Spreadsheet: cc913eb8-7c81-424a-8cac-0b1478273944
Sheet: Sheet1

CHNRI AND WHO RESEARCH PRIORITY SETTING | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | ANSWERABLITY | Unnamed: 6 | Unnamed: 7 | EFFECTIVENESS | Unnamed: 9 | Unnamed: 10 | DELIVERABILITY | Unnamed: 12 | Unnamed: 13 | DISEASE BURDEN REDUCTION | Unnamed: 15 | Unnamed: 16 | EFFECT ON EQUITY | Unnamed: 18 | Unnamed: 19
"BIRTH ASPHYXIA" |  |  |  |  | [NAME] ____1___ |  |  | [NAME] ____2___ |  |  | [NAME] __3 |  |  | [NAME] ____4___ |  |  | [NAME] ____5___
 |  |  |  |  | SCORER x |  |  | SCORER x |  |  | SCORER x |  |  | SCORER x |  |  | SCORER x
[NAME] AND OPTIONS |  |  |  |  | [NAME] | [NAME] | Q.3 | [NAME] | [NAME] | Q.3 | [NAME] | [NAME] | Q.3 | [NAME] | [NAME] | Q.3 | [NAME] | [NAME] | Q.3
[NAME] | RESEARCH AVENUE | RESEARCH OPTION | [NAME] | RESEARCH QUESTION #
Basic epidemiological research | Mortality burden related to "birth asphyxia" | Development and validation of improved case defns | What are the sensitivity and specificity of more precise case defns for accurately tracking intrapartum stillbirths in low resource settings for eg using verbal autopsy? | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0.5 | 0.5 | 0 | 0 | 0
 |  |  | What are the sensitivity and specificity of more precise case defns for monitoring "birth asphyxia" neonatal deaths avoiding misclassification with preterm birth and congenital abnormalities? | 2 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0.5 | 0.5 | 0 | 0 | 0
 |  |  | Can simpler surrogate case definitions be adapted with acceptable sensitivity and specificity for cause of death attribution and programmatic tracking the burden in facility birth registers in low resource settings (eg using age at death and weight)? [NAME] stillbirths plus first 24 hour deaths in babies >2.5 kg. | 3 |  |  |  | 1 | 1 | 0.5 | 1 | 1 | 1 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  | Misclassification of intrapartum stillbirths and early neonatal deaths | What is the magnitude of misclassification between fresh stillbirths and early neonatal deaths, and which factors affect this misclassification? What decision rules (applicable in the community and hospital settings) be used to differentiate? | 4 | 1 | 1 | 1 |  |  |  | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 0 | 1 | 0
 |  | The burden of neonatal deaths when applying various more specific case defns of "birth asphyxia" (restricted to term babies and related to acute intrapartum events to avoid misclassification with preterm birth complications) | What proportion of neonatal deaths is related to acute intrapartum events in term babies and in near term babies (34 to 36.9 weeks) ? What is the cause specific mortality rate in various settings? What is the overlap with infections or other comorbidities? | 5 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 0.5 | 1 | 0 | 1
 |  | The burden of intrapartum stillbirths | What proportion of stillbirths is related to acute intrapartum events? What is the cause specific intrapartum stillbirth rate in various settings? | 6 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0 | 0 | 0 | 1 | 1 | 0.5 | 1 | 0 | 1
 | Morbidity burden related to "birth asphyxia" | Need for resuscitation | What is the prevalence of babies requiring resuscitation in various settings? What is the prevalence for preterm and term babies? | 7 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0 | 0 | 0 | 1 | 1 | 0.5 | 0 | 1 | 0
 |  | The burden of acute morbidity related to acute intrapartum events | What is the prevalence of Neonatal Encephalopathy (NE) graded for mild, moderate and severe, in various settings? What is the prevalence of other organ system dysfunction: cardiac, hepatic, renal? | 8 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 0.5
 |  | The burden of long term disability and impairments related to acute intrapartum events | What are the short term outcomes of NE (1 week, 6 weeks) and is there an increased risk of death amongst survivors? | 9 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5
 |  |  | What are the longer term outcomes of NE (6 months, 1 yr, 5 yr, and school function at 10 years) and is there an increased risk of death as well as disability and reduced school performance? | 10 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0.5 | 0.5
 |  |  | Can improved methods be developed for early identification of babies with significant impairment or for population based screening (eg reduced head circumference, or adapted simpler developmental scoring)? | 11 | 1 | 0.5 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 1
 | Risk factors | Assessment of the effect of maternal risk factors on asphyxia-related outcomes | What are the maternal and antenatal/intrapartum care risk factors for Neonatal Encephalopathy (NE) graded for mild, moderate and severe, in various settings? | 12 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 1 | 1 | 1
