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const fs = require('fs');

// ─── Helper functions ────────────────────────────────────────────────────────

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// ─── Cover Page ──────────────────────────────────────────────────────────────

const coverPage = [
  spacer(), spacer(), spacer(),
  new Paragraph({
    children: [new TextRun({ text: 'RESEARCH PROPOSAL', bold: true, size: 52, font: 'Calibri', color: '1F3864' })],
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// ─── Executive Summary ───────────────────────────────────────────────────────

const executiveSummary = [
  heading1('EXECUTIVE SUMMARY'),
  body(
    'Fetal Alcohol Spectrum Disorder (FASD) represents one of the most preventable causes of neurodevelopmental disability worldwide, yet it remains critically underdiagnosed and poorly understood in sub-Saharan Africa. This proposal seeks ZMW 150,000 in funding to conduct a rigorous cross-sectional study investigating the prevalence and impact of FASD among children in Lusaka, Zambia.'
  ),
  body(
    'The study will be conducted over nine months and will involve pregnant women, children aged 0-10 years, and healthcare providers working in maternal and child health facilities across Lusaka. Using validated screening tools, structured questionnaires, and medical assessments, this research will generate the first baseline data on FASD prevalence in Zambia, identify key maternal risk factors, and reveal critical gaps in healthcare provider knowledge and diagnostic capacity.'
  ),
  body(
    'The findings will directly inform national policy, clinical training programmes, and community-based prevention campaigns. The expected outputs include a peer-reviewed publication, a policy brief for the Ministry of Health, and actionable recommendations for healthcare worker training. This research is both timely and necessary, as Zambia currently lacks the data needed to address FASD as a public health priority.'
  ),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 1: Introduction ─────────────────────────────────────────────────

const introduction = [
  heading1('1. INTRODUCTION'),

  heading2('1.1 Background'),
  body(
    'Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term encompassing a range of conditions caused by prenatal alcohol exposure (PAE). These include Fetal Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (pFAS), Alcohol-Related Neurodevelopmental Disorder (ARND), and Alcohol-Related Birth Defects (ARBD). Affected individuals may experience a spectrum of physical, cognitive, behavioural, and social difficulties that persist throughout life.'
  ),
  body(
    'Globally, FASD affects an estimated 1 in 67 live births, translating to approximately 119,000 children born with FASD each year (Roozen et al., 2016). The disorder places an enormous burden on affected individuals, their families, and health systems. Children with FASD frequently experience difficulties in academic achievement, executive functioning, impulse control, and social adaptation, often leading to increased rates of mental health disorders, substance misuse, and contact with the criminal justice system in adulthood.'
  ),
  body(
    'In sub-Saharan Africa, South Africa has documented some of the highest FASD prevalence rates in the world, with studies reporting rates of 5-10% in certain school-going populations (May et al., 2022). Despite geographical and cultural proximity, data from Zambia remain scarce. Alcohol consumption is prevalent across socioeconomic groups in Zambia, driven by cultural norms, traditional brew consumption, commercial alcohol availability, and limited public health messaging around alcohol use in pregnancy.'
  ),

  heading2('1.2 Rationale'),
  body(
    'Lusaka, Zambia\'s capital city, is home to approximately 3.3 million people and serves as the hub of the national healthcare system. It hosts tertiary referral hospitals, primary health care centres, and a diverse cross-section of the population including urban, peri-urban, and internally displaced communities. This diversity makes Lusaka an ideal and representative setting for a national FASD study.'
  ),
  body(
    'Currently, there is no published prevalence data on FASD from Zambia. Healthcare providers in the country have limited training in FASD recognition and diagnosis, and there are no national screening protocols or support pathways for affected children and families. Without baseline data, it is impossible to advocate for policy change, allocate resources, or design effective interventions. This research will fill that gap and provide the evidence foundation for a national FASD response.'
  ),

  heading2('1.3 Problem Statement'),
  body(
    'Despite the well-documented global burden of FASD and the known prevalence of alcohol use in Zambia, no comprehensive study has investigated the occurrence, risk factors, or systemic barriers related to FASD in the country. Zambia\'s healthcare system lacks FASD-specific screening tools, diagnostic capacity, and trained personnel. Public awareness of the dangers of prenatal alcohol exposure is minimal, and cultural attitudes may normalise alcohol consumption during pregnancy.'
  ),
  body(
    'This evidence gap means that children with FASD are likely being misdiagnosed, underdiagnosed, or not diagnosed at all - resulting in inappropriate educational placements, inadequate medical support, and preventable long-term disability. The absence of data also prevents FASD from being incorporated into national maternal and child health strategies. This study will address these critical gaps directly.'
  ),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 2: Research Questions ──────────────────────────────────────────

const researchQuestions = [
  heading1('2. RESEARCH QUESTIONS'),
  body('This study will seek to answer the following research questions:'),
  bullet('What is the prevalence of FASD among children aged 0-10 years in Lusaka, Zambia?'),
  bullet('What are the maternal risk factors associated with FASD in Lusaka (e.g., frequency, timing, and quantity of alcohol consumption; nutritional status; socioeconomic factors)?'),
  bullet('What is the level of knowledge, awareness, and clinical capacity regarding FASD among healthcare providers in Lusaka?'),
  bullet('What are the barriers to the prevention, early identification, and diagnosis of FASD in Lusaka?'),
  spacer(),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 3: Objectives ───────────────────────────────────────────────────

