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• Interviews with 89 leaders in four countries shed light on the incentives and constraints to effective leadership. • Understanding leadership entails studying the adaptive practice of leaders rather than their personalities. • Leaders studied operate within fluid boundaries set by local political-economies of nutrition. • Successful leaders (high adult development levels) are able to span boundaries and translate between disciplines and sectors. • Supportive action can develop leadership attributes in individuals and their networks in a number of ways identified here. ; Strong leadership has been highlighted as a common element of success within countries that have made rapid progress in tackling child and maternal undernutrition. Yet little is known of what contributes to nutrition leaders' success or lack of it in particular policy environments. This study of 89 individuals identified as influential within child and maternal undernutrition policy and programming in Bangladesh, Ethiopia, Kenya and India sheds light on why particular individuals have been effective in contributing towards positive changes in nutrition policy, and how they operate in the wider policy/political sphere. We employ a framework working outwards from individual capabilities, knowledge and motivations, through to wider political economy considerations and the narratives and knowledge structuring individual capacity. We argue that only by locating individuals within this wider political economy can we begin to appreciate the range of strategies and avenues for influence (or constraints to that influence) that individual leaders employ and encounter.

Background Education is one of the most important human capitals. Investment in education at early age returns best. A lot of factors influence children's educational achievement. Studies in developed countries well established the relation of school achievement with its associated variables. But information is lack on what factors play important role for school achievement at early age in low resource settings like Bangladesh. We aimed to find factors associated with school achievement in rural Bangladesh. Method The data were acquired from a long-term follow up study, conducted in 8-10 years old children (n = 372). We used a locally developed school achievement tool based on Wide Range Achievement Test-4 to measure reading, spelling and math computation, Wechsler abbreviated scale of intelligence to measure intelligence Quotient (IQ), Digit span forward and backward for short term memory, and locally available Strength and Difficulties Questionnaire to measure behaviour. Socioeconomic and anthropometric information of the mothers and children were also collected. Multicollinearity of the data was checked. Unadjusted and adjusted multiple linear regression analysis was performed. Findings Years of schooling and short-term memory were positively related to reading, spelling and math computation. For years of schooling it was-reading B = 8.09 (CI 5.84, 10.31), spelling 4.43 (4.33, 8.53) and math computation 5.23 (3.60, 6.87) and for short term memory- reading 3.56 (2.01,5.05), spelling 4.01 (2.56, 5.46) and math computation 2.49 (1.37, 3.62). Older children had lower scores of reading -0.48 (-0.94, -0.02), spelling -0.41 (-0.88, -0.02) and math computation -0.47 (-0.80, -0.14). Children's IQ predicted reading 0.48 (0.14, 0.81) and spelling 0.50 (0.18, 0.82) skills. Mother and father's education predicted Spelling 0.82 (0.16, 1.48) and reading 0.68 (0.06, 1.30) capacity respectively. Children enrolled in private schools had higher reading 10.28 (5.05, 15.51) and spelling 6.22 (1.31, 11.13) than those in the government schools. Children with more difficult behaviour tended to have lower scores in reading -0.51 (-0.96, -0.05). Conclusion Children's school achievement is influenced by their IQ, years of schooling, type of school and parents' education. Therefore, intervention should be made to focus specifically on these variables and establish the effect of this intervention through robust research design.

This report presents the findings of an operations research study conducted to assess the implementation of the Government of Bangladesh's National Nutrition Services Program (NNS) and to identify the achievements, determine the bottlenecks that adversely impact these achievements, and highlight potential solutions to ensure smooth delivery of the program. A mixed methods research approach was used to evaluate five major domains of the program: management and support services; training and capacity development; service delivery; monitoring and evaluation, and; exposure to interventions. The study found that the overall NNS effort is an ambitious, but valuable approach to support nutrition actions through an existing health system with diverse platforms. The results indicate that although the maintenance of strong and stable leadership of NNS is an essential element to ensure integrated and well-coordinated comprehensive service delivery for the line directorate, the current arrangement is unable to ensure effective implementation and coordination of NNS. Focusing on some of the critical challenges related to leadership and coordination in the first instance, and on embedding a small core set of interventions into well-matched (for scale, target populations, and potential for impact) health system delivery platforms is most likely to help achieve scale and impact. Strategic investments in ensuring transparency, engaging available technical partners for monitoring and implementation support, and not shying away from other potential high coverage outreach platforms like some NGO platforms also could prove fruitful. Moreover, although the Government of Bangladesh, and the health system in particular, must lead the effort to deliver for nutrition, it is clear that development partners who have expressed a commitment to nutrition must coordinate their own activities and provide the support that can deliver on nutrition's potential for Bangladesh.

