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Martínez-Arias A, Valerio L, Roure-Díez S, Fernández-Rivas G, Rivaya B, Pérez-Olmeda MT, Soldevila-Langa L, Parrón I, Clotet-Sala B, Vallès X, Rodrigo C. Zika virus screening during pregnancy: Results and lessons learned from a screening program and a post-delivery follow-up analysis (2016-2022). Birth Defects Res 2023; 115:1646-1657. [PMID: 37668290 DOI: 10.1002/bdr2.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To evaluate a Zika virus screening program applied to asymptomatic exposed pregnant women. METHODOLOGY Analysis of data generated during the roll out of a Zika screening program. We included socio-demographic data, ultrasounds, and serological results (IgM, IgG, and Plaque Reduction Neutralization Test; PRNT) from asymptomatic pregnant women exposed to Zika virus enrolled in the screening program between 2016 to 2019. RESULTS We included 406 asymptomatic ZIKV-exposed pregnant women who gave 400 full-term new-borns. The median age was 30 years (IQR = 25-34), which was lower (29 years; IQR = 24-34) among women of non-EU migrant origin (76.4% of the sample). Migrant women tended to delay the first pre-natal consultation compared to EU origin women (p = .003). Overall, 83.2% (N = 328) of participants had ZIKV low risk serological profile (IgM-/IgG- or IgM-/IgG+ and PRNT-), 3.0% (N = 12) showed high risk of recent ZIKV infection (IgM+ or PRNT+) and 13.7% (N = 54) had indeterminate results. A fetal malformation was identified in 29 children (9.3%). Fetal malformation was associated with a ZIKV high risk serological profile [24 out of the 246 (1.6%) with low risk profile and 3 out of the 12 with at high risk profile (25.0%; p = .02)]. Four newborns with high risk profile had a positive ZIKV-PCR test, which included two cases with microcephaly. No association was observed between maternal exposure to ZIKV infection and developmental abnormalities during the post-natal period follow-up. CONCLUSIONS The ZIKV-screening program had considerable costs and yielded a high rate of indeterminate results among asymptomatic pregnant women. Considering the poor value for decision-making of the results, efforts should focus on providing early access to routine maternity care, especially to migrant women. A simpler screening protocol might consider an initial ZIKV-PCR or IgM determination and subsequent referral to a fetal medicine specialist in those women with a positive result and/or whom ultrasound examination has revealed fetal abnormalities (10% of total women in our study sample).
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Affiliation(s)
- Andrés Martínez-Arias
- Consorci Corporació Sanitària Parc Taulí, Emergency Service, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain
| | - Lluís Valerio
- Programa de Salut Internacional (PROSICS), Gerència Territorial Metropolitana nord, Institut Català de la Salut
| | - Sílvia Roure-Díez
- Programa de Salut Internacional (PROSICS), Gerència Territorial Metropolitana nord, Institut Català de la Salut
- Infectious Diseases Service, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Gema Fernández-Rivas
- Microbiology Service, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Belén Rivaya
- Microbiology Service, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Maria T Pérez-Olmeda
- Centro Nacional de Microbiología, Unidad de Serología, Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Soldevila-Langa
- Programa de Salut Internacional (PROSICS), Gerència Territorial Metropolitana nord, Institut Català de la Salut
- Infectious Diseases Service, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
| | - Ignasi Parrón
- Barcelonès nord-Maresme Epidemiologic Surveillance and Emergency Response Service, Health Department, Generalitat de Catalunya, Barcelona, Spain
| | - Bonaventura Clotet-Sala
- Infectious Diseases Area Clinical Direction, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
- Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Xavier Vallès
- Programa de Salut Internacional (PROSICS), Gerència Territorial Metropolitana nord, Institut Català de la Salut
- Fundació Lluita contra les Infeccions, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
- Institut per a la Recerca en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Badalona, Catalonia, Spain
| | - Carlos Rodrigo
- Pediatrics Area Clinical Direction, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain
