Articles - Training

The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight

WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use. This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world.

Health research capacity development in low and middle income countries: reality or rhetoric?

There has been steady progress in LMIC health research capacity, but major barriers to research persist and more empirical evidence on development strategies is required.

How to create and interpret epidemic curves

Epidemic curves are an important component of the public health and global health toolbox. Learn more about creating and interpretting them.

Understanding the Zika virus

U.S. efforts to combat the Zika virus in the US and abroad

Travel Medicine in the era of Chikungunya, Ebola, and Zika virus

Travel Medicine and Infectious Diseases have evolved rapidly in recent decades as outbreaks such as SARS, Avian Influenza, Ebola, MERS, Chikungunya, and Zika virus have demonstrated how quickly infections can cross international borders.

Comprehensive Public Health Degree Guide

Public Health Degrees.org is a comprehensive search engine designed for students who are interested in learning more about Public Health and Health Sciences programs around the United States.

Research Nurses workshops - India

Global Research Nurses is proud to announce skills sharing workshops at Mumbai and Gujarat, India in March 2016

This Week In Global Health (TWiGH) - Skills and Competencies for Public Health

Greg Martin talks about four areas of competencies needed to be effective in public health and global health. He places particular importance on management, leadership and governance.

Reporting missing participant data in randomised trials: systematic survey of the methodological literature and a proposed guide

Authors conducted a systematic survey of the methodological literature to identify recommended approaches for how and what randomised clinical trial (RCT) authors should report on missing participant data and, on the basis of these approaches, to propose guidance for RCT authors. Most identified approaches invite trial authors to report the extent of MPD and the underlying reasons. Fewer approaches focus on reporting missingness patterns, methods for handling MPD and implications of MPD on results. 

eSeminar: Research papers that make a difference: discussing research waste, reproducibility and impact

Dr Iveta Seimer, Deputy Director of the UK EQUATOR Centre, discusses research waste, reproducibility, and how to use reporting guidelines to make an impact. Poor reporting seriously affects the integrity of health research literature and critically limits the use and impact of published studies.

ASLM: Using a Score Card to Assess Lab Functionality

New articles from the African Society for Laboratory Medicine (ASLM).

Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21st Project

The first international stnadards for monitroing the growth of preterm babies have now been published in the Lancet Global Health (October 2015). 

Annual Meeting of the South African Regional Faculty

International Fetal Growth Standards - latest charts available

New INTERGROWTH-21st Fetal Growth Standards charts for measurements of head circumference (HC), bi-parietal diameter (BPD), occipito-frontal diameter (OFD), femur length (FL) and abdominal circumference (AC) are now available for download.

Individual Participant Data (IPD) Meta-analyses of Randomised Controlled Trials: Guidance on Their Use

Systematic reviews involving the central collection and analysis of individual participant data (IPD) usually are larger-scale, international, collaborative projects that can bring about substantial improvements to the quantity and quality of data, give greater scope in the analyses, and provide more detailed and robust results. Following this step-by-step guide will help reviewers and users of IPD meta-analyses to understand them better and recognise those that are well designed and conducted and so help ensure that policy, practice, and research are informed by robust evidence about the effects of interventions.

Studies Within a Trial or Review

The SWAT and SWAR programme is identifying issues about the methods of trials and systematic reviews about which there is sufficient uncertainty to justify research to support well-informed decision making about future designs and choices.

INTERGROWTH-21st Fetal Growth Standards

Fetal Growth Standards for ultrasound measurements of head circumference (HC), bi-parietal diameter (BPD), occipito-frontal diameter (OFD), femur length (FL) and abdominal circumference (AC) are now available for download. For information about how to perform these measurements, or for other information on standards in ultrasound imaging, please see the ultrasound training toolkit.

PERCH (Pneumonia Etiology Research for Child Health)

In this seminar from January 2014, Dr Jane Crawley talks about clinical standardisation in PERCH (Pneumonia Etiology Research for Child Health), a large case-control study of the causes of and risk factors for severe pneumonia.

The transformation of the science cohort in South Africa

Professor Bongani M Mayosi from the Department of Medicine, Groote Schuur Hospital & University of Cape Town describes the transofmation of the science cohort in South Africa.

Q&A with Professor Trudie Lang: Why Global Health Trials?

In celebration of Global Health Trials' fifth birthday (May 11th 2015) Professor Trudie Lang, Principal Investigator of the programme, talks to us about why Global Health Trials was started, why people should share their experience, and what the future holds.

INTERGROWTH-21st Newborn Size at Birth Chart

Practical chart for health practitioners to use to assess newborn size (weight, length, head circumference) at birth against global standards. This version of the chart is being piloted within the University of Oxford hospital network, and plans to pilot in the INTERGROWTH-21st study sites and in Boston area hospitals are developing quickly. Practitioners can download and use this version of the chart freely. To connect with the INTERGROWTH-21st team regarding your experience with piloting this chart, or to request modifications to the chart (e.g. language; different institutional logo), please contact intergrowth21st@tghn.org.  

