JNMC Research Unit

JNMC Women’s and Children’s Health Research Unit

The Women’s and Children’s Health Research Unit of Jawaharlal Nehru Medical College of KLE Academy of Higher Education and Research (KAHER) (Deemed-to-be-University) has been conducting Community-Oriented Research activities aimed at decreasing maternal and child mortality since 2001. Over the past twenty years, JNMC's multi-disciplinary research team has conducted a number of community / hospital based research projects in collaboration with 27 international Universities and Research Institutes from USA, UK, Canada, South Africa, Australia, Uganda, Zambia and Argentina and 24 Medical Institutes, Universities and Research Institutes in India with funding support from World Health Organization, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Global Network for Women's and Children’s Health Research, other NIH agencies, Bill & Melinda Gates Foundation (BMGF). The Children’s Investment Fund Foundation (CIFF), American Academy of Pediatrics (AAP), Gynuity Health Projects, Thrasher Research Fund, Grand Challenges Canada, Department of Biotechnology (DBT) Govt. of India and the UK Medical Research Council (MRC). The results of these insightful research studies have had a profound impact at national and international levels in shaping public health policies. Till now Research Unit conducted more than 40 trials sponsored by various agencies and published more than 190 research articles out of these trials.

The Research Unit has been funded by National Institute of Child Health and Human Development (NICHD) Global Network since the inception of the network in 2001. Based on its commendable performance during the first cycle, the ‘Research Unit’ gained recognition as one of the six among the ten sites to be re-funded for a third cycle of five years until 2018 and this has been further continued in the Fourth Consecutive Cycle of funding until 2023.

The Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi is designated as a “WHO Collaborating Center for Research in Maternal and Perinatal Health” for a period of four years effective from September 16, 2019.

JNMC Women's and Children's Health Research Unit has received a unique distinction as ICMR Center for Clinical Trials (ICCT) w.e.f December 28, 2021. This is a part of the “Indian Clinical Trial & Education Network (INTENT)” launched by Indian Council of Medical Research (ICMR) and Department of Health Research (DHR) for a period of five years.

The Research Unit has built a strong Public Private Partnership with the District Health Administration of the Belagavi, Bagalkot, Vijayapura, Davanagere, Dharwad-Hubballi, Gadag, Ballari and Raichur districts of Karnataka and Cuttack and Balasore districts of Odisha, Jaipur district of Rajasthan for implementing community / hospital-based interventions. Over the years, in Karnataka itself, the Research Unit has served a population of over 20 lakhs people residing in over 800 villages spread over twenty-three talukas of Belagavi, Bagalkot, Vijayapura, Davanagere, Dharwad-Hubballi, Gadag, Ballari and Raichur districts. This population is served by 116 Primary Health Centers, 15 Taluka Hospitals, 4 District Hospitals, 131 Private Hospitals and Clinics and 20 Academic Tertiary Care Centers. 1,995 Health Care Providers and health workers in these facilities have been trained for ethical conduct of research and data collection. It may be noted that Mothers and Newborns in these areas have been provided treatment free of cost as and when needed.

Research Priorities

• Surveillance System
  • Maternal Newborn Health Registry (MNHR)
• Maternal Health
  • Postpartum Hemorrhage (PPH)
  • Hypertensive Disorders of Pregnancy (HDP)
  • Maternal Nutrition
  • Pregnancy Anaemia
  • Tobacco use during pregnancy
  • Optimizing Intrapartum care during labour
  • Maternal Sepsis
  • Cervical Cancer
  • Prediction of High-risk Pregnancy
  • Maternal Mental Health
• Newborn Health
  • Birth Asphyxia
  • Preterm Birth
  • Infant Neurodevelopment
  • Breastfeeding Support
  • Infant Nutrition
  • Newborn Sepsis
  • Understanding adverse outcomes of pregnancy
• Health System Strengthening
  • Emergency Obstetric and Neonatal Care (EmONC)
  • Safe Childbirth Checklist
• Impact of COVID-19 on Maternal and Neonatal Health
  • Clinical Outcomes of COVID-19 in Pregnancy and Perinatal Health

The Impact

The following is a brief summary of the results of research studies that have had a profound impact at national and international levels in shaping public health policies:

Maternal Health Interventions:

Blood Loss during delivery (Postpartum Hemorrhage)