BACKGROUND: With an estimated 24,000 deaths per year, pneumonia is the single largest cause of death among young children in Bangladesh, accounting for 18% of all under-5 deaths. The Government of Bangladesh adopted the WHO recommended Integrated Management of Childhood Illness (IMCI)-strategy in 1998 for outpatient management of pneumonia, which was scaled-up nationally by 2014. This paper reports the service availability and readiness related to IMCI-based pneumonia management in Bangladesh. We conducted a secondary analysis of the Bangladesh Health Facility Survey-2017, which was conducted with a nationally representative sample including all administrative divisions and types of health facilities. We limited our analysis to District Hospitals (DHs), Maternal and Child Welfare Centres (MCWCs), Upazila (sub-district) Health Complexes (UHCs), and Union Health and Family Welfare Centres (UH&FWCs), which are mandated to provide IMCI services. Readiness was reported based on 10 items identified by national experts as 'essential' for pneumonia management. RESULTS: More than 90% of DHs and UHCs, and three-fourths of UH&FWCs and MCWCs provide IMCI-based pneumonia management services. Less than two-third of the staff had ever received IMCI-based pneumonia training. Only one-third of the facilities had a functional ARI timer or a watch able to record seconds on the day of the visit. Pulse oximetry was available in 27% of the district hospitals, 18% of the UHCs and none of the UH&FWCs. Although more than 80% of the facilities had amoxicillin syrup or dispersible tablets, only 16% had injectable gentamicin. IMCI service registers were not available in nearly one-third of the facilities and monthly reporting forms were not available in around 10% of the facilities. Only 18% of facilities had a high-readiness (score 8–10), whereas 20% had a low-readiness (score 0–4). The readiness was significantly poorer among rural and lower level facilities (p < 0.001). Seventy-two percent of the UHCs had availability of ...

The findings of this study suggest that with improved training for survey data collectors, sisterhood and household deaths methods are viable approaches for measuring pregnancy related mortality. However, wide confidence intervals around the estimates indicate that routine sample surveys cannot provide the information needed to monitor progress towards the MDG target. Other approaches, such as inclusion of questions about household deaths in popular censuses should be considered. (DSE/GIGA)

Antimicrobial drug administration to household livestock may put humans and animals at risk for acquisition of antimicrobial drug–resistant pathogens. To describe animal husbandry practices, including animal healthcare-seeking and antimicrobial drug use in rural Bangladesh, we conducted semi-structured in-depth interviews with key informants, including female household members (n = 79), village doctors (n = 10), and pharmaceutical representatives, veterinarians, and government officials (n = 27), and performed observations at animal health clinics (n = 3). Prevalent animal husbandry practices that may put persons at risk for acquisition of pathogens included shared housing and water for animals and humans, antimicrobial drug use for humans and animals, and crowding. Household members reported seeking human and animal healthcare from unlicensed village doctors rather than formal-sector healthcare providers and cited cost and convenience as reasons. Five times more per household was spent on animal than on human healthcare. Strengthening animal and human disease surveillance systems should be continued. Interventions are recommended to provide vulnerable populations with a means of protecting their livelihood and health.

BACKGROUND: There is evidence on benefits of psychosocial stimulation (PS) and cash transfer programmes in low- and middle-income countries on children's development. We integrated PS into an unconditional cash transfer (UCT) programme for poor Bangladeshi mothers to examine the effects on children's development. METHODS: This cluster randomized controlled trial was conducted in rural Bangladesh from July 2017 to December 2018 in 33 clusters, with 11 clusters randomly assigned to each of the three arms, namely i) PS + UCT ii) UCT-only and iii) Comparison. We enrolled poor mothers and child (6-16 months) dyads eligible to receive maternity allowance by the Government of Bangladesh. Trained local women imparted training to mothers to provide psychosocial stimulation to their children for one year. Children's cognitive, language and motor development were measured with Bayley-III, behaviour with Wolke's ratings and maternal self-esteem with Rosenberg self-esteem scale. The analysis was intention-to-treat. RESULTS: Of the 594 mother-child dyads, 40 (6·8%) were lost to follow-up. Compared to UCT-only, children in the PS + UCT had significant improvement in cognitive (B = 2.96, 95% CI: 0.46-5.47, Effect Size [ES] 0.24SD) and language (2.73, 0.39-5.00, ES 0.21SD) scores and were more responsive to examiner (0.30, 0.06-0.52, ES 0.27SD), while compared to comparison group, they had significantly higher cognitive (3.37, 1.27-6.19, ES 0.32SD), language (2.82, 0.53-5.10, ES 0.24SD) and motor (2.65, 0.24-5.06, ES 0.22SD) scores and were more responsive to examiner (0.30, 0.08-0.52, ES 0.26 SD). The mothers' self-esteem was significantly higher in PS + UCT (2.46, 0.94-3.98, ES 0.48 SD) and UCT-only (1.67, 0.02-3.20, ES 0.32 SD) compared to the comparison group. CONCLUSION: PS integrated into an UCT programme benefited children's neurodevelopment and UCT improved mother's self-esteem. UCT programme may be an important platform for child stimulation programmes for rural poor populations.

