Global Health Research

“As resources will always be limited, these should be used in such a way as to equitably provide those health care forms which have been shown to be effective through appropriately designed assessments.” — Archie Cochrane

GH Maternal Child

Global Network Research in India: The Christiana Care Health Systems (CCHS) – Jawaharlal Nehru Medical College (JNMC) Collaboration

In 2001, Dr. Richard Derman was selected, along with Jawaharlal Nehru Medical College (JNMC) of KLE University in Belgaum (Karnataka, India), for membership in the Global Network for Women’s and Children’s Health Research. Participation in this Network conveyed the benefit of multi-year funding for development of a Research Unit and support of research initiatives under a cooperative agreement with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Dr. Derman, the Endowed Chair of the Department of Obstetrics and Gynecology and the Director of the Center for Women’s, Infants’ and Children’s Health Research at Christiana Care Health Systems (CCHS), serves as the Principal Investigator of the CCHS-JNMC Research Unit which represents an international, multi-disciplinary research team of clinicians, basic scientists, public health experts, and information technology specialists. Dr. Bhalachandra Kodkany of JNMC serves as the Unit’s Senior Foreign Investigator, and Dr. Shivaprasad S. Goudar is the Research Coordinator and Co-Investigator.

The Global Network was established to advance research capacity in resource poor settings and to implement clinical research to identify feasible, cost-effective, sustainable interventions to address public health challenges and to improve health outcomes of women and children. A primary Global Network objective is to accelerate achievement of Millennium Development Goal 4 (to reduce child mortality) and Goal 5 (to improve maternal health) in low and lower-middle income countries.

Accomplishments of the CCHS-JNMC Global Network Research Unit

Implementation in the Belgaum District of Karnataka State, India of a seminal, community-based trial of oral misoprostol for postpartum hemorrhage prevention and the publication of findings in The Lancet and other peer-reviewed journals which provided critical evidence for:

  • inclusion of misoprostol on the World Health Organization’s List of Essential Medicines for prevention of postpartum hemorrhage (PPH) when oxytocin is unavailable,
  • stronger advocacy of misoprostol for PPH prevention by the UN Commission on Life-Saving Commodities for Maternal Health,
  • adoption of the Government of India policy which recommends misoprostol for community level PPH prevention,
  • expansion of the registration and use of misoprostol for PPH prevention, and
  • widespread use of the BRASSS-V calibrated drape, which was developed and validated as a means to elevate the reliability and precision of measurement of postpartum blood loss.

A contribution of nearly 30% of the total maternal and neonatal outcome records for the nearly more than 507,700 pregnant women that had consented (by the end of October 2015) to participate in the multi-site GN Maternal Newborn Health Registry implemented in 2008 to monitor the impact of Global Network interventions; the highest follow-up rates and a percentage of records obtained to records expected of 99.9%.

Participation in the Community Level Interventions for Pre-eclampsia (CLIP) trial to test whether implementing a community- based package of care for women with hypertensive disorders of pregnancy improves maternal and neonatal outcomes.

Provision of mentoring and training in association with the Global Network Scholars Program and design and implementation of studies that included:

  • a randomized controlled trial of the effects of oral clindamycin on preterm delivery, stillbirth and neonatal outcome,
  • the most definitive trial of the effectiveness of low dose sublingual misoprostol for postpartum hemorrhage prevention, and
  • research on the contribution of consanguinity to prematurity, low birth weight and fetal loss.

Other research initiatives completed since the launch of the Research Unit:

  • the Antenatal Corticosteroid Trial (ACT), a multi-site study implemented at 7 GN sites located in Asia, Africa and Latin America, to measure the impact of increasing the availability of antenatal corticosteroids in community-based settings of selected intervention clusters, improving recognition of women at risk for delivering pre-term infants, and removing barriers to administration of a course of corticosteroids (by training providers authorized to use antenatal corticosteroids and improving referral and transfer arrangements),
  • the WHO evaluation of controlled cord traction to reduce postpartum blood loss and co-authorship of the publication presenting study findings,
  • First Breath, a trial launched at 7 GN sites located in Asia, Africa and Latin America on World Health Day, 2005 to assess the effectiveness of the American Academy of Pediatrics (AAP) Neonatal Resuscitation Program implemented in conjunction with the WHO’s Essential Newborn Care Course on stillbirths and early neonatal mortality,
  • the Helping Babies Breathe (HBB) project of the American Academy of Pediatrics which involved assistance from JNMC in the development of a new neonatal resuscitation curriculum for use in low resource countries and JNMC’s training of 816 birth attendants in 86 training sessions using the new HBB module,
  • the Global Network Study to Assess Gestational Age by Fundal Height (TAPE Study – Phase I and Phase II) to assess and validate the accuracy of estimating gestational age with the use of a tape measure developed to estimate the gestational age of a fetus when ultrasound is unavailable,
  • the Emergency Obstetric and Newborn Care (EmONC) study, which assessed the effectiveness of a multifaceted intervention package as a means for reducing stillbirths and neonatal mortality,
  • the Community Birth Attendant Survey to assess maternal and newborn health services provided by community birth attendants,
  • the Brain Research to Ameliorate Impaired Neurodevelopment: Home Based Intervention Trial (BRAIN HIT), which developed a program for home-based intervention, evaluated the effects on neurodevelopmental outcomes, and generated recommendations for implementing strategies to reduce neurodevelopmental disabilities in at-risk young children in low-resource countries and settings,
  • a collaboration between JNMC, WHO and the Harvard School of Public Health which demonstrated the benefits of using the WHO Safe Childbirth Checklist and resulted in the Ministry of Health, Karnataka State recommending adoption of the checklist.

Participation in HBB activities sponsored by the American Academy of Pediatrics and the HBB Global Development Alliance which resulted in the following:

  • assessments of tobacco use, smoking behaviors and indoor pollution,
  • JNMC faculty participation in the design of Basic Newborn Care and Resuscitation Program: Navajat Shishu Suraksha Karyakram (NSSK), a program recommended by the Government of India, and
  • selection of JNMC as one of three GN sites to receive NICHD and private donor funds to implement Evaluation of HELPING BABIES BREATHE in Belgaum, Kenya and Nagpur: Does Implementation of HELPING BABIES BREATHE Save Lives?

In 2015, a multi-site double-blind trial of Aspirin Supplementation for Pregnancy Indicated Risk Reduction In Nulliparas (ASPIRIN), led by CCHS-JNMC investigators, was initiated. The study will determine whether daily low dose aspirin (ASA) per the local standard dosage (75 mg or 81 mg) initiated between 6 0/7 weeks and 12 6/7 weeks through 36 weeks of certain gestation (based on first trimester ultrasound) will reduce the risk of preterm birth by at least 20%.

The GN multi-site evaluation of HELPING BABIES BREATHE assessed the impact of training thousands of birth attendants in the HBB curriculum and establishing HBB programs in facilities in Belgaum and Nagpur, India, and in Kenya. The study results are expected to be published in 2016.

Global Network participation has strengthened the research infrastructure at JNMC and at the sites of other Global Network partners located in low and lower-middle income countries. Further, many partners are leveraging Network membership to gain support from foundations and other organizations that support global health research. The probability is therefore high that Global Network Research Units and international collaboration in women’s and children’s health research third cycle of the Global Network ends in 2018.