const objectives = [
  heading1('3. RESEARCH OBJECTIVES'),

  heading2('3.1 Primary Objective'),
  body('To determine the prevalence of Fetal Alcohol Spectrum Disorder (FASD) among children aged 0-10 years attending health facilities and schools in Lusaka, Zambia.'),

  heading2('3.2 Secondary Objectives'),
  bullet('To identify and characterise maternal risk factors associated with FASD, including timing, frequency, and quantity of prenatal alcohol exposure, as well as nutritional and socioeconomic risk factors.'),
  bullet('To assess the knowledge, attitudes, and clinical practices of healthcare providers in Lusaka regarding FASD recognition, diagnosis, and referral.'),
  bullet('To evaluate the structural, cultural, and systemic barriers that impede effective FASD prevention and diagnosis in Lusaka.'),
  bullet('To provide evidence-based recommendations for policy reform, clinical training, and community awareness programmes.'),
  spacer(),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 4: Literature Review ───────────────────────────────────────────

const litReview = [
  heading1('4. LITERATURE REVIEW'),

  heading2('4.1 Global Context'),
  body(
    'FASD is now recognised as the leading known cause of preventable intellectual disability globally. A landmark systematic review and meta-analysis by Roozen et al. (2016) estimated the global prevalence of FASD at 7.7 per 1,000 live births, though rates vary dramatically by region. Countries such as South Africa, Croatia, Italy, and Belarus report the highest national rates. This variability reflects differences in alcohol consumption patterns, study methodology, and availability of diagnostic expertise rather than true biological differences across populations.'
  ),
  body(
    'Research consistently demonstrates that no safe level of alcohol consumption in pregnancy has been established. Alcohol crosses the placenta freely and can interfere with neuronal migration, brain development, and organ formation at any stage of pregnancy. The dose-response relationship is not linear, and genetic susceptibility among both mothers and children modulates risk. Binge drinking has been identified as particularly harmful due to peak blood alcohol concentration effects on the developing fetus.'
  ),
  body(
    'Beyond FAS - the most recognisable and severe form - the majority of FASD presentations are subclinical and involve neurobehavioural deficits without the classic facial dysmorphia. These partial presentations (pFAS, ARND, ARBD) are far more common yet far harder to diagnose, and are frequently misattributed to ADHD, autism spectrum disorder, or conduct disorder. This diagnostic masking leads to inappropriate treatment and missed opportunities for early intervention.'
  ),

  heading2('4.2 FASD in Sub-Saharan Africa'),
  body(
    'South Africa carries one of the highest documented burdens of FASD in the world. May et al. (2022) reported FASD prevalence rates of 17-29% in rural Western Cape school populations, among the highest ever recorded globally. These rates correlate with high rates of maternal alcohol use, particular drinking patterns (binge drinking), socioeconomic marginalisation, and nutritional deficiencies. The South African data provide a cautionary reference point for Zambia, given regional similarities in social and economic risk factors.'
  ),
  body(
    'A narrative review by Adnams (2017) highlighted that despite significant disease burden, FASD remains poorly characterised across most of sub-Saharan Africa, with few countries outside South Africa having published data. Research from the region is hampered by limited diagnostic capacity, lack of standardised assessment tools validated for African populations, and inadequate training of healthcare professionals. Policy-level engagement with FASD has also been limited, as documented by Adebiyi et al. (2019) in their review of South African policy documents.'
  ),

  heading2('4.3 Zambian Context'),
  body(
    'Zambia has a significant burden of alcohol-related disease. According to the World Health Organization, the adult per capita alcohol consumption in Zambia exceeds the sub-Saharan African average. Traditional fermented beverages such as "chibwantu" and "munkoyo" are widely consumed, including by women who may not be aware they contain alcohol or that alcohol is harmful during pregnancy. Urban areas such as Lusaka have seen increased commercial alcohol availability, further compounding risk.'
  ),
  body(
    'Existing maternal health data in Zambia focus predominantly on HIV, malaria, malnutrition, and obstetric complications. While these remain critical priorities, they have overshadowed the growing need to address alcohol use and its developmental consequences. The current evidence base is insufficient to drive policy or programme development for FASD in Zambia, making this study both timely and necessary.'
  ),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 5: Methodology ──────────────────────────────────────────────────

const methodology = [
  heading1('5. METHODOLOGY'),

  heading2('5.1 Study Design'),
  body(
    'A mixed-methods cross-sectional study design will be employed. Quantitative methods will be used to estimate FASD prevalence and identify associated risk factors. Qualitative methods will be used to explore healthcare provider knowledge, attitudes, and perceptions of systemic barriers. This combined approach will provide both epidemiological data and contextual understanding necessary for actionable recommendations.'
  ),

