Global Network Research in India

Since 2001, Dr. Richard Derman, Christiana Care Health System, has served as Principal Investigator of a Global Network for Women’s and Children’s Health Research Unit, which has been funded through cooperative agreement with the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.

Jawaharlal Nehru Medical College in Belgaum, State of Karnataka, India has served as the collaborating institutional partner for this research initiative. The Christiana Care-JN Medical College research unit is represented, along with other US institutions and foreign site partners, on the Global Network for Women’s and Children’s Health Research--a partnership dedicated to improving maternal and child health outcomes and building health research capacity in resource-poor settings by testing cost-effective, sustainable interventions that provide guidance for the practice of evidence-based medicine.

The first Global Network trial implemented over nearly three years in Belgaum demonstrated that the administration of misoprostol tablets to a woman immediately after delivery of a baby reduced postpartum hemorrhage (PPH) by 42% and severe PPH by 80%. These findings were first published in the Lancet in 2006. Dissemination efforts of the Global Network combined with the work of other global health organizations committed to reduction of maternal deaths, misoprostol was added to the World Health Organization’s essential medicine list for the prevention of postpartum hemorrhage. Another consequence of the misoprostol trial was the invention of a drape that accurately measures postpartum blood loss. Initially used in the misoprostol trial, the drape has been used in subsequent global health research.

The Global Network Research Unit in Belgaum implemented a parental consanguinity and birth weight study under a Global Network Scholars initiative and the unit has participated in the implementation of several common protocols involving Belgaum and other sites associated with other developing countries implemented not only in India but in other countries represented in the Global Network. These studies include, but are not limited, to the following:

• First Breath (completed), a trail to assess whether neonatal resuscitation training provided to community birth attendants added to training based on WHO’s essential newborn care (ENC) training significantly increased newborn survival beyond improved survival associated with ENC training alone (See: Carlo W, Goudar S, Jehan I, et al. for the First Breath Study Group (2010). Newborn-care training and perinatal mortality in developing countries, New England Journal of Medicine, 362(7), 614-23).
• The Maternal Newborn Health Registry (ongoing), a prospective, population-based study of pregnancy outcomes in 7 sites in 6 developing countries (Argentina, Guatemala, India, Pakistan, Zambia and Kenya); and
• The EmONC (Emergency Obstetrics and Newborn Care) Trial (ending in 2011), a study designed to evaluate the ability of a team, whose skills have been enhanced through various training programs, to address problems related to poor pregnancy outcomes and to improve systems of care and the outcomes for mothers and babies.

The Antental Corticosteroid Trial is scheduled for implementation in late 2011. This study is designed to measure the impact of increasing the availability of antental corticosteroids in community-based settings of selected intervention clusters, improving recognition of women at risk for delivering pre-term infants, and removing barriers to administration of a course of corticosteroids (by training providers authorized to use antental corticosteroids and improving referral and transfer arrangements).

Please visit the Global Network for Women’s and Children’s Health Research for additional information. The findings from the various studies conducted at the Belgaum Global Network site can be found in an extensive listing of peer-reviewed publications.