WHO develops guidelines on a broad array of clinical, public health, health system, health promotion and implementation strategies. These interventions are often complex, context-specific, with multiple factors that directly and indirectly impact health and societal outcomes. Standard guideline development methods need to be enhanced to better address these needs. In response WHO commissioned a set of papers, published today in BMJ Global Health, on approaches to improve the process and methods used for evidence-informed decisions about health, addressing complex health interventions and complex systems.
A special supplement of Acta Paediatrica, “Addressing implementation challenges for maternal, newborn and child health interventions,” presents results from nine research studies that tested and documented the delivery of proven maternal, newborn and child health (MNCH) interventions in eight different countries: China, Egypt, India, Lebanon, Kenya, Nepal, Pakistan and Syria. The research was supported by the WHO’s Department of Maternal, Newborn, Child and Adolescent Health (MCA) with funding provided by the Alliance for Health Policy and Systems Research (AHPSR).
"Kangaroo Mother Care" programme in India helps premature triplets thrive
When Renuka Hadapad gave birth to triplets on 25 October 2016 in Koppal, India she saw little reason to celebrate. The babies were all girls. With two daughters already and a culture favouring male children, Renuka and her husband, Somappa, had hoped for a son. Moreover, despite a seamless birth in the district hospital, the triplets were born each weighing less than 1500 grams – making it difficult for them to nurse, stay warm or gain weight. Though Somappa and Renuka were heartbroken, the triplets needed their support to survive. WHO recommends “Kangaroo Mother Care” or continuous skin-to-skin contact between mothers and low-birth weight or premature babies, and exclusive breastfeeding, as soon as they are born.
Immediate Kangaroo Mother Care study - Ongoing
Kangaroo Mother Care (KMC) reduces mortality by 40% after it is started. However, based on current WHO recommendations it is usually started several days after birth when the baby is stable. The aim of this trial is to evaluate the safety and efficacy of continuous KMC initiated immediately after birth compared to the current recommendation of initiating continuous KMC after stabilization, in improving survival of neonates with birth weight from 1.0 to <1.8 kg. The implication of a positive result is the expansion of the survival benefit of KMC in programmes.
Antibiotics for Children with Severe Diarrhoea (ABCD) - Ongoing
Global diarrhoea mortality has been dramatically reduced among under-five-year-old children, due to wide spread use of oral rehydration and zinc treatment. Despite this progress, approximately 500,000 children die for diarrhoea each year. Recent evidence suggests that mortality could be further reduced by treating high-risk children also with azithromycin antibiotic. To test this hypothesis, WHO is coordinating a randomised controlled trial, implemented in seven countries in Asia and Africa, by researchers from 11 collaborating institutions.
Healthy Life Trajectories Initiative (HeLTI) - Ongoing
HeLTI is an international research collaboration where four linked intervention cohorts will implement and test approaches to i) prevent overweight and obesity in children and risk factors for non-communicable diseases (NCDs) and ii) improve early childhood development (ECD). Three of the cohorts will implement cluster randomised designs while the fourth will be an individual randomised controlled study. The initiative is founded on a developmental origins of health and disease concept (DOHaD) and will examine the cumulative effects of interventions starting preconception and continuing through pregnancy into childhood.
Impact of three feeding regimens on the recovery of children from uncomplicated severe acute malnutrition - Completed
This is the first randomised trial comparing options for home management of uncomplicated severe acute malnutrition (SAM). The efficacy of centrally produced ready-to-use therapeutic food (RUTF-C) or locally prepared RUTF (RUTF-L) for home-based management of uncomplicated SAM was compared with micronutrient-enriched, energy-dense home-prepared foods (A-HPF, the comparison group). 906 children aged 6-59 months with uncomplicated SAM were enrolled in this trial. The adjusted Odds Ratio for recovery was 1.71 (95% CI 1.20 to 2.43; p=0.003) for RUTF-L and 1.28 (95% CI 0.90 to 1.82; p=0.164) for RUTF-C, compared with A-HPF. The trial confirms that RUTF-L is more efficacious than A-HPF at home.
Population-based rates, timing and causes of maternal deaths, stillbirths and neonatal deaths - Completed
This multi-country, population–based cohort study in eleven sites in South Asia and Sub- Saharan Africa identified 278,154 pregnancies and followed them through pregnancy, birth and postnatal period to determine the burden, timing and causes of maternal deaths, stillbirths and neonatal deaths. Verbal Autopsies were performed for deaths of all women of reproductive age, neonatal deaths and stillbirths, and physicians used standardised methods for cause of death assignment. The findings of this study contribute accurate and reliable data to the global estimates, and have important implications for public health programmes to improve maternal and newborn survival.
Publications in preparation
INtegrating and Scaling up Pmtct through Implementation Research (INSPIRE) - Completed
INSPIRE was a South:South collaboration supported by WHO and Global Affairs Canada. Six implementation research studies were conducted in Malawi, Nigeria and Zimbabwe that examined interventions to improve retention-in-care of mothers living with HIV. Studies demonstrated the significant impact of peer support provided in either health facilities or in the community on both retention-in-care of mothers and also early testing for HIV status in young infants.
Read the publications