  heading2('5.2 Study Setting'),
  body(
    'The study will be conducted at selected primary and secondary health facilities across Lusaka District, including the University Teaching Hospital (UTH), Chilenje Level 1 Hospital, Chawama Health Centre, Chipata Level 1 Hospital, and community health posts. Purposively selected primary schools will also be recruited for child assessments. Sites were selected to represent a range of socioeconomic backgrounds and catchment populations.'
  ),

  heading2('5.3 Study Population'),
  body('The study population will comprise three groups:'),
  bullet('Children aged 0-10 years attending selected health facilities and primary schools in Lusaka.'),
  bullet('Mothers and primary caregivers of enrolled children, who will be interviewed regarding pregnancy history, alcohol use, and sociodemographic factors.'),
  bullet('Healthcare providers (doctors, nurses, midwives, clinical officers) working in maternal and child health services at selected facilities.'),

  heading2('5.4 Sample Size Calculation'),
  body(
    'Using an estimated FASD prevalence of 5% (a conservative estimate based on South African data and the absence of existing Zambian data), a desired precision of 2%, and a 95% confidence interval, the required sample size is calculated at approximately 456 children. To account for non-response and incomplete data, a 20% inflation factor will be applied, yielding a target sample of 550 children. A purposive sample of 30 healthcare providers will be recruited for qualitative interviews until data saturation is achieved.'
  ),

  heading2('5.5 Sampling Method'),
  body(
    'A two-stage cluster random sampling approach will be used for child and caregiver recruitment. In the first stage, health facilities and schools will be selected using probability-proportional-to-size sampling from a sampling frame of all registered facilities in Lusaka District. In the second stage, children meeting eligibility criteria will be systematically sampled from facility registers and class lists. For healthcare providers, purposive sampling will be used to ensure representation across professional cadres, experience levels, and facility types.'
  ),

  heading2('5.6 Eligibility Criteria'),
  heading3('Inclusion Criteria - Children:'),
  bullet('Age 0-10 years at time of enrolment.'),
  bullet('Residing in Lusaka District.'),
  bullet('Written informed consent from parent or legal guardian.'),
  heading3('Exclusion Criteria - Children:'),
  bullet('Known genetic syndrome causing developmental delay unrelated to alcohol exposure.'),
  bullet('Caregiver unable or unwilling to provide consent.'),
  heading3('Inclusion Criteria - Healthcare Providers:'),
  bullet('Currently employed in maternal and child health services at a selected facility.'),
  bullet('At least 6 months of experience in current role.'),
  bullet('Provides written informed consent.'),

  heading2('5.7 Data Collection'),
  body('Data will be collected through three parallel streams:'),
  heading3('Stream A: Child Neurodevelopmental Assessment'),
  body(
    'A standardised physical examination will be performed on each enrolled child by a trained medical officer to assess for FASD-associated facial dysmorphia (short palpebral fissures, smooth philtrum, thin vermillion border), growth parameters (height, weight, head circumference), and minor structural anomalies. Neurodevelopmental screening will be performed using the Griffiths Mental Development Scales (adapted for the Zambian context) and the Child Behaviour Checklist (CBCL). Formal FASD diagnosis will be made by a specialist using the diagnostic criteria of the 2013 Canadian Guidelines for FASD.'
  ),
  heading3('Stream B: Maternal/Caregiver Interview'),
  body(
    'A structured interviewer-administered questionnaire will collect data on: sociodemographic characteristics; obstetric and pregnancy history; alcohol use before and during pregnancy (type, frequency, quantity, timing - using the AUDIT-C tool); knowledge of FASD; nutritional status during pregnancy; and household socioeconomic indicators. Interviews will be conducted in the preferred language of the participant (English, Nyanja, or Bemba) by trained research assistants.'
  ),
  heading3('Stream C: Healthcare Provider Key Informant Interviews'),
  body(
    'Semi-structured in-depth interviews will be conducted with 30 purposively selected healthcare providers. A topic guide will cover: knowledge and experience of FASD; current screening and diagnostic practices; attitudes toward alcohol use in pregnancy; referral pathways; and perceived barriers to prevention and management. Interviews will be audio-recorded with consent and transcribed verbatim.'
  ),

  heading2('5.8 Data Management and Quality Assurance'),
  body(
    'Quantitative data will be entered using double data entry into REDCap (Research Electronic Data Capture), a secure, validated, web-based platform. Range checks, skip logic, and validation rules will be built into the data entry system. Qualitative interview recordings will be transcribed and imported into NVivo for thematic analysis. A 10% random sample of questionnaires will be re-checked by supervisors for quality control. All data will be stored on password-protected devices and backed up to a secure cloud server.'
  ),

  heading2('5.9 Data Analysis'),
  heading3('Quantitative Analysis:'),
  body(
    'Prevalence of FASD will be calculated as the proportion of children meeting diagnostic criteria with 95% confidence intervals. Descriptive statistics (frequencies, proportions, means, standard deviations) will summarise sociodemographic and clinical data. Univariate and multivariable logistic regression will identify independent maternal risk factors associated with FASD. All analyses will be conducted in SPSS version 26.'
  ),
  heading3('Qualitative Analysis:'),
  body(
    'Thematic analysis will be applied to healthcare provider interview data following the framework of Braun and Clarke (2006). Two independent coders will code the transcripts and reconcile discrepancies through discussion to ensure rigour. Emerging themes will be organised around domains of knowledge, attitudes, practice, and barriers.'
  ),

