Improving child health in developing countries: the critical role of research

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Improving child health in developing countries
the critical role of research
Joanna Orne-Gliemann, Freddy Perez, Valériane
Leroy, Marie-Louise Newell, François Dabis, Anna
Coutsoudis, Hoosen Coovadia
Institut de Santé Publique, dÉpidémiologie et de
Développement, Université Victor Segalen Bordeaux
2, Bordeaux, France Institute of Child Health,
University College, London, UK Department of
Paediatrics and Child Health, University of
Natal, Durban, South Africa
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Context (1)
Research in the field of child health is
essential to

• Evaluate existing activities and programmes,
  identify new interventions, define strategies and
  policies
• Estimate progress of child survival at national
  and international levels

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Context (2)
Main causes of Disability Adjusted Life Years
(DALY) world-wide in 1990
primarily or exclusively childhood diseases
Source WHO 1996
gt Child health in developing countries remains a
public health priority
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Objectives

• During the 1990 decade
• Describe the main child health problems in
  developing countries and evaluate the progress of
  research to control and prevent them
• Appreciate the research activities of the
  institutions involved in child health and compare
  them to selected national public health
  priorities
• Identify the current research gaps and the
  constraints encountered in the implementation of
  research results.

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Methods (1)

• Review of the literature (January 1990- June
  2001)
• published literature (Medline)
• grey literature from
• national and international institutions
• NGOs
• donors
• involved in the field of child health research
• Survey addressed to key stakeholders involved in
  child health in developing countries (February -
  June 2001)

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Methods (2)

• International survey addressed to key
  stakeholders
• Target institutions concerned by research in the
  field of child health (academic, governmental,
  multilateral, NGOs)
• Objective describe their research areas and
  activities, define their priority selection
  process and their involvement in the
  implementation of the research results
• Method standardised open questionnaire, designed
  in three languages (French, English and Spanish),
  sent via post and email (website) qualitative
  analysis (coding of answers)

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Results (1) literature review
Logical framework of analysis of child health
research in developing countries
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Results (2) literature review

• Challenges of child health research in
  developing countries key findings
• Research gaps prevention of respiratory
  diseases and neonatal mortality, accessibility to
  vaccines
• Insufficient financial investments
• Inadequate selection of research priorities (lack
  or misuse of priority setting methods)
• Need to encourage national research capacity

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Results (3) international survey

• Response rate per type of institution

gt 91 institutions contacted, 45 institutions
analysed
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Results (4) international survey
 

N
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Results (5) international survey
Lack of success in the implementation of
research results

• Privileged research areas nutrition (78 of
  respondants)
• perinatal health (51)
• Privileged research strategy community approach
  (73)
• Criteria for defining research priorities
  internal strategy (42)
• partnerships (30)
• Successful research results which were not
  implemented nutrition (n7), biomedical tools,
  algorithms (n4)
• Reasons for not applying research findings lack
  of political support (45)
• lack of financial support (28)

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Results (6)
Summary and confrontation of the literature
review and survey data on child health research
in developing countries (), January 1990-June
2001
(-) rank
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Discussion (1)

• Child health research in developing countries
• (1990-2001) key messages.
• Research contributes to the reduction of child
  morbi-mortality in developing countries
• There remains a gap between child health research
  activities and health needs of children in
  developing countries
• The implementation of research results is
  insufficient
• Field actors do not always have an accurate
  perception of child health research activities in
  developing countries as identified in the
  literature review

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Discussion (2)

• .. Bearing in mind
• The geographical and typological representativity
  of the survey sample
• The focus of the survey respondents highly
  concerned with nutritional considerations

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Conclusions

• Need to develop and apply methods for child
  health research priority setting in developing
  countries
• Need to select research priorities based on the
  evidence and invest in these issues
• Need to encourage the development of a national
  capacity for research
• Need to encourage the collaboration between
  researchers and public health decision-makers, to
  develop the networks of information exchange.

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Related publications

• The Global Forum for Health Research commissioned
  us to prepare a report on the status of Child
  Health and Nutrition Research
• WHO, Global Forum for Health Research. Child
  health research a foundation for improving child
  health. Geneva WHO 2002. p. 30. Report No.
  WHO/FCH/CAH/02.3.
• http//www.who.int/consultation-child-adolescent/
  Documents/ HealthyChild.pdf
• This report forms the basis of a review paper
• Dabis F, Orne-Gliemann J, Perez F, Leroy V,
  Newell ML, Coutsoudis A, et al. Improving child
  health the role of research. BMJ
  2002324(7351)1444-1447.
• http//bmj.com/cgi/reprint/324/7351/1444.pdf

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Acknowledgements

• We thank the participants in the Global Forum for
  Health Research Workshop, Geneva, Switzerland,
  18-21 April 2001 for their valuable input in
  reviewing the background document used for this
  paper. Special thanks are due to the participants
  in the electronic survey
• E. Mouillet (ISPED) assisted with the literature
  review
• Unpublished material and reports were made
  available by A. de Francisco (Global Forum for
  Health Research, Geneva) and O. Fontaine (WHO,
  Geneva)
• We finally thank Pr Gilles Brucker and Dr P
  Astagneau (Paris VII) for reviewing an earlier
  version of this manuscript.