Publications Attributable to the CCHS-JNMC Collaboration

  1. Althabe F, Belizán JM, Mazzoni A, Berrueta M, Hemingway-Foday J, Koso-Thomas M, McClure E, Chomba E, Garces A, Goudar S, Kodkany B, Saleem S, Pasha O, Patel A, Esamai F, Carlo WA, Krebs NF, Derman RJ, Goldenberg RL, Hibberd P, Liechty EA, Wright LL, Bergel EF, Jobe AH, Buekens P.  Antenatal corticosteroids trial in preterm births to increase neonatal survival in developing countries: study protocol. Reprod Health. 2012 Sep 19;9:22. doi: 10.1186/1742-4755-9-22. PMID: 22992312
  2. Althabe F, Belizán JM, Buekens P, McClure EM, Koso-Thomas M; NICHD’s Global Network for Women’s and Children’s Health Research ACT Trial Steering Committee. Antenatal corticosteroids to reduce preterm deaths in low-income settings. Lancet Glob Health. 2014 Aug;2(8):e444. doi: 10.1016/S2214-109X(14)70261-X. Epub 2014 Jul 23. PMID: 25103510
  3. Althabe F, Belizán JM, McClure EM, Hemingway-Foday J, Berrueta M, Mazzoni A, Ciganda A, Goudar SS, Kodkany BS, Mahantshetti NS, Dhaded SM, Katageri GM, Metgud MC, Joshi AM, Bellad MB, Honnungar NV, Derman RJ, Saleem S, Pasha O, Ali S, Hasnain F, Goldenberg RL, Esamai F, Nyongesa P, Ayunga S, Liechty EA, Garces AL, Figueroa L, Hambidge KM, Krebs NF, Patel A, Bhandarkar A, Waikar M, Hibberd PL, Chomba E, Carlo WA, Mwiche A, Chiwila M, Manasyan A, Pineda S, Meleth S, Thorsten V, Stolka K, Wallace DD, Koso-Thomas M, Jobe AH, Buekens PM.  A population-based, multifaceted strategy to implement antenatal corticosteroid treatment versus standard care for the reduction of neonatal mortality due to preterm birth in low-income and middle-income countries: the ACT cluster-randomised trial. Lancet. 2015 Feb 14;385(9968):629-39. doi: 10.1016/S0140-6736(14)61651-2. Epub 2014 Oct 15. PMID: 25458726
  4. Althabe F, Berrueta M, Hemingway-Foday J, Mazzoni A, Bonorino CA, Gowdak A, Gibbons L, Bellad MB, Metgud MC, Goudar S, Kodkany BS, Derman RJ, Saleem S, Iqbal S, Ala SH, Goldenberg RL, Chomba E, Manasyan A, Chiwila M, Imenda E, Mbewe F, Tshefu A, Lokomba V, Bose CL, Moore J, Meleth S, McClure EM, Koso-Thomas M, Buekens P, Belizán JM. A color-coded tape for uterine height measurement: a tool to identify preterm pregnancies in low resource settings. PLoS One. 2015 Mar 30;10(3):e0117134. doi: 10.1371/journal.pone.0117134. eCollection 2015. PMID: 25822529
  5. Althabe F, Moore JL, Gibbons L, Berrueta M, Goudar SS, Chomba E, Derman RJ, Patel A, Saleem S, Pasha O, Esamai F, Garces A, Liechty EA, Hambidge K, Krebs NF, Hibberd PL, Goldenberg RL, Koso-Thomas M, Carlo WA, Cafferata ML, Buekens P, McClure EM. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study. Reprod Health. 2015 Jun 8;12 Suppl 2:S8. doi: 10.1186/1742-4755-12-S2-S8. Epub 2015 Jun 8. PMID: 26063350
  6. Bang A, Bellad R, Gisore P, Hibberd P, Patel A, Goudar S, Esamai F, Goco N, Meleth S, Derman RJ, Liechty EA, McClure E, Carlo WA, Wright LL. Implementation and evaluation of the Helping Babies Breathe curriculum in three resource limited settings: does Helping Babies Breathe save lives? A study protocol. BMC Pregnancy Childbirth. 2014 Mar 26;14:116. doi: 10.1186/1471-2393-14-116. PMID: 24670013
  7. Bauserman M, Lokangaka A, Thorsten V, Tshefu A, Goudar SS, Esamai F, Garces A, Saleem S, Pasha O, Patel A, Manasyan A, Berrueta M, Kodkany B, Chomba E, Liechty EA, Hambidge K, Krebs NF, Derman RJ, Hibberd PL, Althabe F, Carlo WA, Koso-Thomas M, Goldenberg RL, Wallace DD, McClure EM, Bose CL. Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis. Reprod Health. 2015 Jun 8;12 Suppl 2:S5. doi: 10.1186/1742-4755-12-S2-S5. Epub 2015 Jun 8. PMID: 26062992
