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International Health

The Fight against Perinatal Mortality in Bangladesh

MSPH candidate, Liz Thomas, works with Professor Abdullah H. Baqui to implement and improve community-based interventions

For over a decade, the Department has conducted ground-breaking maternal and newborn health research in the Sylhet district of Bangladesh. As part of the Projahnmo project for example,  Professor Abdullah Baqui demonstrated how community health workers (CHW) delivered packages of interventions that reduced neonatal mortality by nearly half. These interventions have subsequently been scaled up in Bangladesh and many other low-income countries. But despite these impressive gains, the burden of stillbirths and neonatal deaths remains high, with over 3 million newborn deaths and an additional 3 million stillbirths globally every year. Moreover, deaths in the first month of life account for about 60% of all deaths in the first year of life and about 40% in the first five years of life.

A CHW in Bangladesh instructs an expectant mother on proper testing procedures and the reasons to check for UTI during pregnancy. Photo Credit: Jennifer Applegate

Liz Thomas, an MSPH student in the Program for Social and Behavioral Interventions, has been working with Professor Baqui on a variety of programs addressing maternal and newborn survival in Bangladesh as part of her master’s practicum. Her research topic focuses on the misclassification of early newborn deaths and stillborn using verbal autopsy data. Standardizing a method for determining birth outcome in the field could help future projects better represent the burden of stillbirth in a community and develop better strategies for training community health workers. Professor Baqui helped arrange for her to conduct her study along with other ongoing projects in Sylhet that the Department’s International Center for Maternal and Newborn Health coordinates.

One of these maternal and newborn survival programs builds on past successes with community health workers in Bangladesh. The Maternal Infection Screening and Treatment (MIST) Program investigates the feasibility and effectiveness of large-scale community-based diagnosis and treatment of maternal genitourinary infections. These infections increase the risk of stillbirths, pre-term births and neonatal infections. The study is funded by the National Institute for Health and includes several local partners, including our long-time collaborators the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B); Shimantik; the Child Health Research Foundation; and the Bangladesh Ministry of Health and Family Welfare. The project has already enrolled over 6,000 women. At the end of 2013 it had found that around 18% of these women tested positive for abnormal vaginal flora, while 11% were found to have a urinary tract infection (UTI). Professor Baqui, who leads the MIST Program, commented on how ongoing field research enriches student training at Hopkins: 

Hosting passionate and promising students, like Liz, in our field site provides opportunities for both the student and our field teams. The student can apply skills learned in the classroom within an organized field research setting. Our local team can practice guiding students through the complexities of implementing interventions on the ground. This complementarity is a unique part of Hopkins’ continual training efforts for both students and faculty.

Liz Thomas in BangladeshTo help supplement her research funding in Bangladesh, Liz applied for, and received, a Center for Global Health Research Award. She also received a U.S. Department of State Critical Language Scholarship to learn Bangla. Over the course of 8 weeks in her language course, she went from an oral competency level of novice to intermediate-high. The familiarity with the language has served her well in the evaluation of causes of death using verbal autopsy and post-delivery interview forms.

While Liz’s experience in Bangladesh has yielded great data, there were several national strikes related to upcoming elections that delayed her research. Vehicles were banned from roadways, making field visits impossible. During these strikes, Liz spent time shadowing project physicians in the neonatal intensive care unit at a tertiary facility in Sylhet city. She once saw three pre-term babies sharing a single incubator. When she asked the head of the department about this, he said that the hospital was built to run at one-third its current capacity. “We don’t even have the resources to teach hand washing.” 

These roadblocks forced her to be flexible and creative. She offers some advice to new students just embarking on their practicum: “Adjust your expectations. It’s good to have a focused research interest—but don’t let your expectations of a proposal limit your ability to explore beyond that topic.” 

Currently, Liz is wrapping up her practicum in Bangladesh working with community health workers to improve the quality of data collection with respect to categorizing stillbirths. And in response to her experience in the neonatal intensive care unit, she’s working on a proposal for formative research to assess how to introduce a hand-washing campaign at the facility.

Mitigating Mortality«Learn more about Projahnmo, the MIST project and Professor Baqui’s work in Bangladesh»