Grant application form January/June 2010

Seeking ESC support for a PROJECT

The ESC will provide funding to support an individual, group, institute or organisation with a project related to the aims of the ESC. Examples include: research, audit, review, needs assessment.
The money MUST be used for a defined project within a definite time frame.
Application / Please use this application form. Note sections with a maximum word count. Forms will be returned if the word count is exceeded.
Who can apply? / Applicants must be paid-up ESC members.
Deadline / Applications will be considered every 6 months.
Applications for the first period MUST be received at ESC Central office by 30 June 2010.
Budget / The available budget for the year 2010 is 50,000 euro:
25,000 euro for applications received between 1 January and 30 June.
25,000 euro for applications received between 1 July and 31 December.
The ESC may not be in a position to fully fund all applications.
Name of applicant / Ilze Vīberga
Job title / Assist. Professor, Riga Stradins University
Address / Aizkraukle Lāčplēša iela 9-37 ab.k.No.69 LV5101
Tel no. / +371 29258263
E-mail /
Date of submission of this form / 30 June 2010
Name of the person responsible for the project (If different to the person named in box A) / Lāsma Līdaka
Contact details of the person noted in this box B:
name of person, job title, address, tel no. email / Lāsma Līdaka, Riga Stradins university, student,
Address:Riga, Nometnu iela 1-4,LV–1048.
Phone: +37125547935
e-mail:
Title of the project / Risk factors for unwanted pregnancy that results in induced abortion in age group 16 – 25, in Latvia.
Comprehensive description of the project. (Max 200 words)
This is case – control study. Women aged 16 – 25 years attending first pregnancy on-request termination in hospitals and out-department units will be compared with control group of nullipara women, hospitalized in surgery departments without known gynecological diseases, but with risk of unwanted pregnancy (having intercourses at least once per month during last six months). Groups will be matched according age, region of living(representing whole Latvia) and level of education. Three controls per one case will be applied. Sample size will be 300 and 100 women respectively. Stratification will be done according to regional distribution of female inhabitants in this particular age group.
Data will be collected by using anonymous self-administrated partly structured questionnaire, consisting of four parts: descriptive data; reproductive anamnesis (coitarche, number of partners per lifetime and per year, past pregnancies, frequency of intercourses); contraceptive habits; assessment of knowledge about contraception (by using multichoice test). One open question will be provided in order to clarify women’s own believes for reasons why unintended pregnancy occurred.
Two pilot-tests for questionnaire are already done in corresponding population(n=20), additional validity of questions measuring knowledge has been proved in corresponding population(n=50)
Approval from Ethical committee of Riga Stradins university is already obtained.
When would it start / finish? (Max 20 words)
1st Sept 2010 – 1st Sept 2011
Where will it take place – country / town, establishment? (Max 20 words)
Data will be collected in 6 main regional hospitals in Latvia – Riga, Liepāja, Ventspils, Bauska, Jelgava, Valmiera, Rēzekne and Daugavpils.
Objectives and needs identified. (Max 20 words)
Objective: to determine main risk factors for unwanted pregnancy that ends up with an abortion in age group 16–25in Latvia.
Sector in the area of contraception, sexual and reproductive health.
Sexual and reproductive health promotion and prophylaxis. Contraception usage promotion in this specific age group.
Is it a ‘new’ project? Yes/No / Yes
If extension of an existing programme, provide information on original programme (Max 50 words)
Although it is a new project, it’s results will be used to enhance prophylactic work already done by LFPSHA ‘’Papardes zieds’’ in following ways:
·  to revise and improve peer education programs in schools
·  in advocacy work to include health education as separate subject in curriculum
What outcomes will be measured? List. (Max 20 words)
National level data in age group 16-25 of:
·  main risk factors for unwanted pregnancy
·  SRH related habits and knowledge
·  women own believes for occurrence of unwanted pregnancy
Do you foresee any reasons (political, climatic, etc) why this project may be adversely affected? (Max 20 words)
No.
Are there other partners or organisations supporting this same project? If so, list.
Yes. Latvia’s Association for Family Planning and Sexual health ‘’Papardes zieds’’
Have you already obtained any funding towards this project? (If yes or still awaiting a response, please give details) (Max 20 words)
No, but Co-founding from Latvia’s Association for Family Planning and Sexual health is guaranteed.
How much money are you requesting? A detailed budget must be provided.
(Max 50 words)
Requested sum of money is 8230 EUR
Total =9300EUR (1070 from this is Co-founding). Staff costs-6000 EUR; questionnaire preparation, distribution, processing-1095EUR; dissemination of results: 650 EUR; administrative costs 777.5 EUR; unexpected expenses 777.5 EUR.
Will this be part of a larger fund or stand alone? (Max 20 words)
This is stand alone project, but results will be used as mentioned above in Part C.
Who will oversee the budget & keep accounts?
Accountant(Diana Lidaka, personal code: 200459 - 10520).

I / We, as responsible agents for this project, agree to the following 6 points:

I/We agree that all monies will be spent appropriately / Yes
I/We agree to advise you at the earliest time if this project is delayed or cannot be completed / Yes
I/We agree to provide a report to the Board of Directors of the ESC within 6 months of the end of the project and yearly, if the project lasts longer than 1 year. / Yes
I/We agree to present the ESC treasurer with a detailed budget at the end of the project. (if the project is longer than 1 year, the funding may be awarded in stages and be dependent on appropriate reporting) / Yes
I/We agree that if you need to make any significant changes to the duration, contents or funding of the project after it has been awarded, I/we will advise the ESC Treasurer. / yes
I/We agree to acknowledge the ESC as a donor in any publications and oral communications resulting from this project. Ideally any manuscript should be sent to the ESC journal in the first instance. / Yes

Signed Ilze Viberga Date 30.06.2010.

Name

Please return this form (by email) to:

ESC Central Office

Opalfeneweg 3

B-1740 Ternat, Belgium

Tel +32 2 582 08 52

Fax +32 2 582 55 15

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