  8. Belizán JM, McClure EM, Goudar SS, Pasha O, Esamai F, Patel A, Chomba E, Garces A, Wright LL, Koso-Thomas M, Moore J, Althabe F, Kodkany BS, Sami N, Manasyan A, Derman RJ, Liechty EA, Hibberd P, Carlo WA, Hambidge KM, Buekens P, Jobe AH, Goldenberg RL. Neonatal death in low- to middle-income countries: a global network study. Am J Perinatol. 2012 Sep;29(8):649-56. doi: 10.1055/s-0032-1314885. Epub 2012 May 29. PMID: 22644832
  9. Bellad MB, Goudar SS. Misoprostol: theory and practice. In: B-Lynch C, Keith LG, Lalonde AB, and Karoshi M, Editors. A Textbook of Postpartum Hemorrhage. A Comprehensive Guide to Evaluation, Management and Surgical Intervention. Duncow, Kirkmahoe, Dumfriesshire: Sapiens Publishing. 2006;114-126.
  10. Bellad MB, Laxmi BV, Goudar SS, Kumar A. Standardized visual estimation of blood loss during vaginal delivery with its correlation hematocrit changes – a descriptive study. J So Asian Fed of Obstet and Gynecol. 2009 Jan-Apr;1(1): 29-34; 2009 Jan-Apr.
  11. Bellad MB, Goudar SS, Edlavitch SA, Mahantshetti NS, Naik V, Hemingway-Foday JJ, Gupta M, Nalina HR, Derman R, Moss N, Kodkany BS. Consanguinity, prematurity, birth weight and pregnancy loss: a prospective cohort study at four primary health center areas of Karnataka, India. J Perinatol. 2012 Jun;32(6):431-7. doi: 10.1038/jp.2011.115. Epub 2011 Aug 18. PMID: 21852769
  12. Bellad MB, Tara D, Ganachari MS, Mallapur MD, Goudar SS, Kodkany BS, Sloan NL, Derman R. Prevention of postpartum haemorrhage with sublingual misoprostol or oxytocin: a double blind randomised controlled trial. BJOG. 2012 Jul;119(8):975-82; discussion 982-6. doi: 10.1111/j.1471-0528.2012.03341.x. PMID: 22703421
  13. Biasini FJ, De Jong D, Ryan S, Thorsten V, Bann C, Bellad R, Mahantshetti NS, Dhaded SM, Pasha O, Chomba E, Goudar SS, Carlo WA, McClure E. Development of a 12 month screener based  on items from the Bayley II Scales of Infant Development for use in Low Middle Income countries. Early Hum Dev. 2015 Apr;91(4):253-8. doi: 10.1016/j.earlhumdev.2015.02.001. Epub 2015 Mar 2. PMID: 25734979
  14. Bloch M, Althabe F, Onyamboko M, Kaseba-Sata C, Castilla EE, Freire S, Garces AL, Parida S, Goudar SS, Kadir MM, Goco N, Thornberry J, Daniels M, Bartz J, Hartwell T, Moss N, Goldenberg R. Tobacco use and secondhand smoke exposure during pregnancy: an investigative study of women in 9 developing countries. Am J Public Health. 2008 Oct;98(10):1833-40. doi: 10.2105/AJPH.2007.117887. Epub 2008 Feb 28. PMID: 18309125
  15. Bose CL, Bauserman M, Goldenberg RL, Goudar SS, McClure EM, Pasha O, Carlo WA, Garces A, Moore JL, Miodovnik M, Koso-Thomas M. The Global Network Maternal Newborn Health Registry: a multi-national, community-based registry of pregnancy outcomes. Reprod Health. 2015 Jun 8;12 Suppl 2:S1. doi: 10.1186/1742-4755-12-S2-S1. Epub 2015 Jun 8. PMID: 26063166
  16. Bucher S, Marete I, Tenge C, Liechty EA, Esamai F, Patel A, Goudar SS, Kodkany B, Garces A, Chomba E, Althabe F, Barreuta M, Pasha O, Hibberd P, Derman RJ, Otieno K, Hambidge K, Krebs NF, Carlo WA, Chemweno C, Goldenberg RL, McClure EM, Moore JL, Wallace DD, Saleem S, Koso-Thomas M.  A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Reprod Health. 2015 Jun 8;12 Suppl 2:S12. doi: 10.1186/1742-4755-12-S2-S12. Epub 2015 Jun 8. PMID: 26063483
