Format for Annual Reports for Central Research Department Funded by xzl68756

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									                        Achieving MDGs 4 and 5:
                        Strategic Research to
                        develop the evidence base
                        for policy for mother and
                        infant care at facility and
                        community level




Annual Report 1st April 2007 – 31st March 2008
Table of contents

1.   Background information                                                   3
2.   Summary                                                                  4
3.   Key themes                                                               6
4.   Lessons learnt                                                           15
5.   Programme Management                                                     16
6.   Annexes
        Annex 1a Logical Framework                                            17
        Annex 1b Action plan following mid-term review                        22
        Annex 2 Financial summary for the year                                30
        Annex 3 Risk assessment matrix                                        32
        Annex 4 Communications strategy                                       33
        Annex 5 Products and Publications                                     40
        Annex 6a Developing Capacity                                          48
        Annex 6b Institutional Capacity building for Towards 4+5 consortium   50
        Annex 7 Existing programme of collaborative trials and analyses       52
        Annex 8 Risk Assessment                                               53




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1. Background information

Title of RPC

Achieving MDGs 4 and 5: Strategic research to develop the evidence base for policy for
mother and infant care at facility and community level


Reference Number

RPC HD5


Period covered by report

1st April 2007 – 31st March 2008


Name of lead institution and Director

Institute of Child Health, Professor Anthony Costello


Key partners

London School of Hygiene and Tropical Medicine (LSHTM), London
Diabetic Association of Bangladesh (DAB), Bangladesh
International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Bangladesh
Mother and Infant Research Activities (MIRA), Nepal
MaiMwana, Malawi
Centre MURAZ, Burkina Faso
Kintampo Health Research Centre (KHRC), Ghana


Countries covered by research so far

Bangladesh, Nepal, Malawi, Burkina Faso, Ghana




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2. Summary

This report covers the period April 2007 - March 2008. The mid-term review was conducted
during this period. While the quality of the research was rated highly, a number of important
comments were made by the reviewers:
    a) research outputs should focus more on integration and become more responsive to
         stakeholders’ needs
    b) communication should focus less on international level, and more on changing policies
         in countries
    c) management requires strengthening, with more emphasis on timeliness of reporting.
As a result, considerable efforts went into re-directing the consortium activities in the second
half of the reporting period. An action plan was developed with Liz Ollier’s support (Annex 1)
and agreed with research managers and policy advisors from DFID.

Research Outputs

Members of the consortium have continued to be productive with a number of high profile
publications, presentations and other forms of research dissemination geared towards policy
makers. We published an extensive number of papers, participated in numerous international
and national conferences, prepared over half a dozen policy briefs, and had one-to-one
sessions with policy makers and journalists (details of these can be found in Annex 5). This
year, several of our key research outputs focussed on the effectiveness of micronutrients in
reducing neonatal, infant and child mortality. Consortium research in the Dhanusha
micronutrient trial of supplementation in pregnancy showed longer-term benefits for children
aged two and a half (Osrin). A systematic review of multiple micronutrient supplementation
during pregnancy showed that supplementation was not associated with any reductions in
stillbirths or neonatal mortality. Consortium members contributed to the Lancet Series on
Maternal and Child Nutrition which appeared in early 2008, reviewing and estimating that
impact on maternal and child health that could be achieved through nutrition-related
interventions (Cousens, Kirkwood). In addition, we focused more explicitly on the integration
of maternal and neonatal health interventions, with participation in two future Lancet series,
and the preparation of a draft policy document. Finally, we finished work on stakeholder
priorities both within consortium countries (Behague et al) and more generally at international
level (Storeng and Behague). We also continued to be responsive to policy-makers’ needs in
partner countries; for example, in Burkina, we identified two research priorities which the MOH
had a particular interest in studying (male involvement in maternal care, impact of removal of
users fees) and for which we are developing proposals. In addition, we published papers on
the consequences of complications, particularly on infant mortality, highlighting the need for
further interventions in postpartum care for mothers and babies.

Fieldwork has continued to progress on the six key studies, including the vitamin A trial in
Ghana, the NEWHINTs project in Ghana, the Audobem trial of audits in hospitals in Burkina
Faso, Benin and Niger, the morbidity study in Bangladesh and the women’s group trials in
Malawi, India and Bangladesh. Results for the women’s group trials and the vitamin A trial are
expected between 2009 and 2010. We will also be able to report next year on the results of a
community-based intervention in Pakistan.

Funding was also obtained for further studies, a total £5.6 million pounds from six different
sources.

Research Impacts

We have decided to recruit two new part-time staff to help us maximise our research impact,
through improved management and improved communication. We have also improved our
links with other consortia and research networks, including CRESH, Realising Rights,
Evidence for Action and IMMPACT, to learn from their good practices and also maximise
resources (CRESH; Evidence for Action). A Communications Officer was appointed in April (to
start post on 1st July) and interviews have been organised for the Consultant post.

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At international level, this year we targeted Norad, The Gates Foundation and WHO, to
influence their programmatic and research agenda and provide technical advice on
interventions where we have expertise (nutrition, evaluation and audits). We also met with a
number of other players, including the Partnership, AMREF, MacArthur Foundation, FCI, and
of course DFID. At national level, we continue targeting Divisions of Family Health in
Ministries of Health. In Malawi, Charles Mwansambo is chair of the national health services
research committee and advises government on reproductive and child health matters.

In September 2007, we submitted evidence with consortium partners to the International
Development Committee Enquiry. Evidence from our report was included in the International
Development Committee report on maternal health.




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3. Key themes

Research outputs

RPC work is conducted under three overarching themes and one cross cutting theme. Our
main thematic areas are:

1.   Health services and audit for better maternal and newborn care
2.   Community based interventions to improve maternal and newborn outcomes
3.   The integration of maternal and newborn care
4.   Cross cutting advocacy and policy issues

1. Health services and audit for better maternal and newborn care

At all our trial sites our work involves baseline audits of provision of health care services and
much of this information is used to inform local policy makers or to inform our specific
research studies. In West Africa we are running a comprehensive audit programme in
Burkino Faso, Benin and Mali through a randomised controlled trial of the use of different
approaches to obstetric audits under an EU grant. Countries have started data collection for
the baseline.

In Malawi we are collaborating with a quality of care improvement intervention in three
districts. The quality of care intervention is run by the US Institute for Healthcare
Improvement in collaboration with Malawian counterparts. Our role is to evaluate the
programme with a randomised and controlled design. The interest of this project is that it links
community with supply side interventions and is being implemented at large scale. A poster
summarising this work was presented at an international Quality of Care conference in Paris.

We provided assistance to WHO in the preparation and field testing of guidelines for low birth
weight infant feeding. These guidelines were prepared on the basis of a literature review
conducted by Karen Edmond.

We identified a lack of evidence on the effectiveness of the inclusion of birth plans in antenatal
care to increase skilled birth attendance and received confirmation that funding for a trial of
the promotion of birth plans during antenatal care visits in Tanzania has been awarded. The
fieldwork will be funded by WHO and will be coordinated by a doctoral student at LSHTM
(Moke Magoma) under the supervision of Towards 4+5 staff.

2. Community based interventions to improve maternal and newborn outcomes

This is a major theme of our RPC. Currently we have three trials approaching completion in
Malawi, India and Bangladesh. These trials are looking at the effect of mobilising women’s
groups on newborn mortality. Their combined analysis may also enable us to look at the
effects on maternal mortality, although there will be caution in interpreting the findings across
very different settings.

We have also conducted a follow-up study of children enrolled in our antenatal micronutrient
supplementation study for pregnant mothers in Nepal. The follow-up demonstrated that
children at nearly 3 years of age had significant weight gain and lower blood pressures and
changes in other physical dimensions in the supplemented group. This work was published in
the Lancet in early 2008 and subsequently covered in regional media. It has important
implications for demonstrating the importance of perinatal interventions on later health.

Other community work on household economic analysis and livelihoods, including a trial of
working through female community health volunteers to treat newborn infants with sepsis, is
also ongoing in Southern Nepal. The intervention has been developed in collaboration with
JSI and the Nepal Government. This trial has already enrolled 15,000 deliveries and we hope
by early 2009 it will be the largest such study in the world to evaluate the use of oral
antibiotics in volunteers and their impact on this important cause of neonatal mortality.
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A meta-analysis of 12 studies in South-Asia and Sub-Saharan Africa examining the effect of
multiple micronutrient supplementation during pregnancy on newborn survival showed that
supplementation was not associated with any reductions in stillbirths or neonatal mortality.

In Malawi a trial which should report by the end of 2008 is looking at the impact of volunteers
of women providing infant care messages on neonatal mortality and exclusive breastfeeding.
Although not a formal partner in the Consortium, we are strongly linked to work ongoing in
urban slums of Mumbai looking at community effects of interventions to improve uptake and
quality of maternal and child health services. This work is a partnership between government,
NGO, UCL and the private sector: the Municipal Corporation of Greater Mumbai, SNEHA (a
local NGO), the UCL Centre for International Health and Development, and the ICICI Centre
for Child Health and Nutrition.

