Editorial[Focus of Global Health Research and Support]

An article in this issue extensively shows how much research have been done and how little have been achieved in the prevention and management of preterm birth. Preterm birth is one of the most important problems that obstetrics is facing both in developing and developed countries. Developed countries are solving such problems through a major improvement in the care of newborns, which implies not only a high survival rate but also an increase in the number of children surviving with handicaps. This signifies a high increase in the cost of care. Such an approach is not possible in developing countries, where scarce resources need to be fairly distributed and the extremely high costs of care for preterm births and handicapped individuals are well out of their scope. In developing countries, major efforts should be made to improve maternal conditions and care, and pioneering interventions are greatly needed. Another article in this issue reviews an innovative and feasible intervention, maternity waiting homes, which can be applied in the rural areas of developing countries to improve pregnancy outcomes. Feasible and innovative interventions are much needed at the global level, where one relevant scope should be on how to scale-up well-known beneficial interventions. As an example, one of the most powerful perinatal interventions to reduce neonatal mortality is the administration of antenatal corticosteroids to pregnant women at high risk of preterm birth. It is assumed that 80% is the maximum rate of use of the intervention in preterm babies below 34 weeks of gestational age (1-3). However, it is estimated that in the 42 countries with 90% of the worldwide childhood deaths in 2000, only 5% of appropriate candidates received antenatal corticosteroids (4). Another study based on data from 75 countries estimated that 10% of appropriate candidates received corticosteroids (1). How can research aid in testing and providing interventions that could achieve an acceptable rate of use of beneficial interventions in a diversity of settings, particularly in developing societies? Research capacity building in developing countries is mandatory, therefore these countries could look for feasible interventions to improve the alarming health situations in their population. Ninety-five percent of funds for research in the world are focused on 5% of the world's population, which is located in the developed countries. To attain an improvement on global health situations, this pattern needs to change both quantitatively and qualitatively. We need strong research structures in developing countries, with support to conduct appropriate research to improve the health situations of their populations. Global health research support should change for a more equitable distribution of funds to benefit those with major needs. Two articles in this issue focused on the subject of assisted fertilization. While this technique is a solution to the problem that some couples face, it is also responsible for an increase in multiple pregnancies, and, consequently, in preterm births in developed countries. It requires selective and careful use, and critical reviews about the technique are required to improve its outcome and diminish its deleterious consequences. REFERENCES [1] Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L, for the Lancet Neonatal Survival Steering Team. Neonatal Survival 2: Evidence-based, cost-effective interventions: how many newborn babies can we save. Lancet 2005; 365: 977-88. [2] Gortner L, Wauer RR, Hammer H, Stock GJ, Heitmann F, Reiter HL, Kuhl PG, Moller JC, Friedrich HJ, Reiss I, Hentschel R, Jorch G, Hieronimi G, Kuhls E. Early versus late surfactant treatment in preterm infants of 27 to 32 weeks' gestational age: a multicenter controlled clinical trial. Pediatrics 1998; 102(5): 1153-60. [3] Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M, Phibbs R, Soll RF; Members of the Vermont Oxford Network. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics 2002; 110(1 Pt 1): 143-51. [4] Jones G, Steketee R, Black RE, and the Bellagio Child Survival Study Group. How many child deaths can we prevent this year? Lancet 2003; 362: 65-71.