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T
he United Nations’ Millennium Development
Goals, a set of interrelated targets adopted by world
leaders in 2000, catalyzed political commitment
toward improving child survival and maternal health. Goals
4 and 5 called for a two-thirds reduction in mortality among
children less than 5 years of age and a three-quarters reduc-
tion in maternal mortality between 1990 and 2015, respec-
tively.
1
Five years before the goals came to a close, the Mus-
koka Initiative was launched at the G8 summit to intensify
efforts toward improving maternal, newborn and child
health in low- and middle-income countries, with Canada
investing $2.85 billion to reduce the burden of disease,
improve nutrition and strengthen health systems in areas
with the greatest need.
2
Although there have been substan-
tial gains in reducing global maternal and child mortality,
progress has been insufcient to achieve the Millennium
Development Goals’ targets.
3,4
Unacceptably high numbers
of women and children are still dying every year, largely due
to conditions that could have been prevented or treated if
existing cost-effective interventions were made universally
available.
5
Currently, there is insufcient knowledge on how
to effectively implement proven affordable interventions in
resource-limited settings.
6
Over the past 5 years, Canadian
funding through the Muskoka Initiative has focused on scal-
Setting an implementation research agenda for Canadian
investments in global maternal, newborn, child
andadolescent health: a research prioritization exercise
Renee Sharma MSc, Matthew Buccioni, Michelle F. Gaffey MSc, Omair Mansoor BSc, Helen Scott PhD,
Zulqar A. Bhutta MBBS PhD; for the Canadian Expert Group on Maternal, Newborn, Child and
Adolescent Health*
Competing interests: No authors declare any conflicts of interest
related to this work.
Disclaimer: Niranjan Kisson is on the Editorial Advisory Board for
CMAJ Open and was not involved in the editorial decision-making
process for this article.
This article has been peer reviewed.
Correspondence to: Zulfiqar Bhutta, [email protected]
CMAJ Open 2017. DOI:10.9778/cmajo.20160088
Background: Improving global maternal, newborn, child and adolescent health (MNCAH) is a top development priority in Canada, as
shown by the $6.35 billion in pledges toward the Muskoka Initiative since 2010. To guide Canadian research investments, we aimed
to systematically identify a set of implementation research priorities for MNCAH in low- and middle-income countries.
Methods: We adapted the Child Health and Nutrition Research Initiative method. We scanned the Child Health and Nutrition
Research Initiative literature and extracted research questions pertaining to delivery of interventions, inviting Canadian experts on
MNCAH to generate additional questions. The experts scored a combined list of 97 questions against 5 criteria: answerability, feasi-
bility, deliverability, impact and effect on equity. These questions were ranked using a research priority score, and the average expert
agreement score was calculated for each question.
Results: The overall research priority score ranged from 40.14 to 89.25, with a median of 71.84. The average expert agreement
scores ranged from 0.51 to 0.82, with a median of 0.64. Highly-ranked research questions varied across the life course and focused
on improving detection and care-seeking for childhood illnesses, overcoming barriers to intervention uptake and delivery, effectively
implementing human resources and mobile technology, and increasing coverage among at-risk populations. Children were the most
represented target population and most questions pertained to interventions delivered at the household or community level.
Interpretation: Investing in implementation research is critical to achieving the Sustainable Development Goal of ensuring health and
well-being for all. The proposed research agenda is expected to drive action and Canadian research investments to improve MNCAH.
Abstract
Research