Photo: Sala Lewis/Verve Photography
Guest post by Alison Chatfield, Project Manager at the Women & Health Initiative, on behalf of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st).
If the idea of implementing and managing global research effectively, and uniformly, across eight global study sites sounds challenging, that’s because it is.
Confronted with the lack of evidence-based, universally-applicable growth charts for monitoring fetal, preterm and newborn growth, a network of researchers formed the International Fetal and Newborn Growth Consortium for the 21st Century to fill these gaps. Implemented in the US, the UK, Brazil, China, Oman, Kenya, Italy, and India, the project is by far the largest collaborative venture in the field of perinatal health research.
The results of the studies will now inform robust resources for monitoring growth and development in the first 1,000 days of life.
Uniform implementation of methodology in each of the eight study sites was critical to success. Controlling variability both within and between study sites ensured that the population-based data from all sites could be combined into a single data set that would inform new international growth standards. To achieve uniformity in such a large, multicenter project, all study sites followed the same standardized anthropometry procedures to measure newborns.
While each study site was unique, three generalizable “lessons learned” emerged from implementing and managing this global research project:
- Assemble the right team. Principal Investigators in each study site were responsible for recruiting a team of anthropometrists. The number of people within each team depended on various institutional characteristics, e.g. size of institution; availability full- or part-time staff. However, team members across all study sites were selected based on some universal criteria: motivation, education, skills, organizational capacity and language ability. Team members not only had to be skilled anthropometrists, they were also required to have the interpersonal skills needed to explain the protocols to parents and effectively measure newborns. Each study site had access to leadership throughout the project’s duration; lead anthropometrists were selected based on experience, leadership abilities, and availability, and a core expert group of anthropometrists from the Coordinating Unit were also key to ensuring standardization amongst the study sites. Dedicated data managers at each site were accountable for regularly uploading measurements to the central database.
- Train dynamically. Before data collection began, rigorous training and standardization sessions were conducted at each study site. These trainings were organized by the local lead anthropometrist and were supervised by an expert. The goals of these sessions were to ensure that measurers develop, refine, and maintain their techniques so that the measurements they yield would be repeatable and reproducible values. Training materials, including a protocol manual creating by the Coordinating Unit and an open-access training video, were used as resources in each site. These trainings covered the over-arching goals of taking measurements, as well as details that might affect the day-to-day measurement process, e.g. the measurer’s nerves, infant struggle, and air and light conditions. Frequent standardization sessions, i.e. every three months, functioned as audits to ensure anthropometry teams were following recommended techniques by monitoring the precision and accuracy of their measurements on real newborns. Hands-on corrections were made and explained, if required.
- Provide the right tools to achieve high standards. “Gold standards” of measuring newborns were established from the project’s outset. During standardization sessions, measuring and re-measuring would be performed by an anthropometrist and an expert to ensure consistency and model the expected behavior. Study sites were provided the same equipment and instructions on how to use it. The training materials developed by the Coordinating Unit leveraged open-access resources, such as an anthropometry training video and evidence-based measurement practices, when available. An online data management system provided central coordination of the data and provided built-in range and consistency checks.
The measurements gathered through the INTERGROWTH-21st Project form a unique and important data set that will advance our understandings of human growth and development. It is also interesting to note that the research team observes that implementing standardized anthropometric methodology in these study sites appears to have improved the overall quality of infant measurements in the participating health institutions.
For more information about the anthropometric protocols and how the research team standardized their quality, and the overall methodology of the INTERGROWTH-21st Project, please refer to the INTERGROWTH-21st Project’s supplement in the British Journal of Gynaecology and Obstetrics.
Photo: Prashanth Vishwanathan/Save the Children
After spending the day caring for mothers and newborn babies, community health worker Durgesh leaves Jahangir Puri in Delhi, India.
Durgesh leaves her home at 10 am daily, to meet new and expectant mothers to discuss prenatal, childbirth and postnatal care. As part of her work, she counsels mothers on proper nutrition during pregnancy to ensure that both mother and baby are as healthy as possible. Importantly, she guides mothers to MHU and nearby hospitals for further treatment and delivery. Her work day officially ends at 2 p.m but her call to duty extends to any emergency that arises day or night.
In June 2012 the Government of India along with the Governments of United States and Ethiopia led the Child Survival Call to Action summit, where it committed to ending preventable child deaths by 2035. In response in February 2013 it launched the multi-year RMNCH+A (Reproductive, Maternal, Newborn, Child Health and Adolescents strategy). Given that 50% of India's under-five child mortality rates are due to neonatal mortality, India should now see that its efforts to address newborn health are integrated into the overall RMNCH+A plan, and that the newborn action plan is successfully implemented.
