Neonatal Survival in Complex Humanitarian Emergencies: Setting an Evidenced-Based Research Agenda

1. Neonatal Survival in Complex Humanitarian Emergencies: Setting an Evidenced-Based Research Agenda Dr. Basia Tomczyk Dr. Diane Morof CDC IAWG Annual Meeting May 31-June 1 Kuala Lumpur, Malaysia

2. Outline • Background • Goal • Methods • Findings • Limitations • Conclusions

3. Background • Saving Newborn Lives (SNL) developed a list of questions deemed critical to improving the evidence base of research. • STC selected those that could potentially be done in a humanitarian context and that are most likely relevant to humanitarian settings. • 36 questions selected.

4. Background (cont’d) • Systematic method for setting priorities in health research investments • Multiple step process • Specify context • Discuss and choose criteria • Select questions and apply criteria to the questions • Flexible process enables prioritization at any level: institutional, regional, national, international or global • Used in child health and nutrition, RH research workshop, mental health and psychosocial support in humanitarian emergencies Rudan et al. Setting Priorities in Global Child Health Research Investments: Guidelines for Implementation of CHNRI Method. Croat Med J. 2008; 49:720-33. www.cmj.hr

5. Research Goal • The goal was to adapt the Child Health Research and Nutrition Initiative (CHRNI) methodology to prioritize neonatal health research in the unique setting of complex humanitarian emergencies.

6. Methods • The context was complex humanitarian emergencies • The time was the interval from now to year 2020   • The population disease burden of interest was all mortality and disability due to neonatal causes   • Survey monkey

7. Definition: Likelihood that research would lead to new knowledge in an ethical way   Would you say the research question can be well framed and endpoints can be well defined?     Would you say that local and national research capacity already exists to answer the research question in many different contexts? Do you think that a study needed to answer the proposed research question would obtain ethical approval without major concerns?     Criterion 1: Answerability

8. Definition: Likelihood that research can be conducted cost-efficiently and lead to generalizable new knowledge     Would you say that well designed studies of moderate scale and sample size would have enough power to provide replicable answer to proposed research question?   Would you say that ongoing programs, resources and research capacities could be amended or expanded to undertake proposed research or uptake the measurement technique cost-efficiently? Would you say that the answer to proposed research question would be generalizable across many (or most) different contexts?             Criterion 2: Feasibility

9. Definition: Likelihood that research would address important condition and critical gap in knowledge and could be readily translated to inform policies and programs     Is the condition being assessed a high burden condition?   Is the proposed research addressing a critical gap in knowledge? Would you say that the results of proposed research could be readily translated/used in health information systems, to improve service delivery, to inform policies and programs?     Criterion 3: Relevance

10. Definition: Likelihood that the proposed epidemiological research would have positive impact on equity and local ownership In given context, would you say that the present distribution of disease burden primarily addressed by the proposed research affects IDPs, refugees, and communities affected by humanitarian crisis? Would the proposed research and its results be owned by local actors (e.g. district managers, health workers, communities)? Would you say that the proposed research has the overall potential to improve equity in disease burden distribution in the longer term (e.g. by 2020)?     Criterion 4: Equity

11. Analysis: Apply criteria to the research questions Yes’s were given 1 point, no’s zero and don’t know 0.5 Determined research priority score (RPS) with a cut off of 0.65 Methods (cont’d)

12. Results • 28 respondents completed • 38 began but didn’t complete • Research prioritization scores ranged from 0.846 to 0.679

13. Results (cont’d) • Four questions dealt with the following: • What is the additional burden of neonatal mortality? • Can pregnancy surveillance be used to measure neonatal mortality? • Can verbal autopsy be used to capture causes of neonatal mortality? • What are the risk factors for neonatal sepsis?

14. Results (cont’d) • The programmatic priorities included a focus on: • How can we increase demand for skilled attendance at birth? • What is the coverage of clean delivery practices? • What are the factors that can increase facility delivery uptake? • What are the best strategies to identify preterm babies at the community level?

15. Limitations • Question clarity, intent, and feasibility • Criteria interpretation • Uncertain if we reached appropriate participants • Time

16. Conclusions • The research priorities identified recognize a need to focus on both the descriptive epidemiology and operations research to improve neonatal health in these settings. • The CHRNI exercise has already stimulated discussion and action to address some of the research gaps by donors, international nongovernmental organizations (NGOs) and researchers.

17. Thank you!