Global Research Activity
(GRA): Technical Vision
The technical vision of
the GRA Partnership in advancing health status of infants,
children, mothers and families is illustrated below in the
areas of Micronutrients and Dietary Interventions, Child
Health, Neonatal Health, Maternal Health, and Tuberculosis.
Within each area lies a comprehensive but focused agenda
to reach these goals by conducting research in key nutrition
and health care service interventions that can shape policy
and practice.
Research is conducted in:
Research on Micronutrient and Dietary Interventions
Insuring adequate nutrition is seminal to preserving health and saving lives of children and mothers in the developing world. Population deficiencies of essential micronutrients can impair growth, resistance to infection, development and survival of infants and young children as well as the health and survival of women during pregnancy and lactation. The GRA research work plan seeks to advance knowledge toward establishing credible benefit, risk and cost aspects of micronutrient interventions in infants, young children and women of reproductive age, and in doing so, inform nutritional approaches to achieving results in the years ahead. The work plan includes vital ongoing research to which USAID, JHU and other partners remain committed and new research that can continue to stimulate future micronutrient programming. Current and planned research activities relate to basic goals of:
- Establishing the efficacy, effectiveness, safety and cost components of zinc supplementation in treating diarrhea and reducing mortality in early childhood;
- Confirming the efficacy and safety of supplementing infants with vitamin A shortly after birth as a means to reduce infant mortality in the presence and absence of HIV;
- Establishing the impact of maternal vitamin A or beta-carotene supplementation in reducing mortality and morbidity related to pregnancy;
- Assessing effects of antenatal micronutrient supplement combinations on maternal, fetal and infant health, anemia and survival, with the aim of guiding development of an optimal antenatal micronutrient supplement.
Research on Child Health
Deaths in children under the age of five years have declined substantially in recent decades, yet nearly 11 million children continue to die annually around the world, mostly from preventable causes. World leaders recently agreed at the United Nations Millennium Summit in September 2000 to work together to reduce the deaths of under-five children by two thirds by the year 2015. This goal is unattainable, however, without focusing efforts on the regions where most deaths occur, namely, South Asia and Africa, and on the major causes of mortality, principally infectious diseases and malnutrition.
The GRA Partnership identifies new technologies and methods for improving child survival and family health, with a particular emphasis on the effective integrated implementation of services that have the greatest impact in developing countries. Community Case Management (CCM) seeks to improve the care for the large number of children who do not reach health facilities in countries with high under-five mortality, and should be a key activity within the household and community component of the Integrated Management of Childhood Illnesses (IMCI). Despite evidence of the impact of well-implemented CCM on under-five mortality, CCM for acute lower respiratory infections (ALRI) has only been implemented at scale in a few sites, and large-scale programs to promote case management for diarrhea have not frequently been sustained. The GRA will investigate the implementation and impact of CCM interventions in several countries.
Research on Neonatal Health
An estimated two-thirds of childhood deaths occur in infancy, and, in turn, two-thirds of infant deaths occur in the first month of life. In addition to these 4 million neonatal deaths, due principally to serious bacterial infections, birth asphyxia, and complications of prematurity and intrauterine growth restriction (IUGR), an estimated 3.9 million pregnancies end in stillbirth. A recent review of the evidence for impact of interventions during the antenatal, intrapartum and post-delivery periods on neonatal mortality identified a number of proven interventions, which, if implemented widely in developing countries, could avert an estimated half of neonatal deaths. Major questions remain, however, regarding cost-effective implementation of neonatal health interventions at scale in the community in a manner that links preventive care in the home and community with care-seeking and curative care at health facilities.
Priority areas of research to advance neonatal health include:
- Adaptation, delivery and evaluation of packages of evidence-based maternal and neonatal health interventions within diverse settings and health care systems
- Development and evaluation of:
- Cost-effectiveness of thermal control interventions
- Strategies for prevention of and care for infants born preterm or with IUGR
- Strategies for prevention and improved management of neonatal infections
- Interventions to prevent and manage birth
asphyxia at the community level
- Integrated case management for major causes of under-five mortality
Research on Maternal Health
Research has suggested that integration of maternal and neonatal health care services is key to optimizing costs and health benefits for mothers and their newborns. This is particularly so if a given intervention has potential direct health benefits for both mothers and newborns. Major research initiatives in Sylhet and Mirzapur, Bangladesh, provide packages of maternal and neonatal interventions, yet a greater emphasis on evaluation of the impact of these services on maternal health is needed.
Research on Tuberculosis
Tuberculosis accounts for approximately two million deaths worldwide each year and is the second greatest contributor among infectious diseases to adult mortality. The World Health Organization (WHO) estimates that more than one-third of the world’s population is infected with Myobacterium tuberculosis (MTB) and more than eight million people with TB infection develop active TB disease each year. If left undiagnosed or untreated, an individual with TB disease may infect between 10 and 15 people each year. TB morbidity can result in 3-4 months of lost work time and a loss of 20% of annual household income, affecting the most productive and economically active segment of the population. The GRA Partnership addresses issues such as multi-drug resistant TB (MDR-TB), co-infection of TB and HIV, and other key areas of research for improving global TB control by promoting strategic research, scientific and programmatic innovation, leadership and training in high-burden countries.
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