Study Image Antenatal Corticosteroids Trial (ACT): The ACT study is a multi-site, randomized controlled trial to reduce neonatal mortality by improving identification of women at risk of preterm delivery and increasing the use of antenatal corticosteroids. A multi-faceted intervention among health care providers will be tested in six middle and low-income countries.
Primary Manuscript
Althabe F, Belizán JM, McClure EM, Hemingway-Foday J, Berrueta M, Mazzoni A, Ciganda A, Goudar SS, Kodkany BS, Mahantshetti NS, Dhaded SM, Katageri GM, Metgud MC, Joshi AM, Bellad MB, Honnungar NV, Derman RJ, Saleem S, Pasha O, Ali S, Hasnain F, Goldenberg RL, Esamai F, Nyongesa P, Ayunga S, Liechty EA, Garces AL, Figueroa L, Hambidge KM, Krebs NF, Patel A, Bhandarkar A, Waikar M, Hibberd PL, Chomba E, Carlo WA, Mwiche A, Chiwila M, Manasyan A, Pineda S, Meleth S, Thorsten V, Stolka K, Wallace DD, Koso-Thomas M,Jobe AH, Buekens PM. A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial. Lancet. 2015 Feb 14;385(9968):629-39. doi: 10.1016/S0140-6736(14)61651-2. Epub 2014 Oct 15. PMID: 25458726
Participating Institutions
Tulane School of Public Health and Tropical Medicine JN Medical College, Belgaum, India
Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina University of Alabama at Birmingham
Aga Khan University, Karachi, Pakistan University Teaching Hospital, Lusaka, Zambia
Massachusetts General Hospital University of Colorado Denver
Lata Medical Research Foundation, Nagpur, India Instituto de Nutrición de Centro América y Panamá
Christiana Care Moi University, Eldoret, Kenya
RTI International

Study Image Safe Pregnancy Through Malaria Control in the Democratic Republic of Congo (DRC): A study to assess the pharmacokinetics and pharmacodynamics of an orally-administered standard adult dose (200 mg) of artesunate, to determine if it is appropriate in parasitemic pregnant women when compared to the same women at three months postpartum and to parasitemic non-pregnant women.
Primary Manuscript
Onyamboko MA, Meshnick SR, Fleckenstein L, Koch MA, Atibu J, Lokomba V, Douoguih M, Hemingway-Foday J, Wesche D, Ryder RW, Bose C, Wright LL, Tshefu AK, Capparelli EVL, Koch M, Atibu J, Lokomba V, Douoguih M, Hemingway-Foday J, Wesche D, Ryder R, Bose C, Wright L, Tshefu A, Capparelli E. Pharmacokinetics and pharmacodynamics of artesunate and dihydroartemisinin following oral treatment in pregnant women with asymptomatic P. falciparum infections in Kinshasa DRC. Malar J. 2011 Feb;10:49. PMCID: PMC3056842 PMID 21352601
Participating Institutions
University of North Carolina at Chapel Hill School of Medicine Kinshasa School of Public Health, Democratic Republic of Congo
RTI International

Study Image Antioxidant Therapy to Prevent Preeclampsia: A randomized, controlled trial testing whether the joint administration of the antioxidants vitamin C (1000mg) and vitamin E (400IU) would reduce the incidence of preeclampsia among chronically hypertensive pregnant patients and patients with a past history of preeclampsia/eclampsia.
Primary Manuscript
Spinnato JA , Freire S, Pinto E Silva JL, Rudge MVC, Martins-Costa S, Koch MA, Goco N, Santos CD, Cecatti JG, Costa R, Ramos JG, Moss N, Sibai BM. Antioxidant therapy to prevent preeclampsia: a randomized controlled trial. Obstet Gynecol. 2007;110(6):1311-18
Participating Institutions
University of Cincinnati University of Campinas, Brazil
Universidade Federal de Pernambuco Hospital de ClÍnicas de Porto Alegre
Faculdade de Medicina de Botucatu, UNESP, Botucatu, Brasil RTI International

