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Dirican AÖ, Korucu DG. A comprehensive evaluation of pregnancy and newborn outcomes in Syrian refugees in Turkey. BMC Pregnancy Childbirth 2024; 24:3. [PMID: 38166924 PMCID: PMC10759474 DOI: 10.1186/s12884-023-06168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The research was conducted to evaluate the birth and newborn outcomes of Syrian immigrant women according to maternal age groups and Vitamin D use. METHODS It was conducted retrospectively using the birth records of 2,866 Syrian migrant women, who had given birth at a tertiary center between January 2016 and May 2020. Demographic features, obstetric and neonatal outcomes were analyzed according to age groups and Vitamin D use. RESULTS The mean age of the patients included in the study was 26.22 ± 5.90, the mean gestational age at birth was 38.06 ± 2.1 weeks, and the mean newborn birth weight was 3.151 g. The mean hemoglobin value of the patients was 11.55 ± 1.54. While most of the patients were taking iron supplements (80.59%), Vitamin D (Vit D) supplement intake was 38.31%. The mean number of antenatal follow-ups was 3.40 ± 1.65. While the most common delivery method was normal vaginal delivery (61.93%), cesarean section rates were found to be 38.07%. The need for blood transfusion was significantly lower in the group that had received Vitamin D than that in the group that had not received it (2.00% vs. 8.94% p < 0.001). The rate of preterm birth was found to be 5.74% in the group that had received Vitamin D and 9.28% in the group that had not received it, which was significantly higher (p < 0.001). CONCLUSIONS We have seen that maternal and fetal outcomes can be improved with hospital follow-up and adequate vitamin supplements in refugee pregnant women.
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Affiliation(s)
- Aylin Önder Dirican
- Department of Gynecology and Obstetrics, Başkent University Konya Practice and Research Hospital, Konya, Turkey.
| | - Dilay Gök Korucu
- Department of Gynecology and Obstetrics, Konya City Hospital, Konya, Turkey
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Miranda J, Sanabria MF, Annicchiarico W, Alfieri N, Cortes MS. Maternal and perinatal health among pregnant patients in the context of a migratory crisis. Int J Gynaecol Obstet 2023; 163:416-422. [PMID: 37439260 DOI: 10.1002/ijgo.14991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE To compare maternal and perinatal outcomes of migrant Venezuelan women with local pregnant patients in a Colombian institution in the context of a migratory crisis. STUDY DESIGN This cross-sectional study included 11 304 deliveries from the Clínica de Maternidad Rafael Calvo in Cartagena de Indias, Colombia, a tertiary referral center on the north coast of Colombia. Data on maternal demographics and perinatal outcomes were obtained by chart review. RESULTS In total, 595 patients were identified as Venezuelan migrants, and their perinatal outcomes were compared against those of 10 709 local pregnant patients. Despite similar baseline maternal conditions in both groups, poorer prenatal follow-up care (3 [1-5] vs. 5 [4-7] visits; P < 0.001) and severe complications were more common in Venezuelan migrant pregnant patients and their children. In addition, maternal hypertension was significantly more common in migrants (11.4% [68/595] vs. 8.3% [887/10709]; P = 0.009). Furthermore, in the group of pregnant migrant patients, the rates of severe maternal morbidity (13.4% [80/575] vs. 9.45%, [1013/10709]; P = 0.002), neonatal respiratory distress syndrome (22/595 [3.7%] vs. 237/10709 [2.23%]; P = 0.03), and perinatal mortality (11/586 [1.88%] vs. 67/10651 [0.63%]; P = 0.003) were significantly higher than in the local pregnant population. CONCLUSION Forced migration during pregnancy may be associated with poorer prenatal care, which may predispose women and their newborns to more frequent adverse maternal and perinatal outcomes.
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Affiliation(s)
- Jezid Miranda
- Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia
- Department of Obstetrics and Gynecology, Centro Hospitalario Serena del Mar, Cartagena de Indias y Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - María F Sanabria
- Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Walter Annicchiarico
- Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena, Colombia
| | - Nikita Alfieri
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, Universita degli Studi di Milano, Milan, Lombardia, Italy
| | - Magdalena Sanz Cortes
- Department of Obstetrics and Gynecology, Division of Fetal Therapy and Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Ramadan M, Rukh-E-Qamar H, Yang S, Vang ZM. Fifty years of evidence on perinatal experience among refugee and asylum-seeking women in Organization for Economic Co-operation and Development (OECD) countries: A scoping review. PLoS One 2023; 18:e0287617. [PMID: 37883411 PMCID: PMC10602334 DOI: 10.1371/journal.pone.0287617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/08/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Members of the Organization for Economic Co-operation and Development (OECD) play a significant role in hosting and supporting refugees. Refugees and asylum seekers in OECD countries may face unique challenges in accessing perinatal healthcare. These challenges can impact their use of and experience with perinatal health services leading to poor maternal and infant outcomes. This scoping review describes the general trends in perinatal health research among refugees/asylum seekers in OECD countries over the past fifty years (1970 to 2021) as well as summarizes their perinatal experience. METHODS Databases including Embase and Medline were searched using relevant key words for "refugee/ asylum seeker", "perinatal ", and " OECD countries.". Articles were excluded if they only involved economic migrants or internally displaced persons, conducted in non-OECD countries, only assessed health behaviors and practices during pregnancy (e.g., smoking), or were published in a language other than English. The final list of articles included 82 unique studies. RESULTS In the 40 years between 1970 and 2009, very few studies (n = 9) examined perinatal health among refugees/ asylum seekers in OECD countries. However, an increasing trend was observed over the past decade. Early studies (1980 to 2009) focused more on traditional perinatal outcomes; however, from 2010 onwards, studies related to perinatal experience were more likely to emerge in the global health literature. Access to timely prenatal care remains a challenge with failure to address the root causes of the problem in several OECD countries including those with a long history of hosting refugees. The limited availability of interpretation services and the lack of a patient-centered approach to care have also interfered with the perceived quality of care. In addition, perceived isolation and the limited social support experienced by this vulnerable population have negatively impacted their perinatal experiences in several OECD countries. CONCLUSION Refugee/asylum seekers in OECD countries face a number of challenges during the perinatal period. Policy changes and further research are needed to address access barriers and identify specific interventions that can improve their well-being during this critical period.
