Centre for Intervention Science in Maternal and Child Health (CISMAC)

The Centre for Intervention Science in Maternal and Child Health (CISMAC) conducts research to improve maternal, newborn and child health (MNCH) in low and middle-income countries. We evaluate promising interventions and help translate research findings into policy and practice. CISMAC is a collaborative research consortium with partners in Asia and Africa and Europe, and works closely with the World Health Organization (WHO). CISMAC was established in 2013; its portfolio of studies is expanding. Currently, we have completed or are running 25 studies. Several of them generate opportunities for important spin-off projects, further extending the scope of our research. CISMAC covers a wide range of interventions addressing important global health challenges, from BCG vaccination of infants born to HIV-infected mothers, impact of community-initiated Kangaroo Mother Care (ci-KMC) in low-birth-weight babies, improving postnatal care, to studies on economic support and empowerment of adolescent girls to reduce the risk of teenage childbearing and fostering entrepreneurship. In one study, we assess whether supplementing infants with vitamin B12 improves their development, while another study explored if adding zinc to standard treatment of serious infections in young infants reduces their risk of dying. Other studies examined if interactive checklists in antenatal care within an electronic health registry improves pregnancy care and outcomes. Responding to Ugandan and international demands for information on the SARS-CoV-2 epidemic, we are undertaking studies of SARS-CoV-2 infection and Covid-19 in HIV-positive and HIV-negative mothers and their infants in Kampala. Our projects provide opportunities for young CISMAC researchers to develop their knowledge and skills and become health intervention and implementation scientists. This is achieved both through participating in CISMAC-facilitated training and by conducting important work in our studies or by leading their own spin-off projects, with close supervision and support from senior researchers. Most of CISMAC's studies are randomized controlled trials, the epidemiologic approach best suited to measuring the effect of interventions. Our studies yield valid and statistically precise effect estimates because they are large and follow up nearly all our study participants to study completion. We value sharing our research questions and methods. We have published 11 study protocols not only to foster quality and transparency; they also document that design and analysis plans are followed. This, in turn, reduces any potential for "cherry-picking" of findings and biased reporting. Our studies address important knowledge gaps producing high quality scientific information to support policy-makers in making evidence-based decisions. In 2019, we published in The Lancet the results of a large ci-KMC trial in India. It demonstrated that community-initiated Kangaroo Mother Care substantially enhances survival in infants. As a reflection of the success, the government of India is incorporating ci-KMC into its newborn program and WHO used our findings when updating its recommendations for KMC. This is an encouraging fulfilment of our desire that findings from high quality research be promptly translated into policy and practice. Follow-up studies have shown that the ci-KMC intervention benefited not only the better off but also the least privileged. Another study showed that post-partum depression was less common among women who provided KMC to their vulnerable babies. In 2020, we published the findings from a large Indian case-control study in the journal Epidemiology, which shows that oxytocin injections given to augment labor may be a direct cause of more than 100,000 Indian babies dying during the birth process or on their first day of life. Oxytocin is an essential drug that saves the lives of many women from life-threatening post-partum bleeding. However, if used to augment labor it can be dangerous unless given very cautiously and where emergency obstetric care is available. If we can arrest misguided use of oxytocin, it should be possible to substantially improve perinatal survival in India and most probably in many other low- and middle-income countries. In 2023, we published the findings of a Nepali trial showing that supplementing pregnant and lactating women with vitamin B12 did not improve their infants’ growth or neurodevelopment. Our findings support the current WHO recommendations of not routinely supplementing pregnant women, even in populations where vitamin B12 deficiency is common. You will find CISMAC's scientific publications here: https://www.uib.no/en/cismac/116825/list-publications. To sum up, CISMAC studies generate results of high scientific quality that guide policies to equitably enhance maternal and child health, survival, and development in low and middle-income countries.