In Ghana, our two trials on vitamin A supplementation to reduce maternal, perinatal and infant
mortality and on home visits by community health workers to reduce neonatal mortality are still
at their data collection stage. Data analysis and preliminary results should be available in early
2009.

From our Pakistan trial on implementing community-based perinatal care, a paper describing
the findings from the pilot study is now out online in Bull WHO
http://www.who.int/bulletin/volumes/86/07.045849.pdf. Fieldwork for the main trial is now
almost complete and results will be available in the coming year.

In addition, Consortium members took part in a major review of issues relating to Maternal
and Child under-nutrition which appeared as a series of five papers in the Lancet in early
2008. In particular, consortium members led the work to model the potential impact of nutrition
related interventions on maternal and child health.

3. The integration of maternal and newborn care

Our research work on integration includes looking at both maternal and newborn health
outcomes in all our trials. Our women’s group interventions focus on both maternity and
newborn care. A PhD student, Astrida Grigulis, is looking at human resource issues across
maternal and newborn care in Malawi. David McCoy and Oona Campbell are leading a new
paper to summarise the policy issues around integration of maternal and child health. We are
also leading a paper contributing to the Lancet series on Integration of Maternal and Newborn
and Child Health Services which should be published to coincide with the 30th anniversary of
Alma Ata in September 2008.

4. Cross cutting policy issues

Our research on the views of policy makers and their response to integration issues has been
continued by Katerini Storeng and Dominique Behague, resulting in a paper in the American
Journal of Public Health.

There was strong representation from all our partners at the Women Deliver conference in
October 2007.

We are extremely interested to understand the factors which enable all women to gain further
access to good quality care. Accordingly, at many of our sites we are conducting quantile
socioeconomic analyses of both uptake of health services and outcomes. This will highlight
the extent to which poorer groups suffer limited access, and will also help us to decide
whether interventions under test are pro-poor. We have developed a proposal on the influence
of distance on health facility use for childbirth and newborn survival which we will be
submitting for funding to the Wellcome Trust. We are also planning further research on
looking at skilled birth attendance as a primary outcome in future trials. The formative
research for designing interventions will very much draw on our work with women’s groups as
they can throw great insight onto why women may or may not use delivery services.
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Crucial to the success of improving skilled birth attendance rates is the evaluation of incentive
schemes. There are new national maternity incentive schemes in operation in Ghana, India
and Nepal. We are working with the DFID country programme in Nepal to evaluate the
maternity incentive programme. Tim Powell-Jackson, from the LSHTM, is leading this work
and he has drawn heavily upon the household data from our Makwanpur and Dhanusha trials
to examine the impact of this scheme. With colleagues in Nepal, he has produced a report
evaluating the introduction and pro-poor nature of the scheme, to which we understand DFID
is a significant contributor. The evaluative work also collected new data at our research site in
Makwanpur. Provisional reports have been sent to DFID and to the Ministry of Health in
country and we hope to continue the evaluation of this work during the remaining years of our
RPC.

Our studies of the impact of obstetric complications on the livelihoods and health of women
and their families are continuing and are important for advocacy. Publication of an Immpact
cohort study (in which we participated during the analysis and writing up) has shown the
impact of complications on infant mortality, women's mortality and the financial status of the
household. A draft paper with similar findings is also available from Benin; Bangladesh
partners are continuing their data collection, and further funding has been obtained from the
Hewlett Foundation to extend the duration of follow-up of the cohort study in Burkina Faso.




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Generation of new knowledge:
Progress on key programme outputs

Outputs*                                  OVIs*                                     Progress**                                  Recommendations/Comments***
1. Evidence on interventions to improve   1.1 Knowledge products support or         1.1a Close relationship with MoH in all     3 trials will report during 2008 with great
the survival of women and infants         challenge the priorities of policy &      countries and in particular Burkina Faso    relevance to international health policy
through (i) community interventions and   programme decision-makers.                has enabled to identify and respond to
(ii) health services delivery                                                       MoH research priorities.                    New communications adviser will assist
                                                                                    1.1b We found that there is                 our dissemination plan
                                                                                    considerable international interest on
                                                                                    the effectiveness of women’s groups
                                                                                    through the numerous requests for
                                                                                    meetings and visits which we receive.
                                                                                    Trials are still ongoing in Bangladesh,
                                                                                    Nepal and Malawi to study the role of
                                                                                    women’s groups and volunteers
                                                                                    treatment of sepsis.
                                                                                    1.1c. Other important trials ongoing will
                                                                                    provide data on the effectiveness/roles
                                                                                    of CHW (NEWHINTs), vitamin A
                                                                                    (Kintampo trial), and audits in West
                                                                                    Africa.
                                          1.2 Knowledge products reflect            1.2 Larger focus on ‘integration’ in
                                          adjustments made during the life of the   response to mid-term reviewers
                                          RPC on the basis of new knowledge,        comments, but also to external requests
                                          lessons learned.                          such as from the Lancet editor.

                                          1.3 Knowledge products meet agreed        1.3. Numerous material published in
                                          quality standards (e.g. journal           high ranking journals, including an
                                          acceptances; internal peer review for     important focus on micronutrients this
                                          non-published material).                  year. New paper in Lancet on later child
                                                                                    outcomes from micronutrient
                                          1.4 Knowledge products delivered in       supplementation in pregnancy.
                                          accordance with research plan (as         Contributions to Women Deliver
                                          adjusted during the life of the RPC).     conference and to two Lancet series

2. Evidence of influencing policy and     2.1 Strategy based on best practice for   2.1a Women’s groups incorporated into
management decision-making on large       advocacy, including:                      new national Nepal Community
scale programmes for maternal and           • focus on priority research topics     Newborn Care Programme.


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infant mortality reduction                 and target institutions and individuals;   2.1b Technical advice provided on
                                           •  has clear communications                several issues in particular on
                                           objectives;                                implementation of audits in countries.
                                           • adjusted during implementation on        2.1c. Policy briefs on Nepal work sent to
                                           basis of lessons learned, feedback         DFID.
                                           from users; (see communications            2.1d. Increased understanding of policy
                                           guidelines).                               environment and information needs for
                                                                                      policy making through the work of
                                                                                      Behague and Storeng.
                                         2.2 Milestones reached on schedule,          2.2a Publications in peer-reviewed
                                         including publications, non-published        journals.
                                         materials, advocacy events &                 2.2bContributions to Women Deliver
                                         processes.                                   conference and to two Lancet series
                                                                                      2.3. Contribution to UK Parliamentary
                                                                                      enquiry.

3. Increased capacity in partner         3.1 Indicators developed during year         3.1Capacity plans developed by all
countries for knowledge generation and   one and revised during implementation,       partners.
policy influence                         on basis of lessons learned. Capacity        3.2New Commonwealth scholarship for
                                         development plans developed on basis         Ghana.
                                         of capacity needs assessment among           3.3 Refocus on the development of
                                         partners. Needs assessment also to be        capacity of network and institutional
                                         informed by design of the                    partners rather than individuals in
                                         communications strategy, itself              accordance to recommendation of mid-
                                         influenced by a needs assessment of          term review (details in Annex 1b).
                                         policy & programme decision makers

*Listed from programme logframe
** A judgement statement on progress so far with evidence to support this
***Any recommendations for key changes to ensure better achievement of output and/or comments that help to explain progress. These can then be discussed with CRD
staff to agree actions.

Progress in terms of purpose

Purpose*                                 OVIs*                                        Progress**                                  Recommendations/comments***
To support the evidence based policy     1.Policy and practice for MCH is             Substantial progress in this area:          The development of policy briefs for
and practice for MCH.                    increasingly based on evidence               several references made to RPC              national and international policy makers
                                         emerging from the MDG 4+5 RPC, e.g.          knowledge products in women deliver         will be our major mean of influencing
                                           • speeches, policy documents, media        conferences, during delegate speeches       policy next year, with the hiring of a part-


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                                          reports, references to RPC knowledge     and presentations, including on past         time Communications Specialist
                                          in other products;                       research on economic costs and
                                          • development of policy-related          consequences of complications;
                                          documents by targeted decision-          literature review on infant feeding in low
                                          makers, incorporating RPC material;      birth weight infants led to WHO
                                          • secondary products, e.g. research      guidelines which are being tested;
                                          commissioned by targeted decision-       Gates request for a meeting to see how
                                          makers on basis of RPC products.         they can access our network in future
                                                                                   activities; many requests for technical
                                        2. Attribution to the work of the MDG 4&   advices received
                                        5 RPC is judged to be at a reasonable
                                        level.


*Listed from programme logframe
** A judgement statement on progress so far with evidence to support this
***Any recommendations for key changes to ensure better achievement of output and/or comments that help to explain progress. These can then be discussed with CRD
staff to agree actions.




