AFRO-NETS> Request for Proposals - Child Health and Nutrition Research Initiative

[Walter Gulbinat <walter@gulbinat.com>]

Request for Proposals - Child Health and Nutrition Research Initiative
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Dear colleagues,
 
It is my pleasure to draw your attention to a Request for Proposals 
(RfP) issued by the Child Health and Nutrition Research Initiative 
(CHNRI). A copy of the RfP is attached for your consideration. You 
may also wish to refer to the website of the Global Forum for Health 
Research: 
http://www.globalforumhealth.org

The announcement invites institutions, particularly in low- or mid-
dle-income countries, to express their interest in conducting re-
search on low birth weight. More specifically, proposals are expected 
for population-based studies to:

(a) define the burden of low birth weight, i.e. prematurity and IUGR, 
    and assess risk factors; and/or

(b) explore the relationship between prematurity and IUGR and neona-
    tal morbidity and causes of death.

Should you feel that the research topics meet your or your institu-
tion's interest we would be delighted to receive your letter of in-
tent by 15 August 2003. 

You should also feel free to inform others about this announcement. 

Looking forward to hearing from you,

Sincerely yours,
 
Walter Gulbinat
International Health Consultant
Global Forum for Health Research
c/o World Health Organization (WHO)
CH-1211 Geneva-27
Switzerland
Tel: + 49-7122-820-014 (direct)
Fax: + 49-7122-820-015 (direct)
mailto:GulbinatW@WHO.int


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Request for Proposals

Child Health and Nutrition Research: Research on Low Birth Weight


1. Global Forum for Health Research

Health research is essential to improve the design of health inter-
ventions, policies and service delivery. Every year more than US$70 
billion is spent on health research and development by the public and 
private sectors. An estimated 10% of this is used for research on 90% 
of the world's health problems. This is what is called 'the 10/90 
gap'.

The Global Forum for Health Research is an independent international 
foundation established in 1998 in Geneva, Switzerland. Its central 
objective is to help correct the 10/90 gap in health research and fo-
cus research efforts on the health problems of the poor by bringing 
together key actors and creating a movement for analysis and debate 
on health research priorities, the allocation of resources, public-
private partnerships and access of all people to the outcomes of 
health research. 

The Global Forum is supported financially by the Rockefeller Founda-
tion, World Bank, World Health Organization and the governments of 
Canada, Denmark, the Netherlands, Norway, Sweden and Switzerland. 

The Global Forum supports networks in health research bringing to-
gether a wide range of partners in a concerted effort to find solu-
tions to priority health problems. One such network is the Child 
Health and Nutrition Research Initiative.

2. Background 

The Child Health and Nutrition Research Initiative  (CHNRI), sup-
ported by the Global Forum for Health Research, was established to 
stimulate and support the expansion of research on priority child 
health and nutrition issues on a global basis, especially in the de-
veloping world. The specific objectives of CHNRI are:
* To promote priority research discussions within a broadened ap-
  proach to child health, nutrition and development
* To expand global knowledge on childhood disease burden and the 
  cost-effectiveness of interventions
* To ensure adequate inclusion of developing country institutions and 
  scientists in the setting of priorities and formulation of plans for 
  child health and nutrition research
* To promote appropriate research capacity development in low and 
  middle income countries for participation in these activities
* To stimulate donor participation by proposing clearly defined and 
  focused research activities and a plan of action, and to increase 
  funding for child health and nutrition research.

Important areas of research identified by Child Health and Nutrition 
Research Initiative partners concern (a) the role of low birth weight 
(LBW) i.e. prematurity and intrauterine growth retardation (IUGR); 
(b) the relation between prematurity and IUGR on the one hand, and 
causes of neonatal death on the other hand; and (c) interventions re-
lated to LBW and their evaluation, including interventions in or pre-
ceding pregnancy, or special interventions for LBW babies.