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Affiliation(s)
- Marwa Ramadan
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Hani Rukh-E-Qamar
- Department of Sociology, McGill University, Montreal, Quebec, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Zoua M. Vang
- Department of Sociology, McGill University, Montreal, Quebec, Canada
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Majlander S, Kinnunen TI, Lilja E, Gissler M, Castaneda AE, Lehtoranta L, Koponen P. Potentially traumatic experiences pre-migration and adverse pregnancy and childbirth outcomes among women of Somali- and Kurdish-origin in Finland. BMC Pregnancy Childbirth 2023; 23:589. [PMID: 37592250 PMCID: PMC10433655 DOI: 10.1186/s12884-023-05906-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/07/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Women in precarious conditions in their countries of origin, especially those who have left the country as refugees, may have been victims of serious mental and physical violence. These potentially traumatic experiences may threaten women's reproductive health. This study examines the prevalence of potentially traumatic experiences pre-migration and female genital mutilation/cutting (FGM/C) and their associations with adverse reproductive outcomes among migrant women of Somali- and Kurdish-origin who have been pregnant in Finland. METHODS Survey and register data of the participants of the Finnish Migrant Health and Wellbeing Study (Maamu), conducted in 2010-2012, were used. Women of 18 to 64 years of age, 185 Somali- and 230 Kurdish-origin, who had at least one pregnancy or birth in Finland were included in the analysis. The survey data were linked to the Finnish Medical Birth Register, the Register of Induced Abortions, and the Care Register for Health Care until 2018. For each outcome, logistic regression was used and adjusted for age, body mass index, time lived in Finland, and the number of births. RESULTS A total of 67% of Somali-origin and 71% of Kurdish-origin women had experienced potentially traumatic experiences pre-migration and 64% of Somali- and 32% of Kurdish-origin women had also undergone FGM/C. In Kurdish-origin women, complications during pregnancy (e.g. bleeding in the first trimester, known or suspected fetal abnormality, signs of fetal hypoxia, death of the fetus and other problems) were significantly more common among women without potentially traumatic experiences (70%) than among women with potentially traumatic experiences (48%) (p-value 0.005). No associations between potentially traumatic experiences or FGM/C and other adverse reproductive outcomes were observed among Somali- or Kurdish-origin women. CONCLUSION Past trauma is common among Somali- and Kurdish-origin women and this needs to be evaluated in maternity care. However, we found no association between potentially traumatic experiences pre-migration and adverse reproductive outcomes.
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Affiliation(s)
- Satu Majlander
- Department of Public Health and Welfare, Unit of Equality, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, Helsinki, 00271, Finland.
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, Tampere, 33014, Finland.
| | - Tarja I Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Arvo Ylpön katu 34, Tampere, 33014, Finland
| | - Eero Lilja
- Department of Public Health and Welfare, Unit of Equality, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, Helsinki, 00271, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, Helsinki, Helsinki, 00271, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Research Centre for Child Psychiatry and Invest Research Flagship, University of Turku, Turku, Finland
| | - Anu E Castaneda
- Department of Public Health and Welfare, Unit of Equality, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, Helsinki, 00271, Finland
| | - Lara Lehtoranta
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, Helsinki, 00271, Finland
| | - Päivikki Koponen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Mannerheimintie 166, PL 30, Helsinki, 00271, Finland
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Haigh C, Lau HWR, Weir T, Glastras S. The experiences of women from culturally and linguistically diverse backgrounds with gestational diabetes mellitus: A mixed methods systematic review. Endocrinol Diabetes Metab 2023:e421. [PMID: 37139646 DOI: 10.1002/edm2.421] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/27/2023] [Accepted: 03/25/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is experienced at a higher rate in women from culturally and linguistically diverse (CALD) backgrounds. The aim of this systematic review is to describe the experiences of women with GDM from CALD backgrounds and compare their experiences to women with GDM from non-CALD backgrounds. MATERIALS AND METHODS MEDLINE, EMBASE, PsycINFO, Scopus, WOS and CINAHL databases were searched for qualitative and quantitative studies which included data on the experiences of CALD background women with GDM during all stages of pregnancy. Quality appraisal utilized checklists for analytical cross-sectional studies and qualitative research. Thematic analysis was performed using nVivo software. RESULTS Of the 3054 studies identified, 24 studies met the inclusion criteria. Data synthesis produced five key themes: (1) Response to diagnosis, (2) Experiences with self-management, (3) Interactions with the healthcare system, (4) Mental health challenges and (5) Facilitators and barriers to support. Women with GDM from CALD and non-CALD backgrounds similarly expressed mental health challenges, feeling burdened by recommendations, and challenges interacting with healthcare professionals (HCP). The major difference in experience was the cultural relevance of recommendations, especially related to diet recommendations. CONCLUSION Gestational diabetes mellitus is a burdensome diagnosis for CALD and non-CALD women, with CALD women uniquely experiencing a lack of culturally relevant recommendations for self-management. The similarities and differences in experience call for optimisation of GDM management and support for women with GDM.