  heading2('5.10 Ethical Considerations'),
  body(
    'Ethical approval will be sought from the University of Zambia Biomedical Research Ethics Committee (UNZA-BREC) and the Zambia National Health Research Authority (NHRA) prior to data collection. All participation will be voluntary, and written informed consent (or assent for children aged 7-10 years with parental consent) will be obtained. Participants will be informed of their right to withdraw at any time without penalty. Confidentiality will be maintained through participant coding; no identifying information will appear in reports or publications. Children identified with FASD will be referred to appropriate paediatric and developmental services. All data will be handled in compliance with Zambia\'s Data Protection Act.'
  ),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 6: Expected Outcomes ───────────────────────────────────────────

const outcomes = [
  heading1('6. EXPECTED OUTCOMES AND SIGNIFICANCE'),

  heading2('6.1 Expected Outputs'),
  bullet('First baseline prevalence estimate of FASD in Lusaka, Zambia, providing data to anchor national policy discussions.'),
  bullet('A profile of maternal risk factors driving FASD in the Zambian context, enabling targeted prevention messaging.'),
  bullet('A report on healthcare provider knowledge and capacity gaps, informing curriculum development for pre-service and in-service training.'),
  bullet('Identification of systemic and cultural barriers to FASD prevention and diagnosis, supporting health system strengthening efforts.'),
  bullet('Referral and clinical support for children identified with FASD during the study.'),

  heading2('6.2 Dissemination'),
  bullet('Publication in a peer-reviewed international journal (e.g., Alcohol and Alcoholism; Paediatrics and International Child Health).'),
  bullet('Policy brief submitted to the Zambia Ministry of Health and Ministry of General Education.'),
  bullet('Presentation at the Zambia Annual Paediatric Conference and relevant regional health platforms.'),
  bullet('Community feedback sessions at study sites to share findings with parents, caregivers, and facility staff.'),

  heading2('6.3 Long-Term Impact'),
  body(
    'This study will establish a foundation for longitudinal follow-up of children with FASD in Zambia, supporting future research on developmental trajectories and intervention outcomes. The data will strengthen advocacy for FASD-specific guidelines, screening protocols, and support services within the Zambian health system. Ultimately, this work contributes to reducing the burden of preventable neurodevelopmental disability in Zambia by enabling evidence-based, targeted action.'
  ),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 7: Budget ───────────────────────────────────────────────────────

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const budgetTable = makeTable(
  [
    ['Budget Category', 'Description', 'Amount (ZMW)'],
    ['Personnel (Research Coordinator)', '9 months @ ZMW 4,000/month', '36,000'],
    ['Personnel (2 Research Assistants)', '6 months @ ZMW 2,500/month each', '30,000'],
    ['Personnel (Medical Officer - part time)', 'Child assessments, 4 months', '12,000'],
    ['Personnel (Data Entry Clerk)', '3 months @ ZMW 2,000/month', '6,000'],
    ['Travel and Transport', 'Field visits to health facilities, fuel, vehicle hire', '14,000'],
    ['Data Collection Materials', 'Printing questionnaires, consent forms, stationery', '4,000'],
    ['Diagnostic Equipment', 'Measuring tapes, growth charts, neurodevelopmental tools', '5,500'],
    ['REDCap & Data Management', 'Software licensing and IT support', '2,500'],
    ['NVivo Software License', 'Qualitative data analysis', '3,000'],
    ['Ethics and Regulatory Fees', 'UNZA-BREC and NHRA application fees', '2,000'],
    ['Training of Research Staff', 'Orientation, protocol training, inter-rater reliability', '4,000'],
    ['Dissemination', 'Report production, conference attendance, policy brief printing', '5,000'],
    ['Communication', 'Airtime, internet, participant communication', '2,000'],
    ['Contingency (5%)', 'Unforeseen expenses', '7,000'],
    ['TOTAL', '', '133,000'],
    ['Indirect / Institutional Costs (13%)', '', '17,000'],
    ['GRAND TOTAL', '', '150,000'],
  ],
  [45, 35, 20]
);

const budgetSection = [
  heading1('7. BUDGET'),
  body('The total budget requested for this 9-month study is ZMW 150,000. The budget has been developed conservatively and reflects the minimum resources necessary to conduct a rigorous, ethical, and impactful study. The breakdown below covers all direct research costs as well as a 13% indirect cost contribution to the hosting institution.'),
  spacer(),
  budgetTable,
  spacer(),

