November 1, 2016—From helping to launch a nutrition program in Tanzanian villages to learning how the World Health Organization (WHO) develops global policies, eight Harvard T.H. Chan School of Public Health students spent this past summer getting a taste of real-world public health. They all were awarded travel grants from the Maternal Health Task Force, part of the School’s Women and Health Initiative, to support internships in countries including Brazil, Nigeria, and Pakistan. At an electronic poster session held at the School on September 19, they shared research findings and spoke about their experiences.
Improving nutrition through farming
Severe malnutrition is the third highest cause of death for children under five in Tanzania, and stunting (diminished growth in children) is estimated to be around 35%, according to Alexandra Bellows, SM ’17. She spent the summer in Tanzania working on a project that aims to prevent malnutrition in children and their mothers through better dietary diversity.
Many rural women in Tanzania maintain small home farms, so Bellows and her fellow researchers at the Homestead Agriculture and Nutrition Initiative (HANU)—a collaboration between Harvard Chan School, the Ifakara Health Institute, and Sokoine University of Agriculture, and part of the School’s Africa Health Partnership—wanted to see if the addition of new crops would improve their health and their children’s health.
The program provided vegetable seeds at no cost to participating households and will monitor their health for one year. The hope is that women and children’s height, weight, body composition, and blood tests will show signs of better health at the end of the study period. An additional potential benefit of the project, Bellows said, is that the women may be able to grow more vegetables than they need at home and sell the surplus.
The project proved to be a lesson in adaptation, said Bellows, who began working remotely as a research assistant in February. The researchers intended to start enrolling study subjects in April, but their funding was delayed. By the time they were ready to start interviewing subjects about their health and dietary habits it was June—when most of their study subjects were fasting for the Muslim holiday of Ramadan. So Bellows spent much of the summer developing a training manual for the program. By the end of the summer, the study was back on track.
Bellows said that she formed close relationship with Tanzanian colleagues, and plans to continue working on the project. Her next step is to clean and analyze the data, and she hopes to return to Tanzania in January for a mid-year assessment of the project.
Shining a light on unregistered children
More than 200 million children around the world lack a birth certificate, and therefore do not legally exist. Amiya Bhatia MPH ’15, SD ’20, who worked with the International Center for Equity in Health in Brazil, spent her summer looking into the scope of this problem and its implications.
When children are unregistered, they don’t appear in the databases researchers use to assess the health of a population—calling into question whether global sustainable development goals are actually being met. And, more importantly, being unregistered leaves children vulnerable to exploitation and hampers their ability to obtain their legal rights throughout their lives.
Bhatia looked at data from surveys of low- and middle-income countries in which households were asked whether children under five had received a birth certificate. Preliminary results suggested that Eastern and Southern Africa had the lowest coverage of birth certificates—approximately 27%. In most of the surveyed countries, there were significant inequalities in coverage by income. For example, data from India suggested that on average birth certificate coverage was 11.2% for the poorest children compared to 57.3% for children from the wealthiest households.
This work raised a lot of questions for Bhatia that she is hoping to tease apart in her dissertation, she said. “How unequal are health data and how do we think about this as we study maternal and child health? When so many people are not being counted, we may be prematurely congratulating ourselves for success.”
Observing the policymakers
Vanessa Brizuela, DrPH ’18, spent the summer learning how research gets translated into global policy as part of the Human Reproduction Programme at World Health Organization (WHO) headquarters in Switzerland. She assisted the Maternal and Perinatal Health and Preventing Unsafe Abortion team on a variety of projects, including co-authoring an article on global initiatives in maternal health for an obstetric medicine journal and doing a literature review that will help WHO develop a statistical model estimating global preterm births.
Brizuela said that one of her goals for the summer was to build a relationship with an organization that she could work with for her DELTA Doctoral Project, an eight-month field placement for the DrPH program. Having the opportunity to watch WHO in action—including sitting in on high-level meetings with donor countries and training sessions for regional field officers who will be implementing a new framework for maternal health care in Asian and African countries—fueled her interest in continuing to work with the organization, she said.
“Working alongside such a committed group of people renewed my passion in maternal health. Being a part of a global institution that sets guidance for implementing evidence-based policy was both exciting and mobilizing,” she said.
Read about more student fieldwork in maternal health (Women and Health Initiative)
Photos: Courtesy of Alexandra Bellows; by Sarah Sholes