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Affiliation(s)
- Claire Haigh
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
| | - Hiu Wing Rachel Lau
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
| | - Tessa Weir
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Sarah Glastras
- Kolling Institute and North Precinct, The University of Sydney, Sydney, New South Wales, Australia
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Adjei Boakye E, Runez AT, Hoskin Snelling CC, Lamberson JR, Halloway V, Ezike N, Kumar GS. Pregnancy Complications Among Resettled Refugees in Illinois. J Immigr Minor Health 2023; 25:1-7. [PMID: 35947321 DOI: 10.1007/s10903-022-01388-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/07/2023]
Abstract
Newly resettled refugee populations often have significant health care needs including pregnancy complications; yet research is lacking on pregnancy complications among refugees in Illinois. This was a retrospective analysis of the 2016-2017 hospital discharge data of refugee women of childbearing age (15-44 years) in Illinois. There were 3,355 hospital encounters by refugee women in our analysis, and 19.1% (n = 640) were associated with complications mainly related to pregnancy. The majority of hospital encounters associated with complications mainly related to pregnancy occurred after the first 8 months of US arrival (85.2%) and were among women who had Medicaid insurance (90.3%), ≥ 5 hospital encounters (60.2%), and who were most commonly from Iraq (23.3%) or Burma (19.4%). Refugee women may benefit from increased awareness and education about prenatal care, support in access, and prompt referrals.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, One Ford Place, 48202, Detroit, MI, USA. .,Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA.
| | - Anh-Thu Runez
- Illinois Department of Public Health, Office of Policy, Planning and Statistics, Division of Patient Safety and Quality, Chicago, IL, USA
| | | | - Jessica R Lamberson
- Illinois Department of Public Health, Center for Minority Health Services, Chicago, IL, USA
| | - Veronica Halloway
- Illinois Department of Public Health, Center for Minority Health Services, Chicago, IL, USA
| | - Ngozi Ezike
- Illinois Department of Public Health, Center for Minority Health Services, Chicago, IL, USA
| | - Gayathri S Kumar
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
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İLERİ A, ATA C, İLERİ H, YILDIRIM KARACA S, ŞENKAYA AR. Suriyeli mülteci ve türk kadınlarının perinatal eğilimleri ve obstetrik sonuçları. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1127397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The impact of migration on health is far-reaching, making migrant populations particularly vulnerable, fueling health inequalities and resulting in serious implications for global health. The aim of our study to assess antenatal care, pregnancy and neonatal outcomes of Syrian refugee women in Turkiye.
Material and Methods: Syrian and Turkish pregnants who delivered between 2013-2019 were recruited and categorized into groups according to maternal age at delivery. First trimester combined test, second trimester triple test, preterm delivery, maternal anemia; neonatal stillbirth, APGAR scores, birth weight and breastfeeding status were assessed.
Results: 4992 Syrian and 6846 Turkish pregnants were included. Maternal anemia was higher in Turkish patients in 20-34 and ≥35 groups. First trimester combined test, APGAR scores and birth weights were lower in Syrian women. Preterm rates higher in Turkish patients in only 20-34 age group. Second-trimester triplet tests were only higher in Turkish women in ≥35 age group. Low birth weight was higher in younger Syrian patients. Satisfying breastfeeding results were found in Syrian women.
Conclusion: Our study stated that Syrian women are at risk of low birth weight in adolescent and 20-34 age groups and low rates in first trimester combined test in all age groups. However decreased risk of pregnancy complications such as maternal anemia, preterm delivery, cesarean delivery and satisfying breastfeeding results were found in Syrian patients.
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Affiliation(s)
- Alper İLERİ
- Obstetrics and Gynecology, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkiye
| | - Can ATA
- Obstetrics and Gynecology, University of Demokrasi Buca Seyfi Demirsoy Education and Research Hospital, Izmir, Turkiye
| | - Hande İLERİ
- Family Medicine, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkiye
| | - Suna YILDIRIM KARACA
- Obstetrics and Gynecology, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkiye
| | - Ayşe Rabia ŞENKAYA
- Obstetrics and Gynecology, Izmir Bakircay University Cigli Training and Research Hospital, Izmir, Turkiye
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Khatri RB, Assefa Y. Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health 2022; 22:880. [PMID: 35505307 PMCID: PMC9063872 DOI: 10.1186/s12889-022-13256-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia. Methods We conducted a scoping review of the literature published from 1st January 1970 to 30th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model. Results A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations. Conclusions People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13256-z.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia.
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Mosley EA, Pratt M, Besera G, Clarke LS, Miller H, Noland T, Whaley B, Cochran J, Mack A, Higgins M. Evaluating Birth Outcomes From a Community-Based Pregnancy Support Program for Refugee Women in Georgia. Front Glob Womens Health 2021; 2:655409. [PMID: 34816209 PMCID: PMC8593936 DOI: 10.3389/fgwh.2021.655409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/18/2021] [Indexed: 11/28/2022] Open
Abstract
Refugee women face numerous and unique barriers to sexual and reproductive healthcare and can experience worse pregnancy-related outcomes compared with U.S.-born and other immigrant women. Community-based, culturally tailored programs like Embrace Refugee Birth Support may improve refugee access to healthcare and health outcomes, but empirical study is needed to evaluate programmatic benefits. This community-engaged research study is led by the Georgia Doula Access Working Group, including a partnership between academic researchers, Emory Decatur Hospital nurses, and Embrace. We analyzed hospital clinical records (N = 9,136) from 2016 to 2018 to assess pregnancy-related outcomes of Embrace participants (n = 113) and a comparison group of women from the same community and racial/ethnic backgrounds (n = 9,023). We controlled for race, language, maternal age, parity, insurance status, preeclampsia, and diabetes. Embrace participation was significantly associated with 48% lower odds of labor induction (OR = 0.52, p = 0.025) and 65% higher odds of exclusive breastfeeding intentions (OR = 1.65, p = 0.028). Embrace showed positive but non-significant trends for reduced cesarean delivery (OR = 0.83, p = 0.411), higher full-term gestational age (OR = 1.49, p = 0.329), and reduced low birthweight (OR = 0.77, p = 0.55). We conclude that community-based, culturally tailored pregnancy support programs like Embrace can meet the complex needs of refugee women. Additionally, community-engaged, cross-sector research approaches could ensure the inclusion of both community and clinical perspectives in research design, implementation, and dissemination.