  heading2('7.1 Budget Justification'),
  heading3('Personnel Costs (ZMW 84,000 - 56% of total)'),
  body(
    'Personnel costs represent the largest budget line, reflecting the labour-intensive nature of multi-site data collection, child developmental assessment, and qualitative interviewing. All salaries are benchmarked against standard government and NGO remuneration scales in Zambia. Personnel include a full-time Research Coordinator who will oversee day-to-day study operations; two Research Assistants responsible for community recruitment and interviewer-administered surveys; a part-time Medical Officer who will conduct physical examinations and neurodevelopmental assessments; and a Data Entry Clerk.'
  ),
  heading3('Operational Costs (ZMW 29,500 - 20% of total)'),
  body(
    'Travel costs cover fuel, vehicle hire, and per diems for field visits to health facilities and schools across Lusaka District. Data collection materials include printing of questionnaires, consent forms, participant information sheets, and study protocols. Diagnostic equipment costs cover standardised measurement tools required for the FASD physical examination protocol.'
  ),
  heading3('Technology and Analysis (ZMW 5,500 - 4% of total)'),
  body(
    'REDCap, a globally validated, free-to-access electronic data capture system, will be used for quantitative data management - licensing and IT support costs are minimal. NVivo software (or equivalent open-source alternative) will be used for qualitative data management and thematic analysis.'
  ),
  heading3('Ethics, Training, and Dissemination (ZMW 11,000 - 7% of total)'),
  body(
    'Ethics and regulatory fees are mandatory for study commencement and include UNZA-BREC and NHRA application and approval fees. Training costs ensure that all research staff are adequately prepared to administer instruments, conduct assessments, and maintain protocol fidelity. Dissemination funds cover report production, policy brief printing, and partial costs for presenting findings at one national conference.'
  ),
  heading3('Contingency (ZMW 7,000 - 5%)'),
  body(
    'A 5% contingency provision is included to cover unforeseen costs such as additional field visits, replacement of lost equipment, or increased fuel costs due to price fluctuations.'
  ),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 8: Timeline ─────────────────────────────────────────────────────

const timelineTable = makeTable(
  [
    ['Phase', 'Key Activities', 'Months'],
    ['Phase 1: Preparation', 'Literature review, protocol finalisation, ethics submission, ethics approval, tool adaptation, pilot testing, recruitment and training of research staff', '1 - 2'],
    ['Phase 2: Data Collection', 'Community mobilisation, participant recruitment and consent, child neurodevelopmental assessments, caregiver interviews, healthcare provider key informant interviews', '3 - 6'],
    ['Phase 3: Data Analysis', 'Quantitative data cleaning and analysis (SPSS), qualitative transcription and thematic analysis (NVivo), integration of findings', '7 - 8'],
    ['Phase 4: Reporting and Dissemination', 'Preparation of final report, manuscript writing, policy brief, community feedback sessions, conference presentation, submission to funders', '9'],
  ],
  [20, 60, 20]
);

const timelineSection = [
  heading1('8. PROJECT TIMELINE'),
  body('The study will be completed over 9 months. The timeline is realistic and accounts for the administrative and regulatory requirements of conducting research in Zambia.'),
  spacer(),
  timelineTable,
  spacer(),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 9: Team ─────────────────────────────────────────────────────────

const teamSection = [
  heading1('9. RESEARCH TEAM'),

  heading2('9.1 Principal Investigator - Dr. Richard Banda'),
  body(
    'Dr. Richard Banda is a medical doctor with expertise in maternal and child health. As Principal Investigator, Dr. Banda will hold overall scientific and administrative responsibility for the study, including protocol development, ethical oversight, data quality assurance, and final reporting. Dr. Banda will also serve as the lead author on all scientific publications arising from this work.'
  ),

  heading2('9.2 Supporting Team'),
  bullet('Research Coordinator: Will manage day-to-day operations, coordinate field activities, supervise research assistants, and maintain regulatory compliance.'),
  bullet('Research Assistants (x2): Will conduct participant recruitment, informed consent procedures, and interviewer-administered surveys in local languages.'),
  bullet('Medical Officer (part-time): A paediatrician or child health specialist will perform standardised physical examinations and neurodevelopmental assessments for FASD diagnosis.'),
  bullet('Data Manager / Entry Clerk: Will oversee REDCap database management, data quality control, and backup procedures.'),
  bullet('Statistical Advisor: An external consultant will advise on sampling strategy and statistical analysis.'),
  spacer(),
  new Paragraph({ pageBreakBefore: true, text: '' }),
];

// ─── Section 10: References ──────────────────────────────────────────────────

const references = [
  heading1('10. REFERENCES'),
  body('Adebiyi, B.O., Mukumbang, F.C., & Beytell, A.M. (2019). To what extent is Fetal Alcohol Spectrum Disorder considered in policy-related documents in South Africa? A document review. Health Research Policy and Systems, 17(1), 46. https://doi.org/10.1186/s12961-019-0448-0 [PMID: 31036004]'),
  body('Adnams, C.M. (2017). Fetal alcohol spectrum disorder in Africa. Current Opinion in Psychiatry, 30(2), 108-112. https://doi.org/10.1097/YCO.0000000000000309 [PMID: 28125440]'),
  body('Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.'),
  body('May, P.A., de Vries, M.M., Marais, A.S., et al. (2022). The prevalence of fetal alcohol spectrum disorders in rural communities in South Africa: A third regional sample of child characteristics and maternal risk factors. Alcohol: Clinical and Experimental Research, 46(10), 1887-1905. [PMID: 35971629]'),
  body('Roozen, S., Peters, G.J., Kok, G., et al. (2016). Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review Including Meta-Analysis. Alcoholism: Clinical and Experimental Research, 40(1), 18-32. https://doi.org/10.1111/acer.12939 [PMID: 26727519]'),
  body('World Health Organization. (2018). Global status report on alcohol and health 2018. Geneva: WHO.'),
  body('Chudley, A.E., Conry, J., Cook, J.L., et al. (2005). Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Canadian Medical Association Journal, 172(5 Suppl), S1-S21.'),
  spacer(),
];

