PEER Health closed the call for concept notes Cycle 2 on March 14, 2014.
Indonesian Solicitation Description and Objectives:
Despite the promising outlook for Indonesia’s future economic growth, the archipelago lags far behind most other countries in its investments in research & development. Indonesia allocates below 0.08% of its GDP for R&D investment – less than 1/10 the average of BRIC economies such as Brazil, Russia, India, and China (2). As a result, Indonesia is not adequately utilizing science, technology and innovation to advance development goals or global competitiveness.
Science, technology, and innovation are among the top stated priorities for the Government of Indonesia (GOI) as reflected in the government’s National Medium-Term Development Plan. Collaborations in science, technology, and innovation are also a high-level development objective under USAID’s five year Country Development Cooperation Strategy (CDCS Indonesia). There is currently tremendous opportunity for Indonesia to advance science, technology and innovation by building on its wealth of human capital, affirmatively expanding opportunities to promising students and researchers, and increasing collaborations with international partners to enhance scientific skills and achieve evidence based development. This PEER Health/Indonesia solicitation, focused on neonatal and maternal mortality, builds on a successful first round of PEER Health. This award will directly support Indonesian investigators in partnership with a USG-funded researcher. The maximum individual award amount is $142,000 USD a year for up to three years (For a total award amount of ($426,000 USD). The Indonesian solicitation focuses on building strong partnerships between USG-funded researchers and their Indonesian counterparts. Following submission and acceptance of a concept note, approved USG-funded researchers will be sponsored by NAS to travel to Indonesia between April and May, to meet with their Indonesian colleagues and draft a full proposal application. NAS will cover air travel costs to Indonesia for the primary USG-funded partner included on the approved Concept Note. NAS will not cover expenses for anyone outside of the primary USG funded partner (including students, post-docs, or family). NAS will not cover salary related expenses for USG partners invited to submit a PEER Health full proposal. Limited support for additional expenses (not exceeding maximum federal per diem guidelines for Indonesia) will be considered for reimbursement to USG partners during the time they are in Indonesia actively working on drafting a full proposal for the PEER Health program. While in Indonesia USG-funded researchers and in-country applicants should anticipate meeting (either by phone or in person) with health leads from USAID/Indonesia.Research Focus: Maternal & Neonatal Survival
The USG’s Global Health Initiative in Indonesia is focused on catalyzing action to accelerate Indonesia’s progress toward achievement of Millennium Development Goals (MDGs) 4, 5 and 6; enhancing the use of quality research and evidence in policy and programming; and partnering to address regional and global infectious disease threats. USAID/Indonesia’s newly published five year strategy includes a strategic results area to improve services to reduce preventable women and children deaths among the poorest and most vulnerable (link to CDCS). This solicitation is intended to identify activities that directly support accelerated progress in achieving MDG’s 4 and 5 through the use of quality research and evidence in policy and programming to reduce newborn and maternal mortality.
Despite Indonesia’s development to a middle-income economy and remarkable progress in a number of health indicators, newborn and maternal mortality have not improved as anticipated, now lagging behind many other indicators of heath and development in Indonesia. A summary of recent Demographic and Health Survey results illustrate this:
Skilled Birth Attendance
Underlying factors in newborn mortality include low birth weight in 11% of births (3), among the highest preterm birth rates globally, estimated at greater than 15% (4) and a high rate of household tobacco smoke exposure during gestation. Major contributors to newborn mortality are low birth weight/preterm, asphyxia and sepsis. Major contributors to maternal mortality include pre-eclampsia/eclampsia, sepsis and post-partum hemorrhage. Where examined, all factors – newborn mortality, birth attendance, facility delivery, low birth weight, and household exposure to tobacco smoke - are strongly related to economic status, with the poorest conditions consistently found in the lowest two wealth quintiles.
Outlined below are specific maternal and newborn health implementation research priorities; additional topics may be proposed. Proposed research should address an aspect of implementation science that addresses major determinants of maternal and newborn mortality. Topics proposed for research should address a major cause of newborn and/or maternal mortality, where policy and program clients are engaged at the outset, and where success may yield sustainable and scalable benefits for the poorest and most vulnerable with the highest rates of morbidity and mortality. Evaluation research is encouraged, building on currently implemented approaches which are promising and innovative.
Maternal Health Implementation Research Priorities
Priority conditions include eclampsia/pre-eclampsia and post-partum hemorrhage. Systems issues include effective referral, quality of care in facilities, and reporting, audits, and program action where maternal deaths occur. Descriptive studies with objectives of providing more accurate population estimates of maternal mortality at provincial and/or district levels, and providing more detailed cause of death information, including system, clinical management and social factors contributing, will be considered.
Newborn Health Implementation Research Priorities
Priority conditions include preterm, low birth weight, intra-partum stillbirth, asphyxia and sepsis. Interventions for both prevention and management may be considered. Systems issues include effective referral, quality of care in facilities, and reporting, audits and program action where newborn deaths occur. Descriptive studies with objectives of providing more accurate population estimates of neonatal mortality at provincial and/or district levels, and providing more detailed cause of death information, including system, clinical management and social factors contributing, will be considered. In addition, specific concept papers are requested that address prenatal exposure to household tobacco related to preterm/low birth weight outcomes – as further described below.
The prevalence of smoking among Indonesian men is among the highest in the world (72 % of men aged 15 – 54 (IDHS 2012)). Smoking prevalence remains very low among women in Indonesia, thanks in part to strong cultural constraints on women’s tobacco use. However, a majority of women are still exposed to secondhand smoke at home, in workplaces, and in public places. The 2011 Global Adult Tobacco Survey (5) found that 75% of Indonesian women are exposed to tobacco smoke at home. Secondhand smoke exposure of mothers and infants is linked to serious adverse health effects. (6)
An area of particular concern for Indonesia is the impact of tobacco smoke exposure on reproductive outcomes. Maternal cigarette smoking is associated with a range of adverse outcomes, including miscarriage, stillbirth, preterm birth, low birth weight, and congenital anomalies such as cleft lip (7). Maternal exposure to secondhand smoke during pregnancy has also been associated with a reduction in birth weight and an increased risk of low birth weight babies (<2500 g). Research is needed to better understand the impact of smoke exposure on birth outcomes and to identify effective interventions to reduce smoke exposure during pregnancy and in the home.
(2) World Bank, 2012b, Knowledge Economy Index.
(3) OECD (2011), “Infant health: Low birth weight”, in Health at a Glance; 2011: OECD Indicators, OECD Publishing. http://dx.doi.org/10.1787/health_glance-2011-11-en
(4) Blencowe et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications; Lancet 2012; 379: 2162–72.
(5) Global Adult Tobacco Survey: Indonesia Report 2011. http://www.depkes.go.id/downloads/laporan%20gats/EXECUTIVE_SUMMARY_GATS.pdf
(6) Bloch M, Althabe F, Onyamboko M, Kaseba-Sata C, Castilla EE, Freire S, Garces AL, Parida S, Goudar SS, Kadir MM, Goco N, Thornberry J, Daniels M, Bartz J,Hartwell T, Moss N, Goldenberg R. Tobacco use and secondhand smoke exposure during pregnancy: an investigative survey of women in 9 developing nations. Am J Public Health. 2008 Oct;98(10):1833-40.
(7) Meeker JD, Benedict MD. Infertility, Pregnancy Loss and Adverse Birth Outcomes in Relation to Maternal Secondhand Tobacco Smoke Exposure. Curr Womens Health Rev. 2013 Feb;9(1):41-49.