Study Image RCT of Misoprostol for Postpartum Hemorrhage in India:A randomized controlled trial to assess the prophylactic effectiveness of oral misoprostol administered in the community to women in the third stage of labor to reduce the incidence of acute postpartum hemorrhage.
Primary Manuscript
Derman R, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, Chakraborty H, Moss N. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006 Oct 7;368(9543):1248-53. PMID 17027730
Participating Institutions
University of Missouri at Kansas City JN Medical College, Karnataka, India
RTI International

Study Image Zhi Byed Versus Misoprostol:A prospective, double-masked randomized study to determine the effect of prophylactic oral ZB11 administered at the beginning of the second stage of labor vs. prophylactic oral misoprostol administered in the third stage of labor, in reducing the incidence of acute PPH among Tibetan women giving birth in three hospitals in Lhasa, TAR.
Primary Manuscript
Miller S, Tudor C, Thorsten V, Nyima, Kalyang, Sonam, Lyakpen, Droyoung, Quzong K, Dekyi T, Hartwell T, Wright LL, Varner MW. Randomized double masked trial of Zhi Byed 11, a Tibetan traditional medicine, versus misoprostol to prevent postpartum hemorrhage in Lhasa, Tibet. J Midwifery Womens Health. 2009 Mar-Apr;54(2):133-141.
Participating Institutions
University of Utah School of Medicine TAR Health Bureau, Lhasa
RTI International

Study Image Tobacco Use: To determine the prevalence of tobacco use (smoking and smokeless tobacco), the Global Network, in collaboration with the National Cancer Institute, conducted a cross-sectional survey of knowledge, attitudes and behaviors regarding tobacco use among pregnant women in nine countries.
Primary Manuscript
Bloch M, Althabe F, Onyamboko M, Kaseba-Sata C, Castilla EE, Freire S, Garces A, Parida S, Goudar SS, Kadir MM, Goco N, Thornberry J, Daniels M, Bartz J, Hartwell T, Moss N, Goldenberg RL. Tobacco use and environmental tobacco smoke exposure during pregnancy: an investigative survey of women in nine developing nations. Am J Public Health. 2008 Oct;98(10):1833-40. PMCID: PMC2636473 PMID 18309125
Participating Institutions
University of North Carolina at Chapel Hill School of Medicine University of Colorado Denver
Kinshasa School of Public Health, Democratic Republic of Congo Instituto de Nutrición de Centro América y Panamá
University of Alabama at Birmingham University of Maryland School of Medicine
University Teaching Hospital, Lusaka, Zambia SCB Medical College, Orissa
University of Iowa Christiana Care
Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC) JN Medical College, Belgaum, India
Aga Khan University, Karachi, Pakistan RTI International

Study Image
Emergency Obstetric and Neonatal Care (EmONC): Three primary training components in the intervention clusters are 1) EmONC facility training to address the primary causes of maternal and perinatal mortality, 2) community mobilization training to increase birth planning and transport, and 3) Home-Based Life Saving Skills (HBLSS) to assist birth attendants in the identification and referral of complications during delivery. The EmONC Study evaluated the ability of community teams, whose skills were enhanced through targeted community mobilization training programs, to explore the problems related to poor pregnancy outcomes and to improve the system of care for women and neonates. Flexibility was provided to the teams to develop solutions which fit their local needs. However, all sites performed training, service, and performance reviews; institutional and community death audits; emergency drills; and detailed data collection. The primary outcome was perinatal mortality, and the secondary outcomes included resuscitation, stillbirths, early neonatal deaths, maternal mortality, causes of neonatal death, and referral.
Primary Manuscript
Pasha O, McClure EM, Wright LL, Saleem S, Goudar SS, Chomba E, Patel A, Esamai F, Garces A, Althabe F, Kodkany B, Mabeya H, Manasyan A, Carlo WA,Derman RJ, Hibberd PL, Liechty EK, Krebs N, Hambidge KM, Buekens P, Moore J, Jobe AH, Koso-Thomas M, Wallace DD, Stalls S, Goldenberg RL; EMONCTrial Investigators. A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: a Global Network cluster randomized trial. BMC Med. 2013 Oct 3;11:215. doi: 10.1186/1741-7015-11-215. PMID: 24090370 PMCID:PMC3853358
Participating Institutions
Tulane School of Public Health and Tropical Medicine Christiana Care
Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina JN Medical College, Belgaum, India
University of Alabama at Birmingham Aga Khan University, Karachi, Pakistan
University Teaching Hospital, Lusaka, Zambia Massachusetts General Hospital
University of Colorado Denver Lata Medical Research Foundation, Nagpur, India
Instituto de Nutrición de Centro América y Panamá Moi University, Eldoret, Kenya
RTI International