INTERGROWTH-21st Newborn Birth Length Standards and Z Scores

Global standards and z scores for length at birth, with information related to their use. Online calculators will be available shortly.

INTERGROWTH-21st Newborn Head Circumference Standards and Z Scores

Global standards and z scores for head circumference at birth, with information related to their use. Online calculators will be available shortly. 

INTERGROWTH-21st Newborn Birth Weight Standards and Z Scores

Global standards and z scores for birth weight at birth, with information related to their use. Online calculators will be available shortly.  

Contribution of respiratory tract infections to child deaths: a data linkage study

Respiratory tract infections (RTIs) are an important cause of death in children, and often contribute to the terminal decline in children with chronic conditions. RTIs are often underrecorded as the underlying cause of death; therefore the overall contribution of RTIs to child deaths and the potential preventability of RTI-related deaths have not been adequately quantified. The authors in this study conclude that RTI-related deaths have not declined in the last decade among children in England, except in infants. Targeted strategies to prevent the winter excess of RTIs and to treat RTIs in children, particularly children with chronic conditions, may reduce RTI-related deaths.    

Ebola PPE guidelines

Ebola PPE guidelines - urgent need to revise WHO and CDC guidelines. This video shows an excerpt from keynote address 'The fuss about face masks', Professor Raina MacIntyre from the School of Public Health and Community Medicine, UNSW Australia.

International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project

These international anthropometric standards were developed to assess newborn size in routine clinical practice that are intended to complement the WHO Child Growth Standards and allow comparisons across multiethnic populations.

International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project

Using the same methods and conceptual approach as the WHO child growth standards, the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project developed international growth and size standards for fetuses for clinical interpretation of routinely taken ultrasound measurements and for comparisons across populations.

Observational Studies: Getting Clear about Transparency

When publishing observational research, what information should journals make available to the medical community before a result can be considered sufficiently reliable to inform patient care or health policy? The PLOS Medicine editors, in recent consultation with our editorial board, endorse measures in four areas to advance transparency in the analysis and reporting of observational studies.

Seven principles for strengthening research capacity in low- and middle-income countries: simple ideas in a complex world

This good practice document of the ESSENCE on Health Research initiative is designed to provide broad guidance on how best to strengthen research capacity with the maximum possible benefit. 

Translating research into practice: the introduction of the INTERGROWTH-21st package of clinical standards, tools and guidelines into policies, programmes and services

This paper describes the approach to translating the findings, tools and resources generated by the INTERGROWTH-21^st Project into practice. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12416/abstract

Implementation of the INTERGROWTH-21st Project in the United States

This paper describes the implementation of the INTERGROWTH-21^st Project in Seattle, USA. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12126/abstract

Implementation of the INTERGROWTH-21st Project in the UK

This paper describes the implementation of the INTERGROWTH-21^st Project in Oxford, UK. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12033/abstract

Implementation of the INTERGROWTH-21st Project in Oman

This paper describes the implementation of the INTERGROWTH-21^st Project in Muscat, Oman. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12043/abstract

Implementation of the INTERGROWTH-21st Project in Kenya

This paper describes the implementation of the INTERGROWTH-21^st Project in Nairobi, Kenya. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12045/abstract

Implementation of the INTERGROWTH-21st Project in Italy

This paper describes the implementation of the INTERGROWTH-21^st Project in Turin, Italy. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12124/abstract

Implementation of the INTERGROWTH-21st Project in India

This paper describes the implementation of the INTERGROWTH-21^st Project in Nagpur, India. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12058/abstract

Implementation of the INTERGROWTH-21st Project in China

This paper describes the implementation of the INTERGROWTH-21^st Project in Beijing, China. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12044/abstract

Implementation of the INTERGROWTH-21st Project in Brazil

This paper describes the implementation of the INTERGROWTH-21^st Project in Pelotas, Brazil. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12046/abstract

Ethical issues arising from the INTERGROWTH-21st Fetal Growth Longitudinal Study

The INTERGROWTH-21^st Project presented a complex set of ethical challenges given the involvement of health institutions in geographically and culturally diverse areas of the world, with differing attitudes to pregnancy. This paper addresses how the research team dealt with some of those issues. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12030/abstract

Statistical considerations for the development of prescriptive fetal and newborn growth standards in the INTERGROWTH-21st Project

This paper considers the statistical aspects of the three components of the INTERGROWTH-21^st Project - the Fetal Growth Longitudinal Study, the Preterm Postnatal Follow-up Study, and the Newborn Corss-Sectional Study - as they relate to the construction of the INTERGROWTH-21^st standards, in particular, the sample size. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12031/abstract