 |  |  | Can specific maternal complications (eg obstructed labour, hypertension, retained twin) with higher risk of intrapartum stillbirth, early neonatal death or other unfavourable asphyxia related outcome be more simply detected at an earlier stage? | 13 | 1 | 0.5 | 1 | 0.5 | 0.5 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1
 |  |  | What is the interaction between maternal infection and neonatal encephalopathy or other asphyxia related outcomes (eg need for resuscitation)?  What is the effect of chorioamnionitis (assessed on placental histology) on NE or other asphyxia related outcomes | 14 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  |  | Does HIV (either thru maternal infection in labour or directly) increase the risk of NE or other related outcomes eg intrapartum stillbirths?  Is histological chorioamnionitis more common in HIV infected mothers? | 15 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  | Assessment of short-term outcomes for babies who do not breath at birth | What are the short term outcomes for term babies who do not breathe spontaneously at birth  - immediate death (esp in settings without resuscitation), NE, later death etc | 16 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  |  | What is the positive and negative predictive value of a very low (<3) and a moderately low (4-6) Apgar score for NE, death, etc | 17 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1
Health Policy and Systems Research (DELIVERY) | BEFORE PREGNANCY Increasing delivery of existing interventions | Age at first pregnancy and birth spacing | In societies with young age at first pregnancy (under 16 years) what are effective techniques to delay the age at first pregnancy and how much effect does this have on intrapartum stillbirths, NE incidence and death, and first hour neonatal deaths in term babies? | 18 | 1 | 0 | 1 | 1 | 1 | 0.5 | 0.5 | 0.5 | 1 |  |  |  | 1 | 0 | 1
 |  |  | What are effective  techniques to promote spacing of pregnancies by at least 24 months and how much impact does this have on intrapartum stillbirths,  NE incidence and death, and first hour  neonatal deaths in term babies? | 19 | 1 | 0 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 0.5 |  |  |  | 1 | 1 | 0
 | DURING PREGNANCY Increasing delivery of existing interventions | Improved interventions during pregnancy | Can community cadres of worker identify a limited number of high risk conditions/danger signs (eg multiple pregnancy, breech, short maternal stature, etc) and successfully refer women for facility birth? What is the predictive value and cost effectiveness? | 20 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 1
 |  |  | Can behaviour change strategies increase the success rate for stopping unhealthy behaviours in pregnancy eg smoking and drug abuse? | 21 | 1 | 0 | 1 | 0.5 | 0.5 | 0.5 | 0 | 0 | 0 |  |  |  | 0 | 1 | 0
 |  |  | Can care of diabetes in pregnancy be operationalised in context of weak health systems to reduce risk of large for gest age babies? | 22 | 1 | 0 | 1 | 0.5 | 0.5 | 1 | 0.5 | 0.5 | 0 |  |  |  | 0 | 1 | 0
 |  |  | What is the effect and cost effectiveness of improving identification and management of pre-eclampsia with relation to stillbirth and neonatal outcomes? | 23 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 0.5 |  |  |  | 1 | 1 | 1
 |  |  | What is the effect and cost effectiveness of identification and management of infections in pregnancy with relation to stillbirth and neonatal outcomes? | 24 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 |  |  |  | 1 | 1 | 1
 |  |  | What is impact of simple messages given to pregnant mothers such as use of kick count in preventing stillbirths, or asphyxia related outcomes? | 25 | 1 | 0 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 1 |  |  |  | 1 | 1 | 1
 | CHILDBIRTH Increasing demand/ utilisation of intrapartum care | Improving demand for skilled birth attendance | What strategies are effective in increasing demand (use of) for skilled attendance? Eg conditional cash transfers, etc | 26 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0 | 0.5 | 1 | 1 | 0.5 | 1 | 0 | 1
 |  | Addressing community level barriers to accessing care especially for emergencies | Behavioural/community participation package to improve recognition and acting on simplified danger signs for mother in labor (community, including transport and phone/radio communication) "emergency preparedness" | 27 | 1 | 1 | 1 | 1 | 1 | 0 | 1 | 1 | 1 |  |  |  | 1 | 0 | 1
 |  |  | Effectiveness of community cadre roles - eg social support, bringing to facility when woman is in labour, danger recognition/referral | 28 | 1 | 1 | 1 | 1 | 1 | 0.5 | 1 | 1 | 1 |  |  |  | 1 | 0 | 1
 |  | Linking home and health facility | Can Maternity Waiting Homes be operationalised in various cultural contexts and how much effect does this have on maternal, stillbirth, neonatal outcomes and for what cost? | 29 | 1 | 1 | 1 | 1 | 1 | 0 | 0.5 | 0 | 0.5 |  |  |  | 1 | 0 | 1
 |  | Use of birthing companion | Does the use of doulas/supportive companion or family member at birth (including relatives) present at facility births increase acceptance/use of facility birth as well as provide the benefit of supportive companion? | 30 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |  |  |  | 1 | 0 | 1
