title: Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda.
abstract: BACKGROUND
  Over 40% of all deaths among children under 5 are neonatal deaths (0-28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings.
  
  
  METHODS
  We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question.
  
  
  RESULTS
  Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories- epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was "What strategies are effective in increasing demand for, and use of skilled attendance?"
  
  
  CONCLUSIONS
  In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in neonatal and complex humanitarian fields to engage on the research priorities needed to save lives most at risk.
authors: Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-74, Atlanta, GA 30341, USA.
authors: Diane F
authors: DF
authors: Morof
authors: Saving Newborn Lives, Save the Children, 28 Lower Main Road, Observatory 7925, South Africa ; University of the Western Cape, Bellville 7535, South Africa.
authors: Kate
authors: K
authors: Kerber
authors: Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA.
authors: Barbara
authors: B
authors: Tomczyk
authors: Epidemiology, London School of Hygiene and Tropical Medicine, Global Evidence and Policy, Saving Newborn Lives, Save the Children, Keppel Street, London WCIE-7HT, UK.
authors: Joy
authors: J
authors: Lawn
authors: Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA.
authors: Curtis
authors: C
authors: Blanton
authors: Emergency Response and Recovery Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F-57, Atlanta 30341GA, USA.
authors: Samira
authors: S
authors: Sami
authors: Save the Children, 54 Wilton Road, Westport, CT 06880, USA.
authors: Ribka
authors: R
authors: Amsalu
keywords: Birth asphyxia; Complex humanitarian emergency; Epidemiology; Inequity; Millennium development goals; Neonatal; Neonatal infections; Newborn; Preterm birth; Priority-setting; Research