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Sharma E, Tseng PC, Harden A, Li L, Puthussery S. Ethnic minority women's experiences of accessing antenatal care in high income European countries: a systematic review. BMC Health Serv Res 2023; 23:612. [PMID: 37301860 PMCID: PMC10256965 DOI: 10.1186/s12913-023-09536-y] [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: 01/10/2022] [Accepted: 05/10/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Women from ethnic minority backgrounds are at greater risk of adverse maternal outcomes. Antenatal care plays a crucial role in reducing risks of poor outcomes. The aim of this study was to identify, appraise, and synthesise the recent qualitative evidence on ethnic minority women's experiences of accessing antenatal care in high-income European countries, and to develop a novel conceptual framework for access based on women's perspectives. METHODS We conducted a comprehensive search of seven electronic databases in addition to manual searches to identify all qualitative studies published between January 2010 and May 2021. Identified articles were screened in two stages against the inclusion criteria with titles and abstracts screened first followed by full-text screening. Included studies were quality appraised using the Critical Appraisal Skills Programme checklist and extracted data were synthesised using a 'best fit' framework, based on an existing theoretical model of health care access. RESULTS A total of 30 studies were included in this review. Women's experiences covered two overarching themes: 'provision of antenatal care' and 'women's uptake of antenatal care'. The 'provision of antenatal care' theme included five sub-themes: promotion of antenatal care importance, making contact and getting to antenatal care, costs of antenatal care, interactions with antenatal care providers and models of antenatal care provision. The 'women's uptake of antenatal care' theme included seven sub-themes: delaying initiation of antenatal care, seeking antenatal care, help from others in accessing antenatal care, engaging with antenatal care, previous experiences of interacting with maternity services, ability to communicate, and immigration status. A novel conceptual model was developed from these themes. CONCLUSION The findings demonstrated the multifaceted and cyclical nature of initial and ongoing access to antenatal care for ethnic minority women. Structural and organisational factors played a significant role in women's ability to access antenatal care. Participants in majority of the included studies were women newly arrived in the host country, highlighting the need for research to be conducted across different generations of ethnic minority women taking into account the duration of stay in the host country where they accessed antenatal care. PROTOCOL AND REGISTRATION The review protocol was registered on PROSPERO (reference number CRD42021238115).
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Affiliation(s)
- Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square London, EC1V 0HB UK
| | - Leah Li
- Population, Policy and Practice Programme, Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH UK
| | - Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square Rm B201, Luton, Bedfordshire LU1 3JU UK
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Rayment-Jones H, Dalrymple K, Harris JM, Harden A, Parslow E, Georgi T, Sandall J. Project20: maternity care mechanisms that improve access and engagement for women with social risk factors in the UK - a mixed-methods, realist evaluation. BMJ Open 2023; 13:e064291. [PMID: 36750277 PMCID: PMC9906302 DOI: 10.1136/bmjopen-2022-064291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVES To evaluate how women access and engage with different models of maternity care, whether specialist models improve access and engagement for women with social risk factors, and if so, how? DESIGN Realist evaluation. SETTING Two UK maternity service providers. PARTICIPANTS Women accessing maternity services in 2019 (n=1020). METHODS Prospective observational cohort with multinomial regression analysis to compare measures of access and engagement between models and place of antenatal care. Realist informed, longitudinal interviews with women accessing specialist models of care were analysed to identify mechanisms. MAIN OUTCOME MEASURES Measures of access and engagement, healthcare-seeking experiences. RESULTS The number of social risk factors women were experiencing increased with deprivation score, with the most deprived more likely to receive a specialist model that provided continuity of care. Women attending hospital-based antenatal care were more likely to access maternity care late (risk ratio (RR) 2.51, 95% CI 1.33 to 4.70), less likely to have the recommended number of antenatal appointments (RR 0.61, 95% CI 0.38 to 0.99) and more likely to have over 15 appointments (RR 4.90, 95% CI 2.50 to 9.61) compared with community-based care. Women accessing standard care (RR 0.02, 95% CI 0.00 to 0.11) and black women (RR 0.02, 95% CI 0.00 to 0.11) were less likely to have appointments with a known healthcare professional compared with the specialist model. Qualitative data revealed mechanisms for improved access and engagement including self-referral, relational continuity with a small team of midwives, flexibility and situating services within deprived community settings. CONCLUSION Inequalities in access and engagement with maternity care appears to have been mitigated by the community-based specialist model that provided continuity of care. The findings enabled the refinement of a realist programme theory to inform those developing maternity services in line with current policy.
