Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
School of Nursing and Midwifery, Queens University, Belfast, UK.
J Glob Health. 2019 Dec;9(3):020703. doi: 10.7189/jogh.09.020703.
Approximately 250 million children under the age of five in low and middle-income countries (LMICs) will not achieve their developmental potential due to poverty and stunting alone. Investments in programming to improve early childhood development (ECD) have the potential to disrupt the cycle of poverty and therefore should be prioritised. Support for ECD has increased in recent years. Nevertheless, donors and policies continue to neglect ECD, in part from lack of evidence to guide policy makers and donors about where they should focus policies and programmes. Identification and investment in research is needed to overcome these constraints and in order to achieve high quality implementation of programmes to improve ECD.
The Child Health and Nutrition Research Initiative (CHNRI) priority setting methodology was applied in order to assess research priorities for improving ECD. A group of 348 global and local experts in ECD-related research were identified and invited to generate research questions. This resulted in 406 research questions which were categorised and refined by study investigators into 54 research questions across six thematic goals which were evaluated using five criteria: answerability, effectiveness, feasibility, impact, and effect on equity. Research options were ranked by their final research priority score multiplied by 100.
The top three research priority options from the LMIC experts came from the third thematic goal of improving the impact of interventions, whereas the top three research priority options from high-income country experts came from different goals: improving the integration of interventions, increasing the understanding of health economics and social protection strategies, and improving the impact of interventions.
The results of this process highlight that priorities for future research should focus on the need for services and support to parents to provide nurturing care, and the training of health workers and non-specialists in implementation of interventions to improve ECD. Three of the six thematic goals of the present priority setting centred on interventions (ie, improving impact, implementation of interventions and improving the integration of interventions). In order to achieve higher coverage through sustainable interventions to improve ECD with equitable reach, interventions should be integrated and not be sector driven.
在中低收入国家（LMICs），约有 2.5 亿 5 岁以下儿童因贫困和发育迟缓而无法充分发挥其发展潜力。投资于改善儿童早期发展（ECD）的方案，有可能打破贫困循环，因此应将其作为优先事项。近年来，对 ECD 的支持有所增加。然而，捐助者和政策制定者继续忽视 ECD，部分原因是缺乏证据来指导政策制定者和捐助者了解他们应该将政策和方案的重点放在何处。需要确定和投资于研究，以克服这些限制，并为改善 ECD 而实施高质量的方案。
应用儿童健康与营养研究倡议（CHNRI）的优先事项制定方法，以评估改善 ECD 的研究优先事项。确定了 348 名全球和本地 ECD 相关研究专家，并邀请他们提出研究问题。这导致了 406 个研究问题，这些问题由研究调查人员按研究主题目标进行分类和细化，共分为六个主题目标，每个目标下有 54 个研究问题，这些问题用五个标准进行评估：可回答性、有效性、可行性、影响和公平性。根据最终研究优先得分乘以 100 对研究方案进行排名。
来自 LMIC 专家的三个最高研究优先选项来自第三个主题目标，即改善干预措施的影响，而来自高收入国家专家的三个最高研究优先选项则来自不同的目标：改善干预措施的整合，增进对健康经济学和社会保护战略的理解，以及改善干预措施的影响。
该过程的结果强调，未来研究的优先事项应侧重于为父母提供培育护理所需的服务和支持，以及培训卫生工作者和非专业人员实施改善 ECD 的干预措施。本优先事项制定的六个主题目标中的三个（即改善影响、实施干预措施和改善干预措施的整合）以干预措施为中心。为了通过可持续的干预措施以公平的方式实现更高的覆盖率，从而改善 ECD，干预措施应综合而不是部门驱动。
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