THE CALLS FOR strong leadership in the fight against global and national malnutrition have multiplied during the past decade. The role of nutrition champions in advocating for nutrition, formulating policies, and coordinating and implementing action in nutrition have increasingly been recognized in such countries as Peru, Brazil, Thailand, and the Indian states of Tamil Nadu and Maharashtra. Global initiatives such as the Scaling Up Nutrition (SUN) Movement, the African Nutrition Leadership Programme, and the European Nutrition Leadership Platform have invested in building up capacity for leadership among national governments, civil society, and the private sector. The World Public Health Nutrition Association's guide on competencies needed to build up the workforce in global public health nutrition identified leadership as key. More widely, leadership within the field of public health has been highlighted as key to moving child or maternal health higher up on the global agenda and tackling critical issues such as HIV and AIDS at the national and community levels. ; PR ; IFPRI1; Transform Nutrition; compact2025; F Strengthening institutions and governance; B Promoting healthy food systems; Stories of Change in Nutrition ; DGO; PHND; A4NH ; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)

BACKGROUND: Several recent reviews of the methods used to set research priorities have identified the CHNRI method (acronym derived from the "Child Health and Nutrition Research Initiative") as an approach that clearly became popular and widely used over the past decade. In this paper we review the first 50 examples of application of the CHNRI method, published between 2007 and 2016, and summarize the most important messages that emerged from those experiences. METHODS: We conducted a literature review to identify the first 50 examples of application of the CHNRI method in chronological order. We searched Google Scholar, PubMed and so-called grey literature. RESULTS: Initially, between 2007 and 2011, the CHNRI method was mainly used for setting research priorities to address global child health issues, although the first cases of application outside this field (eg, mental health, disabilities and zoonoses) were also recorded. Since 2012 the CHNRI method was used more widely, expanding into the topics such as adolescent health, dementia, national health policy and education. The majority of the exercises were focused on issues that were only relevant to low- and middle-income countries, and national-level applications are on the rise. The first CHNRI-based articles adhered to the five recommended priority-setting criteria, but by 2016 more than two-thirds of all conducted exercises departed from recommendations, modifying the CHNRI method to suit each particular exercise. This was done not only by changing the number of criteria used, but also by introducing some entirely new criteria (eg, "low cost", "sustainability", "acceptability", "feasibility", "relevance" and others). CONCLUSIONS: The popularity of the CHNRI method in setting health research priorities can be attributed to several key conceptual advances that have addressed common concerns. The method is systematic in nature, offering an acceptable framework for handling many research questions. It is also transparent and replicable, because it clearly defines the context and priority-setting criteria. It is democratic, as it relies on "crowd-sourcing". It is inclusive, fostering "ownership" of the results by ensuring that various groups invest in the process. It is very flexible and adjustable to many different contexts and needs. Finally, it is simple and relatively inexpensive to conduct, which we believe is one of the main reasons for its uptake by many groups globally, particularly those in low- and middle-income countries.

This article reviews theoretical and practical approaches for setting priorities in global child health research investments. It also provides an overview of previous attempts to develop appropriate tools and methodologies to define priorities in health research investments. A brief review of the most important theoretical concepts that should govern priority setting processes is undertaken, showing how different perspectives, such as medical, economical, legal, ethical, social, political, rational, philosophical, stakeholder driven, and others will necessarily conflict each other in determining priorities. We specially address present research agenda in global child health today and how it relates to United Nation's (UN) Millennium Development Goal 4, which is to reduce child mortality by two-thirds between 1990 and 2015. The outcomes of these former approaches are evaluated and their benefits and shortcomings presented. The case for a new methodology for setting priorities in health research investments is presented, as proposed by Child Health and Nutrition Research Initiative, and a need for its implementation in global child health is outlined. A transdisciplinary approach is needed to address all the perspectives from which investments into health research can be seen as priorities. This prioritization requires a process that is transparent, systematic, and that would take into account many perspectives and build on advantages of previous approaches.