London School of Hygiene & Tropical Medicine

Hi, I’m Rishika - I'm in medical school at the University of North Carolina and I studied MSc Reproductive & Sexual Health Research at LSHTM between my third and fourth years of medical school as an intercalating student.

Describe your MSc Reproductive & Sexual Health Research project in one sentence.

In a nutshell, my project focused on using time-motion data to examine the impact of heat stress on healthcare workers' quality of care in maternity wards in South Africa and Zimbabwe.

Tell us more about the research and the process.

I think the impacts and the overlap between climate change and maternal health is something which is fundamentally understudied - we think about climate change in terms of greenhouse gases, carbon emissions, rising temperatures, and natural disasters. I think it's also really important to start thinking about and studying how these same factors are having really grave impacts on healthcare in general.

There's been some preliminary research on how heat affects pre-term labour and labouring mothers and pregnancy, but it's all pretty qualitative. And so, I was connected with the High Horizons Research Consortium who really focus on the impacts and the overlap between climate change and maternal health. I worked with Prof Veronique Filippi and Nasser Fardousi, who were the London-based representatives in this international research consortium, and they were trying to find a quantitative way to look at how heat impacts the delivery of healthcare services.

We looked at the way that care was delivered to anyone who came into labour and delivery who had a normal pregnancy and used this method called time-motion analysis to basically record activities throughout their labour. There was an observer on the ground in both of these maternity wards in each country who would observe from the moment a patient walked in and anytime an event happened, to record the activity and timestamp it. We focused on professional communication, and the proportion of essential and recommended clinical activities performed as markers for how the quality of care looks as temperatures vary. There were a bunch of temperature probes on the wards and we used wet bulb globe temperatures to track temperatures.

We found that the proportion of professional communication out of total communication decreased significantly for every one degree Celsius increase in temperature on these wards.

That sounds like a lot of data! Can you tell us more about how the data was collected and what it showed?

I'm so eternally grateful to the research teams on the ground that got the data to my hands – the data was all collected prior to me beginning my project, so they were just waiting for someone who had the bandwidth and time to start cleaning it up and analysing it. The data in South Africa was collected from January to April of 2024, so right before I started my analysis. Then in Zimbabwe the data was collected from October 2023 to March 2024, so it was all pretty newly collected.

What was hard was that some of this data didn't necessarily reflect the hottest temperatures that these countries face just simply because of the seasons and the nature on ongoing data collection. However, we now have these benchmarks for different seasons. It was still interesting that after we combed through all the co-variates and adjusted our analyses, we were able to see that professional communication varied somewhat significantly with temperature for every one-degree Celsius change in temperature. And so, whilst it's hard to a certain point because communication can be this nebulous thing to exactly quantify, a huge strength of our time was its granularity, with events such as ‘midwife encourages mother to breastfeed’, or, ‘midwife encourages movement’, or ‘personal chat with family and friends in room’ - things like that were recorded. There's still a lot that can be done as it's really rich data but I'm so grateful for the teams that made this data collection possible because it's such time intensive research - labour can go on from hours to days!

How did you find the research project experience?

This was all a huge learning curve for me; I did feel a bit like a fish out of water because I've never really studied heat stress, but it was a really great learning experience. The data comes with its flaws and it's important to allude to that - my limitation section was probably as long as my results section! But I think it was a good first step in exploring how we can quantitatively look at how heat impacts quality of care and so that was really exciting. There's lots of work to be done in this research area, but it was something new for me to try and flex some of the data analysis skills I gained during my MSc Reproductive & Sexual Health Research programme.

Had you conducted this kind of data analysis before?

I hadn't really worked in STATA at all prior to my MSc studies and so I took a course called Analysing Surveys and Population Data in Term 3, and that really helped when I came to my project data. I really appreciate those professors in the modules and my supervisors helping me work through the weeds of data analysis in practice: how do I get this data into minutes and seconds? And how do I account for these specific covariates? Things like that.

I felt supported by the course and my research team, even though it was a rather daunting undertaking for a master's student, I think. I had worked in R, Python and other programming languages very briefly during my undergraduate studies, but I feel like I haven't truly learnt a new skill like this in so long and so it was nice to feel supported and feel confident enough to complete this dissertation by the end of by the end of it.

You were awarded the RSHR Project Prize for your research. How did that feel?

I was honestly so shocked - I was not expecting that. It's hard as I feel sometimes the research can feel like sets of numbers on paper that can be hard to translate to real-world impact. It was such a privilege alone for my research to be recognised as sound, novel, and potentially useful. I feel like everyone hopes that their research actually translates into some sort of impact. I'm still working with the research team and they're redefining outcomes to see what is the most practical way that this data can be applied, so the research is still continuing to take shape as well so I really hope this is the start of an impactful piece of content.

• Discover MSc Reproductive & Sexual Health Research
• Explore MSc Climate Change & Planetary Health
• Contact a student ambassador
• Read more from Rishika - Rishika's MSc Reproductive & Sexual Health Research Experience.