National research priorities for maternal and newborn health in The Gambia: a stakeholder-led prioritisation exercise

Maternal and newborn mortality in The Gambia remains high despite expanded coverage of essential interventions, and progress towards SDG targets 3.1 and 3.2 has stalled. The National Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) Policy (2017 to 2026) ends in 2026, and a successor plan is in development. We aimed to identify and rank nationally defined maternal and newborn health (MNH) research priorities in The Gambia to inform the successor RMNCAH plan and align research investment with national health system needs. We conducted a national, stakeholder-led MNH research prioritisation exercise in October 2023 using an adapted Child Health and Nutrition Research Initiative (CHNRI) method. Forty-six participants, including Ministry of Health policymakers and programme managers, clinicians, midwives, researchers, and development partners, took part in a two-day workshop. A starting set of 46 questions from the 2019 African Academy of Sciences (AAS) continental MNH prioritisation exercise and four questions from The Gambia's National Health Research Agenda was expanded through facilitated discussion to a final list of 61 questions, organised by MNH grand challenge area and CHNRI research domain. Participants independently scored each question against four weighted criteria, and national rankings were compared descriptively with AAS continental and West African subregional rankings. The priority list was dominated by delivery-focused research (49 of 61 questions, 80 percent), concentrated in better care during pregnancy and better postnatal care. The five highest-ranked priorities addressed management of obstetric emergencies before referral, retention and equitable distribution of the MNH workforce, neonatal resuscitation at peripheral facilities, maternal recognition of danger signs, and kangaroo mother care. Pre-transfer emergency obstetric management was the top national priority but was not prominent in AAS continental or West African subregional rankings. This first national MNH research priority-setting exercise in The Gambia identifies a coherent set of implementation and health systems research priorities and surfaces context-specific questions, particularly pre-transfer emergency management, that were under-emphasised in continental rankings. The agenda provides an evidence base for the successor RMNCAH plan and for partner alignment in The Gambia and comparable high-burden settings.