  17. Carlo WA, Goudar SS, Jehan I, Chomba E, Tshefu A, Garces A, Parida S, Althabe F, McClure EM, Derman RJ, Goldenberg RL, Bose C, Krebs NF, Panigrahi P, Buekens P, Chakraborty H, Hartwell TD, Wright LL; First Breath Study Group. Newborn-care training and perinatal mortality in developing countries. N Engl J Med. 2010 Feb 18;362(7):614-23. doi: 10.1056/NEJMsa0806033. PMID: 20164485
  18. Carlo WA, Goudar SS, Jehan I, Chomba E, Tshefu A, Garces A, Parida S, Althabe F, McClure EM, Derman RJ, Goldenberg RL, Bose C, Hambidge M, Panigrahi P, Buekens P, Chakraborty H, Hartwell TD, Moore J, Wright LL; First Breath Study Group. High mortality rates for very low birth weight infants in developing countries despite training. Pediatrics. 2010 Nov;126(5):e1072-80. doi: 10.1542/peds.2010-1183. Epub 2010 Oct 11.  PMID: 20937655
  19. Carlo WA, Goudar SS, Pasha O, Chomba E, McClure EM, Biasini FJ, Wallander JL, Thorsten V, Chakraborty H, Wright LL; Brain Research to Ameliorate Impaired Neurodevelopment- Home Based Intervention Trial Committee and the National Institute of Child Health and Human Development Global Network for Women’s and Children’s Health Research. Neurodevelopmental outcomes in infants requiring resuscitation in developing countries. J Pediatr. 2012 May;160(5):781-5.e1. doi: 10.1016/j.jpeds.2011.10.007. Epub 2011 Nov 17. PMID: 22099522
  20. Carlo WA, Goudar SS, Pasha O, Chomba E, Wallander JL, Biasini FJ, McClure EM, Thorsten V, Chakraborty H, Wallace D, Shearer DL, Wright LL; Brain Research to Ameliorate Impaired Neurodevelopment-Home-Based Intervention Trial Committee and the National Institute of Child Health and Human Development Global Network for Women’s and Children’s Health Research Investigators. Randomized trial of early developmental intervention on outcomes in children after birth asphyxia in developing countries. J Pediatr. 2013 Apr;162(4):705-712.e3. doi: 10.1016/j.jpeds.2012.09.052. Epub 2012 Nov 16. PMID: 23164311
  21. Chakraborty H, Bartz J, Goudar SS. Estimating the effect of unplanned interventions in the randomized misoprostol trial: A mixed model analysis. Int J Gynaecol Obstet. 2006:94(Supplement 2):S136.
  22. Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, Patted SS, Patel A, Edlavitch SA, Hartwell T, Chakraborty H, Moss N. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006 Oct 7;368(9543):1248-53. PMID: 17027730
  23. Derman R. The role of misoprostol for prevention of postpartum hemorrhage. Int J Gynaecol Obstet; 2006;94(Supplement 2):S131-S132.
  24. Dhaded SM, Somannavar MS, Vernekar SS, Goudar SS, Mwenche M, Derman R, Moore JL, Patel A, Pasha O, Esamai F, Garces A, Althabe F, Chomba E, Liechty EA, Hambidge K, Krebs NF, Berrueta M, Ciganda A, Hibberd PL, Goldenberg RL, McClure EM, Koso-Thomas M, Manasyan A, Carlo WA. Neonatal mortality and coverage of essential newborn interventions 2010 – 2013: a prospective, population-based study from low-middle income countries. Reprod Health. 2015 Jun 8;12 Suppl 2:S6. doi: 10.1186/1742-4755-12-S2-S6. Epub 2015 Jun 8. PMID: 26063125
  25. Garces A, McClure EM, Chomba E, Patel A, Pasha O, Tshefu A, Esamai F, Goudar S, Lokangaka A, Hambidge KM, Wright LL, Koso-Thomas M, Bose C, Carlo WA, Liechty EA, Hibberd PL, Bucher S, Whitworth R, Goldenberg RL. Home birth attendants in low income countries: who are they and what do they do?  BMC Pregnancy Childbirth. 2012 May 14;12:34. doi: 10.1186/1471-2393-12-34. PMID: 22583622
