Dr. Basia TomczykDr. Diane Morof

CDCIAWG Annual Meeting

May 31-June 1Kuala Lumpur, Malaysia

Neonatal Survival in Complex Humanitarian Emergencies: Setting an Evidenced-Based

Research Agenda

Outline Background Goal Methods Findings Limitations Conclusions

Background Saving Newborn Lives (SNL) developed a list of

questions deemed critical to improving the evidence base of research.

STC selected those that could potentially be done in a humanitarian context and that are most likely relevant to humanitarian settings.

36 questions selected.

Background (cont’d) Systematic method for setting priorities in health

research investments Multiple step process

Specify context Discuss and choose criteria Select questions and apply criteria to the questions

Flexible process enables prioritization at any level: institutional, regional, national, international or global

Used in child health and nutrition, RH research workshop, mental health and psychosocial support in humanitarian emergencies

Rudan et al. Setting Priorities in Global Child Health Research Investments: Guidelines for Implementation of CHNRI Method. Croat Med J. 2008; 49:720-33. www.cmj.hr

Research Goal

The goal was to adapt the Child Health Research and Nutrition Initiative (CHRNI) methodology to prioritize neonatal health research in the unique setting of complex humanitarian emergencies.

Methods

The context was complex humanitarian emergencies

  The time was the interval from now to year

2020  

The population disease burden of interest was all mortality and disability due to neonatal causes  

Survey monkey  

Criterion 1: Answerability Definition: Likelihood that research would lead to

new knowledge in an ethical way   Would you say the research question can be well

framed and endpoints can be well defined?    

Would you say that local and national research capacity already exists to answer the research question in many different contexts?

Do you think that a study needed to answer the proposed research question would obtain ethical approval without major concerns?              

Criterion 2: Feasibility Definition: Likelihood that research can be

conducted cost-efficiently and lead to generalizable new knowledge     Would you say that well designed studies of

moderate scale and sample size would have enough power to provide replicable answer to proposed research question?  

    Would you say that ongoing programs, resources

and research capacities could be amended or expanded to undertake proposed research or uptake the measurement technique cost-efficiently?

Would you say that the answer to proposed research question would be generalizable across many (or most) different contexts?                      

Criterion 3: Relevance Definition: Likelihood that research would address

important condition and critical gap in knowledge and could be readily translated to inform policies and programs     Is the condition being assessed a high burden

condition?        

Is the proposed research addressing a critical gap in knowledge?

Would you say that the results of proposed research could be readily translated/used in health information systems, to improve service delivery, to inform policies and programs?          

Criterion 4: Equity Definition: Likelihood that the proposed

epidemiological research would have positive impact on equity and local ownership In given context, would you say that the present

distribution of disease burden primarily addressed by the proposed research affects IDPs, refugees, and communities affected by humanitarian crisis?

Would the proposed research and its results be owned by local actors (e.g. district managers, health workers, communities)?

Would you say that the proposed research has the overall potential to improve equity in disease burden distribution in the longer term (e.g. by 2020)?      

Methods (cont’d)

• Analysis:• Apply criteria to the research questions• Yes’s were given 1 point, no’s zero and

don’t know 0.5• Determined research priority score (RPS)

with a cut off of 0.65

Results

• 28 respondents completed

• 38 began but didn’t complete

• Research prioritization scores ranged from 0.846 to 0.679

Results (cont’d) Four questions dealt with the following:

What is the additional burden of neonatal mortality?

Can pregnancy surveillance be used to measure neonatal mortality?

Can verbal autopsy be used to capture causes of neonatal mortality?

What are the risk factors for neonatal sepsis?

Results (cont’d) The programmatic priorities included a

focus on: How can we increase demand for skilled

attendance at birth? What is the coverage of clean delivery

practices? What are the factors that can increase

facility delivery uptake? What are the best strategies to identify

preterm babies at the community level?

Limitations

• Question clarity, intent, and feasibility

• Criteria interpretation

• Uncertain if we reached appropriate participants

• Time

Conclusions • The research priorities identified recognize

a need to focus on both the descriptive epidemiology and operations research to improve neonatal health in these settings.

• The CHRNI exercise has already stimulated discussion and action to address some of the research gaps by donors, international nongovernmental organizations (NGOs) and researchers.

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you!