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Affiliation(s)
- Elizabeth A. Mosley
- Georgia State University School of Public Health, Atlanta, GA, United States,Emory University Rollins School of Public Health, Atlanta, GA, United States,*Correspondence: Elizabeth A. Mosley
| | | | - Ghenet Besera
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Lasha S. Clarke
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Heidi Miller
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Tracy Noland
- Embrace Refugee Birth Support, Clarkston, GA, United States
| | - Bridget Whaley
- Emory University Rollins School of Public Health, Atlanta, GA, United States
| | | | - Amber Mack
- Healthy Mothers, Healthy Babies Coalition of Georgia, Atlanta, GA, United States
| | - Melinda Higgins
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
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Grundy S, Lee P, Small K, Ahmed F. Maternal region of origin and Small for gestational age: a cross-sectional analysis of Victorian perinatal data. BMC Pregnancy Childbirth 2021; 21:409. [PMID: 34051749 PMCID: PMC8164792 DOI: 10.1186/s12884-021-03864-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Being born small for gestational age is a strong predictor of the short- and long-term health of the neonate, child, and adult. Variation in the rates of small for gestational age have been identified across population groups in high income countries, including Australia. Understanding the factors contributing to this variation may assist clinicians to reduce the morbidity and mortality associated with being born small. Victoria, in addition to New South Wales, accounts for the largest proportion of net overseas migration and births in Australia. The aim of this research was to analyse how migration was associated with small for gestational age in Victoria. Methods This was a cross sectional population health study of singleton births in Victoria from 2009 to 2018 (n = 708,475). The prevalence of being born small for gestational age (SGA; <10th centile) was determined for maternal region of origin groups. Multivariate logistic regression analysis was used to analyse the association between maternal region of origin and SGA. Results Maternal region of origin was an independent risk factor for SGA in Victoria (p < .001), with a prevalence of SGA for migrant women of 11.3% (n = 27,815) and 7.3% for Australian born women (n = 33,749). Women from the Americas (aOR1.24, 95%CI:1.14 to 1.36), North Africa, North East Africa, and the Middle East (aOR1.57, 95%CI:1.52 to 1.63); Southern Central Asia (aOR2.58, 95%CI:2.50 to 2.66); South East Asia (aOR2.02, 95%CI: 1.95 to 2.01); and sub-Saharan Africa (aOR1.80, 95%CI:1.69 to 1.92) were more likely to birth an SGA child in comparison to women born in Australia. Conclusions Victorian woman’s region of origin was an independent risk factor for SGA. Variation in the rates of SGA between maternal regions of origin suggests additional factors such as a woman’s pre-migration exposures, the context of the migration journey, settlement conditions and social environment post migration might impact the potential for SGA. These findings highlight the importance of intergenerational improvements to the wellbeing of migrant women and their children. Further research to identify modifiable elements that contribute to birthweight differences across population groups would help enable appropriate healthcare responses aimed at reducing the rate of being SGA.
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Affiliation(s)
- Sarah Grundy
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.
| | - Patricia Lee
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Kirsten Small
- School of Nursing and Midwifery, Griffith University, QLD, Gold Coast, Australia.,Transforming Maternity Care Collaborative, Griffith University, Gold Coast, QLD, Australia
| | - Faruk Ahmed
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
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11
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Reyes AM, Akanyirige PW, Wishart D, Dahdouh R, Young MR, Estrada A, Ward C, Cruz Alvarez C, Beestrum M, Simon MA. Interventions Addressing Social Needs in Perinatal Care: A Systematic Review. Health Equity 2021; 5:100-118. [PMID: 33778313 PMCID: PMC7990569 DOI: 10.1089/heq.2020.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Health is impacted by a wide range of nonmedical factors, collectively termed the social determinants of health (SDoH). As the mechanisms by which these factors influence wellness and disease continue to be uncovered, health systems are beginning to assess their roles in addressing patient's social needs. This study seeks to identify and analyze clinic-based interventions aimed at addressing patients' social needs in perinatal care, including prenatal, antepartum, and postpartum care. Methods: We conducted a search of six databases through May 2020 for articles describing screening or intervention activities addressing social needs in at least one SDoH domain as defined by Healthy People 2020. We required that studies include pregnant or postpartum women and be based in a clinical setting. Results: Thirty-one publications describing 26 unique studies were identified. Most studies were either randomized-controlled trials (n=10) or observational studies (n=7) and study settings were both public and private. The mean age of women ranged from 17.4 to 34.1 years. Most studies addressed intimate partner violence (n=19). The next most common need addressed was social support (n=5), followed by food insecurity (n=3), and housing (n=2). Types of interventions varied from simple screening to ongoing counseling and case management. There was wide heterogeneity in outcomes investigated. Most IPV interventions that included counseling or ongoing support resulted in reduced IPV recurrence and severity. No intervention with only screening showed a reduction in rate of IPV. Conclusion: This systematic review shines light on several avenues to support pregnant and postpartum women through interventions that embed acknowledgment of social needs and actions addressing these needs into the clinical environment. The results of this review suggest that interventions with counseling or ongoing support may show promise in alleviating social risk factors and improving some clinical outcomes. However, the strength of this evidence is limited by the paucity of studies. More rigorous research is imperative to augment the knowledge of social needs interventions, especially in domains outside of IPV.
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Affiliation(s)
- Ana M Reyes
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Danielle Wishart
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rabih Dahdouh
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maria R Young
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Araceli Estrada
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Molly Beestrum
- Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa A Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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12
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Rumbold AR, Yelland J, Stuart-Butler D, Forbes M, Due C, Boyle FM, Middleton P. Addressing stillbirth inequities in Australia: Steps towards a better future. Women Birth 2020; 33:520-525. [PMID: 33092701 DOI: 10.1016/j.wombi.2020.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/04/2020] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
Persistent disparities in stillbirth risk and care are present in Australia. Eliminating these disparities is possible with a commitment to enhancing and scaling up models of culturally safe maternity care shown to be effective for Aboriginal and Torres Strait Islander women and those of migrant and refugee backgrounds. Campaigns to improve public awareness of stillbirth also play an important role in reducing stillbirth risk and consequences. To achieve reach and impact in communities at risk, messaging needs to be framed around the social and cultural context of women's lives. Here we describe important initiatives underway within the Stillbirth Centre of Research Excellence to develop a coordinated national approach to stillbirth prevention and care in communities that bear a disproportionate burden of stillbirth.