Standardisation of neonatal clinical practice

Given the multicentre nature of the INTERGROWTH-21^st Project and the expected number of preterm births, it is vital that all centres follow the same standardised clinical care protocols to assess and manage preterm infants, so as to ensure maximum validity of the resulting standards as indicators of growth and nutrition with minimal confounding. Moreover, it is well known that evidence-based clinical practice guidelines can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. The INTERGROWTH-21^st Neonatal Group produced an operations manual, which reflects the consensus reached by members of the group regarding standardised definitions of neonatal morbidities and the minimum standards of care to be provided by all centres taking part in the project. This paper describes the process of developing the Basic Neonatal Care Manual, as well as the morbidity definitions and standardised neonatal care protocols applied across all the INTERGROWTH-21^st participating centres. Thoughts about implementation strategies are presented. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12312/abstract

Anthropometric standardisation and quality control protocols for the construction of new, international, fetal and newborn growth standards: the INTERGROWTH-21st Project

The INTERGROWTH-21^st Project involved taking anthropometric measurements, including head circumference, recumbent length and weight of infants, and the stature and weight of parents. In a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes, in detal, the anthropometric training, standardisation and quality control procedures used to collect data for these new standards. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12127/abstract

Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH-21st Project

Meticulous standardisation and ongoing monitoring of adherence to measurement protocols during data collection are essential to ensure consistency and to minimise systematic error in multicentre studies. Strict ultrasound fetal biometric measurement protocols are used in the INTERGROWTH-21^st Project so that data of the highest quality from different centres can be compared and potentially pooled. A central Ultrasound Quality Unit (USQU) has been set up to oversee this standardisation, training and quality control process. This paper describes the procedures used, which can form a model for research settings involving ultrasound measurements.

Ultrasound methodology used to construct the fetal growth standards in the INTERGROWTH-21st Project

A unified protocol is essential to ensure that fetal ultrasound measurements taken in multicentre research studies are accurate and reproducible. This paper describes the methodology used to take two-dimensional, ultrasound measurements in the longitudinal, fetal growth component of the INTERGROWTH-21^st Project. These standardised methods should minimise the systematic errors associated with pooling data from different sites. They represent a model for carrying out similar research studies in the future. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12313/abstract

The objectives, design and implementation of the INTERGROWTH-21st Project

This paper outlines the objectives, design and implementation of the INTERGROWTH-21^st Project, a multicentre, multiethnic, population-based project conducted in eight geographical areas (Brazil, China, India, Italy, Kenya, Oman, UK and USA), with technical support from four global specialised units, to study growth, health and nutrition from pregnancy to early infancy. It aims to produce prescriptive growth standards, which conceptually extend the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) to cover fetal and newborn life. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12047/abstract

Preface to INTERGROWTH-21st Methodology

Professor Sir Sabaratnam Arulkumaran, President of FIGO, introduces the methods of the INTERGROWTH-21^st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12314/abstract

Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size

Reliable ultrasound charts are necessary for the prenatal assessment of fetal size, yet there is a wide variation of methodologies for the creation of such charts. This paper evaluates the methodological quality of studies of fetal biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. Eighty-three studies met the inclusion criteria, and although multiple regression analysis shows that quality of studies has improved over time, there is considerable heterogeneity in study methodology still observed today. Standardisation of methodologies is necessary in order to make correct interpretations and comparisons between different charts. A checklist of recommended methodologies in proposed. http://www.ncbi.nlm.nih.gov/pubmed/22882780

Malaria in Pregnancy

INTERGROWTH-21st Study Protocol

This study protocol descibes the the objectives, design and implementation of the Fetal Growth Longitudinal Study (FGLS), the Preterm Postnatal Followup Study (PPFS), and the Newborn Cross Sectional Study (NCSS). Data from these studies inform new, international fetal and newborn growth standards and a package of accompanying resources, including a new international equation for estimating gestational age through ultrasound. http://www.medscinet.net/Intergrowth/patientinfodocs/Intergrowth%20Protocol%20Sept%202009.pdf

Fetal Growth Longitudinal Study Operation Manual

This operation manual was used to implement the Fetal Growth Longitudinal Study (FGLS), which involved screening healthy women between 9 and 14 weeks gestation at the time of their early antenatal visit, and followed-up with standard clinical and 2D ultrasound examinations every 5 weeks, i.e. up to six times during a term pregnancy. The results of the FGLS inform new, international fetal and newborn growth standards and a package of supportive tools, guidelines and resources, including a new international equation for estimating gestational age through ultrasound. http://www.medscinet.net/Intergrowth/patientinfodocs/FGLS%20Manual%2015-09.pdf

