Almost all (99%) of maternal, neonatal, infant and child deaths arise in low and middle income countries, yet most research is focused on the 1% of deaths that occur in high income countries. There is a need to identify feasible and cost-effective evidence-based interventions applicable in low income and middle income countries, as well as strategies for scaling-up these interventions. The Global Network for Women's and Children's Health Research (GN) is best suited to face that challenge. Our main specific aim is to develop and implement common protocols of randomized controlled trials (RCTs) sponsored by the GN. The consortium between Tulane University and the Institute for Clinical Effectiveness and Health Policy in Buenos Aires, Argentina, has extensive experience in conducting large, collaborative RCTs in Latin America and around the world, including a successful and productive participation in the GN first cycle. We have implemented one cluster RCT in 19 hospitals in six cities of Argentina and Uruguay, one cluster RCT in 16 communities in two provinces of Argentina, and one multicentric survey in 1,523 pregnant women in both countries. As an illustration of the protocols we are planning to develop, we are proposing a cluster RCT to test an intervention to increase the use of antenatal corticosteroids in developing countries to prevent neonatal deaths. The administration of antenatal corticosteroids to babies at high risk of preterm birth is the most powerful antenatal intervention to reduce neonatal mortality, reducing neonatal deaths between 25%- 50%. However, in low and middle income countries, only 10% of preterm babies are currently receiving this form of care. We propose to conduct a cluster RCT among 30 communities in 6-8 GN countries. The intervention will determine if we can increase the use of antenatal corticosteroids and reduce neonatal mortality and will consist of implementing the following strategies at all health care levels at intervention settings: 1) diffusing guidelines to healthcare providers;2) improving the identification of women needing corticosteroids by measuring uterine height with a color-coded tape to estimate gestational age in women with signs of labor;and 3) providing antenatal corticosteroids kits containing corticosteroids Uniject devices and instructions for administration. This research could have a large impact on neonatal mortality in low and middle income countries and is thus highly relevant to public health.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project--Cooperative Agreements (U01)
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Application #
Study Section
Special Emphasis Panel (ZHD1-MCHG-B (25))
Program Officer
Koso-Thomas, Marion
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Tulane University
Public Health & Prev Medicine
Schools of Public Health
New Orleans
United States
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Goldenberg, Robert L; Saleem, Sarah; Ali, Sumera et al. (2017) Maternal near miss in low-resource areas. Int J Gynaecol Obstet 138:347-355
Harrison, Margo S; Pasha, Omrana; Saleem, Sarah et al. (2017) A prospective study of maternal, fetal and neonatal outcomes in the setting of cesarean section in low- and middle-income countries. Acta Obstet Gynecol Scand 96:410-420
Garces, Ana L; McClure, Elizabeth M; PĂ©rez, Wilton et al. (2017) The Global Network Neonatal Cause of Death algorithm for low-resource settings. Acta Paediatr 106:904-911
McClure, Elizabeth M; Goldenberg, Robert L; Jobe, Alan H et al. (2016) Reducing neonatal mortality associated with preterm birth: gaps in knowledge of the impact of antenatal corticosteroids on preterm birth outcomes in low-middle income countries. Reprod Health 13:61
Berrueta, Mabel; Hemingway-Foday, Jennifer; Thorsten, Vanessa R et al. (2016) Use of antenatal corticosteroids at health facilities and communities in low-and-middle income countries. Reprod Health 13:66
Garces, Ana; McClure, Elizabeth M; Figueroa, Lester et al. (2016) A multi-faceted intervention including antenatal corticosteroids to reduce neonatal mortality associated with preterm birth: a case study from the Guatemalan Western Highlands. Reprod Health 13:63
Klein, Karen; McClure, Elizabeth M; Colaci, Daniela et al. (2016) The Antenatal Corticosteroids Trial (ACT): a secondary analysis to explore site differences in a multi-country trial. Reprod Health 13:64
Hibberd, Patricia L; Hansen, Nellie I; Wang, Marie E et al. (2016) Trends in the incidence of possible severe bacterial infection and case fatality rates in rural communities in Sub-Saharan Africa, South Asia and Latin America, 2010-2013: a multicenter prospective cohort study. Reprod Health 13:65
Goldenberg, Robert L; Thorsten, Vanessa R; Althabe, Fernando et al. (2016) The global network antenatal corticosteroids trial: impact on stillbirth. Reprod Health 13:68
Althabe, Fernando; Thorsten, Vanessa; Klein, Karen et al. (2016) The Antenatal Corticosteroids Trial (ACT)'s explanations for neonatal mortality - a secondary analysis. Reprod Health 13:62

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