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Affiliation(s)
| | | | - James M Harris
- Women's Health, Chelsea And Westminster NHS Foundation Trust, London, UK
| | - Angela Harden
- Department of Health Services Research and Management, City University of London, London, UK
| | - Elidh Parslow
- Maternity and Women's Health, North Middlesex University Hospital NHS Trust, London, UK
| | - Thomas Georgi
- Department of Women and Children's Health, King's College London, London, UK
| | - Jane Sandall
- Women and Children's Health, King's College London, London, UK
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Farrant K, Faluyi D, Watson K, Vause S, Birds H, Rowbotham S, Heazell AEP. Role of ethnicity in high-level obstetric clinical incidents: a review of cases from a large UK NHS maternity unit. BMJ Open Qual 2022; 11:bmjoq-2022-001862. [DOI: 10.1136/bmjoq-2022-001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
IntroductionWomen from ethnic minority groups are at more risk of adverse outcomes in pregnancy compared with those from white British groups; suboptimal care may contribute to this increased risk. This study aimed to examine serious clinical incidents at two maternity units to explore causative factors for women from ethnic minorities and determine whether these differed from white women.MethodsA retrospective review was conducted of all serious incidents (n=36) occurring in a large National Health Service maternity provider (~14 000 births per annum) between 2018 and 2020. Data were collected from case records for variables which could mediate the association between ethnicity and adverse outcome. The incident reviews were blinded and reviewed by two independent investigators and data regarding root causes and contributory factors were extracted.ResultsFourteen of the 36 incidents (39%) occurred in women from minority ethnic groups, which is comparable to the maternity population. Women involved in serious clinical incidents frequently had pre-existing medical or obstetric complications. Booking after 12 weeks’ gestation occurred more frequently in women from minority ethnic groups than in the background population. There were differences in root causes of serious incidents between groups, a lack of situational awareness was the most frequent cause in white women and staff workload was most frequent in women from minority ethnic groups. Communication issues and detection of deterioration were similar between the two groups.DiscussionAlthough there was no difference in the proportion of serious incidents between the groups, there were differences in medical and pregnancy-related risk factors between groups and in the root causes identified. Efforts are needed to ensure equity of early access to antenatal care and to ensure that there is adequate staffing to ensure that women’s needs are met; this is particularly cogent when there are complex medical or social needs.
