Funding Research Activities

In 1990 the Commission on Health Research for Development concluded that the majority of health research and development resources are being used on issues that are relevant to only a minority of the world's population. The population that is excluded from the benefits of health research is predominantly in the developing world, largely poor and often marginalized from power and decision making. For the past decade, this imbalance has been captured is the expression the "10/90" Gap which indicates that less than 10% of the estimated US$ 70 billion spent annually on health research by private and public sectors is devoted to 90% of the world 's health problems. These imbalances also prevail in Child Health and Nutrition sector. Today a large discrepancy exists between resource flows for health research and the diseases and conditions that account for the highest disease burden in children. For example in Angola and Niger, 25 in every 100 babies die before the age of 5 years whereas this rate is less than one in Europe.

CHNRI is working since 2001 to promote and prioritize resource-sensitive and context-specific researches that address the ever growing burden of child hood diseases in developing countries. Since its conception CHNRI has funded 9 different research projects under 4 requests for proposals. CHNRI pursues its objectives through an open process of advertising and competitive selection of individuals and institutions to carry out the research and policy work it funds.

Regional Assessment of Research Priorities and Research Institutions in Latin America, Asia and Africa
A systematic assessment of research priorities and an inventory of research organization in the Asia, Africa and Latin America regions was one of the CHNRI's top priorities and greatest challenge. CHNRI found this very critical for expansion of research into priority child health and nutrition problems on a global basis especially in the developing world.

In 2001 the first request for proposal was issued on the "Regional Assessment of Research Priorities and Research Institutions". In 2002, CHNRI contracted with three institutions in Latin America, Asia and Africa to conduct the assessments in their respective regions. The overall goal was to identify key regional challenges for child health and nutrition research for the next decade in each region.

ASIA
A total number of 8 countries were selected for this assessment. The participatory countries were China, India, Indonesia Philippines, Bangladesh, Lao PDR, Pacific Island Countries and Srilanka.

A survey of the researchers, key informants, role players, and institutions was done thru mailed questionnaires using the instruments developed by the CHNR regional team while different country used different methods for case study which include manual and electronic search of published literature on child health and nutrition, desk review of gray materials including unpublished research reports, reviews, proceedings, and student research thesis. Focus group discussion participated by key informants selected from the survey was also carried out in some countries to identify gaps and urgent needs in child health and nutrition research.

The project finished in 2005. Full report will be made available online shortly.

AFRICA
For the assessment of research priorities and research institutions in Africa region, Sub-Saharan Africa was taken as the study population. A purposive sample of 20 countries was taken. The sampled countries represent 80% of the total population under study and 76% of the MEDLINE-indexed research articles on child health and nutrition from the region. A pre-specified systematic approach was followed for the systematic review of research priorities and priority-setting processes. Pre-specified inclusion criteria were reports or other formal documents since 1990 from a national or nationally accredited institution, which describe national health research priorities for child health or child nutrition, either alone or as part of a broader report in which children are an identifiable group. A questionnaire survey of role-players was undertaken, to identify role-players and to distribute and collect questionnaires. Respondents' data were captured in a custom- designed MS-Access database.

The project finished in 2004. A Monograph on this regional assessment will be published in October 2006. The data base will be made available on CD-ROM and on the Internet.

LATIN AMERICA
9 Countries, Brazil, Colombia, Costa Rica, Cuba, Chile, Guatemala, Mexico, Peru and Venezuela were selected for the regional profile.

The survey was conducted using a pre tested questionnaire sent to identify nutrition and health research institutions in each of the nine selected countries: Eligible institutions were defined based on their activities related to nutrition and health. For profiling of institutional capacity on nutrition research collaborators in each of the studied countries were asked to prepare an inventory of institutions working in nutrition research in their country. The requested information included the name of the institution, director's name and e-mail, and name and e-mail of a contact person.
The project finished in 2004. A Monograph on this regional assessment will be published in October 2006.

Research in IMCI Community Component
Every day, thousands of sick children go to different hospitals, health centers, and doctors for treatment. Surveys reveal that many sick children are not properly assessed and treated by the health care providers. In many low-income countries, diagnostic supports, and other equipment are very minimal. These factors make providing quality care to sick children a serious challenge. WHO and UNICEF have addressed this challenge by developing a strategy called Integrated Management of Childhood Illness (IMCI).

IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. The success of IMCI in reducing childhood mortality depends on improvements of overall health systems as well as improvement of family and community health care practices. Among all the research questions that have been identified on this topic so far, one is of particular importance to global efforts: "Given the challenge, how to scale up the success of these interventions?"

In 2002, CHNRI issued its second request for proposal (RFP2) on the IMCI Community Component. Two projects one each in Madagascar and Bolivia were funded under this grant.

MADAGASCAR
In early 2003 CHNRI provided a grant to the Ministry of Health (MOH) of Madagascar and AED (through its LINKAGES project) to initiate a Project to "Promote Exclusive Breastfeeding in Madagascar: A Streamlined Approach to Expand to Two New Regions". The two new regions were Toliara and Mahajanga.

The Project adapted the approach developed by AED/LINKAGES and JSI by reducing the intensity of technical assistance provided as well as focusing on only one technical area, in this case, nutrition. In particular the primary focus was on the promotion of optimal breastfeeding practices. The BCC strategy of the Project remained much the same as before, and was based on the promotion of key ENA messages.

The project finished on 2004. A Research brief on this project was published in 2005 and was distributed in Forum 9 in Mumbai. A Monograph will be published in October 2006.

BOLIVIA
Among all the interventions with the best cost-effective ratio, related with infant survival and well-being, breastfeeding is clearly in the first place. The benefits of human milk, regarding prevention of prevalent diseases, have been well documented by decades of scientific research.

Under RFP2 CHNRI provided a grant to the NGO COTALMA to carry out the project "Extending the duration of exclusive breastfeeding in El Alto, Bolivia, through a community based approach." The main strategy of the Project was to strengthen the community health human resources (Manzaneras de la Salud), in the city of El Alto, Bolivia, for promotion of early and exclusive breast feeding.

The Project finished in 2005. A Research brief and a monograph are expected to be published in 2007.

Research in Low Birth weight - Levels, Determinants and Consequences for Neonatal Morbidity and Survival
Although post-neonatal and child mortality has been declining rapidly in most developing countries, the reduction in neonatal mortality has been slow in developing countries, making up 40% to 70% of all infant mortality. Neonatal mortality largely reflects the persisting high levels of LBW. 33-40% of all infant deaths each year can be attributed to LBW.

In 2003, the third request for proposal (RFP3) was issued on low birth weight and its determinants. The proposal was to conduct population-based studies to: (a) define the burden of low birth weight, i.e. Prematurity and IUGR, and assess risk factors; and/or (b) explore the relationship between Prematurity and IUGR and neonatal morbidity and causes of death. Two projects were funded under this grant.

BANGLADESH
Low Birth Weight and Prematurity in Rural Bangladesh: Levels, Determinants and Consequences for Neonatal Morbidity and Survival. The project is currently underway and the results is expected in early 2007.

GAMBIA
Low Birth Weight: A Prospective Study of Burden, Risk Factors and Neonatal Mortality. The project is currently underway and the results is expected in early 2007.

Research on understanding the Effectiveness of Child health and Nutrition Interventions
The Lancet Series on Child Survival concluded that in the 42 countries with 90% of child deaths in 2000, 68% of these deaths could have been prevented through full implementation of a limited number of known and effective interventions. It is important to separate biologic or behavioral interventions from the delivery systems required to put them in place, and delivery strategies should be tailored to the stage of health system development.

In 2005 CHNRI called for proposals to identify a child health and nutrition intervention of known effectiveness that is already being implemented in a large-scale pilot or at regional or national levels, and then evaluate the impact of a specific and defined delivery strategy on intervention coverage. The aim is to determine factors that promote or retard effective intervention coverage at scale. Two projects were funded under this grant.

MALI
Assessing the Effectiveness of twice Vitamin A Capsule distribution in Mali through National Nutrition Weeks

PAPUA NEW GUINEA
Better Use Of Public Health Campaigns For Child Survival; The Impact, Processes, Costs And Future Opportunities Of The Unique Supplementary Immunization Activity Carried Out In Papua New Guinea 2003 — 2005.

Both the projects will be completed by 2007.