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NICHD Support for Research and Capacity Building in Developing Countries

NICHD Support for Research and Capacity Building in Developing Countries. Yvonne T. Maddox, Ph. D. Deputy Director, NICHD/NIH/DHHS Friends of NICHD Coalition November 13, 2008. Rationale for NICHD/NIH International Investments . Part of the NIH mandate

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NICHD Support for Research and Capacity Building in Developing Countries

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  1. NICHD Support for Research and Capacity Building in Developing Countries Yvonne T. Maddox, Ph. D. Deputy Director, NICHD/NIH/DHHS Friends of NICHD Coalition November 13, 2008

  2. Rationale for NICHD/NIH International Investments • Part of the NIH mandate • Necessary to achieve scientific objectives --access to specific diseases, special populations, and research resources --improve efficiency and help leverage resources • Directly benefits U.S. citizens • Consistent with humanitarian ideals --build international relations

  3. In developing countries more than 10% of children die before they are 5-years old (MDG: WHO & UNICEF)

  4. Major Challenges • 4 million newborns, 3.7 million stillborns, and 550,000 mothers die every year—most of these deaths are preventable • 10.6 million under five deaths in 2001, 99% of whom lived in low-middle-income countries • More than half of child deaths in 2001 were attributable to acute respiratory infections, measles, diarrhea, malaria and HIV/AIDS

  5. NICHD GLOBAL HEALTH PRIORITIES • Health Disparities • Child and Maternal Health • HIV/AIDS • Population Growth/Migration • Antecedents of Health and Disease • Newborn Screening and Prevention of Birth Defects and Intellectual Disabilities • Health Promoting/Seeking Behaviors • Environment and Health • Pediatric Vaccine Development

  6. Partnerships for the Prevention and Treatment of HIV/AIDS • 40,000 estimated new HIV/AIDS cases diagnosed in U.S. • 1.9 million estimated new infections in Sub-Saharan Africa in 2007 • 3.82-4.5 million living with AIDS in India • HIV/AIDS Pandemic must be addressed with partners around the world

  7. Percent of Women in Antenatal Clinics Testing Positive for HIV/AIDS, selected Sites, 2002 Pune Source: National AIDS Control Organization

  8. Mother to Child Transmission of HIV(in the absence of any intervention) • 15-30% in developed countries • 30-45% in developing countries

  9. Examples of NICHD Research in Developing Countries • Prevention of mother to child transmission • Optimal nutrition, including breastfeeding • Behavioral and social science research to advance treatment and prevention • Reproductive health for persons with HIV and their partners, safe pregnancy • Co-morbidities -- other infections in pregnant women and children, including malaria and tuberculosis • Maternal hemorrhage, preeclampsia • Birth asphyxia • Fetal Alcohol Syndrome

  10. HIV Treatment in Mothers, Children • South Africa, Botswana: Studies of women who received single-dose nevirapine for prevention of mother to child transmission to evaluate subsequent response to nevirapine-based combination therapy when needed for own health. • Kenya: Optimization of pediatric anti-HIV therapy – treatment in early infancy; treatment of infants infected despite antiretroviral prophylaxis. • Malawi: Effect of antiretroviral therapy on pediatric HIV encephalopathy.

  11. NICHD International Research Portfolio • Investigator initiated research • Cooperative agreement networks • Training and infrastructure grants • Research and development contracts

  12. Characteristics of NICHD International Programs • Collaborations • Partnerships • Capacity Building • Addressing Important Health Disparities • Reduce Burden of Disease and Disability

  13. NICHD’s Response to Global Health Challenges

  14. Global Network --Leading Causes of Death Among Pregnant Women and Neonates Women • Hemorrhage • Malaria and anemia • Sepsis/unsafe abortion • Eclampsia Neonates • Asphyxia • Prematurity/low birth weight • Infection

  15. Global Network for Women’s and Children’s Health Research • Improve outcomes of mothers and children in low and middle income countries • Build sustainable research and public health infrastructures • Build independent scientific capacity • Collaborate with others to maximize cost-effectiveness • Disseminate findings as the basis for improved public health policy • Originally developed as a partnership with the Gates Foundation

  16. Where is the Global Network?

  17. Global Network for Women’s and Children’s Health Research • Examples of Current Projects • Management of malaria in pregnant women in the Democratic Republic of the Congo • Neonatal resuscitation program (FIRST BREATH) Zambia • Misoprostol for postpartum hemorrhage--India • Preeclampsia—Brazil • Complementary Feeding --Guatemala

  18. Prenatal, Alcohol, SIDS, and Stillbirth (PASS) Network • Established in 2003--NICHD and NIAAA • Community-linked studies to investigate the role of prenatal alcohol exposure in the risk for SIDS, stillbirth, and fetal alcohol spectrum disorders • Clinical sites in North and South Dakota and the Western Cape of South Africa

  19. PASS Clinical Sites

  20. Partnerships for Social and Behavioral HIV/AIDS Research Capacity in Africa • Promote development of social and behavioral science capacity in sub-Saharan Africa. • Build partnerships between US and African institutions. • Established in 2002: South Africa, Ghana, Botswana, Burkina Faso, Zambia, Kenya, Nigeria, Tanzania, Malawi, Democratic Republic of Congo, Uganda • R24 grant mechanisms combining infrastructure development and research projects.

  21. International Extramural Associates Development Award (IEARDA) • Five year grants to strengthen research administration infrastructure in developing countries • Provides institutions in Africa and India with funds to strengthen their grants administration function and provides training in administration and research ethics

  22. New Research Areas • MALARIA • Kenya: Program project for 3 clinical trials related to HIV treatment and malaria in pregnant HIV+ women and children (300-500 m cases, more 1 m deaths) • TUBERCULOSIS • South Africa, Ethiopia, Kenya: Studies to evaluate diagnosis of tuberculosis in HIV-infected children; impact of malnutrition on TB immune reconstitution syndrome in children; pharmacokinetics of anti-HIV and anti-TB drugs/drug interactions in children

  23. NICHD/Gates Partnership: Iron and Malaria Initiative • Background: • 2 billion people have anemia, most due to iron deficiency • WHO guidelines recommend universal supplementation of young children • Evidence indicates that iron supplementation in early childhood increases the risk of morbidity due to malaria, especially in iron replete individuals • Goal: Evaluate key factors affecting safety and efficacy of iron supplementation and related micronutrients in areas where malaria and other infectious diseases are endemic. • Plan: Partnership with WHO, UNICEF, USG agencies and NIH Institutes to develop a research agenda, solicit research project grants and translate findings into practice.

  24. Special International Activities • India/U.S. Joint Working Group in Contraception and Reproductive Health • India/U.S. Joint Working Group on Maternal and Child Health Research • Newborn Screening –Middle East and North Africa

  25. NICHD support of research and research training in Sub-Saharan Africa 2003-2008

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