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Affiliation(s)
- Alice R Rumbold
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
| | - Jane Yelland
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Australia; Department of General Practice, University of Melbourne, Australia
| | - Deanna Stuart-Butler
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia
| | - Madeline Forbes
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia
| | - Clemence Due
- School of Psychology, The University of Adelaide, Australia
| | - Frances M Boyle
- NHMRC Centre of Research Excellence in Stillbirth, Mater Research Institute - The University of Queensland (MRI-UQ), Australia; Institute for Social Science Research, The University of Queensland, Australia
| | - Philippa Middleton
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Australia; Adelaide Medical School, The University of Adelaide, Adelaide, Australia
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13
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Nassar AH, Theron G, Wright A. FIGO Statement: Antenatal care and refugees. Int J Gynaecol Obstet 2020; 152:152-154. [PMID: 32981105 DOI: 10.1002/ijgo.13394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Anwar H Nassar
- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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- Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.,FIGO (International Federation of Gynecology and Obstetrics), London, UK
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14
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Sturrock S, Williams E, Greenough A. Antenatal and perinatal outcomes of refugees in high income countries. J Perinat Med 2020; 49:80-93. [PMID: 32877366 DOI: 10.1515/jpm-2020-0389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The World Health Organisation (WHO) has highlighted a marked trend for worse pregnancy-related indicators in migrants, such as maternal and neonatal morbidity and mortality, poor mental health and suboptimal care. The aim of this study was to determine whether such adverse outcomes occurred in refugees who moved to high income countries by comparing their antenatal and perinatal outcomes to those of non-immigrant women. METHODS A literature search was undertaken. Embase and Medline databases were searched using Ovid. Search terms included "refugee", "pregnan*" or "neonat*", and "outcome". RESULTS The search yielded 194 papers, 23 were included in the final analysis. All the papers included were either retrospective cohort or cross-sectional studies. The refugees studied originated from a wide variety of source countries, including Eritrea, Somalia, Afghanistan, Iraq, and Syria. Refugee women were more likely to be socially disadvantaged, but less likely to smoke or take illegal drugs during pregnancy. Refugee women were more likely to have poor, late, or no attendance at antenatal care. Miscarriages and stillbirth were more common amongst refugee women than non-refugees. Perinatal mortality was higher among refugees. CONCLUSIONS Despite better health care services in high income countries, refugee mothers still had worse outcomes. This may be explained by their late or lack of attendance to antenatal care.
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Affiliation(s)
- Sarah Sturrock
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Emma Williams
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.,The Asthma UK Centre in Allergic Mechanisms of Asthma, Kings College London, London, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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15
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Semaan A, Audet C, Huysmans E, Afolabi B, Assarag B, Banke-Thomas A, Blencowe H, Caluwaerts S, Campbell OMR, Cavallaro FL, Chavane L, Day LT, Delamou A, Delvaux T, Graham WJ, Gon G, Kascak P, Matsui M, Moxon S, Nakimuli A, Pembe A, Radovich E, van den Akker T, Benova L. Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic. BMJ Glob Health 2020; 5:e002967. [PMID: 32586891 PMCID: PMC7335688 DOI: 10.1136/bmjgh-2020-002967] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has substantially impacted maternity care provision worldwide. Studies based on modelling estimated large indirect effects of the pandemic on services and health outcomes. The objective of this study was to prospectively document experiences of frontline maternal and newborn healthcare providers. METHODS We conducted a global, cross-sectional study of maternal and newborn health professionals via an online survey disseminated through professional networks and social media in 12 languages. Information was collected between 24 March and 10 April 2020 on respondents' background, preparedness for and response to COVID-19 and their experience during the pandemic. An optional module sought information on adaptations to 17 care processes. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregating by low-income and middle-income countries (LMICs) and high-income countries (HICs). RESULTS We analysed responses from 714 maternal and newborn health professionals. Only one-third received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, 47% of participants in LMICs and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based practices. CONCLUSIONS Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information-sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations and support rapid development of effective responses.
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Affiliation(s)
- Aline Semaan
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
- Center for Research on Population and Health, American University of Beirut Faculty of Health Sciences, Beirut, Lebanon
| | - Constance Audet
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Elise Huysmans
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bosede Afolabi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Bouchra Assarag
- National School of Public Health, Ministry of Health, Rabat, Morocco
| | | | - Hannah Blencowe
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Séverine Caluwaerts
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Oona Maeve Renee Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Leonardo Chavane
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Louise Tina Day
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Alexandre Delamou
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), Universite Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Therese Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Wendy Jane Graham
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Giorgia Gon
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Kascak
- Department of Obstetrics and Gynaecology, General Hospital Trencin, Trencin, Slovakia
| | - Mitsuaki Matsui
- Department of Global Health, Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Sarah Moxon
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Annettee Nakimuli
- Department of Obstetrics & Gynaecology, Makerere University, Kampala, Uganda
- Department of Obstetrics and Gynaecology, Mulago Specialized Women and Neonatal Hospital, Kampala, Uganda
| | - Andrea Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Vrije Universiteit Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, VU Amsterdam Athena Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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16
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Turkay Ü, Aydın Ü, Salıcı M, Çalışkan E, Terzi H, Astepe BS, Varlıklı O. Comparison of pregnant Turkish women and Syrian refugees: Does living as a refugee have an unfavorable effect on pregnancy outcomes? Int J Gynaecol Obstet 2020; 149:160-165. [DOI: 10.1002/ijgo.13117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/14/2019] [Accepted: 02/07/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Ünal Turkay
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Ümit Aydın
- Department of Obstetrics and Gynecology Medikal Park Hospital İzmit Kocaeli Turkey
| | - Mehmet Salıcı
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Ebru Çalışkan
- Kocaeli Provincial Health Directorate, quality coordinator and productivity İzmit Kocaeli Turkey
| | - Hasan Terzi
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Bahar S. Astepe
- Department of Obstetrics and Gynecology University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
| | - Onursal Varlıklı
- Department of Pediatric Surgery University of Health Sciences Derince Training and Research Hospital Derince Kocaeli Turkey
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17
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Cabigas CKC, Bongga DC, Gabriel AA. Relative validity of a food frequency questionnaire for pregnancy in a low-income urban community in the Philippines. Nutrition 2020; 70S:100012. [DOI: 10.1016/j.nutx.2020.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/07/2020] [Accepted: 07/18/2020] [Indexed: 10/23/2022]
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18
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Jepsen I, Juul S, Foureur MJ, Sørensen EE, Nohr EA. Labour outcomes in caseload midwifery and standard care: a register-based cohort study. BMC Pregnancy Childbirth 2018; 18:481. [PMID: 30522453 DOI: 10.1186/s12884-018-2090-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care. METHODS A historical register-based cohort study was carried out using routinely collected data about all singleton births 2013-2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses. RESULTS Compared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06-1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13-1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03-1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84-1.28). Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11-2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital. For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06-1.29). CONCLUSIONS For most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.