 | CHILDBIRTH Increasing supply and quality of existing intrapartum interventions | Improving availability of intrapartum care and human resources | Can teams with a mix of cadres and skills be used to increase utilization of intrapartum care where there are limited skilled attendants (eg birthing centres with skilled attendant and community cadres, or skilled attendant and auxillaries or a mixture) | 31 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 1 |  |  |  | 0 | 0 | 0
 |  |  | Do shorter course midwife training programmes and other strategies to increase production of midwives still produce the right competencies, or if these competencies are limited at time of graduation can a subsequent phased on site training result in the appropriate skills and increase retention? | 32 | 1 | 0 | 1 | 1 | 1 | 1 | 1 | 1 | 0 |  |  |  | 0 | 0 | 0
 |  |  | Does the use of non physician clinicians for Em Obs care (eg medical assistants or midwives for Em C Section) in hard to serve rural hospitals reduce the incidence of fresh stillbirths and neonatal deaths related to acute intrapartum events? | 33 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0 | 0 |  |  |  | 1 | 1 | 1
 |  | Improving quality of intrapartum care | Can an expanded partogram be developed and validated to encompass events at birth for the baby as well progress of labour and placental outcome? | 34 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 1 | 1 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  |  | Does the use of protocols, training, [NAME],  "fire drills" audit to increase quality of intrapartum monitoring (partograph etc) and speed of intervention reduce the incidence of birth asphyxia? | 35 | 1 | 1 | 1 | 0.5 | 0.5 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 0.5 | 1 | 1 | 1
 |  | Neonatal resuscitation | Can simpler clinical algorithms (recognition and management) be developed and validated for babies who require resuscitation at birth, and does this increase met need for resuscitation at birth? | 36 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 1 | 1 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  |  | What is the effectiveness, cost and effect on long term morbidity of using alternative cadres of healthworkers for neonatal resuscitation in facilities eg patient attendants? | 37 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 0.5 | 0.5 | 0.5 | 0.5 | 1 | 0 | 1
 |  |  | What is the effectiveness, cost and effect on long term morbidity of using alternative cadres of workers for essential newborn care and/or neonatal resuscitation at home  eg CHWs, TBAs? | 38 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 0 | 1
 |  |  | Is room air resuscitation for babies as effective or better than the conventional resuscitation?  What is impact on long term neurodevelopmental outcomes? | 39 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  | Appropriate management of baby with meconium stained amniotic fluid in low resource settings (suction or not, who to do etc) | What is the appropriate management of meconium in the amniotic fluid during labour in resource poor settings (suction or not, who to do, antibiotics or not etc)? | 40 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0.5 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 | POSTNATAL Increasing delivery of existing postnatal interventions | Development of a simpler more specific algorithm for identifying  NE  in low resource settings | Can a simplified algorithm for identification of newborns with neonatal encephalopathy (NE) be developed and validated, with decision rules to exclude non-asphyxia causes of NE in facilities (and  if possible, in community) | 41 | 1 | 0 | 1 | 0.5 | 0.5 | 0.5 | 0 | 0 | 0 | 1 | 0.5 | 0.5 | 1 | 1 | 1
 |  | Care of neonatal encephalopathy (NE) | Do standard, evidence-based protocols for care of newborns with neonatal encephalopathy improve mortality and long term neurodev outcomes and at what cost? (specific sub questions eg fluid restriction, induced hypothermia, anticonvulsants etc) | 42 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0.5 | 0.5
 |  | Follow up/early identification of disability | Does early identification of babies with development problems following NE improve utilization of services (feeding, physio, speech and language, hearing)and/or outcomes (hearing, vision, school performance) | 43 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0.5 | 0 | 0
 | CROSS CUTTING/ AUDIT | Audit | Does regular use of perinatal audit reduce the incidence of adverse outcomes related to acute intrapartum events? | 44 | 1 | 0 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 1 |  |  |  | 1 | 1 | 1
 |  |  | Does regular use of perinatal audit improve adherence to clinical standards for intrapartum care? Eg use of partograph, monitoring of fetal heart rate, resuscitation etc | 45 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 1 |  |  |  | 1 | 1 | 1
