In 2013 Bangladesh proudly announced her success in reducing the under-5 mortality rate by two-thirds since 1990, becoming one of the first countries to achieve United Nations Millennium Development Goal-4. This was made possible by the overwhelming success in implementing the national immunization program and reducing mortality due to diarrheal diseases. However, Bangladesh still lags behind significantly in combating other infectious diseases like pneumonia, typhoid and meningitis – diseases that kill more children than all other infectious diseases together.
One of the main reasons for this lag is the lack of evidence for policy makers to act on. Clinical research in Bangladesh is arguably one of the most challenging endeavors to be undertaken by scientific investigators, since most hospitals must devote their very limited resources to patient care and are not able to support the research activities necessary to generate evidence.
In spite of this challenge, a small microbiology laboratory in the “corridor” of Dhaka Shishu Hospital (DSH) teamed up with a group of bold and driven clinical colleagues, and in 1989 set out to fill this evidence gap. The laboratory decided to focus solely on pediatric infectious diseases, with specific emphasis on pneumonia, typhoid and meningitis, with absolutely no funding commitment. Faced with this funding challenge, we discovered other resources within our team at DSH. The microbiology team was passionate, bold and had inexhaustible will power to move forward with minimal facilities and limited resources.
Together, we started to work towards breaking the vicious cycle of “limited resources and no generation of evidence” and turning it into a virtuous cycle by generating evidence using the resources available in our own setting. The large pediatric hospital, huge number of patients, and supportive clinical and epidemiological colleagues turned out to be invaluable resources for research. By 1997, we started generating evidence on Hib and pneumococcal diseases in Bangladesh. These preliminary successes facilitated the extension of our team to form a multi disciplinary group. Seeing the potential of this teamwork and the impact on evidence generation and its implications, we started to work towards building an even broader coalition. In 2007, while keeping our umbilical connection intact with Dhaka Shishu Hospital, we founded Child Health Research Foundation (CHRF) to focus on research in addition to serving the patients. CHRF established a network off our hospitals comprising 1,100 beds for children, as well as two population-based field sites in urban and rural Bangladesh.
Standing strong in 2014, CHRF now has members from all different fields, from community health workers to statisticians, clinicians to epidemiologists. Our many generous and supportive collaborators come from all over the world. In this large group, the laboratory researchers play the role of prime mover by generating new research ideas and bringing the resources. The versatile CHRF team does not stop at the level of patient services, research and publications in journals. It goes a step further to translate evidence into public policies by collaborating closely with policy makers. As a result, the CHRF team has contributed significantly to the evidence-based decision making process to introduce Hib and pneumococcal vaccines in Bangladesh.
CHRF is continuing its work to generate evidence on the impact of these new vaccines in our population to keep policy makers updated with evidence in real time. We are continuing to use our own model to build capacity at each collaborating field site, making those capable of providing quality service to children and generating evidence for policy decisions.