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Evidence for interaction with policy makers and other stakeholders 1

We have much evidence of interaction with policy makers and other stakeholders at national, sub-
national, regional and global level. A summary of our activities is provided below. Further details
can be provided on request.

National level:

In countries, our policy exchanges took the shape of dissemination workshops, meetings to share
knowledge with other stakeholders, attendance of MoH meetings on particular policy issues, and
technical advice to other national institutions, in addition to numerous one-to-one verbal exchanges.

Relationships with ministries of health at national level are excellent in all our partner countries, and
there were numerous examples of cooperation during the year. Professor Kishwar Azad played a
key role in the development of the first National Neonatal Health Strategy in Bangladesh, which is
expected to be completed by June 2008, and also participated in the National Task Force for MDGs
4 and 5 through monthly meetings in MoH, the monthly meetings of the GoB and partners on the
integration of maternal and neonatal health. In Burkina Faso, Dr Ganaba and Dr Meda developed
close links with the MoH and are trying to be responsive to the research needs for the national MCH
policy in three areas: reduced fees for maternal health services, gender issues in the provision of
maternal health services, and improvement of the routine collection of information from MNCH
services. This led to the preparation of two proposals which will be submitted to the MoH. Similar
activities with ministries took place in Nepal, Ghana and Malawi.

One of our projects in Bangladesh came to an end this year. Our Perinatal Care Project run by DAB
held a Dissemination Meeting on ‘Scaling up of community mobilisation activities to improve
maternal and neonatal health in Bangladesh’ in September 2007. The meeting was well attended
by more than 80 representatives of MoH, NGOs, development partners, ICDDR,B and academics.

Our partners’ particular areas of expertise are well recognised in their home countries. For example,
in Malawi, The MaimWana project has been involved in consultancy with two other projects: The
Health Foundation Project and Ntcheu Perinatal Care Project. This has included technical advice
and training in relation to community mobilization and monitoring and evaluation.

In addition, we were active at district level and are most likely to have an immediate impact through
our ‘home grown’ research. In Malawi, Nepal and Ghana, where we conduct RCT research at
population surveillance sites, our relationship with district level stakeholders is excellent. In Ghana,
there were Trial Steering Committee meetings for Obaapavita and NEWHINTs in March 2008.
Directors of the District Health Services in all the 6 participating districts were invited to a briefing
session. Key statistics from the Obaapavita trial were presented for discussion and an update on
the NEWHINTs trial was presented. The IE&C team of the Maternal Mortality trial (Obaapavita
study) hold monthly meetings with opinion leaders and members of communities to update them on
the current status of the trial. This is an ongoing activity which started in 2004 and will end in July
2009.

Regional level:

At regional level, ICDDR,B organised a meeting of the investigators of the ‘integration’ case study
(Bangladesh, India, Pakistan), which took place in Ahmedabad, India in February 2008, to share
study findings from each of the countries, set recommendations for policy implications, review
papers for journal publications and visit field sites with different programmes (targeted maternal
health intervention program for the poor, first level referral centres for EmOC, an effective model of
services)

Another example of regional exchange was a visit by the Director and co-ordinator of BRAC and the
National Family Health Programme team to the MIRA Makwanpur project in March 2007, in order to
observe women’s groups in action.

1
    This includes other DFID RPCs, DFID staff in partner and case study countries and other institutions.
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Global level:

We continued our close cooperation with The Lancet and its editor, as a means to reach policy
makers in international organisations and donor countries, as well as national policy makers in poor
countries. This year, this was the case with two papers on Women Deliver special issues (showing
the importance of emergency obstetric care in Bangladesh, and the need for long term interventions
for women who suffer severe complications and their babies); but also with the nutrition series,
where we contributed to show that impact on maternal and child health that could be achieved
through nutrition-related interventions. In addition, we have drafted a paper for a further series or
articles, including the two integration series mentioned earlier.

We provided technical advice to WHO in our areas of expertise, such as audits (China, Uzbekistan,
Kazakhstan), the measurement of maternal mortality and morbidity (global issues, also in Tunisia),
the evaluation of MNCH programmes, and formative research (by the NEWHINTs team).

We organised a meeting in January 2008 with representatives from the Gates Foundation, USAID
and DFID to discuss the research agenda for community interventions in maternal and child health.
We also visited Norad to discuss their research funding intentions and promote our research.

Participation in conferences was also very important this year, in particular the Women Deliver
Conference which was attended by all our partners and where we made numerous presentations.
We participated in a Workshop on Harnessing UK expertise in maternal, newborn and child health
to achieve MDGs 4 and 5 which was organised by Women and Children First in London in March
2008 (Attended by Gillian Merron MP, Dr Francisco Songane, Ms Anne Pettifor, UNICEF,
representatives of numerous NGOs, DFID and Sarah Brown).

Good communication of results

Our primary challenges have been in understanding the nature of the communications strategy. The
last year has been particularly useful for this and we think we have a clear idea of the aim and
content of the strategy. However, the complexity of the debate on the links between research and
policy has made clarity of approach difficult. We have faced some problems in achieving an
understanding both of the importance of the strategy and of the requirements to fulfil it across the
broad consortium. The RPC risk assessment has been amended to reflect this, with relevant risks
rising from low to medium. In a way this was to be expected, since the RPC involves many partners
and a unified approach takes time to achieve.

The Towards 4+5 communications strategy has been redrafted in this period. We faced problems
with understanding the nature and aims of the strategy by partners. We discussed these in regular
conference calls, and reframed our ideas in light of (a) a DFID communications workshop in the
summer of 2007, and (b) opinions from the mid-term evaluation. The main change was a
re-orientation of the strategy to foreground deliverables and evaluation. Partner communications
deliverables, the structure of the system and reporting requirements have been clarified, simplified
and highlighted. We have used examples in the tool. Reporting and evaluation has improved and
we have produced a draft stakeholder map across all RPC partners. (Please see updated strategy
in Annex 4).

Methods used to collect and monitor baseline evidence in order to track programme impact
on poverty

In Dhanusha, Nepal, we are using a household economy approach to assess poverty and its
connections with maternal and child survival. In Makwanpur, Nepal we are examining the
relationship between socio-economic status and child illness and death.

Although not funded by DFID, David Osrin (a key member of Towards 4+5 RPC) is examining the
degrees of poverty among slum dwellers and how they relate to inequalities in care and outcomes
for mothers and infants in Mumbai. This reflects a growing interest in integrating the RPC work with
the international dialogue on inequalities. At this stage, we are developing our understanding of the
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language and techniques in use in this field, particularly by the World Bank, and have begun to
analyse data across a number of projects. We are standardising our approach to socioeconomic
quantiling through the generation of asset-based scores using principal components analysis. Of
particular interest is the communication of inequity to mixed audiences of specialists and
policymakers, using products such as concentration curves, concentration indices and rich-poor
ratios.

We are conducting a study in Burkina Faso to look at the long term impact of obstetric
complications and their costs on poverty (including impoverishment) and child survival and
development.




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4. Lessons learnt

Working with Partners

Organising at least one annual meeting to share findings and future plans is important. This year we
organised our meeting to coincide with the Women Deliver Conference in October 2007 so that
partners could participate in both events and network with safe motherhood stakeholders. Our
success in obtaining new funding – with for example, the active contribution of our partners from
Malawi, Nepal and Bangladesh to develop a new Wellcome Trust strategic grant - is also testimony
to our continuous successful partnership. New funding from Hewlett Foundation/ESRC will also
enable us to bring King’s College London into more active participation in Consortium activities.

Good Practice/Innovation

This year, we put procedures in place which have helped us to be more effective in our
management activities. For example, providing our partners with appropriate standardised
templates to enable them to track their expenditure and keeping in regular contact with them has
helped us submit our financial reports on time. As Towards 4+5 had more than one potential
candidate for the Commonwealth PhD scholarship, we put a selection process in place to enable us
to select a candidate fairly: each candidate was required to send an outline for his PhD proposal,
with a description of how the project fitted with the goals of the Consortium, and this documentation
was reviewed by the two directors.

Another innovation has been to try to generate funders’ support for Towards 4+5 research activities
by organising joint meetings on research priorities. Representatives of the Gates Foundation and
DFID participated in a meeting at ICH in January 2008. Gates was particularly keen to learn about
the institutional strengths of the Consortium partners for future multi-centre trials.

In October 2007 the CIHD hosted a global sepsis conference at ICH, funded by USAID/SNL which
brought together experts from all over the world and again, it was attended by a number of our
overseas partners.