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Cosstick E, Nirmal R, Cross-Sudworth F, Knight M, Kenyon S. The role of social risk factors and engagement with maternity services in ethnic disparities in maternal mortality: A retrospective case note review. EClinicalMedicine 2022; 52:101587. [PMID: 35923429 PMCID: PMC9340503 DOI: 10.1016/j.eclinm.2022.101587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Reasons for ethnic disparities in maternal death in the UK are unclear and may be explained by differences in social risk factors and engagement with maternity services. METHODS In this retrospective systematic case note review, we used anonymised medical records from MBRRACE-UK for all Other than White, and White European/Other women plus a random sample of White British/Irish women who died in pregnancy or up to 1 year afterwards from 01/01/2015 to 12/31/2017. We used a standardised data extraction tool developed from a scoping review to explore social risk factors and engagement with maternity services. FINDINGS Of 489 women identified, 219 were eligible for the study and 196 case notes were reviewed, including 103/119 from Other than White groups, 33/37 White European/Other and a random sample of 60/333 White British/Irish. The presence of three or more social risk factors was 11⋅7% (12/103) in Other than White women, 18⋅2% (6/33) for White European/Other women and 36⋅7% (22/60) in White British/Irish women. Across all groups engagement with maternity services was good with 85⋅5% (148/196) receiving the recommended number of antenatal appointments as was completion of antenatal mental health assessment (123/173, 71⋅1%). 15⋅5% (16/103) of Other than White groups had pre-existing co-morbidities and 51⋅1% (47/92) had previous pregnancy problems while women across White ethnic groups had 3⋅2% (3/93) and 33⋅3% (27/81) respectively. Three or more unscheduled healthcare attendances occurred in 60⋅0% (36/60) of White British/Irish, 39⋅4% (13/33) in White European/Other and 35⋅9% (37/103) of Other than White women. Evidence of barriers to following healthcare advice was identified for a fifth of all women. None of the 17 women who required an interpreter received appropriate provision at all key points throughout their maternity care. INTERPRETATION Neither increased social risk factors or barriers to engagement with maternity services appear to underlie disparities in maternal mortality. Management of complex social factors and interpreter services need improvement. FUNDING National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands.
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Affiliation(s)
| | - Rachel Nirmal
- University of Birmingham Medical School, Birmingham B15 2TH, UK
| | - Fiona Cross-Sudworth
- Institute of Applied Healthcare, University of Birmingham, Birmingham B15 2TT, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Sara Kenyon
- Institute of Applied Healthcare, University of Birmingham, Birmingham B15 2TT, UK
- Corresponding author at: Institute of Applied Healthcare, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
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Puthussery S, Tseng PC, Sharma E, Harden A, Griffiths M, Bamfo J, Li L. Disparities in the timing of antenatal care initiation and associated factors in an ethnically dense maternal cohort with high levels of area deprivation. BMC Pregnancy Childbirth 2022; 22:713. [PMID: 36123628 PMCID: PMC9484064 DOI: 10.1186/s12884-022-04984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort. METHODS A retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007-March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13-19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors. RESULTS Overall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke. CONCLUSIONS There is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.
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Affiliation(s)
- Shuby Puthussery
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK.
| | - Pei-Ching Tseng
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Esther Sharma
- Maternal and Child Health Research Centre, Institute for Health Research, University of Bedfordshire, Park Square, Luton, LU1 3JU, Bedfordshire, UK
| | - Angela Harden
- School of Health Sciences, Division of Health Services Research and Management, City, University of London, Northampton Square, EC1V 0HB, London, England
| | - Malcolm Griffiths
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Jacqueline Bamfo
- Department of Obstetrics and Gynaecology, The Luton and Dunstable University Hospital NHS Foundation Trust, Lewsey Rd, Luton, LU4 0DZ, Bedford, UK
| | - Leah Li
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
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Michel M, Alberti C, Carel JC, Chevreul K. Social inequalities in access to care at birth and neonatal mortality: an observational study. Arch Dis Child Fetal Neonatal Ed 2022; 107:380-385. [PMID: 34656994 DOI: 10.1136/archdischild-2021-321967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To look at the association of socioeconomic status (SES) with the suitability of the maternity where children are born and its association with mortality. DESIGN Retrospective analysis of a prospective cohort constituted using hospital discharge databases. SETTING France POPULATION: Live births in 2012-2014 in maternity hospitals in mainland France followed until discharge from the hospital. MAIN OUTCOME MEASURE Unsuitability of the maternity to newborns' needs based on birth weight and gestational age, early transfers (within 24 hours of birth) and in-hospital mortality. RESULTS 2 149 454 births were included, among which 155 646 (7.2%) were preterm. Preterm newborns with low SES were less frequently born in level III maternities than those with high SES. They had higher odds of being born in an unsuitable maternity (OR=1.174, 95% CI 1.114 to 1.238 in the lowest SES quintile compared with the highest), and no increase in the odds of an early transfer (OR=0.966, 95% CI 0.849 to 1.099 in the lowest SES quintile compared with the highest). Overall, newborns from the lowest SES quintile had a 40% increase in their odds of dying compared with the highest (OR=1.399, 95% CI 1.235 to 1.584). CONCLUSIONS Newborns with the lowest SES were less likely to be born in level III maternity hospitals compared with those with the highest SES, despite having higher prematurity rates. This was associated with a significantly higher mortality in newborns with the lowest SES. Strategies must be developed to increase health equity among mothers and newborns.
