The Global Network for Women's and Children's Health Research (GN) was conceived in 2001 as a unique private-public partnership between the U.S. National Institutes of Health (NIH) and the Bill and Melinda Gates Foundation in response to the alarming rates of morbidity and mortality in women and children and the lack of research expertise and infrastructure in the developing world. Its mission is to expand scientific knowledge, develop research infrastructures and improve health outcomes by building research partnerships to conduct research on feasible, cost-effective, sustainable interventions to address the major causes of perinatal morbidity and mortality of women and children in the developing world. Our goals are the following:
- To address important perinatal public health problems to improve the outcome of mothers and children in the developing world;
- To build sustainable public health and research infrastructures;
- To build scientific capacity;
- To provide multidisciplinary, multi-level training opportunities ;
- To collaborate with governments, communities, maternal-child health organisations, advocacy groups, other funding agencies and donors to maximise cost-effectiveness of research;
- To disseminate research findings as the basis for local and national health policy.
The Global Network (GN) was initially funded as cooperative agreements between 10 sites, Research Triangle Data Coordinating Centre and the National Institutes of Health to fund 10 large individual protocols to address preeclampsia, post-partum hemorrhage, infection-related perinatal mortality, Tibetan childbirth practices, neonatal sepsis, low birth weight and cleft lip and palate. The GN has transitioned to the conduct of community-based common protocols in order to scale up infrastructure and interventions more rapidly and increase the likelihood of sustainability.
The current Global Network is comprised of six multidisciplinary research units with established collaborations between a U.S. and a developing country institution. A U.S. based senior Principal Investigator (PI) and a Senior Foreign Investigator (SFI) based in the developing world lead each team. A Data Coordinating Centre (DCC) provides research support services to the Global Network. A National Institute of Child Health and Human Development (NICHD) senior programme scientist provides scientific oversight for the Global Network. A Steering Committee composed of all PIs, SFIs, the DCC PI and the senior NICHD programme scientist meets at least twice annually to develop and implement research protocols, interventions and evaluation strategies, train staff to implement protocols and disseminate findings. The Global Network is chaired by Jerry Keusch, MD, Associate Provost for Global Health, Boston University and Associate Dean for Global Health at Boston University School of Public Health. Prior to this appointment, Dr Keusch served as Director of the Fogarty International Centre at the National Institutes of Health. A Data and Safety Monitoring Board provides the overall guidance and management of the Global Network.
In the first five years, the GN has developed successful, innovative strategies to overcome the many barriers to international collaborative research. IRBs have been constituted in countries with little or no exposure to research, and training activities conducted at many levels, including illiterate patients and health providers. To overcome the lack of infrastructure, data are transmitted by land lines, wireless, satellite and hand-held personal digital assistants. Several sites have introduced a drape to reliably quantify postpartum blood loss. The Belgaum , India , site tested misoprostol in a large (n=1420) community-based trial using local auxiliary nurse midwife staff. The trial, which demonstrated that one case of postpartum hemorrhage (PPH) was prevented for every eighteen women treated, was published in the 10/7/06 Lancet . The Tibet site conducted formative research on childbirth practices, taught Western obstetric methods and completed the first randomised trial to test a traditional Tibetan medication (ZB11) vs. misoprostol to prevent PPH. To address the problem of neonatal deaths in rural India , the Orissa site trained local Anganwadi workers (AWW) to evaluate and refer village-born neonates for sepsis, resulting in a 20 to 25 per cent decrease in the neonatal mortality rate in 223 villages after AWW training. Collaborators at the Guatemalan site are adapting the low phytate maize to the Guatemalan lowland climate and testing zinc supplementation to improve growth in Guatemalan infants. The Democratic Republic of the Congo site is conducting the first pharmacokinetic study of artesunate in pregnant women in Africa . This site also is reinforcing the DRC surveillance system to conduct a large prospective study to determine the burden of human monkey pox, define its epidemiology and assess the feasibility of future treatment and vaccination trials. The Zambian site developed the pilot for FIRST BREATH to address the most frequent cause of neonatal deaths worldwide, acute perinatal asphyxia, by training nurse midwives on the new WHO Essential Newborn Care (ENC) programme, followed by AAP Neonatal Resuscitation Programme (NRP) training. This pilot was scaled up in the common FIRST BREATH trial, a community-based cluster-randomised trial to teach all birth attendants neonatal care and resuscitation of asphyxiated infants. More than 5,000 birth attendants from 100 GN communities with 100,000 deliveries have been trained on this common protocol with materials adapted from the WHO ENC before randomisation to either ENC plus NRP or vs. continued ENC. This is the first RCT of neonatal resuscitation training--its goal is to save 8,000 to 10,000 lives/year.
The Global Network has completed a series of individual trials directed at the major causes of morbidity and mortality in mothers and young children in the developing world. These projects have provided NIH-quality evidence for effective, feasible interventions and improved the health care delivery for mothers and children. Multi-site common Global Network trials, e.g., FIRST BREATH, address critical perinatal problems in high-burden countries, provide high-quality data to prove the effectiveness and feasibility of the interventions and scale up implementation-critical steps to increase political will and change public health policy.
The Global Network collaborates with other Institutes and international agencies, including WHO, UNICEF, USAID, DHHS and NGOs by providing the evidence basis for programme development and advocacy. The Global Network is committed to providing high-quality scientific evidence on the effectiveness of feasible, sustainable interventions to inform decisions about changes in health policy. It works directly with countries and collaborators to scale-up such interventions in high-burden countries, simultaneously building independent scientific/research capacity and public health infrastructures.
Global Network at Aga Khan University
The Department of Community Health Sciences, Aga Khan University (AKU) in collaboration with the Departments of Paediatrics, Psychiatry, Obstetrics and Gynaecology and the School of Nursing form the Pakistan Site of the Global Network. Our efforts are supported by the principal investigator, Dr Robert Goldenberg at Drexel University in Pennsylvania and by the data coordinating centre of the Network, the Research Triangle Institute. Locally, we work with the Dow University of Health Sciences, the Sindh District Government and other public and private sector institutions in Karachi and other areas of Sindh to promote research on maternal-neonatal health.
- As part of the Global Network, to conduct multi-centre randomised trials of interventions for pregnant women and newborns to reduce maternal and perinatal mortality and morbidity in Pakistan and other developing countries;
- To promote scientifically sound research on maternal-neonatal health;
- To stimulate the development and growth of Pakistani researchers and promote collaborations between AKU researchers and those from Drexel University ;
- To attract new US and Pakistani investigators to the field of international maternal and child health research by systematic mentoring of promising junior investigators and recruiting senior scientists from related fields;
- To enhance the research environment available to AKU scientists by providing high quality responsive administrative/statistical and research support services within a scientifically stimulating multidisciplinary setting.
Learn more about Aga Khan University and Drexel University.