Project/programme Management

As recommended by the mid-term reviewers, we are in the process of recruiting a Management
Consultant and a Communications Officer (see below). The management review conducted by Liz
Ollier (Consultant from DFID) was very useful in helping us develop a detailed action plan and a job
description for the Management Consultant. We have also improved our links with other
consortiums or research networks including CRESH, Realising Rights, Evidence for Action and
IMMPACT to learn from their good practices and also maximise resources (sharing communication
and administration staff with CRESH; Evidence for Action). The RPC continues to hold monthly
meetings involving all overseas partners via audio-conference. These meetings ensure that all
partners are involved in making major decisions, on a regular basis, allowing us to check progress,
set and review targets, provide each other with updates and review our general direction.

Communication

We recognise that communication activities are best done by communication specialists and, with
CRESH and the Global HIV/AIDS Initiatives Network, set up to recruit a Communications Officer
(recruited in April 2008, starting date: 1st July). Following feedback from the mid-term review, we are
redirecting some of our consortium communication activities towards policy makers in countries, for
example by preparing a policy document on integration of MNCH at country level, and by proposing
to invite policy makers to our next annual meeting in Ghana in October 2008.

A particular turning point was our understanding of DFID’s own view of the strategy. Until the 2007
workshop, we had assumed that the issue was that we were not taking specific action under a
number of headings. Our learning from the workshop was that DFID itself is interested in
understanding how communication strategies can best be framed and implemented: there are no
right answers, and part of the agenda is to ask questions about the nature of communication and policy.
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16
Annexes

Annex 1a.        Logical Framework

If any changes are being proposed this should be flagged in the main body of the report and all changes clearly marked in the logical framework. If there are no changes
then the original logframe should be supplied for reference.

Outputs                                                                Inputs                             Means of verification    Assumptions linking activities to
                                                                                                                                   outputs

1. Evidence on interventions to improve the survival of women and      1.1 Knowledge products             1.1 Checks by RPC        Targeted stakeholders use the new
infants through (i) community interventions and (ii) health services   support or challenge the           managers, presented      knowledge for reducing maternal &
delivery                                                               priorities of policy &             in annual reports;       infant ill-health and mortality.
                                                                       programme decision-makers.         independent              Newly appointed policy &
2. Evidence of influencing policy and management decision-making                                          assessments through      programme decision-makers
on large-scale programmes, for maternal and infant mortality                                              stakeholder interviews   continue to be receptive to RPC
reduction.                                                                                                at MTR & final review.   knowledge products.

3. Increased capacity in partner countries for knowledge generation    1.2 Knowledge products             1.2 Checks by RPC
and policy influence                                                   reflect adjustments made           managers, presented
                                                                       during the life of the RPC on      in annual reports;
                                                                       the basis of new knowledge,        independent checks at
                                                                       lessons learned.                   MTR & final review.

                                                                       1.3 Knowledge products meet        1.3 Ditto.
                                                                       agreed quality standards (e.g.
                                                                       journal acceptances; internal
                                                                       peer review for non-published
                                                                       material).

                                                                       1.4 Knowledge products             1.4 Ditto.
                                                                       delivered in accordance with
                                                                       research plan (as adjusted
                                                                       during the life of the RPC).

                                                                       2.1 Strategy based on best         2.1 RPC management
                                                                       practice for advocacy,             & partners’
                                                                       including:                         assessments of
                                                                          • focus on priority             strategy content &
                                                                          research topics and target      performance in annual
                                                                          institutions and individuals;   reports; independent
                                                                          • has clear                     assessment in MTR,
                                                                          communications objectives;      final review.
                                                                          • adjusted during
                                                                          implementation on basis of      Use RAE approaches


                                                                                                                                                                       17
                                                                            lessons learned, feedback    to assess quality and
                                                                            from users; (see             the impact of
                                                                            communications               documents and
                                                                            guidelines).                 whether made
                                                                                                         available in open
                                                                                                         access journals

                                                                          2.2 Milestones reached on      2.2 Ditto
                                                                          schedule, including
                                                                          publications; non-published
                                                                          materials; advocacy events &
                                                                          processes.

                                                                          3.1 Indicators developed       3.1 Capacity
                                                                          during year one and revised    Development strategy
                                                                          during implementation on       (to be finalised in year
                                                                          basis of lessons learned.      3) and capacity
                                                                          Capacity development plans     development plans.
                                                                          developed on basis of
                                                                          capacity needs assessment
                                                                          among partners. Needs
                                                                          assessment also to be
                                                                          informed by design of the
                                                                          communications strategy,
                                                                          itself influenced by a needs
                                                                          assessment of policy &
                                                                          programme decision makers.

Activities                                                                Inputs                          Means of                   Assumptions linking activities to
                                                                                                          verification               outputs

Year Four

1.1 Continue to generate multiplier funding                               RPC budget                     Annual report              Security and environmental
                                                                          £429,688.57                                               conditions allow partnerships to
1.1.1    Obtain funding for the MANTRA trial; a three-year                Re-submit to DFID                                         work.
         programme to evaluate the use of treatment packages to
         reduce mother and newborn deaths in five thousand rural                                                                    Bureaucratic obstacles can be
         and remote villages in seven developing countries (Nepal,                                                                  resolved.
         India, Bangladesh, Pakistan, Burkina Faso, Ghana and
         Malawi)                                                                                                                    Opportunities for multiplier funding
1.1.2    Obtain further funding for a nutrition component of a trial of   Awaiting response from UBS                                are available.
         the effect of a) women’s groups and b) home-based                Optimus Foundation                                        New RPC staff can be recruited
         management of neonatal sepsis in Dhanusha, Nepal.                                                                          Ethical approvals obtained on time.
         (Lead: David Osrin, Anthony Costello, Dharma Manandhar)                                                                    Policy & programme decision-
1.1.3    Start actitivities for the Wellcome Trust global network         Funding awarded; starting                                 makers are sufficiently amenable (&


                                                                                                                                                                           18
         research programme to study maternal, newborn and child          date 1st June 2008                                       available) to take part in needs
         survival interventions, with research centres in India,                                                                   analyses.
         Bangladesh, Nepal and Malawi (Anthony Costello)                                                                           Continuity of partners’ staff.
1.1.4    Start study funded by Hewlett/ ESRC for funding on “the          Funding awarded; fieldwork                               Success in building ongoing working
         effects of obstetric complications and their costs on the long   and initial analysis to be                               relations among partners, committed
         term economic and social well being of women and their           completed by March 2009                                  to RPC objectives.
         families in Burkina Faso” (Veronique Filippi, Nicolas Meda,
         Susan Murray, Katerini Storeng and Tom Marshall)
1.1.5    Submit a proposal to WHO/HRP for a study on “The                 Funding awarded; fieldwork to
         effectiveness of antenatal birth plans in increasing skilled     be completed by March 2009
         delivery and post delivery care utilization in a pastoralist
         setting in northern Tanzania” (Moke Magoma, Veronique
         Filippi, Oona Campbell and Simon Cousens)
1.1.6    Submit a research protocol for a multicentre RCT of the          Being considered 14 May
         impact of body cooling on mortality and                          2008 – at Wellcome Trust
         neurodevelopmental outcomes following moderate or
         severe birth asphyxia (Lead: Anthony Costello, and Nikki
         Robertson – UCLH)
1.1.7    Assist with development of a proposal focussing on               Approved by Ministry of
         measuring the impact of community-based treatment of             Health. Awaiting ethical
         neonatal sepsis on neonatal mortality in Ethiopia (Simon         clearance from Ethiopian
         Cousens).                                                        ethics board
1.1.8    Assist with development of a proposal focussing on               Funding agreed by SNL.
         measuring the impact of a neonatal care package on               Will start 2008.
         neonatal mortality in Tanzania (Simon Cousens).
1.1.9    Submit a proposal to the Wellcome Trust to model the             Funded by SNL
         effect of HIV on maternal mortality.                             Will start 2008

1.2 Work towards better integration of maternal and newborn health

1.2.1    Development of two Lancet series’ which focus on the             Lancet integration review       Series to be published
         integration of MCH (A Costello, Z Bhutta, J Lawn and C           meeting 3rd June 2008           September 2008.
         Ronsmans).
1.2.2    Policy paper on the integration of maternal, neonatal and        To be submitted by July 2008
         child health services being prepared by David McCoy et al.

