From left: Elizabeth Mireku, RN, joins Marianne Felice, MD, Julia Johnson, MD, and Tiffany Moore Simas , MD, at Dr. Felice’s Grand Rounds, “Infant Mortality Rate in Worcester: The Ghana Connection,” held Sept. 10. Drs. Felice, Johnson and Moore Simas are wearing traditional Ghanaian dresses handmade for them in July during a trip they took to Ghana with Mireku; Rosemary Theroux, PhD, and Robin Klar, DNSc, to study possible factors linked to the high infant mortality rate among West African immigrants in Worcester.

At any given time of year, there are scores of students, faculty and researchers off campus—some way, way off campus—in the Dominican Republic, Peru, Ghana, Liberia—providing aid, serving fellowships and gaining experience they can apply to their work, and their patients, here at home. As an ongoing, periodic feature on UMassMedNow, we will profile some of these travelers and give you some insight into the impact—both small scale and large—that the people of UMMS are making on our world.

For years, Worcester has had one of the highest infant mortality rates in the commonwealth: nearly nine infants per thousand born to mothers in the city die before their first birthdays. Statewide, the rate is five per thousand and nationwide, seven per thousand. The Worcester Infant Mortality Reduction Task Force (WIMRTF), formed in 1996 and currently chaired by Marianne E. Felice, MD, chair and professor of pediatrics, has explored various causes for these high rates, but hard evidence to help clinicians lower the rate remains elusive.

“Most of the Worcester mothers who lose infants just don’t fit the profile of women who are at risk,” said Dr. Felice. “They are married, they receive adequate prenatal care, they don’t smoke, and they don’t use drugs. But the Task Force found something we can’t yet explain: a higher percentage of infants born to Ghanaian immigrant mothers in the city are delivered very prematurely, too premature to survive. We just don’t know why.”

This summer, a team of five UMMS and GSN faculty and one UMass Memorial Health Care nurse traveled to Ghana—where approximately 50 infants per thousand do not survive their first year—to seek clues to what may be keeping the infant mortality rate high among Worcester’s Ghanaian community.

Felice and Julia V. Johnson, MD, chair and professor of obstetrics & gynecology;
Tiffany Moore Simas, MD, assistant professor of obstetrics & gynecology;
Robin Toft Klar, PhD, assistant professor in the Graduate School of Nursing; Rosemary Theroux, RNC, PhD, associate professor in the Graduate School of Nursing; and Elizabeth Mireku, an RN with UMass Memorial Medical Center and a native of Ghana, spent 10 days with health care providers, public health officials, community advocates and a vast array of women in both academic health centers and in village clinics.

(Throughout the trip, the team was deftly aided and escorted by Nii Addy, a native Ghanaian who had worked as an orthopedic technician at UMass Memorial Medical Center for over 25 years before retiring to his home country last spring.)

In Accra, the capital city of 4 million people, the team met with obstetricians and pediatricians at Korle Bu Teaching Hospital, the clinical arm of the University of Ghana Medical School, where 10,000 to 12,000 infants are born each year. In a country where the majority of births occur in small community clinics or at home, tended by midwives or female relatives, only women whose pregnancies are identified as very high risk—or very wealthy women—deliver in hospitals. Often, the distance to a hospital spells doom for both mother and child in unexpectedly complicated deliveries.

The group also met with health care providers in community hospitals and with community caregivers in the southern village of Pokuase, where Theroux and Klar have a longstanding relationship with the Women’s Trust, a non-government organization (NGO) dedicated to improving the economic, education and health status of women in Ghana.

“Through these interviews and interactions, we got a better look at additional cultural and sociological factors to consider when caring for our patients in Worcester,” said Felice, noting that, in both countries, women are responsible for all household duties. In Worcester, many Ghanaian women work multiple jobs to support their family in Worcester and to send money home to Ghana, possibly adding to stress that could affect pregnancy.

The team also inquired about nutrition and learned of the practice of consuming dried clay during pregnancy as well as the use of herbs, including those used intra-vaginally, and is now analyzing samples of locally purchased herbs to assess potential toxicity either to the mother or child.

In addition, said Dr. Johnson, “Many of the caregivers we spoke to suggested that the elective termination of pregnancies among younger women may be far more common than we believed previously. Although legal, abortion is considered taboo and thus is not discussed, even with caregivers, so our data have been skewed.” The relationship between induced abortions and later pregnancies is an area that needs more exploration. Felice and Dr. Moore Simas are also looking into DNA markers for a genetic predisposition to cervical insufficiency, which may lead to preterm delivery.

“When we peel away the factors not seen in the U.S.—poor sanitation, lack of access to hospital care, high rates of infectious disease, lack of clean water for some—the infant mortality rates in Ghana and among Worcester’s Ghanaian babies may both be high and may have some similar causes,” said Moore Simas, who is also a member of WIMRTF, along with Mireku. The team hopes to collaborate with physicians in Ghana to conduct research that would benefit both countries.

“While there were no dramatic ‘Ah-Ha!’ moments,” Felice said, “we came back from Ghana with some very helpful ideas and insights that will help us plan our future endeavors. We will use this experience to find ways to protect the babies of Worcester.”