PARTNERS IN SERVICE: UMass Medical School and the Community  


INFANT MORTALITY REDUCTION

The Infant Mortality Rate (IMR), defined as the rate at which infants do not survive their first year of life, is monitored and compared throughout the world as a critical indicator of the health of populations. Although the differences are very small, Worcester has had a persistently higher IMR than Massachusetts and the United States overall.

The puzzle of why so many babies are not surviving in a city that has superb prenatal and newborn care galvanized a group of community leaders, including faculty and clinicians from UMass Medical School and UMass Memorial Health Care, to work together in search of causes and solutions; in the mid-1990s they established the Worcester Infant Mortality Reduction Task Force. Members looked at the known risk factors for infant mortality, such as mothers being smokers, teenagers or unmarried, and were taken aback when it was discovered that these risk factors did not apply to the population of women whose babies were dying. Rather, the Task Force determined that many of these babies had been born to immigrant women from Western Africa, predominantly Ghana.

UMass Medical School faculty are founding members of the Worcester Infant Mortality Reduction Task Force, comprising clinicians, state and city public health departments, social service agencies, and community members and groups to respond to Worcester’s higher than average infant mortality rate.

The Task Force’s research has found that infants at highest risk of death in Worcester are born to women who emigrated from West African countries such as Ghana and Liberia.

An interdisciplinary team of medical and nursing students studied Worcester’s Ghanaian immigrant families to develop plans for action in partnership with the Task Force.

One such initiative is a series of public service announcements to educate the public about risk factors for infant mortality and what individuals can do to reduce those risks.

This finding caught the attention of Rosemary Theroux, RNC, PhD, assistant professor in the Graduate School of Nursing, who saw the IMR issue as an opportunity for study by her Community Health Clerkship group (pictured left with Dr. Theroux). UMass Medical School is currently the only medical school in the nation that requires first-year medical students to study health problems of populations traditionally neglected in medical education by spending a two-week clerkship in local communities; Dr. Theroux’s group was the first to include nursing students.

The group found that, rather than the usual risk factors associated with infant mortality, Ghanaian infant deaths can be traced to indigenous cultural outlooks and practices, such as not considering pregnancy a  medical condition and, therefore, not seeking prenatal care. The students noted that physicians can make improvements in communication with patients by acknowledging and encouraging the need for an   interpreter; adjusting the patient interview to account for culturally sensitive topics such as sexual history and mental health; and conferring with community case managers. Community outreach to African women, through trusted entities such as churches, is also effective in persuading them to seek prenatal care in earlier stages of pregnancy than is customary in their culture.

Theroux encouraged the students to present their findings to the Infant Mortality Reduction Task Force. Their presentation validated one of the Task Force’s key objectives, according to its chair, Marianne E. Felice, MD, professor and chair of pediatrics at the Medical School. “To reduce infant mortality, doctors, nurses and caregivers must be culturally respectful to help encourage women to seek prenatal care.”

Online: 
www.umassmed.edu/pap/Newsmakers/2007/Newsmakers.aspx
(April)

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