Background: Despite progress in reducing neonatal deaths, preterm birth (PTB) remains the leading cause, with millions of babies affected and significant survival gaps between high- and low-resource settings. Addressing the burden of PTB in resource-limited settings requires targeted research on its causes, mechanisms, and risks, along with cost-effective maternal and newborn health interventions. My PhD aimed to address this evidence gap and inform future recommendations regarding PTB in LMICs within the SDG era by: (i) identifying and prioritising research on PTB and pre-eclampsia and eclampsia (PE/E) (ii) conducting community-level exploration to identify gaps and opportunities for improving care for preterm babies among high-risk adolescents in rural Bangladesh.
Methods: I used an adapted Child Health and Nutrition Research initiative (CHNRI) method to determine research priorities on PTB in LMICs and Bangladesh, and PE/E in LMICs. Using qualitative research, I explored perception and experiences of adolescents and communities in caring for preterm babies in rural Bangladesh. This involved in-depth or key informant interviews with mothers of premature and term babies, family members and healthcare providers and focus groups with community members.
Results: In study 1 on PTB research priority setting, health systems and policy related research were prominent among the top 20 priorities for LMICs. These were related to facility and community-based Kangaroo Mother Care (KMC), breastfeeding, referral and transportation, use of skilled attendants, quality improvement, and antenatal steroid use. There was substantial overlap in research priorities for LMICs and Bangladesh.
In study 2 on PE/E priority setting, experts prioritised health systems and delivery research to enhance detection, transfer, and management of women with PE/E in LMICs. Topics were related to care delays, availability of supplies and quality of care in facilities, provider and facility readiness, guideline implementation, Magnesium Sulphate use, providers’ knowledge gaps, referral systems, early identification and screening.
Study 3 examined two main themes: perception and understanding of preterm birth and care practices for preterm babies. The first theme revealed inconsistent knowledge about preterm birth's definition, appearance, causes, and associated problems. The second theme highlighted inappropriate care, multiple healthcare provider usage and delayed care-seeking due to factors like perceived illness severity, costs, and quality, including inadequate equipment and trained personnel. Adolescents showed significant knowledge gaps and relied on family members for baby’s care.
Conclusions: My PhD systematically identifies and prioritises future research areas for preventing and managing PTB and PE/E in LMICs, particularly Bangladesh. By integrating research prioritisation with insights from high-risk groups, especially adolescents in low-resource settings, this study informs policy and practice to reduce maternal and newborn health disparities.