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Affiliation(s)
- Ingrid Jepsen
- University College of Northern Denmark, Selma Lagerløfs Vej 2, 9220, Aalborg Øst, Denmark. .,Clinical Nursing Research, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
| | - Svend Juul
- Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus C, Denmark
| | - Maralyn Jean Foureur
- Research unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Sdr Boulevard 29, 5000, Odense C, Denmark.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Erik Elgaard Sørensen
- Clinical Nursing Research, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Ellen Aagaard Nohr
- Research unit for Gynaecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark, Sdr Boulevard 29, 5000, Odense C, Denmark.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.,Centre of Women's, Family and Child Health, University of South-Eastern Norway, Kongsberg, Norway
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19
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Xu K, Watanabe-Galloway S, Qu M, Grimm B, Kim J. Common Diagnoses among Refugee Populations: Linked Results with Statewide Hospital Discharge Database. Ann Glob Health 2018; 84:541-550. [PMID: 30835394 PMCID: PMC6748192 DOI: 10.29024/aogh.2354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: According to the U.S. State Department’s Refugee Processing Center and the U.S. Census Bureau, in the fiscal year 2016, among all states in the United States, Nebraska resettled the highest number of refugees per capita. Objectives: The objectives of this study were to determine the most common reasons for refugees utilizing hospital services in Nebraska between January 2011 and September 2015, and to examine whether refugee patients had increased risks for adverse health conditions compared to non-refugee patients. Methods: Statewide linkage was performed between Nebraska Medicaid Program’s immigration data, and 2011–2015 Nebraska hospital discharge data inpatient and outpatient files. The linkage produced 3017, 5460, and 775 cases for emergency department visits, outpatient clinic visits, and inpatient care for the refugee sample, respectively. Findings: Refugee patients were at increased risk for a number of diagnoses or medical conditions, including pregnancy complications, abdominal pain, upper respiratory infections, viral infections, mood disorders, disorders of teeth and jaw, deficiency and anemia, urinary system disorders, headache, nausea and vomiting, limb fractures, spondylosis, essential hypertension, and uncomplicated diabetes mellitus. Conclusions: The findings suggest a greater emphasis on preventive healthcare, especially in areas of maternal health and perinatal outcomes, psychological counseling, screening for infectious diseases, nutrition and healthy eating, and oral health. Additionally, culturally appropriate measures to address prevention, health screening, and treatments should be adopted by health providers who care for refugees.
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Affiliation(s)
- Kerui Xu
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, US
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198-4395, US
| | - Ming Qu
- Division of Public Health, Nebraska Department of Health and Human Services, 301 Centennial Mall South, Lincoln, NE 68509-5026, US
| | - Brandon Grimm
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, US
| | - Jungyoon Kim
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350, US
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20
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Iannuzzi L, Branchini L, Clausen JA, Ruiz-Berdún D, Gillen P, Healy M, Beeckman K, Seijmonsbergen-Schermers A, Escuriet Peiró R, Morano S, Di Tommaso M, Downe S. Optimal outcomes and women's positive pregnancy experience: a comparison between the World Health Organization guideline and recommendations in European national antenatal care guidelines. ACTA ACUST UNITED AC 2018; 70:650-662. [PMID: 30291700 DOI: 10.23736/s0026-4784.18.04301-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The publication of the World Health Organization (WHO) recommendations on antenatal care in 2016 introduced the perspective of women as a necessary component of clinical guidelines in maternity care. WHO highlights the crucial role played by evidence-based recommendations in promoting and supporting normal birth processes and a positive experience of pregnancy. This paper aims to explore and critically appraise recommendations of national antenatal care guidelines across European countries in comparison with the WHO guideline. METHODS We collected guidelines from country partners of the EU COST Action IS1405. Components of the documents structure and main recommendations within and between them were compared and contrasted with the WHO guideline on antenatal care with a particular interest in exploring whether and how women's experience was included in the recommendations. RESULTS Eight out of eleven countries had a single national guideline on antenatal care while three countries did not. National guidelines mostly focused on care of healthy women with a straightforward pregnancy. The level of concordance between the national and the WHO recommendations varied along a continuum from almost total concordance to almost total dissonance. Women's views and experiences were accounted for in some guidelines, but mostly not placed at the same level of importance as clinical items. CONCLUSIONS Findings outline convergences and divergences with the WHO recommendations. They highlight the need for considering women's views more in the development of evidence-based recommendations and in practice for positive impacts on perinatal health at a global level, and on the experiences of each family.