Research on improving existing interventions (increasing deliverability or reducing cost) DEVELOPMENT | Improved pre-pregnancy interventions | Nutrition of the girl child to reduce later risk of obstructed labor and asphyxia-related outcomes | Are there specific, feasible nutritional interventions for the girl child that improve skeletal growth and reduce later risk of obstructed labor and asphyxia-related outcomes? | 46 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 |  |  |  | 1 | 0 | 1
 | Improved pregnancy interventions | Improved pregnancy interventions | Can low cost, low tech approaches be developed to  identify post term infants and severe IUGR for early obstetric intervention? eg probes for doppler U/s attached to laptops to monitor umbilical flow | 47 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0 | 0 | 0 |  |  |  | 1 | 1 | 1
 |  |  | Does addressing micronutrient deficiencies and/or anaemia in pregnancy reduce asphyxia-related adverse outcomes, or increase the riskof cephalopelvic disproportion and obstructed labor in populations with high rates of maternal malnutrition/stunting? | 48 | 1 | 0 | 1 | 1 | 1 | 1 | 0.5 | 1 | 1 |  |  |  | 1 | 0 | 1
 | Improved intrapartum interventions | Intrapartum devices | Can low-cost, robust, simple fetal heart monitors be developed and tested that are more user friendly than the Pinard - eg adaptations of doppler FHM? Does use of such a device improve fetal heart rate monitoring and reduce Ip stillbirths and asphyxia related outcomes? | 49 | 1 | 1 | 1 | 1 | 1 | 0 | 0.5 | 0 | 0 | 1 | 1 | 0.5 | 1 | 1 | 1
 |  |  | Can robust, simple fetal heart monitors be developed that count beat to beat variability and make detection of clinically significant fetal distress simpler and with higher positive predictive value? | 50 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  |  | Can simpler/cheaper/more robust technology be developed for neonatal resuscitation, (eg bag and mask, suction devices) and for resuscitation training (resus dummies) and more feasible models of maintaining clinical competency for resuscitation | 51 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 1 | 1 | 0.5 | 0.5 | 1 | 1 | 1
 |  | Intrapartum procedures | Can the procedure of amnio infusion be adapted to lower resource settings and would this impact on asphyxia-related outcomes? Are there clinically important risks from the procedure? | 52 | 1 | 1 | 1 | 0 | 0 | 0 | - | - | - |  |  |  | 0 | 0 | 0
 |  |  | Can emergency obstetric procedures such as C-section and symphysiotomy be safely simplified further for use by non obstetric personnel? | 53 | 1 | 1 | 1 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 |  |  |  | 1 | 0 | 1
 |  | Training | Does distance learning for intrapartum care improve competencies? How do skills and cost compare with conventional training? How often does provider re-training need to be performed to maintain competency in neonatal resuscitation, also frequency for different cadres? | 54 | 1 | 0 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 0.5 | 0.5 | 0.5 | 0.5 | 1 | 0 | 1
 | Improved postnatal interventions | Head cooling | Can head cooling/body cooling be adapted to be feasible/lower cost for low resource settings, both the early recognition of cases and the device? | 55 | 1 | 1 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0.5 | 0.5
 |  | Care of babies with NE | Can oxygen use be managed better with availability of pulse oximeters, and can robust low cost pulse oximeters and oxygen concentrators be used in care of babies with NE? | 56 | 1 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 0.5 | 0.5 | 0.5 | 0.5
Research for new interventions (DISCOVERY) | Clinical | The role of  treating of infections during pregnancy to reduce NE | Can the synergy of  infections/ maternal pyrexia with neonatal encephalopathy (NE) be addressed through interventions – eg antibiotic therapy for pyrexial women in labour? | 57 | 1 | 1 | 1 | 1 | 1 | 0.5 | 0.5 | 1 | 1 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 |  | New technology for detecting fetal distress or NE in low income settings | Can new, simple to use, robust technology be developed to better detect fetal distress or NE in low income settings? Eg amplitude-integrated EEG (Cerebral Function Monitor, [NAME]) to identify NE for postnatal therapeutic interventions | 58 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1
 | Basic science | Other novel approaches to reducing cerebral damage after insult | Would novel micronutrient approaches reduce cerebral damage after insult (magnesium, nitrates, combinations etc)? | 59 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1
 |  |  | Would other novel drug treatments reduce cerebral damage after insult (allopurinol, epo, opioids etc)? | 60 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0
 |  |  | Are there genes or other biomarkers that predict susceptibility to intrapartum hypoxic injury? | 61 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0.5 | 0.5 | 0.5 | 1 | 1 | 1