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Finding new ways to save lives in South Asia

Johns Hopkins
Bloomberg School associate professor Parul Christian, DrPh, MSc, visits with villagers in rural Bangladesh, the site of a long-term study (JiVitA) on the role of micronutrients on maternal and infant health. JiVitA senior manager Abu Ahmed Shamin is at the far right.


On a hot summer morning in a rural region of northwestern Bangladesh, Nur Banu crouches beside a day-old baby boy, asleep in a shed on a bed of rags and straw. With scissors, she snips off the end of a vitamin A capsule and expertly squeezes the contents into the baby's mouth.

Each day, Banu, along with nearly 600 other Bangladeshi women who work for the Johns Hopkins Bloomberg School of Public Health's decade-old JiVitA nutrition study, fan out to rural villages, visiting pregnant women, new mothers and babies, and women of childbearing age to gather scientific data in one of the world's largest trials on the role of nutrition in maternal and infant survival. Known to the research team as Jivitaland - a play on the Bangla word jibheetoh, or "alive" - the project territory has a population of 650,000 and covers 270 square miles.

The JiVitA Project grew out of a groundbreaking nutrition trial in Nepal, ended in 1997, that was also led by Bloomberg School researchers who found that giving vitamin A to pregnant women reduced maternal deaths by 44 percent overall.

"We see great opportunities for public health approaches to improve health and reduce infant mortality in these vast rural settings of South Asia," says JiVitA Project director Keith P. West, DrPH '87, MPH '79, RD, the George G. Graham Professor of Infant and Child Nutrition, who also led the Nepal study.

In 2008, JiVitA researchers found that a single two-cent dose of vitamin A given to newborns cut infant death rates by 15 percent. Researchers predicted that by giving vitamin A to 70 percent of vulnerable newborns the deaths of 24,000 babies could be prevented in Bangladesh alone.

Over the past 10 years, the JiVitA Project has established a strong presence in the study area, mainly through the work of the 596 field distributors, all women. Each month they supply vitamins to about 8,000 pregnant women. On an average day in Jivitaland, those women give birth to 29 babies.

At the start of the study, all field staff completed an intensive training program in data collection. If the data is flawed, says Parul Christian, DrPH '96, MSc, MPH '92, a JiVitA investigator and associate professor of International Health at the Bloomberg School, "you're not going to get the right answers to the research questions."

Good data is the first step in realizing the Project's goals: bringing about lifesaving policy changes, such as widespread distribution of vitamin A to newborns.

The JiVitA study concludes in 2011, however project leaders have plans in the works for further investigations in maternal and child health. With the research infrastructure already in place, the site is fertile ground for scientists to build on JiVitA's solid foundation.

The Johns Hopkins Bloomberg School of Public Health is the largest and the oldest school of public health in the world. The School has 2,056 students from 78 nations, and is dedicated to the improvement of health and the prevention of disease and disability around the world.

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