Optimizing Maternal-Child Health in Kenya

描述(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在怀孕期间容易导致严重的并发症，特别是在分娩和分娩期间。此外，这些母亲的孩子可能会患上中线出生缺陷、大脑发育改变和感染的易感性。尽管发布了新的方法和指南，通过对医疗保健提供的简单修改来优化孕产妇和婴儿的营养，但发展中国家的临床实践往往仍然根深蒂固，采用的是不是最先进的护理模式。我们认为，在资源匮乏的环境中解决优化妇女及其子女营养的紧迫问题需要一个论坛，在这个论坛上，当地多学科的临床医生和研究人员专家教员小组可以开会反思这些临床进展；自由地就这些数据与他们的实践的相关性进行交流；找出文献中可以通过研究解决的差距；然后制定短期研究项目，然后为更大的预防战略奠定基础，以优化母婴营养。在肯尼亚的埃尔多雷特，有一个新的基础设施，在AMPATH(提供医疗保健的学术模型；http://www.iukenya.org/)-a有20年的历史，由莫伊大学的MOI教学和转诊医院和一个北美大学财团组成-拥有拥有专业知识和学科研究记录的教师，涉及行为与社会科学、儿科学、生殖健康、成人医学和营养学。AMPATH有兴趣加强跨学科研究的交叉受精方面，重点是在资源匮乏的情况下优化对妇女和儿童的护理。因此，这项R13提案的具体目的是将AMPATH的教职员工聚集在一起举行两次会议，挑战他们在学科内孤岛之外的思维，并与其他学科的成员合作，实施适合背景的低技术干预措施，这些干预措施可以对资源匮乏环境中的妇女、婴儿和儿童的营养产生积极影响。对于第一次会议，在反思了母婴营养方面的最新进展之后，并基于工作组对R21提案中应解决的关键具体目标的共识，我们将制定有重点的计划，以在下一年产生必要的初步信息。我们还将利用焦点小组和保健俱乐部--肯尼亚社区集会的惯常形式--发起妇女、长老和思想领袖之间的对话，以加深社区对围绕母婴保健和营养的社会文化问题的了解。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、行为和智力发育的益处 一年后。这样的研究是通过NIH R01格式进行的更大的基于社区的纵向项目的必要前奏。1

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