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Affiliation(s)
- Morgane Michel
- ECEVE, Université de Paris, Paris, France .,URC Eco, Hôtel Dieu / Unité d'épidémiologie clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123, Inserm, Paris, France
| | - Corinne Alberti
- ECEVE, Université de Paris, Paris, France.,Unité d'épidémiologie clinique / Unité de recherche clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123 / CIC-EC 1426, Inserm, Paris, France
| | - Jean-Claude Carel
- Pediatric Endocrinology and Diabetology Department and Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,NeuroDiderot, Inserm, Université de Paris, Paris, France
| | - Karine Chevreul
- ECEVE, Université de Paris, Paris, France.,URC Eco, Hôtel Dieu / Unité d'épidémiologie clinique, Hôpital Robert Debré, Assistance Publique - Hôpitaux de Paris, Paris, France.,UMR 1123, Inserm, Paris, France
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Jardine JE, Frémeaux A, Coe M, Gurol Urganci I, Pasupathy D, Walker K. Validation of ethnicity in administrative hospital data in women giving birth in England: cohort study. BMJ Open 2021; 11:e051977. [PMID: 34426472 PMCID: PMC8383876 DOI: 10.1136/bmjopen-2021-051977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To describe the accuracy of coding of ethnicity in National Health Service (NHS) administrative hospital records compared with self-declared records in maternity booking systems, and to assess the potential impact of misclassification bias. DESIGN Secondary analysis of data from records of women giving birth in England (2015-2017). SETTING NHS Trusts in England participating in a national audit programme. PARTICIPANTS 1 237 213 women who gave birth between 1 April 2015 and 31 March 2017. PRIMARY AND SECONDARY OUTCOME MEASURES: (1) Proportion of women with complete ethnicity; (2) agreement on coded ethnicity between maternity (maternity information systems (MIS)) and administrative hospital (Hospital Episode Statistics (HES)) records; (3) rates of caesarean section and obstetric anal sphincter injury by ethnic group in MIS and HES. RESULTS 91.3% of women had complete information regarding ethnicity in HES. Overall agreement between data sets was 90.4% (κ=0.83); 94.4% when collapsed into aggregate groups of white/South Asian/black/mixed/other (κ=0.86). Most disagreement was seen in women coded as mixed in either data set. Rates of obstetrical events and complications by ethnicity were similar regardless of data set used, with the most differences seen in women coded as mixed. CONCLUSIONS Levels of accuracy in ethnicity coding in administrative hospital records support the use of ethnicity collapsed into groups (white/South Asian/black/mixed/other), but findings for mixed and other groups, and more granular classifications, should be treated with caution. Robustness of results of analyses for associations with ethnicity can be improved by using additional primary data sources.