2.1 Premature delivery, intrauterine growth retardation (IUGR) and 
LBW

The period of intrauterine growth and development is one of the most 
vulnerable in the human lifecycle. The weight of an infant at birth 
is an important indicator of maternal health and nutrition prior to 
and during pregnancy, and a powerful predictor of infant growth and 
survival. Birth weight is the final expression of gestational age and 
rate of intrauterine growth. Low birth weight (LBW), therefore, is 
the result of premature delivery or intrauterine growth retardation 
(IUGR) or a combination of the two.

LBW is especially common in South Central Asia, where 21% of newborns 
are affected, accounting for about 64% of all affected newborns 
worldwide. Low birth weight at term is also common in Central and 
Western Africa, but much less so in Latin America and the Caribbean.
In developing countries, the major determinants of IUGR are related 
to the mother's nutritional status: inadequate nutritional status be-
fore conception, short stature (primarily due to under-nutrition and 
infection during childhood) and poor nutrition during pregnancy (low 
gestational weight gain due primarily to inadequate diet). Micronu-
trient deficiencies play a part but their specific role in IUGR re-
mains an important research question. Gastroenteritis, intestinal 
parasitosis and respiratory infections are prevalent in developing 
countries and may also have an important effect. Malaria is a major 
determinant in countries where that disease is endemic. Cigarette 
smoking is becoming an increasingly important factor in some parts of 
the developing world4.

The immediate causes of IUGR often operate simultaneously with deeply 
rooted underlying causes related to the status of women in society, 
access to quality health services, sanitation, household food secu-
rity, education and poverty. 

Hence, observational community-based studies on the roles of prema-
turity and IUGR in LBW are expected to lead to conclusions of direct 
applicability in developing countries. There is a an urgent need for 
such studies that can improve and deepen our understanding of the 
cultural and social factors which underlie food security, status of 
women in society and the other factors described above.

2.2. LBW and neonatal death

Although post-neonatal and child mortality has been declining rapidly 
in most developing countries, the reduction in neonatal mortality has 
been slow, and accounts for between 40% and 70% of all infant mortal-
ity in developing countries, largely reflecting the persisting high 
levels of LBW .

Of the approximately 10.4 million infant deaths each year in develop-
ing countries, 33-40% (population attributable risk) can be attrib-
uted to LBW, i.e. 3.5 to 4 million infant deaths each year. LBW in-
creases the risk of dying due to other direct causes and therefore 
addressing these other direct causes. At least a third of all infant 
deaths may be averted with the prevention of LBW and with preventive 
interventions against the sequelae of LBW during early childhood

2.3. Interventions related to LBW

Interventions related to LBW may be preventive, or they may be aimed 
at overcoming the developmental risks typically associated with LBW.

Prenatal care has long been endorsed as a means of identifying moth-
ers at risk of delivering a preterm or growth-retarded infant and to 
providing an array of available medical, nutritional and educational 
interventions intended to reduce the determinants and incidence of 
LBW and other adverse pregnancy conditions and outcomes. Although the 
general notion that prenatal care is of value to both mother and 
child has became widely accepted, the empirical evidence supporting 
the association between prenatal care and reduced rates of low birth 
weight has been equivocal. The literature indicates that the most 
likely known targets for prenatal interventions to prevent low birth 
weight rates are psychosocial (aimed at smoking), nutritional (aimed 
at low pre-pregnancy weight and inadequate weight gain) and medical 
(aimed at general morbidity).

System-level approaches to improve the accessibility and the appro-
priateness of prenatal health care services to entire groups of women 
together with population-wide health promotion, social service and 
case-management approaches may also offer potential benefits. How-
ever, data on the effectiveness of these services are lacking, and 
whether interventions focused on building cohesive, functional commu-
nities can do as much or more to improve low birth weight rates as 
individualized treatments has yet to be explored. The ultimate suc-
cess of prenatal care in substantially reducing current low birth 
weight percentages may depend on the development of a much broader 
and more unified conception of prenatal care than currently prevails.

More recent developments focus on the low-birth-weight child and tar-
get special interventions, e.g. warming. Currently under discussion 
is the question to what extent are such findings transferable to the 
conditions prevailing in less developed countries. The feasibility 
and effectiveness of alternative approaches need to be evaluated .

