College of Public Health Study Pinpoints How Delays in Care Impact Neonatal Health in Rwanda

June 9, 2017 by Rachel Bules | CPH Communications
Categories: Alumni, rwanda, Maternal Health, world health organization

College of Public Health Study Pinpoints How Delays in Care Impact Neonatal Health in Rwanda

Ohio State University College of Public Health graduate Efua “Nana” Wilmot, MPH ’14, recently published her research on Rwandan neonatal health in the Maternal and Child Health Journal. College of Public Health professors and co-authors Marcel Yotebieng, MD, MPH, PhD, and Alison Norris, MD, PhD, assisted her as faculty advisers during her research process.

Wilmot’s study, “Missed Opportunities in Neonatal Deaths in Rwanda: Applying the Three Delays Model in a Cross-Sectional Analysis of Neonatal Death,” conducted while she was pursuing her MPH at Ohio State, used a “three-delays” model (the delays include delay in seeking care, in arriving at a health facility, and in receiving adequate care) to help pinpoint the areas that need to be improved upon to decrease child mortality. Wilmot analyzed neonatal mortality data from the Maternal and Child Health Unit database at the Ministry of Health in Rwanda.

“In the context of Rwanda, the findings of this study identify that mothers who were delayed in seeking obstetrical care combined with the delays in the care they received were associated with increased neonatal death,” Wilmot says.

Wilmot is currently a medical student at the Edward Via College of Osteopathic Medicine in South Carolina. Her research in Rwanda began during her time at Ohio State and was sparked by a summer practicum she held in Rwanda with the World Health Organization (WHO).

“Having already expressed interest in maternal and child health, my WHO boss placed me in the maternal and child health unit,” Wilmot says.  “I was brought on board with a project about community health workers and the impact they had on reducing maternal mortality in the country.”

Wilmot (second from right) with co-workers from the World Health Organization (WHO).

According to Wilmot, neonatal mortality accounts for about half of global deaths for children under five years old because of the vulnerability of the neonatal period, which includes the first 28 days of life.

Inherently, low-income countries bear the burden of this problem, as pregnant women have less access to health care during and after their pregnancies.

“If we can assume that virtually no child should die – for example, only four out of a thousand live births in Sweden do not live to their fifth birthday– if you consider that as what biologically can be considered acceptable, then everything after those four are unacceptable,” Yotebieng says.

“Nana’s research is really important because globally, we know why children die and we know that virtually all children’s deaths are preventable, so identifying each stage that could lead to death is very critical in reducing child mortality,” Yotebieng says.

Yotebieng and Norris were key mentors in helping Wilmot with her research because they both have experience with research and service in Africa.

“Prior to embarking on this journey to Rwanda, I consulted with Dr. Norris because of her extensive work in the Eastern African region,” Wilmot says. “I had never been to that area and I needed someone who had the expertise, skillset and cultural understanding of the region to provide some guidance.”

Norris, an epidemiologist at OSU, studies sexual and reproductive health and has focused much of her research in eastern and southern Africa, with an ongoing research program called “Health for Life” in Malawi.

“I was Nana’s advisor for the second year of her MPH at CPH,” Norris says. “When she graduated from OSU and started medical school, she persevered in turning her culminating project into a beautiful paper for publication. She is a great collaborator with huge enthusiasm, passion for public health, and an open mind.”

Additionally, Wilmot sought help from Yotebieng because of his expertise in carrying out research projects in the Democratic Republic of Congo, where he is a visiting professor at the Kinshasa School of Public Health, as well as holding an assistant professor position in epidemiology at OSU’s College of Public Health.

“They both pushed me very hard to go beyond what I ever imagined this project would be,” Wilmot says. “Every time I thought of not going through with it, I thought about the impact these two individuals were making on the lives of others. Considering they are both also physicians by training, they understood the toll and the hard work that was required of me while in medical school. They were very patient but checked in on my progress frequently to make sure if I needed help with anything.”

“There were heartbreaking moments but overall, I left feeling empowered knowing that through my education and experiences, I am being geared to serve and impact such a population.”

Although this research was based on data collected in Rwanda, the data has a global impact in helping health providers target neonatal health issues in other low-income countries and increasing healthy pregnancies and preventing health complications and death in children.

“Nana’s research is really important because globally, we know why children die and we know that virtually all children’s deaths are preventable, so identifying each stage that could lead to death is very critical in reducing child mortality,” Yotebieng says.

According to Yotebieng, since efforts have been concentrated towards reducing neonatal mortality, the child mortality rates in Rwanda have fallen from 200 out of 1,000 in the late 1990s to 50 out of 1,000, which is a sharp drop considering the obstacles that health care providers face.

“Rwanda is a success story in reducing child mortality,” Yotebieng said. “Nana’s analysis highlights where Rwandan health care providers need to focus their attention.”

Wilmot (right) with Rwanda's President Paul Kagame. 

Besides having the opportunity to conduct research in Rwanda, Wilmot has since expanded her passion for international public health by participating in a medical outreach program in El Salvador during her time as a medical student.  

“Working on this project and the kind of exposure I had while working alongside individuals from all walks of life who had sacrificed a great deal to pursue careers that would benefit humanity, especially those in underserved areas, reaffirmed what my purpose in life is,” Wilmot says. “There were heartbreaking moments but overall, I left feeling empowered knowing that through my education and experiences, I am being geared to serve and impact such a population.”

Currently, Wilmot is serving people by completing clinical rotations for medical school in South Carolina.

“I have had the unique opportunity to work in rural and urban parts of South Carolina, which is also opening my eyes to the need of major public health interventions in underserved areas within America,” Wilmot says.

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About The Ohio State University College of Public Health

The Ohio State University College of Public Health is a leader in educating students, creating new knowledge through research, and improving the livelihoods and well-being of people in Ohio and beyond.  The College’s divisions include biostatistics, environmental health sciences, epidemiology, health behavior and health promotion, and health services management and policy.   It is ranked 19th among all colleges of public health in the U.S. by U.S. News & World Report, and also includes the top 10-ranked MHA degree program.  The College provides leadership and expertise for Ohio and the world through its Center for Health Outcomes, Policy and Evaluation Studies (HOPES), Center for Public Health Practice, and the NCI-funded Center of Excellence in Regulatory Tobacco Science (CERTS).

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