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Affiliation(s)
- Jennifer Elizabeth Jardine
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
- Clinical Quality, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Alissa Frémeaux
- Clinical Quality, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Megan Coe
- Clinical Quality, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Ipek Gurol Urganci
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
- Clinical Quality, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kate Walker
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
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McDonald H, Moren C, Scarlett J. Health inequalities in timely antenatal care: audit of pre- and post-referral delays in antenatal bookings in London 2015-16. J Public Health (Oxf) 2021; 42:801-815. [PMID: 31976525 DOI: 10.1093/pubmed/fdz184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antenatal booking has potential to reduce infant and maternal health inequalities; yet, those most in need are least likely to access timely care. This audit describes late referral and antenatal booking across London in 2015-16, according to maternal characteristics. METHODS Referral < 8 weeks' gestation, booking < 2 weeks after referral and booking < 10 weeks' gestation were audited against maternal and referral characteristics. RESULTS Of 122 275 antenatal bookings, 27.1% were before 10 weeks' gestation and 72.8% by 12 + 6 weeks. Characteristics associated with late booking were living in more deprived areas, age < 20 years, higher parity, Black or Minority ethnicity (particularly Bangladeshi or Black African), birth in Somalia, Jewish religion, first language other than English, unemployment of self or partner, lack of social support, or single parent families. Women living in more deprived areas, with first language other than English, of Jewish religion, Black and Minority ethnicity or who were unemployed, waited longer from referral to booking, despite later referral. CONCLUSIONS Post-referral delays can compound late referral for some women, exacerbating health inequalities, but should be amenable to provider interventions. Different patterns of pre- and post-referral delay suggest that a tailored approach is needed to address inequalities in access to antenatal care.
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Affiliation(s)
- H McDonald
- Antenatal and Newborn Screening, Public Health Commissioning Department, NHS England (London Region), London SE1 6LH, UK
| | - C Moren
- East London Health & Care Partnership/East London LMS, London E15 1DA, UK
| | - J Scarlett
- Antenatal and Newborn Screening, Public Health Commissioning Department, NHS England (London Region), London SE1 6LH, UK
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Hu W, Hu H, Zhao W, Huang A, Yang Q, Di J. Current status of antenatal care of pregnant women-8 provinces in China, 2018. BMC Public Health 2021; 21:1135. [PMID: 34120600 PMCID: PMC8201670 DOI: 10.1186/s12889-021-11154-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal care (ANC) played a crucial role in ensuring maternal and child safety and reducing the risk of complications, disability, and death in mothers and their infants. The objective of this study was to evaluate the current status of ANC emphasizing the number, timing, and content of examinations on a national scale. METHODS The data was collected from maternal and newborn's health monitoring system at 8 provinces in China. After ethical approval, all pregnant women registered in the system at their first prenatal care visit, we included 49,084 pregnant women who had delivered between January 1, 2018 and December 31, 2018. Descriptive statistics of all study variables were calculated proportions and chi-square for categorical variables. RESULTS Of the 49,084 women included in this study, the mean number of ANC visits was 6.95 ± 3.45. By percentage, 78.79% women received ANC examinations at least five times, 39.93% of the women received ANC examinations at least eight times and 16.66% of the women received ANC examinations at least 11 times. The proportion of first ANC examination in first trimester was 61.87%. The percentage of normative ANC examinations and the percentage of qualified ANC examinations were 30.98 and 8.03% respectively. Only 49.40% of the total women received all six kinds of examination items in first ANC examination: 91.47% received a blood test, 91.62% received a urine test, 81.56% received a liver function examination, 80.52% received a renal function examination, 79.07% received a blood glucose test, and 86.66% received a HIV/HBV/syphilis tests. 50.85% women received the first ANC examination in maternal and child health care (MCH) institutions, 14.07% in a general hospital, 18.83% in a township hospital, 13.15% in a community health services center, and 3.08% in an unspecified place. The proportion of women who received each of the ANC examination items in community health services center was the highest, but that in the MCH institutions was the lowest. CONCLUSIONS There is a big difference between the results of this study and the data in official reports, this study found the current status of antenatal care is not optimal in China, findings from this study suggest that the systematization, continuity and quality of ANC examinations need to be improved.
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Affiliation(s)
- Wenling Hu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Huanqing Hu
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Wei Zhao
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Aiqun Huang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Qi Yang
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No.12, Dahuisi Road, Beijing, 100081, China.
