The project supports studies using both established and innovative models of research design, whichever can most effectively provide the kind of credible evidence needed to improve delivery programs. Such translational or implementation research studies may identify barriers to introducing and implementing key interventions, develop new approaches to scale-up, or evaluate the comparative cost-effectiveness of different scale-up approaches. Studies are expected to improve service delivery scale-up in the countries where they are conducted and provide knowledge results that could often be useful and replicable in other countries.
Current research priority areas are:
Maternal and Newborn Health
Safe maternal care is particularly challenging because of the geographic problems impeding access to care and the sudden development of life-threatening complications during childbirth. Managing these complications often requires special training and resources. Much progress has been made in the last few years in improving access to and the quality of prenatal care, in encouraging deliveries by skilled birth attendants, in reducing post-partum hemorrhage by the Active Management of the Third Stage of Labor, in reducing obstructed labor by improved monitoring of labor with the partogram, in preventing eclampsia, and in increasing health care providers' ability to manage complications. These interventions must now be implemented and scaled up on a national level, often as phased-in packages.
As post-neonatal mortality has declined in many countries, neonatal mortality has increased as a percentage of infant mortality. New or improved prenatal, perinatal, and newborn care interventions have been developed and tested for use in developing countries: preventing mother-to-child transmission of HIV, steroids for threatened pre-term delivery, perinatal monitoring with the partogram, clean delivery, newborn resuscitation, immediate breastfeeding, careful post-delivery monitoring, kangaroo care for low birth-weight newborns, and early identification and treatment of newborn sepsis. Few countries have yet packaged all these effective interventions for delivery nationwide.
The most important interventions to reduce post-neonatal infant mortality and child mortality aged 1 to 4 continue to be exclusive breastfeeding, the prevention of malnutrition, routine immunizations, treatment of diarrhea with oral rehydration salts and zinc, pneumonia treatment, malaria case management, and Vitamin A distribution. Many of these interventions have been scaled up in developing countries resulting in significant reductions in child mortality. However, significant gaps must be closed to achieve the Millennium Development Goals (MDGs). In addition, there has been some backsliding both in immunization coverage and appropriate treatment of diarrhea. Enhanced and strengthened child health programs are needed nationwide in many countries if the MDGs are to be reached in the timeframes planned.
Two diseases are of particular importance for the project.
Malaria remains one of the most important causes of child mortality, especially in Africa. Case management is challenged by parasite resistance to many available anti-malarial drugs. The President’s Malaria Initiative, Roll Back Malaria, and the Global Fund have provided significantly increased resources and attention to the continued problem of malarial infections. Indoor residual spraying (IRS) and long-lasting insecticide-treated bednet programs (LLINs) have demonstrated good results in reducing malaria transmission, infections, and deaths. Expanded use of rapid diagnostic tests and artemisinin drugs can improve case management. These interventions now need research to identify the best mix to deploy in different countries and determine the best approaches for scaling up and sustainability.
Tuberculosis remains the leading cause of death by any infectious disease. Its incidence has been increasing due to reduced resistance in HIV-infected persons and its transmission from these persons to others in their household and community. Because of poor compliance with therapy, resistance to anti-TB drugs has increased in many countries, resulting in multiple-drug resistance, which complicates treatment, increases costs, and poses additional threats to patients and the community. Better diagnostic tests are needed as is the strengthening of programs that coordinate HIV and TB services to ensure completion of therapy with sputum negative confirmation. USAID, the Global Fund, and other donors are providing added financial support to developing countries to expand and strengthen their TB programs.
Reproductive Health and Family Planning
Reproductive health and family planning services and use in developing countries have spread significantly over the past 50 years. Fertility rates have declined worldwide, resulting in reduced numbers of maternal deaths, better child spacing, and reduced child mortality. Nevertheless, in a number of countries, many women lack access to counseling or services and are put at risk from multiple pregnancies and unsafe abortions. In Africa, thousands of women suffer from recto-vaginal fistulas due to tears during childbirth. Family planning programs need strengthening and expansion with an appropriate mix of contraceptive methods. Family planning services need much better integration with maternal care clinics, child health clinics, and HIV/AIDS services. Improved public-private collaborations would also increase access to care.