Finally, a particular intervention may work under study conditions. 
However, it may not be possible to take it to scale or implement it 
as effectively under real-life conditions.  It is important that pro-
posed interventions are seen in this context and that particular at-
tention is placed on evaluation.

3. Purpose of this Request for Proposals

This announcement calls for proposals to conduct population-based 
studies to:
(a) define the burden of low birth weight, i.e. prematurity and IUGR, 
    and assess risk factors; and/or
(b) explore the relationship between prematurity and IUGR and neona-
    tal morbidity and causes of death.

Proposals should address (a) and/or (b), and should guide the devel-
opment of potential interventions/programmes. In addition to describ-
ing the biological relationships, the study must analyse the avail-
ability and utilization of health and nutrition services that would 
affect the risk of prematurity and IUGR and their consequences. 

A key criterion in selecting studies will be that these could lead to 
the implementation of realistic interventions/programmes at high cov-
erage in community settings, possibly using existing health infra-
structure. 

The expected duration of work should not be more than 24 months with 
at least 12 months of data collection. Interim reports will be ex-
pected every six months.
 
4. Applicants

Institutions, research groups and individual scientists from develop-
ing (low- and middle-income) countries are eligible to apply for this 
grant. Developing-country institutions and researchers may apply 
alone or in collaboration with institutions in the developed world. 
However, such collaborating institutions/individuals cannot be prin-
ciple investigators. Individuals from UN organizations may provide 
technical assistance but cannot be the recipients of funds. 
 
5. Budget

An amount of some US$ 400,000 is currently available for CHNRI's re-
search programme. It is anticipated that between two and four propos-
als will be selected and funded within this framework.

6. Schedule of Work
 
The deadline for proposals is 15 August 2003. Review will take place 
and selection of groups be announced by October 2003. It is expected 
that projects will begin by January 2004. 

7. Review Criteria

Proposals will be reviewed by a selection committee comprising repre-
sentatives of the Child Health and Nutrition Research Initiative 
Board, the Global Forum for Health Research, WHO and external techni-
cal experts from the developing world, according to the following 
criteria:
1. Demonstrated knowledge of the field.
2. Demonstrated understanding of the scope and intent of the research 
   topic.
3. Experience (individual or group applicant) in the conduct of in-
   tervention research. 
4. Existence or ability to establish a multidisciplinary group with 
   complimentary skills necessary for research on such subjects.
5. Thoughtful and complete plan for the execution of the required re-
   search and design of a reasonable and practical process to complete 
   that research on a timely basis.
6. Ability to meet deadlines and organize a complex effort.
7. Access to necessary tools and support services.
8. Demonstrated support from associated institutions.
9. Plan for translation of research results into action/policy.

In the proposal it will be important to include a detailed descrip-
tion of how the findings will be translated into action. 

8. Application Process

Applicants are requested to send in a proposal of no more than 10 
pages including an executive summary (excluding appendices which 
should also not exceed 10 additional pages) covering the following 
sections.

Cover letter (detailing mailing and email address)
In the 10-page proposal:
1. Executive summary
2. Background 
3. Purpose/goal of the project
4. Specific objectives
5. Methods/strategies to be used 
6. Expected results
7. Time-lines 
Annexes
Estimated budget  
Resume of the principal investigator and core investigators.

Investigators whose proposals have been selected may be invited to 
submit a more detailed research project.

Proposals will only be accepted in English. 
Proposals should be received by 15 August 2003 at the 

Child Health and Nutrition Research Initiative Secretariat
Attn. Walter Gulbinat
Global Forum for Health Research 
c/o World Health Organization 
20 avenue Appia
1211 Geneva 27, Switzerland
Tel: +41-22-791-4497
Fax: +41-22-791-4394
mailto:gulbinatw@who.int

Please note: Institutions and research organizations are cautioned 
that there will be no extension on the above-stated time-frames. Ap-
plicants should carefully consider their capacity to deliver the 
products on time.
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