1.3 Protocols for new research

1.3.1    Conduct study to examine the reasons for variation in            Protocol being submitted for
         mortality rates across Bangladesh and Malawi, and risk           ethical approval
         factors for mortality in both countries (Iqbal Anwar).
1.3.2    Development of proposal on the influence of distance on          To be submitted to the
         health facility use for childbirth and newborn survival          Wellcome Trust

1.4 Hit targets for ongoing research activity to work plans



                                                                                                                                                                         19
1.4.1      Continue the existing programme of collaborative trials and    DSMBs in Bangladesh,
           analyses in Nepal, Burkina Faso, Bangladesh, Malawi,           Malawi, Pakistan and India in
           Ghana and other countries such as Pakistan, Benin, Mali,       2008
           Zambia and India, and to report findings in a timely manner
           (all consortium)
1.4.2      Continue secondary analysis on ICDDR'B population              Elahi Chowdhury to take over
           surveillance data (Carine Ronsmans, Marge Koblinsky)           from Marge Koblinsky
1.4.3      Continue fieldwork for the RCT of the use of near-miss
           audits in different settings (Benin, Mali, Burkina Faso)
           (Lead: Matthias Borchert)
1.4.4      Continue fieldwork on the NEWHINTS trial to evaluate the       Training of Trainers and of
           impact of routine home visits t in the third trimester of      CBSVs for 2nd phase, facility
           pregnancy and the 1st week of life on neonatal mortality in    strengthening, development
           rural Ghana (Lead: Charlotte Tawiah)                           of process evaluation
1.4.5      Continue monitoring the impact of community-based health
           promotion interventions to reduce maternal and neonatal
           mortality in Malawi, and hold a DSMB end 2008.
1.4.6      Continue monitoring the impact of community-based
           interventions for infant and maternal health in rural Nepal.
1.4.7      Complete study evaluating the impact of training TBAs and      New funding being sought
           community-based interventions for maternal and newborn         from UBS – decision by end
           health in rural Bangladesh, and hold DSMB in June and          June 2008
           September 2008.
1.4.8      Continue providing consortium support on for the Vitamin A     Results due in 2009
           and maternal mortality trial in Ghana as required
1.4.9      Continue fieldwork to determine the burden of maternal ill     Interim analysis workshop in
           health and death and its programmatic implications in rural    November 2008
           Bangladesh (Lead: Marge Koblinsky, Carine Ronsmans,
           Elahi Chowdhury, Veronique Filippi)
1.4.10     Providing estimates relating to the global burden of           Provide estimates to central    Publication of results
           neonatal mortality and morbidity for the Global Burden of      team in November 2008           as part of GBD
           Disease (GBD) exercise co-ordinated by the Institute of
           Health Metrics in Seattle (Simon Cousens, Joy Lawn et al)
1.4.11     Report on the field-testing of WHO guidelines on Low Birth
           Weight infants in 3 countries (Ghana, Pakistan, India)
           (Karen Edmond, Charlotte Tawiah and Alex Manu)

1.5 Modify research plan on basis of lessons learned, feedback
    from stakeholders.


2.1     Continue to generate multiplier funding                           Big Lottery Fund obtained        Annual report

2.2     Continue to implement the communications strategy

2.2.1      Implement the communication strategy for our RPC, and


                                                                                                                                   20
           continue to monitor its implementation via the sub-             Communications strategy
           committee (David Osrin, Dominique Behague, Veronique            revised. Stakeholder maps
           Filippi, Anthony Costello, Betty Kirkwood, Sarah Ball,          developed.
           Rebecca Wolfe (new Communications Officer) and
           partners)
2.2.2      Communications committee to remain active
2.2.3      Continue participating in the organisation of international     Communications Officer
           events such as the biennial international conferences on        appointed.
           ‘Countdown to 2015, Child Survival’ with the Lancet and the
           Partnership for Maternal and Newborn Health
2.2.4      Continue to attend international conferences such as the
           Alma Ata conference in September 2008 at LSHTM
2.2.5      Continue with activities to translate our research into
           practices in particular with respect to the implementation of
           audits to improve quality of care in developing countries
           hospitals, or to train programme managers in MNCH
2.2.6      Influence of ICDDR,B research upon reproductive health          All ICDDR,B research             Articles published
           policy in Bangladesh (Iqbal Anwar)                              protocols and outputs in the
                                                                           field of RH to be inventoried.
                                                                           National level policy
                                                                           documents to be reviewed.
Prepare policy briefs

2.3     Modify strategy as a result of lessons learned, feedback from
        stakeholders.

3.1     Start to generate multiplier funding                                                                Annual report

3.1.1      Apply for Commonwealth Scholarships for 2009 if there is        Applicants will be identified
           an interested candidate.                                        Applicant will encourage our
                                                                           integration theme
3.2     Produce, review and finalise capacity building plans for all       Consultant to take forward
        partners.

3.3     Start implementation of capacity building plans to fill resource   Consultant to take forward
        and skill groups.

3.3.1      Monitor the implementation of the capacity building plan.

3.4 Modify plan on basis of lessons learned, feedback from
    stakeholders.

Recruit Consultant in Consortium Programme Management                      Interviews in May. Consultant
                                                                           to be in post by July.




                                                                                                                                 21
Annex 4.        Communications strategy highlighting any changes made during the
year.

The Towards4+5 communications strategy has been redrafted in this period. We faced problems
with understanding of the nature and aims of the strategy by partners. We discussed these in
regular conference calls, and reframed our ideas in light of (a) a DFID communications workshop
in the summer of 2007,and (b) opinions from the mid-term evaluation. The main change was a
Re-orientation of the strategy to foreground deliverables and evaluation. Partner communications
deliverables, the structure of the system and reporting requirements have been clarified, simplified
and highlighted. We have used examples in the tool. Reporting and evaluation has improved and
we have produced a draft stakeholder map across all RPC partners.




          To support evidence-based policy and practice for maternal and child health


1. User input
         Try to engage users of research evidence to identify relevant issues and frame questions to fit
         policy needs
2. Applied research
         Conduct applied rather than basic biomedical research and consider the potential for scaling up and
         programmatic implementation
3. User-shaped output
         Advocate and communicate research findings accessibly and in a useable format
4. User uptake
         Try to make sure that potential users of research findings are aware of Towards4+5 advocacy and
         evidence



                                                                               Communications tools

Provided by each RPC partner
1. Priority stakeholder list
          This will be used to map stakeholders for communications activities
2. Communications planning tool for projects
          This will be completed for each individual research project and revised annually
3. Partner annual communications plan
          This will be developed and evaluated annually
4. Communications, capacity building and funding report
          This will be completed every 6 months
5. Case studies and success stories
          These will be reviewed and planned at every communications subcommittee meeting

Provided by RPC core group
1. RPC identity
          The Towards4+5 brand will be developed and used across platforms
2. Communications strategy
          This will be reviewed every 6 months
3. Priority stakeholder map
          The core group will analyse priority stakeholder lists and produce a map for communications
4. Annual report
          This will contain information on communications activities and impact




                                                                                                         22
                                                                  Evaluation of communications
Output
Evidence of influencing policy and management decision making on large-scale programmes for
maternal and infant mortality reduction

Towards4+5 will use 4 big questions to work towards this output

Question                                               How we will answer it
1. How evidence-based is maternal and child health policy?
What is the current evidence base for maternal and Reviews such as Lancet series
child health policy?                                   Conferences, meetings and workshops
                                                       Towards4+5 members' own research
What types of evidence convince policymakers?          Towards4+5 policy study
How is evidence usually presented and is it effective?
Has available evidence been ignored and why?           Reviews such as Lancet series
                                                       Conferences, meetings and workshops
                                                       Towards4+5 members' own research
                                                       Towards4+5 policy study
2. How can Towards4+5 help policy to be more evidence-based?
What are the issues, challenges and requirements for Towards4+5 members' discussions with
policymakers in the area of maternal and newborn policymakers
health?                                                Towards4+5 policy study
                                                       Lancet Delphi study
Who are the potential users of research findings?      Towards4+5 priority stakeholder analysis
What information do users need?                        RPC members' discussions with policymakers
                                                       Towards4+5 policy study
Are users able to receive and use information?         Towards4+5 policy study
Can potential users be involved in implementation?     Towards4+5 priority stakeholder analysis
                                                       Communications planning tool for projects
3. Is the evidence base visible to policy makers?
Is the RPC oriented to communication?                  Communications subcommittee minutes
                                                       Communications strategy implemented
                                                       Communications planning tool for projects
                                                       Conferences, meetings and workshops
                                                       Website
                                                       Leaflet
                                                       Case studies
                                                       Policy briefs
                                                       Publications
Which decisions does the RPC want to influence?        Communications planning tool for projects
Who are the priority audiences for evidence?           Towards4+5 priority stakeholder analysis
                                                       Communications planning tool for projects
What do we want them to do with the information?       Communications planning tool for projects
How likely is the RPC to achieve this?
What are the right messages for each group of users?
What are the most effective dissemination channels?
What events can the RPC use for opportunistic piggy- Communications planning tool for projects
backing?                                               DFID and Towards4+5 calendars of events
4. Can Towards4+5 improve the evidence base for maternal and child health policy?
What research has the RPC done?                        Case studies and success stories
                                                       Publicity material
                                                       Publications
                                                       Presentations
                                                       Annual report
Are people aware that the research has been completed Towards4+5 policy study phase 2
and is available?                                      Annual Report
Has there been uptake and incorporation of research Case Studies and success stories
findings?




                                                                                                    23
                                                  RPC partner reporting and planning tools
Each partner will complete a Communications planning tool for projects for each project that falls
under the RPC at the beginning of the project.

