Zavala, Eleonor

School of Public Health

MSPH

Nepal

Nepal Nutrition Intervention Project Sarlahi (NNIPS)

A randomized trial of a food supplement given to pregnant women and through 6 months of lactation to assess the impact on infant nutritional status at birth and growth through 12 months postpartum.
A study assessing accuracy of recall at 6 months postpartum of services provided in antenatal care visits.

PI Mentor: Joanne Katz

My GHEFP grant helped support my MSPH practicum experience in International Health and Human Nutrition. As part of my practicum, I traveled to Nepal where I worked with the Nepal Nutrition Intervention Project Sarlahi (NNIPS), a research organization and field site established by faculty at Johns Hopkins University. I was involved in the preparatory phases of the Mother and Infant Nutrition Trial (MINT), a two-by-two factorial, household randomized control trial to assess balanced protein energy supplementation in pregnancy and lactation on birth and child growth outcomes. As a nutrition student, I was involved in preparing the methods and materials for a dietary assessment sub-study to assess whether dietary diversion was occurring in supplemented groups compared with the control. This involved planning the recruitment of women into the sub-study, adapting tools to reflect the local diet and facilitate recall, creating an app for data collection, and developing training materials for local staff. Working with NNIPS has been an incredible opportunity to see first-hand how large community randomized trials are designed and conducted. I learned so much from the investigators and field staff, many of whom have been working there since the inception of the field site 30+ years ago. With their guidance, I was able to apply the skills I learned in the classroom into a real-world research context.

In addition to developing my research skills, I also learned about some of the realities of the global health research world and the need to be adaptable. For example, when I left Baltimore in June, I believed I would have time upon my arrival in Nepal to take language classes and learn about the culture from my Kathmandu coworkers. As it worked out, all the principal and co-investigators of the project traveled to Nepal at that time and so I immediately joined them on our field site in the Sarlahi district of the terai. Those initial few days were overwhelming with all the new people I was meeting, the foreign language I couldn’t yet understand, and the 100+ degree heat. But it was also exciting to be immediately immersed in the research setting and having all the staff there was a great opportunity to introduce myself and explain my purpose for being there. I never did end up taking language classes in Kathmandu as I had hoped, but the NNIPS staff encouraged my efforts and I learned bit by bit. 

The main trial enrollment was anticipated to start in October of 2019, but as all global health research tends to go, this was delayed. New government policies in Nepal have made it extremely difficult to get this trial started, despite having ethical approval from the Nepal Health Research Council. It was demoralizing to see my colleagues go through all these extra procedures and meetings, with no clear start date even now. As a student and foreigner, there was little I could do to the support the team in this regard. It was interesting to hear the team had never had so many complications in previous years which may be an indication of a growing anti-global health research sentiment. Health research regulation and transparency is important and necessary, but it is disheartening to see a country discouraging health research investments by making the procedures and policies increasing complex and difficult to achieve.

Despite these challenges, the delays provided us with extra time to refine our data collection procedures and test out new electronic data capture systems. When enrollment begins, we will be able to collect almost all our data through tablet-based applications allowing for more immediate data monitoring and quality control checks. A constant theme throughout my practicum and something I learned about global health research is that the old adage holds true: “when life gives you lemons, make lemonade.” 

 

 

People

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation
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Projects

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