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Nellums LB, Powis J, Jones L, Miller A, Rustage K, Russell N, Friedland JS, Hargreaves S. "It's a life you're playing with": A qualitative study on experiences of NHS maternity services among undocumented migrant women in England. Soc Sci Med 2021; 270:113610. [PMID: 33383485 PMCID: PMC7895812 DOI: 10.1016/j.socscimed.2020.113610] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Undocumented migrant women experience complex barriers to maternity services, are less likely to receive the recommended level of maternity care, and have poorer obstetric outcomes than non-migrant women. There are concerns increasing restrictions on entitlement to health services have a detrimental impact on access to services and obstetric outcomes, particularly among undocumented migrant women. The study aimed to investigate the experiences of undocumented migrant women who have been pregnant in England, and factors affecting access to care and health outcomes. METHODS We conducted in-depth semi-structured interviews June-December 2017 with a purposive sample of migrant women born outside the UK (aged>18) who had experiences of pregnancy and undocumented status (without permission to reside) in the UK, recruited through Doctors of the World (DOTW) UK. Interpreting services were used on request. Interviews were recorded, transcribed, and analysed using thematic analysis. Ethical approval: Imperial College London Research Ethics Committee (ICREC reference: 17IC3924). RESULTS Semi-structured interviews were conducted with 20 participants, 10 of whom had their first antenatal appointment after the national target of 13 weeks, and nine of whom reported complications. Themes defining women's experiences of pregnancy included: restricted agency, intersecting stressors, and an ongoing cycle of precarity, defined by legal status, social isolation, and economic status. CONCLUSIONS This study provides new evidence of women's experiences of pregnancy in the UK in the context of increasingly restrictive health policies including charging and data sharing. Six recommendations are made to ensure the UK and other migrant receiving countries work towards reducing inequalities and achieving national and global targets for maternal and child health and universal health coverage.
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Affiliation(s)
- Laura B Nellums
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Clinical Sciences Building, Hucknall Road, NG5 1PB, UK; Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, SW17 0RE, UK.
| | - Jaynaide Powis
- Infectious Diseases & Immunity, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 ONN, UK
| | - Lucy Jones
- Doctors of the World UK (Médecins du Monde), 29th Floor, One Canada Square, London, E14 5AA, UK
| | - Anna Miller
- Doctors of the World UK (Médecins du Monde), 29th Floor, One Canada Square, London, E14 5AA, UK
| | - Kieran Rustage
- Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, SW17 0RE, UK
| | - Neal Russell
- Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, SW17 0RE, UK
| | - Jon S Friedland
- Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, SW17 0RE, UK
| | - Sally Hargreaves
- Institute for Infection and Immunity, St. George's, University of London, Cranmer Terrace, SW17 0RE, UK.
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12
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B, Salt K. Access to and interventions to improve maternity care services for immigrant women: a narrative synthesis systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
In 2016, over one-quarter of births in the UK (28.2%) were to foreign-born women. Maternal and perinatal mortality are disproportionately higher among some immigrants depending on country of origin, indicating the presence of deficits in their care pathways and birth outcomes.
Objectives
Our objective was to undertake a systematic review and narrative synthesis of empirical research that focused on access and interventions to improve maternity care for immigrant women, including qualitative, quantitative and mixed-methods studies.
Review methods
An information scientist designed the literature database search strategies (limited to retrieve literature published from 1990 to 2018). All retrieved citations (45,954) were independently screened by two or more team members using a screening tool. We searched grey literature reported in related databases and websites. We contacted stakeholders with subject expertise. In this review we define an immigrant as a person who relocates to the destination country for a minimum of 1 year, with the goal of permanent residence.
Results
We identified 40 studies for inclusion. Immigrant women tended to book and access antenatal care later than the recommended first 10 weeks of pregnancy. Primary factors included limited English-language skills, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Immigrant women had mixed perceptions regarding how health-care professionals (HCPs) had delivered maternity care services. Those with positive perceptions felt that HCPs were caring, confidential and openly communicative. Those with negative views perceived HCPs as rude, discriminatory or insensitive to their cultural and social needs; these women therefore avoided accessing maternity care. We found very few interventions that had focused on improving maternity care for these women and the effectiveness of these interventions has not been rigorously evaluated.