• Study Title: “Randomized controlled Trial of Oral Misoprostol for prevention of Postpartum Haemorrhage in women delivering at homes or sub-centres of four Primary Health Centre Areas of Belagavi District”. Misoprostol Tablet is approved by the Government of India for community level prevention of blood loss after delivery (postpartum haemorrhage). This study provided the precious evidence for the inclusion of Misoprostol on the World Health Organization's List of Essential Medicines and stronger advocacy of Misoprostol for prevention of blood loss after delivery by the United Nation's Commission on Life-saving commodities for maternal It has also prompted expansion of the registration and use of Misoprostol for prevention of postpartum bleeding, by the Ministries of Health of 26 countries.
• The BRASSS-V drape, developed with input from JNMC Research Unit investigators, being more accurate than visual estimation of blood loss has particular utility for prompt detection of blood loss during delivery and aids reduction of maternal morbidity and mortality in low resource settings. BRASSS-V drape has been added in the list of Labour room equipment and accessories of ‘Maternal and Newborn Health Tool Kit’ by the Ministry of Health& Family Welfare, Government of India.
• JNMC Research Unit’s participation in the WHO sponsored clinical trial “A phase III, randomized, double- blind, active, controlled, multinational, multi-center, non-inferiority trial using carbetocin room temperature stable (RTS) for the prevention of postpartum haemorrhage during the third stage of labour in women delivering vaginally” was indeed an exciting and fulfilling journey from conception of the research (March 2013) through implementation of the trial (May 2016 to January 2018), publication of the results in New England Journal of Medicine (June 2018), updating of the WHO recommendations for the use of uterotonics for prevention of PPH (December 2018), inclusion in the WHO List of Essential List of Medicines (March 2019) to regulatory approval for manufacturing and marketing by Central Drugs Standard Control Organization (Drugs Controller General of India) (September 2020). It is a matter of pride that global release of RTS Carbetocin for public use at a public sector pricing (INR 93 inclusive of GST) on par with standard Oxytocin, was organised by JNMC Women’s and Children’s Health Research Unit in KLE Centenary Convention Center, Belagavi on 23rd July 2021. The first dose of this injection was given in KLES Dr Prabhakar Kore Charitable Hospital on the same day. Carbetocin RTS is also included in UNFPA Product Catalogue of Quality Assured Products related to Reproductive Health (April 24, 2021) and FIGO-ICM recommendation for the use of uterotonics for the prevention of Postpartum Haemorrhage (June 2021).

Hypertensive (Blood Pressure) Disorders of Pregnancy

• Microlife CRADLE, a semi-automated device for detection of hypertension was tested in rural Africa and within India by the JNMC and King’s College, London collaborative research team to further develop the device as an accurate and low-cost means to improve antenatal detection of high blood pressure (pre-eclampsia) as well as hypotension associated with blood loss after delivery and infection. The trial was co-funded by the United Kingdom Medical Research Council and the Government of India, Department of Biotechnology. Notably, the India CRADLE trial received the first ever Newton Prize for excellent research and innovation in support of economic development and social welfare in Newton Fund partner countries. This device was one of 30 (among 500) high impact innovations to save lives Reimagining Global Health, Innovation Countdown 2030 initiative.

Newborn Health Interventions:

Birth Asphyxia

• The JNMC Research Unit was one of the five global sites selected by AAP for field testing the Helping Babies Breathe (HBB) curriculum. “Field Implementation of Helping Babies Breathe" project trained over 1,200 birth attendants working in 25 public sector (District Hospital, Belagavi, 7 Taluka hospitals, 2 community health centres and 15 primary health centres) and 8 private sector hospitals of Belagavi district for demonstrated reviving newborn babies who do not breathe immediately after birth (resuscitation). Subsequently, HBB was incorporated into the neonatal resuscitation training curriculum of the Basic Newborn Care and Resuscitation program called "Navajat Shishu Suraksha Karyakram" (NSSK) of the Government of India.

Antenatal Corticosteroids for Preterm birth

• JNMC Research Unit participated in the Global Network study "Antenatal Corticosteroid Trial". The results of the trial led to updating of WHO recommendations on preterm birth in 2015 and a new WHO research initiative to assess the efficacy of ACS in reducing mortality in early and late preterm births. Subsequently, JNMC Research Unit participated in the ‘The WHO Antenatal Corticosteroids for Improving Outcomes in Preterm Newborns (WHO-ACTION) trials’ and the primary paper was published in NEJM in Dec, 2020.

Health Systems Interventions:

• ‘Implementation of the WHO Safe Childbirth Checklist program’, a novel childbirth safety program for hospital births incorporating a 29-item checklist containing essential practices that target the major causes of childbirth-related deaths, was evaluated as a pilot, pre-post-intervention study in a sub-district level birth centre in Karnataka, India between July and December 2010 by JNMC Research Unit with a Collaborative effort with the World Health Organization and Harvard School of Public Health. The study demonstrated a significant improvement in the delivery of 28 out of 29 essential safety practices by health workers. This validation of the WHO Safe Childbirth Check List Program has resulted inclusion as one of the component in ‘Maternal and Newborn Health Tool Kit’ by the Ministry of Health& Family Welfare, Government of India. Using this WHO Safe Childbirth Checklist, as a quality improvement tool, trial was conducted in 60 pairs of facilities across 24 districts of Uttar Pradesh to test the effect of ‘Better Birth program’. JNMC Research Unit investigators provided the technical consultation for the implementation of this study.

Subsequently JNMC Research Unit’s participation in “Evaluating the WHO Labour Care Guide in clinical settings” pilot testing has led to launch of the WHO Labour Care Guide and its User’s Manual by WHO in December 2020.