Accomplishments and lessons learned since the establishment of the GNMIH

Over the past two years, March of Dimes Global Network for Maternal and Infant Health® (GNMIH) partners have collaborated on the development and implementation of programs in four key areas: research focused on surveillance of birth defects, preterm birth and other adverse outcomes of pregnancy; professional training to improve diagnosis and care; community education to raise awareness about birth defects and preterm birth and the steps that couples can take to reduce their risk; and youth activities to engage students and young health professionals in community education. By working together, the principal investigators from each GNMIH site have shared their knowledge, expertise and experience in ways that have contributed to the strengthening of the interventions conducted and to the forging of mutually supportive and sustained professional ties.

Research highlights to date:

Researchers on a large-scale national project in China are collecting robust data on the rate of preterm birth and associated risk factors in 52 Maternal and Child Health Hospitals across 13 Chinese provinces. Recent analyses indicate a preterm birth rate of 5.6 percent in the populations studied.
In the Philippines, the National Birth Defects Surveillance Project established under the GNMIH has collected data on more than 2,000 newborns with birth defects at 18 sentinel sites and 82 health facilities across the country.
In Lebanon, the principal investigator and his team developed a set of core indicators for surveillance of birth defects and preterm birth. These indicators and outcomes were added to the existing National Collaborative Perinatal Neonatal Network.
Lessons learned -The greatest challenge to implementing harmonized methods of data collection on birth defects and preterm birth across the GNMIH has been the difficulty of retrospectively adjusting existing surveillance systems and the tools used to collect data. Current efforts have focused instead on the prospective introduction of harmonized methods and means for collecting data on new outcomes such as preterm birth. Experience has shown that the integration of programs across the GNMIH is more rapidly and effectively achieved if partners work together on common goals and objectives from the earliest stages of program development through the conduct and evaluation of interventions, rather than trying to fit new programs within existing systems.

Professional training highlights to date:

In the Philippines, primary health care providers have been taught about the care and prevention of birth defects and preterm birth and appropriate referral of affected newborns.
A manual on identification, diagnosis and referral of newborns with birth defects was developed in Lebanon as an educational tool for nurses and physicians.
In Brazil, the GNMIH partner who also heads a WHO Collaborating Center for the development of medical genetics in Latin America developed a pilot training program in medical genetics for primary care providers.
Lessons learned - There is a lack of high-quality training available to primary care providers in the field of medical genetics and also a generalized lack of information on the care of preterm babies in middle-income countries.

Community education highlights to date:

GNMIH partners in China are delivering a series of preconception health courses for women and men of reproductive age and conducting a campaign to raise public awareness of birth defects and the steps that couples can take to reduce their risk.
In the Philippines, partners are distributing educational materials on preterm birth to raise awareness of warning signs during pregnancy and to encourage institutional deliveries. These materials are being distributed to women of reproductive age at prenatal clinics and rural health units as well as at mothers’ classes in both hospital and community settings.
The team in Brazil developed a pamphlet to raise awareness at the community level of environmental risk factors such as alcohol and exposure to certain drugs that can increase the risk of birth defects.
Lessons learned - As with professional education, each GNMIH site developed educational materials to meet the specific needs of its target populations. Partners have identified the importance of community education as an essential adjunct to the training of health care providers to reduce the risk of mortality and disability from birth defects and preterm birth in their middle-income countries.

Youth activity highlights to date:

In China and the Philippines, teams of youth volunteers made up of students and young health professionals have been instrumental in providing health education to target communities.
Students and youth volunteers carry out these activities through public awareness campaigns in which they create and distribute posters and other health promotion materials, organize symposia and deliver talks in these and other venues.
Lessons learned - Through exposure to March of Dimes Team Youth activities in the United States, our partners have recognized that their young people, including students and recently graduated young medical professionals, are a valuable resource for carrying out public education. The numbers of youth and communities reached in the 2 years of GNMIH youth activities demonstrate the power of youth to raise public awareness of important community health issues.

In sum, the GNMIH after 2 years is showing the considerable potential of global networks to improve birth outcomes through collaborative programs in the areas of research, professional training, community education and youth activities. The GNMIH has shown that the key to effective partnership and harmonization of effort is communication and collaboration from the earliest stages of proposal development through the conduct and evaluation of network projects. The GNMIH experience demonstrates that the best results come when strategies and outcomes are shared, and when implementation - including development of educational materials, surveillance tools, and identification of target populations - is carried out by each project leader according to the needs and resources of his or her country.

See also: Management of Birth defects and Haemoglobin Disorders (PDF, 354kb), The March of Dimes Global Network for Maternal and Infant Health (PDF, 258kb)