Communications planning tool for projects will be completed for existing projects and revised every
March.

Each partner will complete a Partner annual communications plan every March.

Each partner will complete a Communications, capacity building and funding report every March
and September.




                                                Communications planning tool for projects
What sort of things will we be able to tell people as a result of the research project?
Examples:
"We will be able to tell people whether or not vitamin A is a good intervention for child survival"
"We will be able to tell people more about how property is related to health care uptake"
"We will be able to tell people how to do audits"
"We will be able to say whether or not women's groups are a feasible and possibly effective intervention
to improve newborn survival that needs more studies for confirmation"

In that case, what sort of change do we realistically want to achieve?
Tick boxes
Change in the lives of beneficiaries involved in the project
Development and use of a new tool or method
Change in local policy and practice
Change in national policy
Change in international recommendations
Change in the health and development discourse
Strengthening of advocacy for maternal and newborn health issues
Integration of maternal and newborn care
Other (please detail)




                                                                                                     24
In order to achieve these changes:
Who are the most important users of the research?




What will we do to engage them early in developing the project?




What will we do to communicate the research with them in the most useable way, in
order to achieve the change we want?
Specific activities only; e.g. a workshop with members of the Family Health Division to help plan the
project and a workshop with the same people in the 3rd year to discuss the results; e.g. an annual
meeting with DFID country office to discuss the project; e.g. a policy brief to give to the Minister of
Health.




                                                                                                          25
                                              Partner annual communications plan
This annual plan should be written using the Communications Strategy and Communications planning
    tool for projects as a guide, helping you to decide what activities are most appropriate for you.

What publications are planned in the next year? e.g. peer reviewed papers, books or chapters




What policy briefs or reports are planned in the next year?




What conference or seminar presentations are planned in the next year?




What publicity materials are planned in the next year? e.g. press releases, leaflets, factsheets,
executive summaries, manuals, newspaper/magazine articles, video/DVD, radio, webpages




What dissemination events across partner countries are planned in the next year? e.g.
meetings, workshops or feedback of results to potential users




What meetings with policymakers, conferences and workshops are planned in the next year?
Includes meetings with DFID




What consultancy work and technical advice are planned in the next year?




                                                                                                   26
                                  Communications, capacity building and funding report

1) Publications e.g. peer reviewed papers, books or chapters
(Please provide reference)
e.g. Sombie I, Meda N, Ky-Zerbo O, Dramaix-Wilmet M, Cousens S. A theme issue by, for, and about
Africa: maternal mortality in rural Burkina Faso. BMJ 2005,331:779.



2) Policy briefs or reports
(Please provide reference)
e.g. Borghi J & Lissner C. A Review of Options for Financing Maternal and Newborn Health Care in
Developing Countries. Report prepared for WHO as part of Maternal and Newborn Health and Poverty
project. November 2005.



3) Conference or seminar presentations
(Please provide the conference title and dates, presentation abstracts, the name of who
presented and the name of anyone significant who attended)
e.g. Costello, A. Power, placebos and participation: the struggle for health in rural Nepal. Britain Nepal
Academic Council Annual lecture, Oxford University, 16th November.




4) Publicity material e.g. press releases, leaflets, factsheets, executive summaries, manuals,
newspaper/magazine articles, video/DVD, radio, webpages
(Please provide copies/weblinks etc if possible)
e.g. Edmond KM et al. Delayed breastfeeding initiation increases risk of neonatal mortality. DFID Press
release, March 2006.



5) Dissemination events across partner countries e.g. meetings, workshops or feedback of
results to potential users
 (Please provide event name, date and location, identify key people who attended)
e.g. Edmond KM, Bahl R. Optimal feeding of the low birth weight infant. Technical Review and
Guidelines for health professionals. World Health Organization Technical Meeting September 2005.
Attendees included Zulfiqar Bhutta, Vinod Paul, Jose Martines.



6) Interaction with policymakers and stakeholders e.g. meetings, conferences and
presentations, workshops, working in partnership with governments, contact with DFID
advisors in country and in UK
(Please provide dates, details of who you met with and a brief summary of what was discussed)
e.g. Directors of the District Health Services in all the 6 participating districts in the ObaapaVitA trial,
Ghana, were invited to a briefing session at the end of the TSC in Feb 2006, and key surveillance
statistics from the ObaapaVitA trial were presented for discussion.



7) What evidence is there that policy makers and stakeholders have increased awareness of
your research findings and that has this led to changed attitudes and practice?
(Please provide brief details)
e.g. The Nepali government implemented a national maternity care financing scheme, using the
evidence from our health economics research in this area.


                                                                                                        27
8) Consultancy work and technical advice
(Please provide brief details)
e.g. Veronique Filippi facilitated the WHO Beyond the Numbers national workshop, Chisinau, Moldova,
in order to start and scale up near-miss audits (July 2005).



9) Developing Capacity - North-south, south-south and south-north learning
(Please provide brief details of capacity building activities e.g qualifications, visits, training and
learning workshops)
e.g. ICH ran a management workshop 26th – 30th September 2005 to familiarize the senior management
of DAB, MIRA and other organizations with the process of Appreciative Inquiry and to develop
management skills. We have also organised a Research Workshop to take place in Mumbai in April
2006.



10) Multiplier funding awarded
(Please provide details of the funding body, amount of funding, duration of funding, title of the
project/grant and the lead investigators)
e.g.
Funding Body: Swiss financial investment foundation
Amount of funding: 500,000CHF
Duration of funding: July 2005 - June 2007
Title and lead investigators: Research on community-based interventions for infant health in Nepal
(lead: David Osrin, Anthony Costello, Dharma Manandhar)

Funding Body:
Amount of funding:
Duration of funding:
Title and lead investigators:




                                                                                                   28
Annex 5.       Products and Publications

Peer reviewed publications for the year

Baggaley RF, Ganaba R, Filippi V, Kere M, Marshall T, Sombié I, Storeng KT, Patel V (2007)
Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso. Trop
Med Int Health. Oct;12(10):1225-9.

Bajracharya BL, Manandhar DS, Baral MR (2008) Hemoglobin status in children in the age
group 6 to 60 months. J Nepal Med Assoc. Jan-Mar;45(161):190-5.

Barnett S, Nair N, Tripathy P, Borghi J, Rath S, Costello A (2008) A prospective key informant
surveillance system to measure maternal mortality - findings from indigenous populations in
Jharkhand and Orissa, India. BMC Pregnancy Childbirth. Feb 28;8:6.

Bazzano AN, Kirkwood BR et al. (2008) Beyond symptom recognition: care-seeking for ill
newborns in rural Ghana. Trop Med Int Health 13(1): 123-8.

Béhague DP, Storeng KT (2008) Collapsing the vertical-horizontal divide: an ethnographic
study of evidence-based policymaking in maternal health. Am J Public Health. Apr;98(4):644-
9.

Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B,
Morris SS, Sachdev HPS, Shekar M (2008) Maternal and Child Undernutrition 3 - What
works? Interventions for maternal and child undernutrition and survival. Lancet
371(9610):417-440.

Chowdhury ME, Botlero R, Koblinsky M, Saha SK, Dieltiens G, Ronsmans C (2007)
Determinants of reduction in maternal mortality in Matlab, Bangladesh: a 30-year cohort study.
Lancet 370(9595):1320-8.

Collin SM, Anwar I, Ronsmans C (2007) A decade of inequality in maternity care: antenatal
care, professional attendance at delivery, and caesarean section in Bangladesh (1991-2004).
Int J Equity Health. 2007 Aug 30;6:9.

Costello A, Filippi V, Kubba T, Horton R (2007) Research challenges to improve maternal and
child survival. Lancet 369 (9569): 1240–3.

Costello A, Grant M, Horton R (2008) The Lancet-UCL Commission: health effects of climate
change. Lancet. 2008 Apr 5;371(9619):1145-7.

Darmstadt GL, Walker N, Lawn JE, Bhutta ZA, Haws RA, Cousens S (2008) Saving newborn
lives in Asia and Africa: cost and impact of phased scale-up of interventions within the
continuum of care. Health Policy and Planning 23(2):101-117.

Edmond KM, Kirkwood B et al. (2007) Effect of early infant feeding practices on infection-
specific neonatal mortality: an investigation of the causal links with observational data from
rural Ghana. Am J Clin Nutr 86(4): 1126-31.

Fegan GW, Noor AM, Akhwale WS, Cousens S, Snow RW (2007) Effect of expanded
insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal study.
Lancet. 370:1035-39.

Fenn B, Kirkwood BR, Popatia Z, Bradley DJ (2007) Inequities in neonatal-survival
interventions: evidence from national surveys. Arch Dis Child Fetal Neonatal Ed 92(5):F361-6.

                                                                                                 29
Filippi V, Ganaba R, Baggaley RF, Marshall T, Storeng KT, Sombié I, Ouattara F, Ouedraogo
T, Akoum M, Meda N (2007) Health of women after severe obstetric complications in Burkina
Faso: a longitudinal study. Lancet. Oct 13;370(9595):1294-5.