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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addSlideHeader(s, 'Methodology', 'Mixed-Methods Cross-Sectional Study Design');

  // Study design center badge
  s.addShape(pres.ShapeType.roundRect, { x: 3.9, y: 1.25, w: 2.2, h: 0.85, fill: { color: C.navy }, rectRadius: 0.1 });
  s.addText('MIXED METHODS\nCROSS-SECTIONAL', { x: 3.9, y: 1.25, w: 2.2, h: 0.85, fontSize: 10, bold: true, color: C.gold, fontFace: 'Calibri', align: 'center', valign: 'middle' });

  const boxes = [
    { x: 0.3,  y: 1.25, w: 3.3, h: 1.1, color: C.blue, title: 'STUDY POPULATION', lines: ['550 children (0-10 yrs)', '550 mothers/caregivers', '30 healthcare providers'] },
    { x: 6.4,  y: 1.25, w: 3.3, h: 1.1, color: C.teal, title: 'SAMPLING', lines: ['2-stage cluster random sampling', 'Purposive sampling for HCPs', 'Multi-site: hospitals + schools'] },
    { x: 0.3,  y: 2.55, w: 3.3, h: 1.6, color: C.blue, title: 'DATA COLLECTION', lines: ['STREAM A: Child neurodevelopmental assessments & physical exams', 'STREAM B: Caregiver structured interviews (AUDIT-C)', 'STREAM C: HCP in-depth interviews'] },
    { x: 3.6,  y: 2.55, w: 2.9, h: 1.6, color: C.teal, title: 'DATA MANAGEMENT', lines: ['REDCap for quantitative data', 'NVivo for qualitative data', 'Double entry + quality checks', '10% random re-verification'] },
    { x: 6.7,  y: 2.55, w: 3.0, h: 1.6, color: C.navy, title: 'ANALYSIS', lines: ['Descriptive statistics', 'Multivariable logistic regression', 'Thematic analysis (Braun & Clarke)', 'SPSS v26 + NVivo'] },
  ];

  boxes.forEach(b => {
    s.addShape(pres.ShapeType.roundRect, { x: b.x, y: b.y, w: b.w, h: b.h, fill: { color: b.color }, rectRadius: 0.08 });
    s.addText(b.title, { x: b.x + 0.12, y: b.y + 0.08, w: b.w - 0.2, h: 0.32, fontSize: 10, bold: true, color: C.gold, fontFace: 'Calibri', charSpacing: 1 });
    s.addText(b.lines.join('\n'), { x: b.x + 0.12, y: b.y + 0.4, w: b.w - 0.2, h: b.h - 0.46, fontSize: 10, color: C.white, fontFace: 'Calibri', valign: 'top' });
  });

  // Ethics note
  s.addShape(pres.ShapeType.roundRect, { x: 0.3, y: 4.32, w: 9.4, h: 0.95, fill: { color: C.light }, line: { color: C.gold, width: 1.5 }, rectRadius: 0.08 });
  s.addText('Ethics & Regulatory Compliance: ', { x: 0.5, y: 4.42, w: 2.5, h: 0.3, fontSize: 11, bold: true, color: C.navy, fontFace: 'Calibri' });
  s.addText('Ethics approval from UNZA-BREC and Zambia NHRA required prior to data collection. All participation voluntary with written informed consent. Children identified with FASD will be referred to paediatric services.', {
    x: 0.5, y: 4.68, w: 9.1, h: 0.5, fontSize: 10, color: C.darkgrey, fontFace: 'Calibri',
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 8 — Expected Outcomes
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addSlideHeader(s, 'Expected Outcomes & Significance');

  const outcomes = [
    { icon: '1', color: C.blue, title: 'Prevalence Data', body: "Zambia's FIRST baseline estimate of FASD prevalence — essential to anchor all future national policy and planning." },
    { icon: '2', color: C.teal, title: 'Risk Factor Profile', body: 'Identification of key maternal and socioeconomic risk factors to enable precisely targeted prevention campaigns.' },
    { icon: '3', color: C.gold, title: 'Capacity Assessment', body: "Report on healthcare provider knowledge gaps to guide pre-service and in-service curriculum development." },
    { icon: '4', color: C.red, title: 'Barrier Analysis', body: 'Understanding of cultural and systemic barriers to inform health system strengthening and community engagement.' },
    { icon: '5', color: C.darkgrey, title: 'Dissemination', body: 'Peer-reviewed publication + Policy brief for Ministry of Health + National conference presentation + Community feedback.' },
    { icon: '6', color: C.navy, title: 'Clinical Impact', body: 'Enrolled children with FASD will be referred to paediatric services — direct benefit to families in the study.' },
  ];

