Research Plans and Progress

Hans Troedsson, Jose Martines, Jelka Zupan Research and implementation of programs to improve perinatal and neonatal health are carried out by a broad collaboration of clusters at the WHO. Most activities are centered in the Family and Community Health cluster, but research and development activities also occur in the Health Technology and Pharmaceuticals cluster, the Sustainable Development and Healthy Environments cluster (nutrition), and Communicable Diseases cluster. The Tobacco-Free Initiative, a cabinet project, also seeks to improve perinatal health by reducing smoking during pregnancy. Major strategies to develop and adapt evidence -based guidelines for detection and treatment of clinical conditions are done through Integrated Management of Pregnancy and Childbirth ( IMPAC) and Integrated Management of Childhood Illness ( IMCI). Research and development activities to improve facility -based care of pregnant women and their infants currently focus on field testing and validation of IMPAC guidelines; revision of IMCI young infant guidelines; managerial tools for strengthening access to and quality of the health care system; development of simpler, effective treatments of neonatal infections and follow-up of infants at risk. Community -based research and interventions seek to: improve home care and care seeking; provide linkages with the community and support for women with special needs; early initiation of exclusive breast feeding; prevention of MTCT of HIV through feeding; and maximize the benefits of IMCI feeding counseling. Specific research activities to improve infant feeding in settings of high prevalence of HIV infections include: assessing the influence of infant feeding patterns on MTCT, infant morbidity, and mortality; identifying feasible and practical ways of improving the quality and safety of replacement feeding; determining how best to ensure that the transition period between exclusive breast feeding and no breast feeding carries a minimum risk of HIV transmission, nutritional, and psychological risks for infant and mother; examining the role of mastitis in HIV transmission through breast milk and how to minimize such problems; and assessing the effects of infant feeding recommendations for HIVinfected mothers on general population behaviors related to breast feeding. One study on care seeking and adherence to treatment for neonatal illness has recently been completed in a periurban cohort in New Delhi, India. WHO researchers found that 60% of deaths occurred within 24 hours of recognition of illness, 40% of caregivers did not seek outside care, and 70% of care was sought from private providers. Half of those private providers had no formal medical education, and failed to refer 70% of the newborns that eventually died. Lastly, less than half of caregivers followed referral recommendations. Further work is currently in progress to understand the barriers to care seeking for young infants and develop interventions to improve it.