  26. Geller SE, Patel A, Naik VA, Goudar SS, Edlavitch SA, Kodkany BS, Derman RJ. Conducting international collaborative research in developing nations. Int J Gynaecol Obstet. 2004 Dec;87(3):267-71. PMID: 15548406
  27. Geller SE, Adams MG, Kelly PJ, Kodkany BS, Derman RJ. Postpartum hemorrhage in resource-poor settings. Int J Gynaecol Obstet. 2006 Mar;92(3):202-11. Epub 2006 Jan 19. Review. PMID: 16427056
  28. Geller SE, Naik V, Patel A, Goudar SS, Edlavitch SA, Kodkany BS, Derman RJ. Ethical issues in conducting international research studies. Int J Gynaecol Obstet. 2006:94 Suppl 2:S129-30.
  29. Geller SE, Goudar SS, Adams MG, Naik VA, Patel A, Bellad MB, Patted SS, Edlavitch SA, Moss N, Kodkany BS, Derman RJ. Factors associated with postpartum hemorrhage in low-risk women delivering in rural India. Int J Gynaecol Obstet. 2008 Apr;101(1):94-9. doi: 10.1016/j.ijgo.2007.08.025. Epub 2008 Mar 4. PMID: 18291401
  30. Goldenberg RL, McClure EM, Kodkany B, Wembodinga G, Pasha O, Esamai F, Tshefu A, Patel A, Mabaye H, Goudar S, Saleem S, Waikar M, Langer A, Bose CL, Rubens CE, Wright LL, Moore J, Blanc A. A multi-country study of the “intrapartum stillbirth and early neonatal death indicator” in hospitals in low-resource settings. Int J Gynaecol Obstet. 2013 Sep;122(3):230-3. doi: 10.1016/j.ijgo.2013.04.008. Epub 2013 Jun 21. PMID: 23796259
  31. Goudar SS, Brinkley MF, Forvendel DG, Singh AP, Revankar AP, Kodkany BS, Derman RJ. Data management system for community-based randomized controlled trial in India. In Proceedings of the Indian Conference on Medical Informatics and Telemedicine, IIT Kharagpur. 2005;Feb 27-Mar:171-75.
  32. Goudar SS, Chakraborty H, Edlavitch SA, Naik VA, Bellad MB, Patted SS, Patel A, Moore J, McClure EM, Hartwell T, Moss N, Derman RJ, Kodkany BS, Geller SE. Variation in the postpartum hemorrhage rate in a clinical trial of oral misoprostol. J Matern Fetal Neonatal Med. 2008 Aug;21(8):559-64. doi: 10.1080/14767050802132158. PMID: 18609354
  33. Goudar SS, Dhaded SM, McClure EM, Derman RJ, Patil VD, Mahantshetti NS, Bellad RM, Kodkany B, Moore J, Wright LL, Carlo WA; study investigators. ENC training reduces perinatal mortality in Karnataka, India. J Matern Fetal Neonatal Med. 2012 Jun;25(6):568-74. doi: 10.3109/14767058.2011.584088. Epub 2011 Jul 27. PMID: 21793707
  34. Goudar SS, Carlo WA, McClure EM, Pasha O, Patel A, Esamai F, Chomba E, Garces A, Althabe F, Kodkany B, Sami N, Derman RJ, Hibberd PL, Liechty EA, Krebs NF, Hambidge KM, Buekens P, Moore J, Wallace D, Jobe AH, Koso-Thomas M, Wright LL, Goldenberg RL. The Maternal and Newborn Health Registry study of the Global Network for Women’s and Children’s Health Research. Int J Gynaecol Obstet. 2012 Sep;118(3):190-3. doi:  10.1016/j.ijgo.2012.04.022. Epub 2012 Jun 26. PMID: 22738806
  35. Goudar SS, Somannavar MS, Clark R, Lockyer JM, Revankar AP, Fidler HM, Sloan NL, Niermeyer S, Keenan WJ, Singhal N. Stillbirth and newborn mortality in India after helping babies breathe training.Pediatrics. 2013 Feb;131(2):e344-52. doi: 10.1542/peds.2012-2112. Epub 2013 Jan 21. PMID: 23339215
  36. Goudar SS, Derman RJ, Honnungar NV, Patil KP, Swamy MK, Moore J, Wallace DD, McClure EM, Kodkany BS, Pasha O, Sloan NL, Wright LL, Goldenberg RL. An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial. Matern Child Health J. 2015 Dec;19(12):2698-706. doi: 10.1007/s10995-015-1792-0. PMID: 26205277
