Kokui Klutse, a PhD student at the Lawrence Bloomberg Faculty of Nursing, has received an International Doctoral Research Award (IDRC- IDRA) from Universities Canada supporting her exploration of developmentally supportive care practices for preterm infants in Ghana.
The annual IDRC-IDRA is given to exemplary PhD students with the goal of helping to build capacity and research skills that will improve the lives of people in the developing world.
For Klutse, winning this award is also a testament to the support of her supervisory committee and Bloomberg Nursing Dean, Linda Johnston, whom she says have made her feel immensely welcome as an international PhD student.
“There have been countless times where I have experienced imposter syndrome, especially when I attended my first class in the program and noticed I was the only Black student there,” says Klutse, “but the encouragement and cordial relationship between students and staff, which is a hallmark of U of T and the Faculty of Nursing in particular, made me feel like I was right where I should be.”
Klutse is a registered pediatric nurse from Ghana and was among the first to graduate from a cohort of internationally trained pediatric nurses. Her passion for helping infants and the joy families express when their children recover, motivates her to continue improving their care. Kluste is currently in Ghana working on data collection for her doctoral research, which aligns with one of Ghana’s Sustainable Development Goals (SDG goal 3); which includes reducing the global neonatal mortality rate to 12 per 1000 live births by 2030. The current neonatal mortality rate in Ghana is close to 25 per 1000 live births, and Klutse is hopeful her research will facilitate the creation of new policies that support better care for preterm infants in the NICU.
“It is not only about providing care so that these infants survive, but also ensuring a better quality of life after survival,” says Klutse.
Externally recreating an environment like the womb is difficult, especially in under-resourced health care facilities. Klutse points out that evidence-based interventions like controlling light and noise in the NICU can help reduce the stress of the external environment on preterm infants, helping to stabilize them and promote their development. Additional interventions also contribute to promoting growth and development by reducing stress in preterm infants. These include effective pain management strategies such as swaddling and administering dextrose drops on an infant’s tongue before and during a painful procedure such as intravenous cannulation. Another example is kangaroo mother care, a method of having an infant held on its mother’s bare chest and wrapped snugly. This helps with temperature regulation, particularly for preterm infants outside of an incubator, and promotes bonding which can assist in reducing maternal anxiety.
Each of these interventions are more likely to be used in high-income countries, but in Ghana, Klutse indicates that nurses’ lack of awareness of these interventions, understaffing, and other complex factors, can be barriers to ensuring a consistent approach to care in the NICU.
“If we have one nurse taking care of five critically ill babies, that nurse is reliant on the sound of the alarms to intervene in the infants care. The beeping draws their attention to an urgent need of a particular baby and in such situations, one may say the louder the alarm, the higher the chances of catching the nurse’s attention. Yet that loud beeping is detrimental to babies, particularly preterm infants and is a barrier in trying to maintain appreciably low levels of noise in the NICU,” says Klutse.
At a policy level, Klutse adds, educating nurses and other NICU staff on developmentally supportive practices in the NICU, including covering incubators to reduce some amount of noise and light exposure, may be critical to changes in practice.
Klutse’s two-phase study will first use a quantitative approach to describe what the preterm infant populations are like in three healthcare facilities in Ghana, and include key points about the gestational ages, feeding modalities, congenital abnormalities, and kangaroo care practice all of which can affect preterm infant survival. This phase will be followed by observations of developmentally supportive practices in the NICU and qualitative interviews with healthcare providers and family caregivers to explore their challenges and what enables their practice in the NICU.
“We don’t need a million dollars to implement these interventions; we need individual commitment and changes at the policy level,” says Klutse. “If we can reduce preterm infant mortality from the current 25 per 1000 live births and improve survival outcomes with these cost-effective interventions, that will be a success story.”
Klutse encourages any international PhD student at U of T to consider applying for the IDRC award. Finances, she says, can be a significant challenge for international students, and awards like the IDRC- IDRA provide both relief and recognition.
“The world is a global village, and the IDRC, through this award, aims to grow and develop the skills of researchers in low-middle income countries to improve lives globally. The findings of this research may apply to resource constrained settings, including those in high-income countries,” says Klutse.