- C. Howson, M. Kinney, L. McDougall, J. Lawn, et al. Born Too Soon: Preterm birth matters.
- H. Blencowe, S. Cousens, D. Chou, et al.). Born Too Soon: The global epidemiology of 15 million preterm births.
- S. Dean, E. Mason, C. Howson, et al. Born Too Soon: Care before and between pregnancy to prevent preterm births: from evidence to action.
- J. Requejo, M. Merialdi, F. Althabe, et al. Born Too Soon: Care during pregnancy and childbirth to reduce preterm deliveries and improve health outcomes of the preterm baby.
- J. Lawn, R. Davidge, V. Paul, S. von Xylander, et al. Born Too Soon: Care for the preterm baby.
- J. Lawn, M. Kinney, J. Belizan, et al. Born Too Soon: Accelerating actions for prevention and care of 15 million newborns born too soon.
USAID is observing World AIDS Day this year by celebrating ten years of our HIV and AIDS work under PEPFAR.
More than 85,000 infants in Nigeria are at risk of HIV transmission from their mothers every year. While the number of HIV-positive pregnant women who receive antiretroviral treatment (ART) is increasing, robust efforts to improve coverage are needed if national targets (PDF) for prevention of mother-to-child transmission of HIV (PMTCT) are to be met in 2015.
Over the past year, the Leadership, Management and Governance (LMG) Project helped support the PLAN-Health Nigeria project, funded by PEPFAR through USAID and managed by Management Sciences for Health (MSH), to pilot Leadership Development Program Plus (LDP+), which focuses on empowering teams to improve PMTCT results. The program also emphasizes new approaches tied in to country ownership, national health priorities, and specific health indicators.
LDP+ was piloted in the town of Gwagwalada, Nigeria. The Gwagwalada Council is one of the five Local Government Area Councils of the Federal Capital Territory (FCT) of Nigeria. LMG and PLAN-Health worked with the Gwagwalada Council, which selected 20 participants—two from each of the 10 facilities providing PMTCT services in the area—to form 10 teams to participate in the LDP+. Together, the teams decided to address PMTCT and focused on improving some standard indicators such as number of new antenatal care (ANC) clients; number of pregnant women tested for HIV, counseled and received their results; and the number of HIV-positive women. The program ran from October 2012 to May 2013. During this time, the teams worked within their facilities to create a vision of improved results around PMTCT, align stakeholders around this vision, implement their action plans, and share learning with other teams to identify the most useful local interventions and activities. The teams also received coaching in the areas of monitoring, evaluation, and reporting.
Most of the facilities reported encouraging results for their key indicators after participating in LDP+. For example, the Old Kutunku Health Center reported an increase from 17 to 61 new ANC clients per month. At the Gwako health center, the percentage of ANC clients who delivered in a health facility increased from 18 to 42 percent. Prior to LDP+, the Township clinic counseled and tested the partners of only three percent of pregnant women, compared with 20 percent after the program.
The Gwagwalada Council’s oversight committee plans to continue the program with its own resources, expanding it to another eight facilities in the area. Through these efforts, this local government agency is furthering Nigeria’s national efforts to ultimately eliminate mother-to-child transmission of HIV.
Follow @USAIDGH on Twitter through World AIDS Day, observed on December 2, for key facts, resources, and photos from our programs and partners and join the conversation using the hashtag #WAD2013.
Photo: Jane Hahn/Getty Images for Save the Children
Three newborn babies sleep in the same bed in the High Dependency Ward in the Neonatal Unit of the Komfo Anokye Teaching Hospital in Kumasi, Ghana.
This past week's announcement of the creation of the Maternal and Newborn Health Professional Society in Ghana by Evidence4 Action is intended to push national politicians to make greater commitments to and be more accountable for maternal and newborn health.
While Ghana has lowered the neonatal mortality rate from 40.2 in 1990 to 28.4 in 2012, making further efforts to scale up essential newborn care interventions will help the country to achieve Millennium Development Goal (MDG) 4 for under 5 child mortality. According to Dr. Jemima Dennis-Antwi of the International Confederation of Midwives, Ghana needs to lower maternal mortality from 350 to 150 per 100,000 live births, to reach MDG5.
By bringing health professionals from across the maternal and newborn sectors, more can be done to address both common goals, improving the chance of survival for both Ghana's mothers and their newborns.
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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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