Fottrell E, Campbell O (2008) Clinical perceptions of infectious causes of maternal death,
Response to PLoS Medicine Vol. 5, No. 2, e44, doi:10.1371/journal.pmed.

Hakamies N, Geissler PW, Borchert M (2008) Providing reproductive health care to internally
displaced persons: barriers experienced by humanitarian agencies. Reprod Health Matters 16:
1-11.

Hill Z, Kirkwood B, Kendall C, Adjei E, Arthur P, Agyemang CT (2007) Factors that affect the
adoption and maintenance of weekly vitamin A supplementation among women in Ghana.
Public Health Nutr 10 (8): 827–33.

Hill Z, Tawiah-Agyemang C, Odei-Danso S, Kirkwood B (2008) Informed consent in Ghana:
what do participants really understand? J Med Ethics 34 (1): 48–53.

Houweling, T.A.J.; Ronsmans, C.; Campbell, O.M.R.; Kunst, A.E. (2007) Huge poor-rich
inequalities in maternity care: an international comparative study of maternity and child care in
developing countries. Bulletin of the World Health Organization 85(10):745-754.

Hurt LS, Alam N, Dieltiens G, Aktar N, Ronsmans C (2008) Duration and magnitude of
mortality after pregnancy in rural Bangladesh. Int J Epidemiol 37(2):397-404.

Kabakian-Khasholian T, Campbell OM (2007) Impact of written information on women's use of
postpartum services: a randomised controlled trial. Acta Obstet Gynecol Scand.
2007;86(7):793-8.

Karaolis N, Jackson D, Ashworth A, Sanders D, Sogaula N, McCoy D, Chopra M, Schofield C
(2007) WHO guidelines for severe malnutrition: are they feasible in rural African hospitals?
Arch Dis Child 92 (3): 198–204.

Lawn JE, Costello A, Mwansambo C, Osrin D (2007) Countdown to 2015: will the Millennium
Development Goal for child survival be met? Arch Dis Child 92 (6): 551–6.

McCoy D, Mwansambo C, Costello A, Khan A (2008) Academic partnerships between rich
and poor countries. Lancet. Mar 29;371(9618):1055-7.

MoHsin F, Nahar N, Azad K, Nahar J (2007) Vaginal bleeding with multicystic ovaries and a
pituitary mass in a child with severe hypothyriodism. Mymensingh Med J 16: 60-62, 2007.

MoHsin F, Zabeen B, Zinnat R, Azad K, Nahar N (2007) Clinical Profile of Diabetes Mellitus in
Children and Adolescents under Eighteen Years of Age. Ibrahim Medical College Journal 1
(1): 11-15.

More NS, Bapat U, Das S, Patil S, Porel M, Vaidya L, Koriya B, Barnett S, Costello A,
Fernandez A, Osrin D (2008) Cluster-randomised controlled trial of community mobilisation in
Mumbai slums to improve care during pregnancy, delivery, postpartum and for the newborn.
Trials. Feb 10;9:7.

Nahar J, Zabeen B, Akhter S, Azad K, Nahar N (2007) Neonatal morbidity and mortality
pattern in SCABU of BIRDEM. Ibrahim Medical College Journal 1 (2):1-4.

Nambiar B, Lewycka S, Mwansambo C, Costello A (2007) Planning health care in developing
countries. Anaesthesia. Dec;62 Suppl 1:5-10. Review.
                                                                                              30
Nkonki LL, Doherty TM, Hill Z, Chopra M, Schaay N, Kendall C (2007) Missed opportunities
for participation in prevention of mother to child transmission programmes: Simplicity of
nevirapine does not necessarily lead to optimal uptake, a qualitative study. AIDS Res Ther 4:
27.

Rudan I, Gibson J, Kapiriri L, Lansang MA, Hyder AA, Lawn J, Darmstadt GL, Cousens S,
Bhutta ZA, Brown KH, Hess SY, Black M, Gardner JM, Webster J, Carneiro I, ChandraMoHan
D, Kosek M, Lanata CF, Tomlinson M, Chopra M, Ameratunga S, Campbell H, El Arifeen S,
Black RE; Child Health and Nutrition Research Initiative (CHNRI) (2007) Setting priorities in
global child health research investments: assessment of principles and practice. Croatian
Medical Journal 48:595-604.

Storeng KT, Baggaley RF, Ganaba R, Ouattara F, Akoum MS, Filippi V (2007) Paying the
price: the cost and consequences of emergency obstetric care in Burkina Faso. Soc Sci Med.
Feb;66(3):545-57. Epub 2007 Dec 3.

Sue J. Lee, Shakoor Hajat, Philip J. Steer, Veronique Filippi (2008) A time-series analysis of
any short-term effects of meteorological and air pollution factors on preterm births in London,
UK. Environmental Research 106:185–194.

Tamim H, El-Chemaly SY, Nassar AH, Aaraj AM, Campbell OM, Kaddour AA, Yunis KA;
National Collaborative Perinatal Neonatal Network (2007) Cesarean delivery among
nulliparous women in Beirut: assessing predictors in nine hospitals. Birth. Mar;34(1):14-20.

Vaidya A, Saville N, Shrestha BP, Costello AM, Manandhar DS, Osrin D (2008) Effects of
antenatal multiple micronutrient supplementation on children's weight and size at 2 years of
age in Nepal: follow-up of a double-blind randomised controlled trial. Lancet. Feb
9;371(9611):492-9.

Zabeen B, Nahar J, MoHsin F, Azad K, Nahar N (2008) Diabetic Ketoacidosis in a tertiary
Hospital. Ibrahim Medical College Journal 2 (1)17-20.

Zabeen B, MoHsin F, Taher A, Khan M, Azad K, Nahar N (2008) Cleidocranial Dysplasia.
Mymensingh Med J Jan; 17(1):82-84.

Publication in press or submitted

Azim T, Khan SI, Haseen F, Haq NL, Lars H, Pervez MM, Chowdhury ME, Sarafian I.
HIV/AIDS in Bangladesh. In: Sack DA (eds.) Achieving Millennium Development Goals for
Health and Nutrition in Bangladesh: Key Issues and Interventions. Dhaka:ICDDR,B, 2006.
pp:80-99. (In press)

Bazzano AN, Tawiah-Agyemang C, Owusu-Agyei S, Adongo PB, Kirkwood B. Walking
between life and death: the social costs of skilled attendance at birth in rural Ghana. IJGO. (In
Press)

Béhague DP et al. Scrutinizing the role of international research for national-level evidence-
based policy-making: the limits of international public health. (To be submitted to The Millbank
Quarterly in June 2008)

Bell JS, Ouédraogo M, Ganaba R, Sombié I, Byass P, Baggaley RF, Filippi V, Fitzmaurice AE,
Graham WJ. The epidemiology of pregnancy outcomes in rural Burkina Faso. Trop Med Int
Health. (In press)



                                                                                               31
Edghill EL, Flanagan SE, Patch AM, Boustred C, Parrish A, Shields B, Shephred MH, Hussain
K, Kapoor RR, Alecki M, MacDonald MJ, Stoy J, Steiner JF, Philipson LH, Bell GI, the
Neonatal Diabetes International Collaborative Group Andrew T. Hattersley and Sian Ellard.
Insulin Mutation Screening in 1044 patients with Diabetes: Mutation in the INS gene are a
Common Cause of Neonatal Diabetes but a Rare Cause of Diabetes Diagnosed In Childhood
or Adulthood. Diabetes Care (In Press)

Edmond KM, Kirkwood B, Tawiah-Agyemang C, Owusu Agyei S. Impact of early infant
feeding practices on mortality in low birth weight infants from rural Ghana. J Perinatol. (In
Press)

Tawiah-Agyemang C, Hill Z, Kirkwood B. Early initiation of breastfeeding: Barriers and
Facilitators. J Perinatol. (In Press)

Ronsmans C, Chowdhury ME, Alam N, Koblinsky M, Arifeen SE. Trends in stillbirths, early
and late neonatal mortality in rural Bangladesh: the role of public health interventions.
Paediatric and Perinatal Epidemiology. (Under review – responded reviewers’ comments 05
July 2007)

Storeng KT and Béhague DP. Public Health Experts Writing History: The Use of Historical
Research in Public Health and the Challenge to Epidemiology. Medical Anthropology
Quarterly. (Under review)

Policy Briefs

The development of the First National Neonatal Health Strategy in Nepal is expected to be
completed by June 2008.

Five Technical Subcommittees (TSCs) have been tasked with the development of the
Strategy and Guidelines on Maternal Health, Birth Asphyxia, Neonatal Sepsis, Healthy
Newborn, Low-birth weight infant in Bangladesh. This is led by Kishwar Azad and will feed
into the National health Policy document.

