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BU’s bid on global health gets help

$8.5m grant aims at newborn deaths

Dr. Jonathon Simon is director of the new center. Dr. Jonathon Simon is director of the new center.
By James F. Smith
Globe Staff / December 7, 2009

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Just three months after its launch, Boston University’s Center for Global Health and Development has won an $8.5 million grant from the Bill & Melinda Gates Foundation for a project that will test simple, low-cost methods that could save many of the 4 million newborns who die each year in the world’s poorest countries.

The four-year grant, being announced today, will allow a team of BU medical researchers to test whether an antiseptic wash can reduce infections of the umbilicus in the month after birth - and sharply curtail deaths of newborns from those infections.

Dr. Jonathon Simon, director of the new center, said the funds will allow his team to recruit 28,800 women in southern Zambia, one of the poorest regions of sub-Saharan Africa, and assess the health of their babies at birth. The study will rely on basic cellphone technology to gather data.

Simon said advances in treating maternal illnesses and childhood ailments have helped reduce the number of deaths of mothers in childbirth and deaths of children under the age of 5. But the problem of neonatal mortality - defined as death in the first 28 days - has remained stubbornly high, in part because of infections of the umbilicus stump in the days after birth.

In rural southern Africa, it is common to treat the umbilical stump with cow dung or mustard oil, Simon said. In the study, half of the women will continue to use the traditional methods, while the other half will be given chlorhexidine to clean the stump, the small piece of umbilical cord that remains attached to the stomach for about a week after the cord is cut. That is a common treatment in the West.

“We think we have a cheap and simple intervention that has a huge effect on mortality, and can be managed by the mom or grandma in the house,’’ he said in a phone interview. “These interventions don’t require a health infrastructure, or big investment or big technology, and that’s our bread and butter.’’

Simon said the Gates Foundation grant will allow the new BU global health center to increase its annual research by about 25 percent, to nearly $12 million in the coming year.

He said the center has pulled together many experts from across BU to enable it to tackle massive studies like the Zambia project that the Gates Foundation is able to finance. Simon noted that his own previous work on new treatments for childhood pneumonia had taken more than a decade and required seven separate studies to achieve similar research depth.

The five districts being studied in southern Zambia, spread around the town of Choma, have very basic health facilities, Simon said, and 60 percent to 80 percent of the births take place in the home. The researchers will rely on a network of community health workers and the mothers to send details of neonatal health by phone or text message.

The BU team includes Dr. David Hamer, an infectious diseases specialist; and epidemiologist Katherine Semrau as coleaders, along with Dr. Julie Herlihy, a pediatric specialist. Dr. Donald Thea, a tropical diseases expert, will oversee the project with Simon.

Deaths in the first 28 days of life are especially hard to prevent in poor areas, and it has proved more difficult to introduce effective interventions for neonatal health than for illnesses that often afflict toddlers and older children, such as malaria and diarrhea.

“It’s a huge problem. About 4 million neonates die a year globally,’’ Simon said. Zambia has one of the highest neonatal mortality rates in Africa, which overall has the highest in the world. Zambia’s neonatal mortality rate is 40 per 1,000 live births, compared with 4 per thousand in the United States, according to the World Health Organization.

Recent studies have developed data on neonatal deaths in Nepal and Bangladesh, but this is the first such study in Africa. Another parallel study to be announced soon will be conducted simultaneously in Tanzania by another university to expand the reach of the research, Simon said.

The WHO said in its 2005 World Health Report that while neonatal mortality has fallen steadily in Asia, the number of deaths in Africa has increased, and the continent accounts for almost 30 percent of all newborn deaths.

“The reversal of progress in neonatal health in sub-Saharan Africa is both concerning and unusual,’’ the WHO report said. Causes probably include economic decline and conflict, punishing the most vulnerable.

“Although a good start in life begins well before birth, it is just before, during and in the very first hours and days after birth that life is most at risk,’’ the report said. “Babies continue to be very vulnerable through their first week of life, after which their chances of survival improve markedly.’’

James F. Smith writes about Boston’s global ties. His blog is at boston.com/worldlyboston. He can be reached at jsmith@globe.com.