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Affiliation(s)
- Laura Iannuzzi
- Physiological Pregnancy Pathway and Margherita Birth Center, Department of Health Care Professions, Careggi University Hospital, Florence, Italy -
| | - Lucia Branchini
- MondoDonna Onlus, Association for Support and Integration of Immigrant Populations and Vulnerable Women, Bologna, Italy
| | - Jette A Clausen
- Department of Midwifery, University College Copenhagen, Copenhagen, Denmark
| | - Dolores Ruiz-Berdún
- Department of Surgery, Medical and Social Sciences, University of Alcalá, Alcalá de Henares, Spain
| | - Patricia Gillen
- Southern Health and Social Care Trust, Portadown, UK.,School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Maria Healy
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Katrien Beeckman
- Unit of Nursing and Midwifery Research, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussel, Belgium
| | - Anna Seijmonsbergen-Schermers
- Department of Midwifery Science, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | | | - Sandra Morano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Infant Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Soo Downe
- Research in Childbirth and Health Unit (ReaCH), School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
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21
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Turkay Ü, Aydın Ü, Çalışkan E, Salıcı M, Terzi H, Astepe B. Comparison of the pregnancy results between adolescent Syrian refugees and local adolescent Turkish citizens who gave birth in our clinic. J Matern Fetal Neonatal Med 2018; 33:1353-1358. [PMID: 30173583 DOI: 10.1080/14767058.2018.1519016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Adolescence is the transition period from childhood to adulthood; the World Health Organization has defined it as the ages between 10 and 19. Approximately 11% of all births in the world are by adolescent mothers. Pregnant adolescent refugees who have been forced to emigrate due to civil wars raging on in their native countries often face difficult social life conditions, have little or no access to hospitals, and experience language barriers and poor nutritional status have been found to experience poor maternal and obstetric outcomes. These include an increase in cesarean births, premature births, intrauterine growth retardation, and low-birth-weight infant rates. The purpose of the article was to share with you the comparative results of the adolescent pregnancies among the immigrants and among the local adolescents who gave birth between January 2016 and July 2017 in Kocaeli Derince Training and Research Hospital Gynecology Clinic in Kocaeli, Turkey. Its materials and method is a comparative study planned retrospectively between 67 adolescent Syrian refugees and 188 adolescent Turkish locals who gave birth between January 2016 and July 2017. The demographic data, obstetric outcomes, hospitalization durations, and neonatal outcomes of the patients were compared between the groups. Results, no statistically significant difference was found between pregnancy numbers, normal birth rates, cesarean sections and interventional birth rates, nullipara-multipara birth rates, or premature birth rates (<37 weeks) of the pregnant Turkish adolescents and pregnant immigrant adolescents (p > .05). The number of days these patients were hospitalized was found to be lower among Syrian immigrants than among the Turkish locals and statistically significant (p = .045 and p < .05, respectively). In addition, an analysis of the birth rates of low-birth-weight infants revealed that said rates were higher among the Syrian refugees than the Turkish local and statistically borderline significant (p = .049, p < .05, respectively). Between January 2016 and July 2017, a total of 8,570 live births were performed in our clinic. In our study of the 255 patients under the age of 19 who gave live births, 188 were Turkish and 67 were Syrian refugees. The average age of Turkish mothers under 19 was found to be 17.30 ± 1.01 years and the average age of immigrant mothers was found to be 17.27 ± 0.82 years. In conclusion, adolescent pregnancies are more common among Syrian refugees. Adolescent pregnancies are at risk for obstetric and neonatal outcomes. Therefore, studies should be done to prevent these pregnancies.
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Affiliation(s)
- Ünal Turkay
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
| | - Ümit Aydın
- Department of Obstetrics and Gynecology, Medikal Park Hospital, Kocaeli, Turkey
| | - Ebru Çalışkan
- Kocaeli Provincial Health Directorate, Kocaeli, Turkey
| | - Mehmet Salıcı
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
| | - Hasan Terzi
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
| | - Bahar Astepe
- Department of Obstetrics and Gynecology, University of Health Sciences Derince Training and Research Hospital, Kocaeli, Turkey
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22
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Parker AL, Parker DM, Zan BN, Min AM, Gilder ME, Ringringulu M, Win E, Wiladphaingern J, Charunwatthana P, Nosten F, Lee SJ, McGready R. Trends and birth outcomes in adolescent refugees and migrants on the Thailand-Myanmar border, 1986-2016: an observational study. Wellcome Open Res 2018; 3:62. [PMID: 30027124 PMCID: PMC6039938 DOI: 10.12688/wellcomeopenres.14613.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Currently there are more adolescents (10-19 years old) and young adults (20-24 years old) than ever. Reproductive health among this age group is often overlooked, although it can have a profound impact on the future. This is especially the case in conflict zones and refugee settings, where there is a heightened need for reproductive health care, and where both the resources and possibility for data collation are usually limited. Methods: Here we report on pregnancies, birth outcomes and risk factors for repeat pregnancies among adolescent and young adult refugees and migrants from antenatal clinics on the Thailand-Myanmar border across a 30 year time span. Results: Pregnancy and fertility rates were persistently high. Compared with 20-24-year-olds, 15-19-year-olds who reported being unable to read had 2.35 (CI: 1.97 – 2.81) times the odds for repeat pregnancy (gravidity >2). In primigravidae, the proportion of small for gestational age (SGA) and preterm births (PTB), and neonatal deaths (NND) decreased with increasing maternal age (all p <0.001). After adjustment, this association retained significance for PTB (cut-off point, ≤18 years) but not for SGA and NND. Conclusions: There is considerable room for improvement in adolescent pregnancy rates in these border populations, and educational opportunities may play a key role in effective interventions.
