Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015.
Setting research priorities to reduce global mortality from preterm birth and low birth weight by 2015.
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DOI：
10.7189/jogh.02.010403
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发表时间：
2012-06-01
影响因子：
7.2
通讯作者：
Rudan, Igor
中科院分区：
文献类型：
--
作者：
Bahl, Rajiv;Martines, Jose;Rudan, Igor
目的：本文旨在确定能够提高联合国千年发展目标4中规定的全球早产和低出生体重新生儿死亡率(PB/LBW)的进展速度的卫生研究优先事项。方法：我们应用儿童健康和营养研究倡议(CHNRI)方法来确定卫生研究投资的优先事项。在世界卫生组织2007-2008年协调的过程中，21名对儿童、产妇和新生儿健康感兴趣的研究人员提出了82项研究想法，涉及流行病学研究、保健政策和系统研究、改进现有干预措施和开发新干预措施等广泛领域。然后使用CHNRI方法对82个研究问题的可答性、有效性、交付能力、最大降低死亡率的潜力和对公平的影响进行评估。结果：确定的前10个研究优先事项主要是卫生系统和政策研究问题(例如，确定出生24-48小时内在家出生的LBW婴儿进行额外护理的方法；提高卫生机构对LBW婴儿的护理质量的方法；确定最佳家庭护理做法的障碍，包括寻求护理；以及在早产中增加产前皮质类固醇的使用和改善LBW婴儿获得医院护理的途径)。其次是改进现有干预措施的优先事项(例如，及早开始母乳喂养，包括为那些不能直接从母乳中哺乳的婴儿提供喂养方式和技术；改进脐带护理，如洗必泰的应用；以及替代袋鼠母亲护理(KMC)的方法，以在社区环境中为LBW婴儿保暖)。排名最高的流行病学问题建议改进识别需要在医院护理的LBW婴儿的标准。在新的干预措施中，最大的支持是开发新的简单有效的干预措施，以便在母亲不能接受KMC的情况下为LBW婴儿提供热护理。结论：这项工作的背景是在千年发展目标4中设定的，要求在降低低出生体重死亡率方面取得紧急和快速的进展，而不是确定最具潜力的长期战略解决方案。在短期背景下，为改善现有干预措施的可及性和覆盖面而进行的保健政策和系统研究，以及为提高现有干预措施的有效性、可交付性和接受度而进行的进一步研究，以及为解决知识方面的主要差距而进行的流行病学研究，都被强调为研究优先事项。
AIM: This paper aims to identify health research priorities that could improve the rate of progress in reducing global neonatal mortality from preterm birth and low birth weight (PB/LBW), as set out in the UN's Millennium Development Goal 4.METHODS: We applied the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments. In the process coordinated by the World Health Organization in 2007-2008, 21 researchers with interest in child, maternal and newborn health suggested 82 research ideas that spanned across the broad spectrum of epidemiological research, health policy and systems research, improvement of existing interventions and development of new interventions. The 82 research questions were then assessed for answerability, effectiveness, deliverability, maximum potential for mortality reduction and the effect on equity using the CHNRI method.RESULTS: The top 10 identified research priorities were dominated by health systems and policy research questions (eg, identification of LBW infants born at home within 24-48 hours of birth for additional care; approaches to improve quality of care of LBW infants in health facilities; identification of barriers to optimal home care practices including care seeking; and approaches to increase the use of antenatal corticosteriods in preterm labor and to improve access to hospital care for LBW infants). These were followed by priorities for improvement of the existing interventions (eg, early initiation of breastfeeding, including feeding mode and techniques for those unable to suckle directly from the breast; improved cord care, such as chlorhexidine application; and alternative methods to Kangaroo Mother Care (KMC) to keep LBW infants warm in community settings). The highest-ranked epidemiological question suggested improving criteria for identifying LBW infants who need to be cared for in a hospital. Among the new interventions, the greatest support was shown for the development of new simple and effective interventions for providing thermal care to LBW infants, if KMC is not acceptable to the mother.CONCLUSION: The context for this exercise was set within the MDG4, requiring an urgent and rapid progress in mortality reduction from low birth weight, rather than identifying long-term strategic solutions of the greatest potential. In a short-term context, the health policy and systems research to improve access and coverage by the existing interventions, coupled with further research to improve effectiveness, deliverability and acceptance of existing interventions, and epidemiological research to address the key gaps in knowledge, were all highlighted as research priorities.