  outcomes.forEach((o, i) => {
    const col = i % 3;
    const row = Math.floor(i / 3);
    const x = 0.28 + col * 3.2;
    const y = 1.22 + row * 2.02;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: 3.05, h: 1.85, fill: { color: C.white }, line: { color: o.color, width: 1.2 }, rectRadius: 0.1 });
    s.addShape(pres.ShapeType.ellipse, { x: x + 0.14, y: y + 0.14, w: 0.5, h: 0.5, fill: { color: o.color } });
    s.addText(o.icon, { x: x + 0.14, y: y + 0.14, w: 0.5, h: 0.5, fontSize: 15, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle' });
    s.addText(o.title, { x: x + 0.72, y: y + 0.16, w: 2.2, h: 0.42, fontSize: 12, bold: true, color: o.color, fontFace: 'Calibri', valign: 'middle' });
    s.addText(o.body, { x: x + 0.14, y: y + 0.7, w: 2.82, h: 1.0, fontSize: 10, color: C.darkgrey, fontFace: 'Calibri', valign: 'top' });
  });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 9 — Budget
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addSlideHeader(s, 'Budget Breakdown', 'Total Request: ZMW 150,000');

  // Donut-style representation using stacked shapes
  const segments = [
    { label: 'Personnel',      pct: '56%', amt: 'ZMW 84,000',  color: C.blue },
    { label: 'Operations',     pct: '20%', amt: 'ZMW 29,500',  color: C.teal },
    { label: 'Dissemination',  pct: '7%',  amt: 'ZMW 11,000',  color: C.gold },
    { label: 'Technology',     pct: '4%',  amt: 'ZMW 5,500',   color: C.darkgrey },
    { label: 'Contingency',    pct: '5%',  amt: 'ZMW 7,000',   color: C.red },
    { label: 'Indirect Costs', pct: '8%',  amt: 'ZMW 13,000',  color: '7B68EE' },
  ];

  // Visual bar chart
  const barColors = [C.blue, C.teal, C.gold, C.darkgrey, C.red, '7B68EE'];
  const vals = [84, 29.5, 11, 5.5, 7, 13];
  const maxVal = 84;
  const barW = 1.1;

  segments.forEach((seg, i) => {
    const x = 0.45 + i * 1.55;
    const barH = (vals[i] / maxVal) * 2.9;
    const y = 4.08 - barH;
    s.addShape(pres.ShapeType.roundRect, { x, y, w: barW, h: barH, fill: { color: seg.color }, rectRadius: 0.05 });
    s.addText(seg.pct, { x, y: y - 0.32, w: barW, h: 0.32, fontSize: 13, bold: true, color: seg.color, fontFace: 'Calibri', align: 'center' });
    s.addText(seg.amt, { x: x - 0.1, y: 4.12, w: barW + 0.2, h: 0.3, fontSize: 9, color: C.darkgrey, fontFace: 'Calibri', align: 'center' });
    s.addText(seg.label, { x: x - 0.1, y: 4.4, w: barW + 0.2, h: 0.4, fontSize: 9.5, bold: true, color: C.navy, fontFace: 'Calibri', align: 'center' });
  });

  // Baseline
  s.addShape(pres.ShapeType.rect, { x: 0.35, y: 4.08, w: 9.4, h: 0.04, fill: { color: C.grey } });

  // Total box
  s.addShape(pres.ShapeType.roundRect, { x: 0.35, y: 1.2, w: 9.3, h: 0.88, fill: { color: C.navy }, rectRadius: 0.1 });
  s.addText([
    { text: 'GRAND TOTAL: ', options: { color: C.grey, fontSize: 16, fontFace: 'Calibri', bold: false } },
    { text: 'ZMW 150,000', options: { color: C.gold, fontSize: 22, fontFace: 'Calibri', bold: true } },
    { text: '  |  Duration: 9 Months  |  5% Contingency Included  |  13% Institutional Indirect Costs', options: { color: C.grey, fontSize: 11, fontFace: 'Calibri' } },
  ], { x: 0.35, y: 1.2, w: 9.3, h: 0.88, align: 'center', valign: 'middle' });
}

// ══════════════════════════════════════════════════════════════
// SLIDE 10 — Timeline
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addSlideHeader(s, 'Project Timeline', '9-Month Phased Implementation Plan');

  const phases = [
    { label: 'PHASE 1', title: 'Preparation', months: 'Months 1-2', color: C.blue,     activities: 'Literature review, ethics approval,\ntool adaptation & pilot testing,\nstaff recruitment & training' },
    { label: 'PHASE 2', title: 'Data Collection', months: 'Months 3-6', color: C.teal,     activities: 'Community mobilisation, recruitment,\nchild assessments, caregiver interviews,\nhealthcare provider KII' },
    { label: 'PHASE 3', title: 'Data Analysis', months: 'Months 7-8', color: C.gold,     activities: 'Quantitative data cleaning & SPSS analysis,\nqualitative transcription & NVivo,\nfinding integration' },
    { label: 'PHASE 4', title: 'Reporting', months: 'Month 9', color: C.red,      activities: 'Final report, manuscript,\npolicy brief, community feedback,\nfunder submission' },
  ];