  37. Goudar SS, Stolka KB, Koso-Thomas M, Honnungar NV, Mastiholi SC, Ramadurg UY, Dhaded SM, Pasha O, Patel A, Esamai F, Chomba E, Garces A, Althabe F, Carlo WA, Goldenberg RL, Hibberd PL, Liechty EA, Krebs NF, Hambidge MK, Moore JL, Wallace DD, Derman RJ, Bhalachandra KS, Bose CL. Data quality monitoring and performance metrics of a prospective, population-based observational study of maternal and newborn health in low resource settings. Reprod Health. 2015 Jun 8;12 Suppl 2:S2. doi: 10.1186/1742-4755-12-S2-S2. Epub 2015 Jun 8. PMID: 26062714
  38. Goudar SS, Goco N, Somannavar MS, Vernekar SS, Mallapur AA, Moore JL, Wallace DD, Sloan NL, Patel A, Hibberd PL, Koso-Thomas M, McClure EM, Goldenberg RL. Institutional deliveries and perinatal and neonatal mortality in Southern and Central India. Reprod Health. 2015 Jun 8;12 Suppl 2:S13. doi: 10.1186/1742-4755-12-S2-S13. Epub 2015 Jun 8. PMID: 26063586
  39. Gülmezoglu AM, Widmer M, Merialdi M, Qureshi Z, Piaggio G, Elbourne D, Abdel-Aleem H, Carroli G, Hofmeyr GJ, Lumbiganon P, Derman R, Okong P, Goudar S, Festin M, Althabe F, Armbruster D. Active management of the third stage of labour without controlled cord traction: a randomized non-inferiority controlled trial. Reprod Health. 2009 Jan 21;6:2. doi: 10.1186/1742-4755-6-2. PMID: 19154621
  40. Gülmezoglu AM, Lumbiganon P, Landoulsi S, Widmer M, Abdel-Aleem H, Festin M, Carroli G, Qureshi Z, Souza JP, Bergel E, Piaggio G, Goudar SS, Yeh J, Armbruster D, Singata M, Pelaez-Crisologo C, Althabe F, Sekweyama P, Hofmeyr J, Stanton ME, Derman R, Elbourne D. Active management of the third stage of labour with and without controlled cord traction: a randomised, controlled, non-inferiority trial. Lancet. 2012 May 5;379(9827):1721-7. doi: 10.1016/S0140-6736(12)60206-2. Epub 2012 Mar 6. Erratum in: Lancet. 2012 May 5;379(9827):1704. Lancet. 2012 Jul 21;380(9838):218. PMID: 22398174
  41. Hambidge KM, Krebs NF, Westcott JE, Garces A, Goudar SS, Kodkany BS, Pasha O, Tshefu A, Bose CL, Figueroa L, Goldenberg RL, Derman RJ, Friedman JE, Frank DN, McClure EM, Stolka K, Das A, Koso-Thomas M, Sundberg S; Preconception Trial Group. Preconception maternal nutrition: a multi-site randomized controlled trial. BMC Pregnancy Childbirth. 2014 Mar 20;14:111. doi: 10.1186/1471-2393-14-111. PMID: 24650219
  42. Harrison MS, Ali S, Pasha O, Saleem S, Althabe F, Berrueta M, Mazzoni A, Chomba E, Carlo WA, Garces A, Krebs NF, Hambidge K, Goudar SS, Dhaded SM, Kodkany B, Derman RJ, Patel A, Hibberd PL, Esamai F, Liechty EA, Moore JL, Koso-Thomas M, McClure EM, Goldenberg RL. A prospective population-based study of maternal, fetal, and neonatal outcomes in the setting of prolonged labor, obstructed labor and failure to progress in low- and middle-income countries. Reprod Health. 2015 Jun 8;12 Suppl 2:S9. doi: 10.1186/1742-4755-12-S2-S9. Epub 2015 Jun 8. PMID: 26063492
  43. Kadir MM, McClure EM, Goudar SS, Garces AL, Moore J, Onyamboko M, Kaseba C, Althabe F, Castilla EE, Freire S, Parida S, Saleem S, Wright LL, Goldenberg RL; Global Network Tobacco Study Group. Exposure of pregnant women to indoor air pollution: a study from nine low and middle income countries. Acta Obstet Gynecol Scand. 2010;89(4):540-8. doi: 10.3109/00016340903473566. PMID: 19961275
  44. Kelly PJ, Goudar SS, Chakraborty H, Moore J, Derman R, Kodkany B, Bellad M, Naik VA, Angolkar M, Bloch M. Pregnant women and children’s exposure to tobacco and solid fuel smoke in southwestern India. J Matern Fetal Neonatal Med. 2011 Jul;24(7):973-7. doi: 10.3109/14767058.2010.537411. Epub 2010 Dec 15. PMID: 21158490
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