Pregnancy and Delivery Form Instructions

This resource was used to train health professionals on how to record key data on pregnancies and deliveries for women participating in the Fetal Growth Longitudinal Study (FGLS) and Newborn Cross Sectional Study (NCSS). http://www.medscinet.net/Intergrowth/patientinfodocs/Pregnancy%20and%20Delivery%20Form%20Instructions.pdf

Basic Neonatal Care Manual

The INTERGROWTH-21^st Project used this manual to standardize definitions, treatment and management recommendations of neonatal morbidities.  http://www.medscinet.net/Intergrowth/patientinfodocs/Neonatal%20Manual%20Final.pdf

Anthropometry Handbook

This handbook describes the methods used to perform accurate, precise and standardized anthropometric measurements for all components of the INTERGROWTH-21^st study, including:

• height and weight of pregnant mothers
• birth weight, length and head circumference of newborns
• weight, length and head circumference of preterm babies

Measurement of Symphysis Fundus Height Protocol

This protocol outlines the technique for measuring symphysis fundus height. http://www.medscinet.net/Intergrowth/patientinfodocs/Measurement%20of%20Symphysis%20Fundus%20Height.pdf

Blood Pressure Measurement Protocol

This protocol outlines the technique for taking a pregnant woman's blood pressure. http://www.medscinet.net/Intergrowth/patientinfodocs/BP%20protocol.pdf

Ultrasound Operations Manual

The aims of this manual are to ensure all trained ultrasonographers are familiar with the standardized way measurements should be taken for the purposes of using the INTERGROWTH-21^st growth standards, including standardization of the way the equipment should be used, ultrasound findings are recorded, data is entered and transfered, and how to train, asesses and certify these standardized techniques.  http://www.medscinet.net/Intergrowth/patientinfodocs/US%20Manual%20FINAL.pdf

Correct Measurement of Fetal Crown Rump Length and Standardization of Ultrasonographers

The aim of this manual is to ensure all trained ultrasonographers are familiar with the standardized way crown-rump length measurements should be taken for the purposes of using the INTERGROWTH-21^st fetal growth standards. http://www.medscinet.net/Intergrowth/patientinfodocs/CRLstandardisation_Website.pdf

Sleep-Wake Cycle Assessment Manual

This manual details the technique for assessing sleep-wake cycles in children. http://www.medscinet.net/Intergrowth/patientinfodocs/Sleep-wake%20cycle%20assessment%20manual%20July%202014.pdf

Five keys to improving research costing in low- and middle-income countries

ESSENCE on Health Research have created a good practice document on research costing. It includes a review of the funding practices related to the definition and funding of direct and indirect costs. 

Implementation Research in Health: A Practical Guide from the WHO

This guide, developed by the WHO and released in December 2013, aims to facilitate implementation research in LMICs.

PRISMA for Abstracts: Reporting Systematic Reviews in Journal and Conference Abstracts

Despite published guidance on writing the abstract in the PRISMA Statement guiding the reporting of systematic reviews in general and elsewhere, evaluations show that reporting of systematic reviews in journal and conference abstracts is poor. Teh authors developed consensus-based reporting guidelines as an extension to the PRISMA Statement on good reporting of systematic reviews and meta-analyses in abstracts.

Guidelines for an Integrated Approach to the Nutritional care of HIV-infected children

We share the WHO 2009 guideline that provides a framework for integrating nutrition support into the routine care of HIV-infected children (6 months-14 years). HIV-infected children deserve special attention because of their additional needs to ensure growth and development and their dependency on adults for adequate care including nutrition care and support for treatment. Vertical implementation of HIV programmes, such as PMTCT and ART, have resulted in missed opportunities to gain synergy with other existing services.

Community based supplementary feeding for promoting child growth-The Guideline

HIV and Infant Feeding-The Guidelines

Previously we have shared the guidelines pertaining to the early initiation and continuation of breast feeding and complementary feeding for newborns and infants. However there are concerns regarding breast feeding for women living with HIV. In particular, evidence has been reported that antiretroviral (ARV) interventions to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of postnatal transmission of HIV through breastfeeding. This evidence has major implications for how women living with HIV might feed their infants, and how health workers should counsel these mothers. In light of this, the World Health Organization (WHO) commenced a guideline development process, culminating in a Guideline Development Group meeting in Geneva on 22–23 October 2009. We share here the revised guidelines by WHO for principles and recommendations for infant feeding inthe context of HIV.

Research Reporting Criteria

Research reporting guidelines are standard statements that provide guidance on how to report research methodology and findings. These are in the form of checklists, flow diagrams or texts. Most of the biomedical journals require authors to comply with these guidelines. Guidelines are available for reporting various study designs:

• CONSORT Statement (reporting of randomized controlled trials)
• STARD (reporting of diagnostic accuracy studies)
• STROBE (reporting of observational studies in epidemiology)
• PRISMA (reporting of systematic reviews)
• MOOSE (reporting of meta-analyses of observational studies)