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

2. September 2002 Research in the field of child health is essential to: Evaluate existing activities and programmes, identify new interventions, define strategies and policies Estimate progress of child survival at national and international levels Context (1)

3. September 2002 Context (2) => Child health in developing countries remains a public health priority Main causes of Disability Adjusted Life Years (DALY) world-wide in 1990 * primarily or exclusively childhood diseases Source: WHO 1996

4. September 2002 Objectives During the 1990 decade: Describe the main child health problems in developing countries and evaluate the progress of research to control and prevent them; Appreciate the research activities of the institutions involved in child health and compare them to selected national public health priorities; Identify the current research gaps and the constraints encountered in the implementation of research results.

5. September 2002 Methods (1) Review of the literature (January 1990- June 2001) published literature (Medline) grey literature from : national and international institutions NGOs donors involved in the field of child health research Survey addressed to key stakeholders involved in child health in developing countries (February - June 2001)

6. September 2002 Methods (2) International survey addressed to key stakeholders Target Target: institutions concerned by research in the field of child health (academic, governmental, multilateral, NGOs) Objective Objective : describe their research areas and activities, define their priority selection process and their involvement in the implementation of the research results Method Method: standardised open questionnaire, designed in three languages (French, English and Spanish), sent via post and email (website); qualitative analysis (coding of answers)

7. September 2002 Results (1) : literature review To analyse retrospectively and monitor prospectively the scaling-up of child health interventions Policies (impregnated bednets) To increase the effectiveness of child health interventions and services Health systems (Integrated Management of Child Illnesses) To measure the effect of the implemented strategies and raise new research questions Impact and evaluation (vitamin A) To design the most appropriate strategies to improve child health Development of interventions (prevention of mother to child transmission of HIV) To understand the determinants of childhood diseases Aetiology and mechanisms (viral and bacterial agents) To describe the magnitude of the problem, to identify the causes of child illness and death in different communities Epidemiology and burden of disease (injuries) Logical framework of analysis of child health research in developing countries

8. September 2002 Challenges of child health research in developing countries : key findings Research gaps : prevention of respiratory diseases and neonatal mortality, accessibility to vaccines Insufficient financial investments Inadequate selection of research priorities (lack or misuse of priority setting methods) Need to encourage national research capacity Results (2) : literature review

9. September 2002 Response rate per type of institution Results (3) : international survey => 91 institutions contacted, 45 institutions analysed 45 (100.0%)91 (100.0%)Total 42.83 (6.6%)7 (7.7%)Other 50.05 (11.1%)10 (11.0%)NGO 31.56 (13.4%)19 (20.9%) Bilateral, international institution 41.55 (11.1%)12 (13.2%) National governmental institution 57.08 (17.8%)14 (15.4%) Public research institution 62.918 (40.0%)29 (31.8%)Academic institution Participation rate (%) (b/a) Questionnaires received (b) Questionnaires sent (a) Type of institution 49.5

10. September 2002 Targeted institutions Analysed institutions 01000 km Results (4): international survey Geographical setting of the different institutions contacted according to their participation to the survey – February-June 2001 N

11. September 2002 Privileged research areas: nutrition (78% of respondants) perinatal health (51%) Privileged research strategy: community approach (73%) Criteria for defining research priorities: internal strategy (42%) partnerships (30%) Successful research results which were not implemented: nutrition (n=7), biomedical tools, algorithms (n=4) Reasons for not applying research findings: lack of political support (45%) lack of financial support (28%) Results (5) : international survey Lack of success in the implementation of research results

12. September 2002 Results (6) 2.28.820.05.0 (7)Malaria 6.6 9.07.0 (6)Measles 13.311.129.010.0 (5)HIV/AIDS 17.730.351.018.0 (4)Perinatal health 2.2 (5)6.6 (7)20.0 (5)19.0 (2) Respiratory diseases 2.28.826.019.0 (2) Diarrhoeal diseases 33.373.778.055.0 (1)Malnutrition NeglectedImplementedAddressed% of mortality Survey addressed to research actorsLiterature Research themes Summary and confrontation of the literature review and survey data on child health research in developing countries (%), January 1990-June 2001 (-) rank

13. September 2002 Child health research in developing countries (1990-2001): key messages………. Research contributes to the reduction of child morbi-mortality in developing countries There remains a gap between child health research activities and health needs of children in developing countries The implementation of research results is insufficient Field actors do not always have an accurate perception of child health research activities in developing countries as identified in the literature review Discussion (1)

14. September 2002 ….. Bearing in mind: The geographical and typological representativity of the survey sample The focus of the survey : respondents highly concerned with nutritional considerations Discussion (2)

15. September 2002 Need to develop and apply methods for child health research priority setting in developing countries; Need to select research priorities based on the evidence and invest in these issues; Need to encourage the development of a national capacity for research; Need to encourage the collaboration between researchers and public health decision-makers, to develop the networks of information exchange. Conclusions

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

17. September 2002 Acknowledgements We thank the participants in the Global Forum for Health Research Workshop, Geneva, Switzerland, 18-21 April 2001 for their valuable input in reviewing the background document used for this paper. Special thanks are due to the participants in the electronic survey; E. Mouillet (ISPED) assisted with the literature review; Unpublished material and reports were made available by A. de Francisco (Global Forum for Health Research, Geneva) and O. Fontaine (WHO, Geneva); We finally thank Pr Gilles Brucker and Dr P Astagneau (Paris VII) for reviewing an earlier version of this manuscript.