Optimizing Maternal-Child Health in Kenya

描述（由申请人提供）：营养不良的关键矿物质和微量营养素（M&M）缺乏铁，锌，叶酸和维生素b12的妇女在怀孕期间容易导致严重的并发症，特别是在分娩期间。此外，这些母亲的孩子可能会出现中线出生缺陷，大脑发育改变，易受感染。尽管发布了通过简单修改保健服务优化孕产妇和婴儿营养的新方法和指南，但发展中国家的临床实践往往仍然固守着不是最先进的护理模式。我们认为，在资源贫乏的环境中，迫切需要解决优化妇女及其儿童营养的问题，需要一个论坛，由当地多学科的专家临床医生研究人员组成的教师小组可以在这里开会，反思这些临床进展；自由沟通这些数据与他们的实践的相关性；找出可以通过研究解决的文献空白；然后开展短期研究项目，为优化母婴营养的更大的预防战略奠定基础。在肯尼亚埃尔多雷特，有一个新颖的基础设施，AMPATH（提供医疗保健的学术模式；http://www.iukenya.org/）-a有20年历史的组织结构，由莫伊教学和转诊医院、莫伊大学和北美大学联盟组成，其教师具有专业知识，并在涉及行为与社会科学、儿科学、生殖健康、成人医学和营养学的学科研究方面有着良好的记录。卫生适宜方案有意加强跨学科研究的相互促进方面，这些研究的重点是在资源贫乏环境中对妇女和儿童的最佳照顾。因此，R13提案的具体目标是将AMPATH的教师聚集在一起，举行两次会议，挑战他们跳出学科内部的藩篱，与其他学科的成员合作，实施适合环境的“低技术”干预措施，这些干预措施可以对资源贫乏环境中的妇女、婴儿和儿童的营养产生积极影响。在第一次会议上，在反思了母婴营养方面的最新进展之后，并基于小组对R21提案中应解决的关键具体目标的共识，我们将制定重点计划，在接下来的一年里产生必要的初步信息。我们还将利用焦点小组和卫生barazas（肯尼亚社区集会的习惯形式）在妇女、老年人和思想领袖之间发起对话，以加深社区对围绕妇幼保健和营养的社会文化问题的理解。在第二次会议上，我们将讨论这些初步结果，并完善NIH R21提案草案，该提案侧重于一项创新的临床试验，旨在评估出生时M&M干预对婴儿血液学特征、感染易感性、行为和智力发展的益处

DESCRIPTION (provided by applicant): Undernourishment with key mineral and micronutrient (M&M) deficiencies of iron, zinc, folate, and vitamin-B12 among women during pregnancy predisposes to serious complications, especially during labor and delivery. In addition, children of such mothers can develop midline birth defects, altered brain development, and a predisposition to infections. Despite the publication of new methods and guidelines to optimize maternal and infant nutrition through simple modifications in healthcare delivery, clinical practic in developing countries often remains entrenched in patterns of care that are not state-of-the-art. We believe that addressing the urgent imperative to optimize nutrition among women and their children in resource-poor settings requires a forum where a local multi-disciplinary faculty group of expert clinician-researchers can meet to reflect on these clinical advances; freely communicate on the relevance of these data to their practice; identify gaps in the literature that can be addressed through research; and then develop short-term research projects that can then lay the foundation for a larger preventive strategy to optimize maternal-child nutrition. There is a novel infrastructure in Eldoret, Kenya, at AMPATH (Academic Model Providing Access To Healthcare; http://www.iukenya.org/)-a 20-year old organizational construct consisting of Moi Teaching and Referral Hospital, Moi University, and a consortium of North American Universities-with faculty who have expertise and a track record of disciplinary research involving Behavioral & Social Sciences, Pediatrics, Reproductive Health, Adult Medicine, and Nutrition. AMPATH is interested to strengthen the cross-fertilization aspects of inter-disciplinary research that focuses on the optimization of care for women and children in resource-poor settings. So the Specific Aim of this R13 proposal is to bring AMPATH faculty together for two conferences to challenge them to think outside of their intra-disciplinary silos and collaborate with members of other disciplines to implement contextually appropriate 'low-tech' interventions that can positively impact the nutrition of women, infants, and children in resource-poor settings. For the first conference, after reflecting on recent advances in maternal-child nutrition, and based on the group's consensus on the key specific aims that should be addressed in an R21 proposal, we will develop focused plans to generate the necessary preliminary information over the following year. We will also use focus groups and health barazas-the customary form of community assembly in Kenya-to initiate a dialogue among women, elders and thought leaders to attain a deeper community understanding of socio-cultural issues surrounding maternal-child health and nutrition. At the second conference, we will discuss these preliminary results and refine the draft of a NIH R21 proposal that focuses on an innovative clinical trial designed to assess the benefit of a M&M intervention at birth on the infant's hematologic profile, susceptibility to infections, behavioral and intellectual development a year later. Such studies are a necessary prelude to a larger community-based longitudinal project via a NIH R01 format. 1 PUBLIC HEALTH RELEVANCE: This is a proposal to bring together a multi-disciplinary team of clinician-researchers from Eldoret, Kenya, for two conferences to learn about recent advances on ways to improve the iron-, zinc-, folate-, and vitamin-B12- status of women and children. Then, using a focused approach to brainstorm on these methods, we will identify gaps in the literature that pertain to research-poor settings, and then develop short- term R21 research plans to test clinical interventions to prevent and treat these deficiencies as a prelude to larger community-based interventions in Kenya. 0