intermediate scores for each of the criterion (based on input from technical experts) RPS is an average of the intermediate scores

RPS =

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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Scored questions by technical area N=205

60 Number of questions

50
40 30 20 19 10 0 Preterm birth Intrapartum related* Neonatal infection Congenital and others Integrated care 45 46 46 49

*Intrapartum related outcomes included perinatal asphyxia and stillbirth

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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Results
Top 10 priorities in newborn health

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TITLE fromNewborn VIEW and SLIDE MASTER | April 17, 2013 Global Conference, South Africa, April 2013

Top 10 overall newborn health priorities

RANK RESEARCH ISSUES

1
2 3 4 5 6 7 8 9 10
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Evaluate a simplified neonatal resuscitation program delivered by trained health workers

Evaluate approaches to scale up health worker skills in preventing and managing asphyxia Evaluate simple clinical algorithms to identify newborns with infection by CHW Identify and address main barriers for exclusive breastfeeding in low resource settings Evaluate training of CHWs in basic newborn resuscitation Evaluate approaches to scale up antibiotic treatment for newborn sepsis Evaluate a community based initiation of KMC Evaluate the effect of provision of bags and masks to skilled birth attendants trained in resuscitation Evaluate impact of chlorhexidine in facility births and in low NMR settings Evaluate approaches to improve quality of care during labour and child birth
| April TITLE fromNewborn VIEW and SLIDE MASTER 17, 2013 Global Health Conference, Conference, South Africa, South April Africa, 2013 April 2013

The top 20 research priorities

By technical area
Intrapartum related

By domain
5%

25%

30%

Neonatal infections Preterm birth

Delivery Development

15% 30%
Integrated care

95%

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| April TITLE fromNewborn VIEW and SLIDE MASTER 17, 2013 Global Health Conference, Conference, South Africa, South April Africa, 2013 April 2013

Using research priorities

Dissemination strategies

Early dissemination to funders

Publication in a high-impact journal Promotion strategies Approach key national stakeholders (government, NGOs, research institute) to generate research interests Keep approaching donors and funders to generate funding opportunities Monitoring strategy Monitor the impact of the exercise
Monitor RFPs, research funding, and trial registers to ensure key priorities are addressed after the exercise
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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013

Thank you!

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| April 17, 2013 TITLE fromNewborn VIEW and SLIDE MASTER Global Health Conference, South Africa, April 2013