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Affiliation(s)
- Amber L Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand.,Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, Program in Public Health, University of California, Irvine, Irvine, California, USA
| | | | - Aung Myat Min
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand
| | - Mary Ellen Gilder
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand
| | - Maxime Ringringulu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand
| | - Elsi Win
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand
| | - Prakaykaew Charunwatthana
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand.,Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - François Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, OX3 7FZ, UK
| | - Sue J Lee
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, 10400, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, OX3 7FZ, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Un, Mahidol University, Mae Sot, 63110, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, OX3 7FZ, UK
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23
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Wanigaratne S, Shakya Y, Gagnon AJ, Cole DC, Rashid M, Blake J, Dastoori P, Moineddin R, Ray JG, Urquia ML. Refugee maternal and perinatal health in Ontario, Canada: a retrospective population-based study. BMJ Open 2018; 8:e018979. [PMID: 29643152 PMCID: PMC5898303 DOI: 10.1136/bmjopen-2017-018979] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Immigrants are thought to be healthier than their native-born counterparts, but less is known about the health of refugees or forced migrants. Previous studies often equate refugee status with immigration status or country of birth (COB) and none have compared refugee to non-refugee immigrants from the same COB. Herein, we examined whether: (1) a refugee mother experiences greater odds of adverse maternal and perinatal health outcomes compared with a similar non-refugee mother from the same COB and (2) refugee and non-refugee immigrants differ from Canadian-born mothers for maternal and perinatal outcomes. DESIGN This is a retrospective population-based database study. We implemented two cohort designs: (1) 1:1 matching of refugees to non-refugee immigrants on COB, year and age at arrival (±5 years) and (2) an unmatched design using all data. SETTING AND PARTICIPANTS Refugee immigrant mothers (n=34 233), non-refugee immigrant mothers (n=243 439) and Canadian-born mothers (n=615 394) eligible for universal healthcare insurance who had a hospital birth in Ontario, Canada, between 2002 and 2014. PRIMARY OUTCOMES Numerous adverse maternal and perinatal health outcomes. RESULTS Refugees differed from non-refugee immigrants most notably for HIV, with respective rates of 0.39% and 0.20% and an adjusted OR (AOR) of 1.82 (95% CI 1.19 to 2.79). Other elevated outcomes included caesarean section (AOR 1.04, 95% CI 1.00 to 1.08) and moderate preterm birth (AOR 1.08, 95% CI 0.99 to 1.17). For the majority of outcomes, refugee and non-refugee immigrants experienced similar AORs when compared with Canadian-born mothers. CONCLUSIONS Refugee status was associated with a few adverse maternal and perinatal health outcomes, but the associations were not strong except for HIV. The definition of refugee status used herein may not sensitively identify refugees at highest risk. Future research would benefit from further refining refugee status based on migration experiences.
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Affiliation(s)
- Susitha Wanigaratne
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yogendra Shakya
- Access Alliance Multicultural Health and Community Services, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Donald C Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Meb Rashid
- Crossroads Medical Clinic, Women’s College Hospital, Toronto, Ontario, Canada
| | - Jennifer Blake
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Parisa Dastoori
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Access Alliance Multicultural Health and Community Services, Toronto, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel G Ray
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Keenan Research Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo L Urquia
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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24
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Biro MA, East C. Poorer detection rates of severe fetal growth restriction in women of likely refugee background: A case for re-focusing pregnancy care. Aust N Z J Obstet Gynaecol 2017; 57:186-192. [DOI: 10.1111/ajo.12593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mary Anne Biro
- School of Nursing and Midwifery; Clayton Campus, Monash University; Clayton Victoria Australia
| | - Christine East
- School of Nursing and Midwifery; Clayton Campus, Monash University; Clayton Victoria Australia
- Monash Health; Monash Medical Centre; Clayton Victoria Australia
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25
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Callister LC, Edwards JE. Sustainable Development Goals and the Ongoing Process of Reducing Maternal Mortality. J Obstet Gynecol Neonatal Nurs 2017; 46:e56-e64. [PMID: 28286075 DOI: 10.1016/j.jogn.2016.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2016] [Indexed: 10/20/2022] Open
Abstract
Innovative programs introduced in response to the Millennium Development Goals show promise to reduce the global rate of maternal mortality. The Sustainable Development Goals, introduced in 2015, were designed to build on this progress. In this article, we describe the global factors that contribute to maternal mortality rates, outcomes of the implementation of the Millennium Development Goals, and the new, related Sustainable Development Goals. Implications for clinical practice, health care systems, research, and health policy are provided.
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26
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Clinical characteristics and pregnancy outcomes of Syrian refugees: a case–control study in a tertiary care hospital in Istanbul, Turkey. Arch Gynecol Obstet 2016; 295:45-50. [DOI: 10.1007/s00404-016-4188-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
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27
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Haque MA, Dash SK, Chowdhury MAB. Maternal health care seeking behavior: the case of Haor (wetland) in Bangladesh. BMC Public Health 2016; 16:592. [PMID: 27430897 PMCID: PMC4949891 DOI: 10.1186/s12889-016-3296-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 06/24/2016] [Indexed: 11/29/2022] Open
Abstract
Background The state of maternal healthcare (MHC) in Bangladesh is a grave concern especially in the remote haor areas. In this study, we aimed to determine the factors affecting the utilization of MHC services in the haor areas, to discover mothers’ knowledge of MHC, and explore their attitudes toward MHC as well as practices in seeking MHC services. Method In this cross-sectional survey (n = 400), we randomly selected mothers (aged 15–49 years) from haor areas of the Habiganj district of Bangladesh. The study participants’ socio demographic information as well as the extent of their knowledge about MHC, their attitudes, and practices in seeking MHC services were ascertained. The degree of association between the respondents’ socio-demographic characteristics and their health-seeking behavior (before, during, and after childbirth) was assessed by the odds ratio (OR) with 95 % confidence intervals (CI) estimated from the bivariate and multivariable logistic regression analyses. Results The mean age of the study participants was 27.26 years. Respondents had an average of 2.64 children, and 88.6 % had at best a primary education or less. Among the study participants, 61 % of mothers had no knowledge about the availability of MHC in the study area, and only 36 % received any antenatal care (ANC). Also, 47 % sought ANC from government healthcare institutions. Irrespective of complications and potential danger signs, 95 % of births were delivered at home with the assistance of untrained birth attendants. Only 19.75 % of mothers and 12.3 % of infants received postnatal care (PNC). Moreover, mothers who had a secondary or tertiary education level had a higher likelihood of receiving ANC (OR: 3.48, 95 % C.I: 1.49–7.63) compared to mothers with no education. Also, mothers aged 25 years or older were less likely (OR: 0.24, 95 % C.I: 0.06–0.095) to give birth in a health facility than mothers who were younger than 25. The low utilization of MHC services can be attributed to many factors such as a lack of communication, a lack of knowledge about MHC services, low income, decision making, and the lack of a companion with whom to visit health services. Conclusion To improve MHC utilization, to reach national targets and to save the lives of mothers and newborns, boat or ship-based special healthcare and educational programs should be implemented in the haor areas.
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Affiliation(s)
- Md Aminul Haque
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Surjya Kanta Dash
- Department of Population Sciences, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Muhammad Abdul Baker Chowdhury
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, 33199, USA
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