Global Network | About

Global Network participants at SC VI January 2005 in Miami.

Mission Statement

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  organizations, advocacy groups, other funding agencies, and donors to maximize cost-effectiveness of research
• To disseminate research findings as the basis for local and national health policy.

The NIH currently funds all Global Network activities.

Function

The Global Network (GN) was funded initially as cooperative agreements between 10 sites, Research Triangle Data Coordinating Center, 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 7 multidisciplinary research units (including new sites in Kenya and Nagpur, India) 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. The Data Coordinating Center (DCC) provides research support services to the Global Network.  A National Institute of Child Health and Human Development (NICHD) senior program scientist provides scientific oversight for the Global Network.  A Steering Committee composed of all PIs, SFIs, the DCC PI, and the senior NICHD program 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 Chairman of the Global Network is a senior international researcher chosen by NICHD.  A Data and Safety Monitoring Board monitor safety, data quality and management of the Global Network trials and studies. 

Results

In the first 6 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 accurately quantify postpartum blood loss. The Belgaum, India, site tested misoprostol (MP) in a large (n=1420) community-based randomized controlled trial (RCT) using local auxiliary nurse midwife staff. The RCT, which prevented 1 case of postpartum hemorrhage (PPH) for every 18 women treated, was published in the 10/7/06Lancet.  The GN has promoted MP adoption in collaboration with PATH, USAID, etc. As a result MP has been approved by India, Bangladesh, Nepal, Nigeria, Tanzania, Zambia, and Uganda, and is awaiting approval in Ethiopia. The Tibet site conducted formative research on childbirth practices and taught Western obstetric methods, before completing the first Tibetan RCT which demonstrated that misoprostol was superior to a traditional Tibetan medication (ZB11) in preventing PPH. The Pakistan site recently completed a trial of chlorhexidine washes to prevent adverse perinatal outcomes; data analysis is underway. 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 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 tested 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 (MPX), define its epidemiology, and assess the feasibility of future treatment and vaccination trials. They recently completed a population-based serosurvey of 2,600 individuals in the Kasai Province to assess rates of exposure to MPX, HIV, and viruses. Finally, the GN completed a 9,000 pregnant woman survey of tobacco exposure and knowledge of its dangers.

The Zambian site developed a large pilot that trained nurse midwives to resuscitate and care for asphyxiated newborns.  This pilot was scaled up in the Global Network’s first common RCT, the FIRST BREATH TRIAL, which is a community-based cluster-RCT to teach neonatal care and resuscitation of asphyxiated infants to all birth attendants at participating sites.  More than 3,700 birth attendants from 100 GN communities with 150,000 deliveries have been trained in neonatal care and resuscitation using the WHO Essential Newborn Care (ENC) training program, followed by randomization to ENC plus the AAP Neonatal Resuscitation Program or continued ENC.  This is the first RCT of neonatal resuscitation training--its goal is to save 5,000 to 8,000 lives/year.

Our five-year strategic plan builds on the FIRST BREATH trial with a follow-on trial of emergency and neonatal care (using the train-the trainer model to improve the quality of care in the referral facilities and at the community level and community mobilization to develop transport systems), a trial to optimize growth of infants between 6 and 18 months with complementary feeding, and a trial of Uniject antenatal steroids to improve preterm survival and outcome—the major remaining causes of perinatal mortality. We plan to assess indoor air pollution and alternative stoves as measures to reduce the risk of respiratory infection in mothers and children. We also are developing trials to define optimal presumptive therapy for neonatal sepsis and acute respiratory infections.

How the Global Network relates to the mission and goals of the NIH

The Global Network collaborates with other Institutes and international agencies, including WHO, UNICEF, USAID, DHHS, PATH, AAP, Saving Newborn Lives, and other NGOs by providing the evidence for program 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.