The research agenda for child health and nutrition: Filling the gaps

1. The research agenda for child health and nutrition: Filling the gaps Igor Rudan, Shams El Arifeen and Robert E. Black Child Health and Nutrition Research Initiative (CHNRI) An initiative of the Global Forum for Health Research www.chnri.org

2. Assessing the burden correctly Research agenda from the perspective of disease burden reduction:

3. Assessing the burden correctly Understanding the “architecture” of the burden (identifying key risk factors and measuring exposures in the population) Research agenda from the perspective of disease burden reduction:

4. Assessing the burden correctly Understanding the “architecture” of the burden (identifying key risk factors and measuring exposures in the population) Developing, evaluating and implementing interventions to reduce the burden Research agenda from the perspective of disease burden reduction:

5. Assessing the burden correctly Understanding the “architecture” of the burden (identifying key risk factors and measuring exposures in the population) Developing, evaluating and implementing interventions to reduce the burden Setting priorities in future health research investments to reduce the burden systematically, fairly and cost-efficiently Research agenda from the perspective of disease burden reduction:

7. WHO Child Health Epidemiology Reference Group (CHERG): • Conducted systematic reviews to identify data from the period 1980-2000 on the major causes of morbidity and mortality in children under 5 years in countries with vital registration coverage <90% • From more than 17,000 papers reviewed, only 308 studies (“information units”) considered likely to provide unbiased estimates of disease burden in a community

8. Geographical distribution of 308 studies

9. Time trends in conducting the 308 studies

10. The information units are generallyvery scarce They tend tocluster in 5 regions: • Northeastern Brazil • West Africa (especially in The Gambia) • East Africa (especially in Tanzania) • Egypt • Bangladesh, North Indiaand Pakistan (Geographic distribution highlights the role ofInternational Research Centres)

11. The level ofresearch output on epidemiology of childhood pneumonia and diarrhoea has fallen sharply since the late 1980s • This coincides with the development of highly cost-effective interventions to fight the two diseases • However, 20 years later they still remain the two leading single causes of death in children under 5 years of age globally

12. Gaps? Between 1980-2000, CHERG foundno units of information in public domain in “gap” countries where 30% of all child deaths occur: • Middle East and North Africa (Afghanistan, Iran, Iraq, Somalia, Sudan, Yemen) • Sub-Saharan Africa (Angola, Burkina Faso, Madagascar, Mozambique, Niger, Uganda and Zambia) • Asian countries (China, Laos, Burma, Philippines and Vietnam)

14. Situation analysis in the population

15. Situation analysis in the population

16. Situation analysis in the population

17. Gaps? • Understanding the prevalence of exposure to risk factors and intervention coverage globally is improving (e.g. MICS, DHS): • Prevalence of risk exposures and intervention coverage now estimated for countries housing more than 90% of all under-fives • The data still missing for a considerable number of countries (up to 20%, depending on the risk factor or intervention): the priorities are Somalia and Afghanistan • The uncertainty around the estimates is unclear – the inter-country variation is often very large

19. Impact of interventions on disease burden by instruments of health research (Box 2,3,4)

20. Gaps? • Promoting the value of health policy and systems research, and of the research on improving the existing interventions • Health policy and systems research along with multidisciplinary research on original and more creative approaches to delivering interventions could substantially improve the coverage • The research on improving the existing interventions could make them more deliverable, affordable and sustainable

22. Investing in health research

23. A concern: Prioritization in research funding ispartly driven by attractiveness, advocacy and potential for high publication impact This favours research onnew interventions (BOX 4), mainly basic research addressing very difficult upstream technology developments

24. Fundingavailable for BOX 4 research grossly exceeds that ondelivery, health policy and systems research (BOX 2)or onimproving the existing interventions (BOX 3)

25. Redefining a “health research option”

26. Gaps? • Development of priority setting methodology that should: • take into account more dimensions relevant for priority setting than attractiveness, level of advocacy and potential publication impact • be simple enough to gain wider acceptance • be applicable at different levels and for different priority setting questions and problems • be systematic, scientifically sound and repeatable • be fair, transparent and legitimate

27. The proposed next steps by CHNRI* in developing and applying the new priority setting methodology • Application inseveral different topics at the global level(major child diseases, conditions or risk factors), at thenationallevel (in 1 developing country as a model), and within 1 majorfunding/donor agency • Testing the application on health policy and systems research avenues (Box 2)across all major diseases/conditions • Developing user-friendly tool (software)with appropriateuser manualto enable child health research priority setting based on the proposed conceptual framework Child Health and Nutrition Research Initiative of the Global Forum for Health Research; www.chnri.org

28. Credits: This presentation was compiled using substantial input from a large number of individuals working for: • Child Health Epidemiology Reference Group (CHERG) • CHNRI Board and Secretariat, Dhaka, Bangladesh • Joint Centre for Bioethics, University of Toronto, Canada • The University of Phillipines (formerly COHRED) • Disease Control Priorities Project II • The World Bank • Johns Hopkins Bloomberg School of Public Health, Baltimore, USA • The University of Edinburgh, Scotland, UK