English version CISMAC is an international consortium of research and post-graduate training institutions. Its vision is to improve maternal, neonatal and child health (MNCH) in low and middle-income countries (LMIC) through the development and evaluation of promising interventions that, if effective, can be translated into policy and practice. CISMAC is anchored at the University of Bergen (UiB). It includes Norwegian and international partners and collaborates closely with the World Health Organization. CISMAC’s project portfolio is carefully crafted to focus on impactful interventions, those that may effectively improve MNCH. Capacity strengthening in intervention science is an integral part of the research. CISMAC has undertaken/undertakes more than 20 studies. Its largest study, with 8400 low birth weight babies, was conducted in India and showed that keeping the newborns exclusively breastfed and in skin-to-skin contact with their mother (kangaroo mother care or KMC) for several hours a day substantially increased their survival chances, even when KMC was initiated at home. In Nepal, one of our studies examines whether vitamin B12 supplements given to pregnant and lactating women improve their children's cognitive development. In Uganda, two studies aim to reduce the risk of severe bacterial infections in babies. One examines whether the timing of BCG vaccination influences this risk in babies of HIV-positive mothers (so called HIV-exposed babies). The other tests whether applying Chlorhexidine to the umbilical cord stump of HIV unexposed babies reduces this risk. With substantial co-funding from the Research Council of Norway’s GLOBVAC program, a large randomized trial in several Indian hospitals examines whether zinc given together with antibiotics decreases the case fatality risk in young infants with severe bacterial infections. In Zambia, also with substantial GLOBVAC support as well as support from the Swedish Foreign Ministry (through its Embassy in Zambia), a recently completed trial examines to what extent economic support, alone or in combination with community dialogue, reduces adolescent childbearing and increases girls’ school retention. Norsk versjon CISMAC er et internasjonalt konsortium av forskningsinstitusjoner. Senteret har som mål å bedre mødre- og barnehelse i lav- og mellominntektsland ved å utvikle og måle effekten av lovende intervensjoner, CISMACs visjon er å skape et fruktbart og bærekraftig nettverk bestående av institusjoner og individer som sammen arbeider for å utvikle og evaluere lovende intervensjoner for mødre- og barnehelse. CISMAC arbeider for at resultatene fra forskningen skal omsettes i praksis. CISMAC er forankret ved Universitetet i Bergen (UiB) og består av et nettverk av norske og internasjonale partnere som samarbeider tett med Verdens Helseorganisasjon (WHO). CISMACs prosjektportefølje har fokus på intervensjoner som på en effektiv måte kan bedre mødre- og barnehelse. Kapasitetsstyrking innenfor intervensjonsforskning er en viktig del av CISMACs målsetting. CISMAC har mer enn 20 ulike studier. En av de største studiene, med 8,400 barn med lav fødselsvekt, fant at fullamming kombinert med at barna holdes tett inntil mors kropp flere timer hver dag ("Kangaroo Mother Care" eller KMC) økte overlevelsen for barna med 25% i første halvår av livet, også når dette ble startet opp hjemme. I Nepal undersøker en av våre studier om vitamin B12 gitt til gravide og ammende kvinner kan forbedre barnas kognitive utvikling. I Uganda har vi to studier rettet mot å redusere risiko for sepsis hos spedbarn. Den ene studien undersøker om tidspunktet for BCG-vaksinasjon påvirker risiko for alvorlige generaliserte infeksjoner hos barn av HIV-positive mødre. Den andre studien undersøker om bruk av klorheksidin til å vaske navlestrengstumpen hos nyfødte barn reduserer risikoen for slike livstruende infeksjoner. Med betydelig støtte fra Forskningsrådets GLOBVAC-program gjennomfører vi en stor randomisert kontrollert studie på flere indiske sykehus. Studien undersøker om sink gitt sammen med antibiotika kan øke overlevelsen hos spedbarn med kliniske tegn på sepsis. I en stor nylig avsluttet studie i Zambia måler vi i hvilken grad økonomisk støtte, alene eller kombinert med folkemøter og seksualundervisning, kan redusere forekomsten av tenåringsgraviditeter og øke andelen jenter som fullfører ungdomsskolen.