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International Health

Naoko Kozuki, MSPH '11

Doctoral candidate, International Health, Program in Global Disease Epidemiology & Control (GDEC)

Naoko talks about testing the feasibility of using portable ultrasound to reduce fetal and newborn deaths in rural Sarlahi District, Nepal, and she gives some advice to current and prospective students

Katz and Kazuki in Nepal
Naoko Kozuki (left) and Professor Joanne Katz in Nepal where they tested the feasibility of portable ultrasound use by community-based health workers to reduce stillbirths and early neonatal deaths. The research was funded by the Children’s Prize, which Prof. Katz was awarded.

I caught up recently with doctoral candidate Naoko Kozuki shortly after she returned from a year of field work in Nepal. I spoke to her about her thesis project, conducted under the supervision of her advisor Professor Joanne Katz. The project explored the topic of fetal and neonatal death during the intrapartum period, and tested the feasibility of using community-based portable ultrasound to reduce fetal and newborn deaths in rural Sarlahi District, Nepal.

The Children’s Prize, an open web-based competition focused on under-five child survival, funded the project. Aleyda K. Mejia, director of the Children's Prize, commented on how the prize is a significant and non-traditional financial opportunity to advance research and program implementation simultaneously: 

Knowing that the prize funding can provide science-based field experience to the next generation of global health professionals, like Naoko, illustrates why the Children's Prize welcomes applicants from all walks of life across the globe. We are happy to support work that enriches the understanding of what can be done at the community level to impact health outcomes for newborns and mothers. 

Naoko and Dr. Katz will soon be publishing their findings. They hope the findings from this study will be a starting point for a larger study to examine whether antenatal ultrasound diagnosis for obstetric risk factors can in fact influence health outcomes.

Naoko will defend her dissertation later this year. So, before she moves on to her professional career, I took the opportunity to ask about her experiences as both a doctoral and master’s student in International Health and to see if she had any advice to share with current or prospective students.

Tell me about your thesis research.
My thesis is entitled “Epidemiology, diagnosis, and care-seeking related to risk factors for intrapartum-related fetal and neonatal death in rural Nepal.”  The dissertation consists of four studies:

  1. estimating the association between risk factors like breech and multiple birth, and outcomes like fetal and neonatal death
  2. a survey on awareness and utilization of obstetric ultrasonography in this community
  3. testing how accurately lower-level health workers can diagnose obstetric risk factors using ultrasonography
  4. a qualitative study that explored perceptions people held about breech births.

How did the Children’s Prize support your dissertation work?
Children’s Prize was essential to the thesis project, in that it provided funding to explore the ultrasonography component of the thesis project.  Much of the research also used the existing infrastructure of the Nepal Nutrition Intervention Project – Sarlahi study site and Nepal Oil Massage Study being conducted there right now.

How can portable ultrasound machines save lives?
Many women in our community who have had either breech births or twins weren’t aware prior to delivery, and these pregnancy conditions have extremely high risk of fetal and neonatal death.  We found that lower-level health workers were able to accurately diagnose breech position and twins in late pregnancy. In countries like Nepal where there is a dearth of radiologists and sonographers, we see potential for task shifting for basic sonographic exams.  While our study wasn’t powered to detect differences in health outcomes among those who were diagnosed through our study and those who were not, we observed lower rates of adverse outcomes.  It shows promise, and will require further research to see if antenatal diagnosis of these conditions can actually lower rates of adverse outcomes.

What made you want to apply to the MSPH GDEC program in International Health at Hopkins?
I remember the initial “hook” was reading about Professor Luke Mullany’s work in maternal and newborn health in Burma on the Department’s website. The more I looked into the diverse fields of health and geographic regions the faculty in the Department works in, the more I thought that this would be the perfect place to start exploring my interest in global health.

What made you want to go on to the PhD program?
I had the most amazing training experience during my master’s practicum, working at a Hopkins field research site in rural Nepal. I came away with a completely new appreciation for research and with an understanding of what it takes to conduct high-quality research. Once I decided to do a PhD, I knew I wanted to continue working with the staff and the mentors affiliated with that research site.

Any advice to students considering the master's or doctoral program in GDEC?
The take-home message of getting a degree at the Bloomberg School is evidence, evidence, evidence. The GDEC program gives you all the tools to develop a discerning eye toward existing public health research and programs.  That discerning eye has helped me identify my role in global health.   

What do you want to do after you graduate?
I hope to bridge the fields of research and programs by pursuing opportunities such as implementation research and impact evaluation.  Also, as a product of great mentoring, I hope to find an academic position that allows me to teach and mentor students.

--Brandon Howard
November 2015