Study Image
Birth Attendant Survey: Birth attendants were interviewed to assess training level, knowledge, skills, and access to medical equipment, and testing. The interaction of more than 100 home delivery attendants with their health care systems in 7 international sites in India, Pakistan, Guatemala, the Democratic Republic of the Congo, Kenya, and Zambia was also assessed. The study found that community birth attendants were often illiterate, could not read numbers, and had little formal training. They had limited skills and access to medications and equipment that are necessary to reduce maternal, fetal, or neonatal mortality. In view of these findings, the provision of limited additional training to community birth attendants is unlikely to result in large scale improvements in pregnancy outcomes without significant investments in other components of the health care delivery system. The information provided by these data will be useful to health care providers and policy makers as they try to improve pregnancy outcomes in their regions, as well as for planning future Global Network research projects. Funding for this project was provided in part by the Bill and Melinda Gates Foundation through the MANDATE Project.
Primary Manuscript Garces A, McClure EM, Chomba E, Patel A, Pasha O, Tshefu A, Esamai F, Goudar S, Lokangaka A, Hamidge KM, Wright LL, Koso-Thomas M, Bose C, Carlo WA, Liechty EA, Hibberd PL, Bucher S, Whitworth R, Goldenberg RL. Home birth attendants in low income countries: who are they and what do they do? BMC Pregnancy Childbirth. 2012 May 14; 12(1):34. [Epub ahead of print] PMID: 22583622
Participating Institutions
University of Alabama at Birmingham Aga Khan University, Karachi, Pakistan
University Teaching Hospital, Lusaka, Zambia Massachusetts General Hospital
University of Colorado Denver Lata Medical Research Foundation, Nagpur, India
Instituto de Nutrición de Centro América y Panamá Christiana Care
Moi University, Eldoret, Kenya JN Medical College, Belgaum, India
RTI International

Study Image Tape for Assessing Gestational Age: Development and validation of a fundal height color-coded Tape for Assessing Gestational Age was conducted in 2 phases. First, an observational study was conducted to design a tape for fundal height measurement, which corresponds to a growth chart to identify pre-term pregnancies between 24 and 38 weeks. Three color-coded tapes, using region-specific upper and lower values of preterm gestational age were then designed and tested for the validity of identifying preterm pregnancies between 24-36 weeks of gestational age in Pakistan, India and Argentina. The tape is being used to identify women with unknown gestational ages who are eligible for the receipt of corticosteroids in ACT. A manuscript is in preparation.
Primary Manuscript Manuscript in development
Participating Institutions
University of Alabama at Birmingham JN Medical College, Belgaum, India
University Teaching Hospital, Lusaka, Zambia Aga Khan University, Karachi, Pakistan
Christiana Care RTI International

Study Image Verbal Autopsy:The verbal autopsy study examined cause of death (COD) for community-based perinatal deaths using a VA tool; COD assigned by non-physicians was comparable to physicians.
Primary Manuscript Engmann C, Garces A, Jehan I,, Ditekemena J, Phiri M, Thorsten V, Mazariegos M, Chomba E, Pasha O, Tshefu A, Wallace D, McClure EM, Goldenberg RL, Carlo WA, Wright L, Bose C. Birth attendants as perinatal verbal autopsy respondents in low-income countries: A viable alternative? Bull World Health Organ. 2012 Mar 1;90(3):200-8. PMCID: PMC3314200 PMID 22461715
Participating Institutions
University of North Carolina at Chapel Hill University Teaching Hospital, Lusaka, Zambia
Kinshasa School of Public Health, Kinshasa, DRC University of Colorado Denver
University of Alabama at Birmingham Instituto de Nutrición de Centro América y Panamá
Aga Khan University, Karachi, Pakistan RTI International
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