  // Gantt-style horizontal flow
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    const x = 0.3 + i * 2.38;
    // Arrow connector (except last)
    if (i < 3) {
      s.addShape(pres.ShapeType.rect, { x: x + 2.12, y: 1.85, w: 0.3, h: 0.22, fill: { color: C.grey } });
    }
    // Phase box
    s.addShape(pres.ShapeType.roundRect, { x, y: 1.22, w: 2.1, h: 0.92, fill: { color: p.color }, rectRadius: 0.08 });
    s.addText(p.label, { x, y: 1.24, w: 2.1, h: 0.35, fontSize: 10, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle', charSpacing: 2 });
    s.addText(p.title, { x, y: 1.55, w: 2.1, h: 0.34, fontSize: 13, bold: true, color: C.white, fontFace: 'Calibri', align: 'center', valign: 'middle' });
    // Month badge
    s.addShape(pres.ShapeType.roundRect, { x: x + 0.22, y: 2.28, w: 1.68, h: 0.36, fill: { color: C.navy }, rectRadius: 0.06 });
    s.addText(p.months, { x: x + 0.22, y: 2.28, w: 1.68, h: 0.36, fontSize: 11, bold: true, color: C.gold, fontFace: 'Calibri', align: 'center', valign: 'middle' });
    // Activities box
    s.addShape(pres.ShapeType.roundRect, { x, y: 2.8, w: 2.1, h: 2.45, fill: { color: C.white }, line: { color: p.color, width: 1 }, rectRadius: 0.08 });
    s.addShape(pres.ShapeType.rect, { x, y: 2.8, w: 2.1, h: 0.06, fill: { color: p.color } });
    s.addText(p.activities, { x: x + 0.1, y: 2.9, w: 1.9, h: 2.28, fontSize: 10.5, color: C.darkgrey, fontFace: 'Calibri', valign: 'top' });
  });

  // Month ruler
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.14, w: 9.4, h: 0.08, fill: { color: C.grey } });
  for (let m = 1; m <= 9; m++) {
    const mx = 0.3 + (m - 1) * (9.4 / 9) + 0.52;
    s.addText(`M${m}`, { x: mx - 0.22, y: 1.18, w: 0.44, h: 0.22, fontSize: 8, color: C.darkgrey, fontFace: 'Calibri', align: 'center' });
  }
}

// ══════════════════════════════════════════════════════════════
// SLIDE 11 — Closing / Call to Action
// ══════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  // Accent strip
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.teal } });
  s.addShape(pres.ShapeType.rect, { x: 0.18, y: 0, w: 0.07, h: 5.625, fill: { color: C.gold } });

  s.addText('Why This Research Matters', {
    x: 0.5, y: 0.4, w: 9, h: 0.55, fontSize: 14, color: C.teal, fontFace: 'Calibri', bold: true, charSpacing: 3, align: 'left',
  });
  s.addText('Fund the Evidence.\nEnd a Preventable Disability.', {
    x: 0.5, y: 0.9, w: 9, h: 1.5, fontSize: 36, bold: true, color: C.white, fontFace: 'Calibri', align: 'left', lineSpacingMultiple: 1.1,
  });

  s.addShape(pres.ShapeType.rect, { x: 0.5, y: 2.52, w: 4.5, h: 0.05, fill: { color: C.gold } });

  const points = [
    'FASD is 100% preventable — the data to act on it does not yet exist in Zambia.',
    'ZMW 150,000 will generate the first national baseline and directly inform policy.',
    'Findings will protect future generations of Zambian children.',
    'Every child identified during the study will be referred for clinical support.',
  ];
  points.forEach((pt, i) => {
    s.addShape(pres.ShapeType.rect, { x: 0.5, y: 2.68 + i * 0.6, w: 0.1, h: 0.36, fill: { color: C.teal } });
    s.addText(pt, { x: 0.72, y: 2.66 + i * 0.6, w: 8.6, h: 0.42, fontSize: 12.5, color: C.white, fontFace: 'Calibri', valign: 'middle' });
  });

  s.addShape(pres.ShapeType.roundRect, { x: 0.5, y: 5.0, w: 9.0, h: 0.46, fill: { color: C.teal }, rectRadius: 0.08 });
  s.addText('Dr. Richard Banda  |  Principal Investigator  |  2nd July 2024  |  Proposed Budget: ZMW 150,000', {
    x: 0.5, y: 5.0, w: 9.0, h: 0.46, fontSize: 11, bold: true, color: C.navy, fontFace: 'Calibri', align: 'center', valign: 'middle',
  });
}

// ══════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════
pres.writeFile({ fileName: '/home/daytona/workspace/fasd-proposal/FASD_Research_Proposal_Presentation.pptx' })
  .then(() => console.log('SUCCESS: PPTX created.'))
  .catch(err => console.error('ERROR:', err));