Kokui D. Klutse has finally achieved her dream of graduating from the University of Toronto with a PhD in Nursing from the Lawrence Bloomberg Faculty of Nursing with a collaborative specialization in Global Health from the Dalla Lana School of Public Health. A pediatric nurse from Ghana, she left behind her family and home, to pursue research in an area of care that she remains passionate about – improving the survival of preterm infants by ensuring they receive better care in the country’s NICUs.
“Although I missed home, I would remind myself that I came here for a reason, to gain knowledge, and this helped me during moments when I felt most homesick” says Klutse.
In 2022 at the time Klutse was beginning her data collection, Ghana’s neonatal mortality rate was close to 25 deaths per 1000 live births. Her goal was to explore the implementation of cost-effective interventions during NICU care, knowing how these could directly improve survival outcomes and reduce this mortality rate in alignment the United Nations Sustainable Development Goals.
“I realized we don’t need a million dollars to implement these interventions, instead, it required individual commitment, policy‑level changes, and, most importantly, evidence to inform recommendations” says Klutse.
In early 2023 Klutse received the International Doctoral Research Award from Universities Canada and set out to conduct a multi-phase retrospective study, exploring the use of developmentally supportive care practices for pre-term infants in the NICU at three health care facilities in Ghana. This included a bundle of interventions, such as kangaroo mother care (where the infant is placed on the mother’s chest for extended periods of time), reduced noise and lighting in the NICU space, and effective pain management such as sucrose drops or nutritive sucking.
These interventions have been shown to reduce infant death in the first 28 days of life by 41 to 72 per cent and there is also evidence that they improve the long-term neurodevelopment of preterm infants. In countries like Ghana, Klutse’s research showed that these interventions were under utilized with significant barriers to having them implemented in practice.
“NICUs are congested in these care facilities, there are many infants that need to be cared for, and often there is limited knowledge about the non-pharmacological management of an infant’s procedural pain, creating a therapeutic environment, or reducing noise or alarms,” says Klutse.
One of the important findings indicated that no preterm infant received immediate kangaroo mother care. Of the barriers Klutse uncovered in her research was the lack of accommodation for parents especially mothers, to provide the most simple and effective intervention of kangaroo mother care. Busy NICUs meant little space for mothers to sit by the incubator, and the cost of transportation or their own healing process post-partum were also inhibiting factors. However, kangaroo mother care alone when started early, can reduce mortality rates by 25 per cent in preterm infants. For Klutse, this means she sees this research and any future recommendations that come from it, as essential to the reduction of pre-term infant mortality globally and the improvement of overall quality of life for some of the most vulnerable in Ghana’s population.
Reflecting on her PhD journey, Klutse is still amazed at her accomplishment. It was overwhelming she recalls, having to navigate her research across different countries, and labour intensive with thousands of pre-term infants’ paper medical charts needing to be analyzed.
She credits her supervisor Linda Johnston, Professor at Bloomberg Nursing, and Principal and Vice-President at U of T Scarborough, for supporting her through an arduous but ultimately successful academic journey, as well as her supervisory committee and especially her friends and family.
“I will be working on disseminating my findings and exploring career opportunities as my next steps,” says Klutse, “This PhD experience is one I will cherish for the rest of my life as I continue in my area of research and strive to make a lasting impact.”