Hilaire C. Dadjo, the former communicator of Immpact Burkina Faso produced a report on a
successful community dissemination of research results (from the program led by Veronique
Filippi) through theatre. This story is being taken as an example for a new proposal to the
Wellcome Trust in collaboration with the University of Aberdeen, for disseminating all key
results of the Immpact project at a large scale in Burkina Faso.

Campbell OMR and Graham W. Stopping women dying during childbirth: how are the
Commonwealth countries doing? Commonwealth Finance Ministers Reference Report 2007

Input to Parliament consultation:
In September 2007, we submitted evidence with consortium partners to the International
Development Committee Enquiry. Evidence from our report was included in the International
Development Committee report on maternal health.

Campbell O. International Development Select Committee. Inquiry into Maternal Health.
'Teach-in'/seminar. House of Commons. London 11 October 2007.

Publicity material/press releases

•   Malewa Women’s Group gave an interview on radio discussing the issues they were
    facing in accessing Insecticide Treated Nets and called for the situation to be improved.
    Interview was aired in August 2007 on Mudzi Wathu Community Radio Station, Mchinji,
    Malawi.
                                                                                                32
•   1000 copies of a French version of the RPC leaflet has been produced.

•   Mahbub Elahi. Non-marital sexual behaviour of males in the community. Interview with
    BBC (Bangla Program), October 2007.

•   Marge Koblinsky of ICDDR,B featured in a front-page article in the id21 insights health
    bulletin on improving the health of mothers and babies (August 2007 issue), highlighting
    that one of the main reasons behind the key constraints to progress in this field is the
    world’s acute lack of maternal health workers.

•   Newborn Research eUpdates, an e-newsletter compiled by Saving Newborn Lives (Save
    the Children) included an article co-authored by Simon Cousens entitled Setting Priorities
    in Global Child Health Research Investments: Assessments of Principle and Practice in
    December 2007.

•   David Osrin of ICH was quoted in an article entitled Women on vitamins have bigger
    babies in the Times of India (10th February 2008). The article drew on his findings from his
    study published in the Lancet and also on findings from his follow-up investigation of 917
    children in Nepal.

•   Anthony Costello of ICH was interviewed by BBC World Service on the News Hour
    programme on 3rd March 2008 discussing the House of Commons Select Committee
    report on Maternal Health.

•   The Communication Initiative featured information about the ‘Participatory Intervention
    with Women’s Group’ project in Nepal in the September 2007 issue of their e-magazine
    The Drum Beat, a magazine designed for the international development community.

•   The DFID Press Office requested information about the trials of women’s group
    interventions to publicise our work on International Women’s Day on 8th March.
    Summaries of our projects in Malawi, Nepal, India and Bangladesh were supplied by
    Naomi Saville.

•   Executive summary of the maternal health series, prepared by Family Care International,
    edited by C Ronsmans, J Borghi, O Campbell, V Filippi, W Graham, M Koblinsky, A Mills.
    Available on CD from May 2007.

Press release material were prepared for the Women Deliver Lancet papers (Veronique Filippi
et al and Elahi Chowdhury and Carine Ronsmans et al papers). Veronique Filippi and Carine
Ronsmans presented their papers at the Lancet press conference on 11 October 2008. They
were also interviewed and Podcasts of these interviews are available on the LSHTM website:
http://www.lshtm.ac.uk/news/audio/2007/. The Lancet paper on Bangladesh research was
reported on the BBC website http://news.bbc.co.uk/1/hi/health/7039647.stm.

Website links

Towards 4+5 website
www.towards4and5.org.uk

Institute of Child Health
http://www.ucl.ac.uk/cihd/

International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)
http://www.ICDDR,B.org/


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Perinanatal Care Project, Diabetic Association of Bangladesh (DAB)
http://www.dab-bd.org/

Centre MURAZ, Burkina Faso
http://membres.lycos.fr/centremuraz/

Kintampo Health Research Centre (KHRC), Ministry of Health/Ghana Health Services
http://www.ghana-khrc.org/

Mother and Infant Research Activities (MIRA)
http://www.mira.org.np/contactus.htm

London School of Hygiene and Tropical Medicine
http://www.lshtm.ac.uk/ideu/mp/towards4and5.html

The Communication Initiative
http://www.comminit.com/experiences/pds2006/experiences-3757.html

Dissemination events across partner countries; where this involved meetings or
workshops identify key people who attended.

A selection of our dissemination events across partner countries from the previous year are as
follows:

The Perinatal Society of Nepal organised a conference in January 2008 in Kathmandu, Nepal
which included a session sponsored by MIRA and ICH. Attendees included Anthony Costello
(ICH), Marge Koblinsky (ICDDR,B, Bangladesh) and Kishwar Azad (DAB).

Mahbub Elahi et al. “Trends and determinants of Pregnancy related mortality in Matlab,
Bangladesh” from Case Study presented at 11th ASCON, March 2007.

Iqbal Anwar et al. “Maternal Healthcare Situation in Bangladesh” from Case Study presented
in Symposium on Health Sector Reforms - Sharing National and International Best Practice,
Kolkata 18-19 April 2007.

Charlotte Tawiah attended and presented a progress report of the NEWHINTs trial to Towards
4+5 members at a yearly workshop organized by the consortium in October 2007 in London.

Results of the NEWHINTs formative research was presented at the SNL workshop in Malawi
in November 2007. Zelee Hill and Alex Manu attended the said workshop.

The first NEWHINTS Data Monitoring and Ethics Committee (DMEC) took place in London
from 11-15th February 2008. This meeting brought together maternal and newborn health
experts who discussed the technical issues of the project and its implications on the subjects.
Betty Kirkwood, Alex Manu, Guus Ten Asbroek and Justin Fenty attended on behalf of KHRC.

Charlotte Tawiah attended and presented a progress report of the NEWHINTs trial to Towards
4+5 members at a yearly workshop organized by the Consortium in October 2007 in London.

Results of the NEWHINTs formative research was presented at the SNL workshop in Malawi
in November 2007. Zelee Hill and Alex Manu attended the said workshop.

Dharma Manadhar attends regular meetings on the safe motherhood and newborn care
committees of the Department of Health Services, Government of Nepal.



                                                                                            34
Oona Campbell was a guest speaker at an International Women’s Day event hosted by the
King's College London StopAIDS Society on March 7th 2008.

Conference Presentations

   •   CIHD hosted a Royal Society of Tropical Medicine and Hygiene international meeting
       on acute malnutrition on 20th March 2007. The event was attended by over 200
       people and numerous presentations were made including one by Anthony Costello.

   •   Anthony Costello (ICH), Prasant Tripathy (Ekjut) and Kishwar Azad (DAB) all gave
       presentations at the Women and Children First (UK) workshop and conference on 6th
       March 2008 around meeting the challenges of MGDs 4 and 5. The event was also
       attended by overseas colleagues Charles Mwansambo, Dharma Manadhar and Sarah
       Barnett.

   •   As part of the Bloomsbury Nutrition Seminar Series, David Osrin delivered a seminar
       on micronutrient supplementation during pregnancy on 17th March 2008.

   •   Joanna Morrison presented the results of our women’s group trials in Makwanpur at
       the Randomised Controlled Trials in the Social Sciences conference in September
       2007.

   •   Stefania Vergnano (CIHD PhD student) gave a presentation at the Royal College of
       Pediatrics and Child Health (RCPCH) annual conference in March 2007. The
       conference brought together debate and research in paediatrics, children's and young
       people's health.

Some of the conferences staff from Malawi attended were the following:

   •   RSTMH Centenary meeting (13-15 September 2007, London). Presentations were on
       the coverage and uptake of maternal and newborn health services in rural Malawi.

   •   NAC National Research and Best Practice Dissemination Conference (27-29 June
       2007, Lilongwe, Malawi). Presentations were on the coverage and equity of HIV
       counselling and testing among mothers in the Mchinji district.

   •   RCPCH Spring meeting (March 2007, York, UK). Presentations were on equity
       analysis of maternal healthcare and health seeking behaviour in rural Malawi.

Staff from Bangladesh took part and presented at:

   •   The Perinatal Society of Nepal (PESON) conference (January 2008)
   •   The First International Conference of Bangladesh Neonatal Forum (February 2008,
       Dhaka, Bangladesh)
   •   The First International Conference of the Bangladesh Neonatal Forum (February 2008)

From LSHTM:

   •   Veronique Filippi attended the second annual research conference on population,
       reproductive health and economic development in Arusha, Tanzania, with the objective
       of securing funding for the Hewlett/ESRC project on the long term economic
       consequences of complications in Burkina. Funding was later obtained.

   •   Oona Campbell attended a technical meeting convened by the Extending Service
       Delivery Project (3-8 September 2007, Bangkok, Thailand) entitled ‘Scaling Up High-


                                                                                           35
Impact FP/MNCH Best Practices: Achieving the Millennium Development Goals in
Asia and the Near East’.




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