Limitations
Our review findings are limited by the available research evidence related to our review questions. There may be many aspects of immigrant women’s experiences that we have not addressed. For example, few studies exist for perinatal mental health in immigrant women from Eastern European countries (in the review period). Many studies included both immigrant and non-immigrant women.
Conclusions
Available evidence suggests that the experiences of immigrant women in accessing and using maternity care services in the UK are mixed; however, women largely had poor experiences. Contributing factors included a lack of language support, cultural insensitivity, discrimination and poor relationships between immigrant women and HCPs. Furthermore, a lack of knowledge of legal entitlements and guidelines on the provision of welfare support and maternity care to immigrants compounds this.
Future work
Studies are required on the development of interventions and rigorous scientific evaluation of these interventions. Development and evaluation of online antenatal education resources in multiple languages. Development and appraisal of education packages for HCPs focused on the provision of culturally safe practice for the UK’s diverse population. The NHS in the UK has a hugely diverse workforce with a vast untapped linguistic resource; strategies could be developed to harness this resource.
Study registration
This study is registered as PROSPERO CRD42015023605.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gina MA Higginbottom
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | | | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Karen Salt
- Faculty of Medicine and Health Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
- Centre for Research into Race and Rights, University of Nottingham, Nottingham, UK
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13
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Higginbottom GMA, Evans C, Morgan M, Bharj KK, Eldridge J, Hussain B. Experience of and access to maternity care in the UK by immigrant women: a narrative synthesis systematic review. BMJ Open 2019; 9:e029478. [PMID: 31892643 PMCID: PMC6955508 DOI: 10.1136/bmjopen-2019-029478] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED One in four births in the UK is to foreign-born women. In 2016, the figure was 28.2%, the highest figure on record, with maternal and perinatal mortality also disproportionately higher for some immigrant women. Our objective was to examine issues of access and experience of maternity care by immigrant women based on a systematic review and narrative synthesis of empirical research. REVIEW METHODS A research librarian designed the search strategies (retrieving literature published from 1990 to end June 2017). We retrieved 45 954 citations and used a screening tool to identify relevance. We searched for grey literature reported in databases/websites. We contacted stakeholders with expertise to identify additional research. RESULTS We identified 40 studies for inclusion: 22 qualitative, 8 quantitative and 10 mixed methods. Immigrant women, particularly asylum-seekers, often booked and accessed antenatal care later than the recommended first 10 weeks. Primary factors included limited English language proficiency, lack of awareness of availability of the services, lack of understanding of the purpose of antenatal appointments, immigration status and income barriers. Maternity care experiences were both positive and negative. Women with positive perceptions described healthcare professionals as caring, confidential and openly communicative in meeting their medical, emotional, psychological and social needs. Those with negative views perceived health professionals as rude, discriminatory and insensitive to their cultural and social needs. These women therefore avoided continuously utilising maternity care.We found few interventions focused on improving maternity care, and the effectiveness of existing interventions have not been scientifically evaluated. CONCLUSIONS The experiences of immigrant women in accessing and using maternity care services were both positive and negative. Further education and training of health professionals in meeting the challenges of a super-diverse population may enhance quality of care, and the perceptions and experiences of maternity care by immigrant women.
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Affiliation(s)
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Myfanwy Morgan
- Institute of Pharmaceutical Sciences, King's College London, London, UK
| | | | - Jeanette Eldridge
- Research and Learning Services, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Basharat Hussain
- School of Health Sciences, University of Nottingham, Nottingham, UK
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14
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McAuslane H, Utsi L, Wensley A, Coole L. Inequalities in maternal pertussis vaccination uptake: a cross-sectional survey of maternity units. J Public Health (Oxf) 2019; 40:121-128. [PMID: 28369548 DOI: 10.1093/pubmed/fdx032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 03/07/2017] [Indexed: 11/12/2022] Open
Abstract
Background This study aims to estimate pertussis vaccine uptake in pregnant women in England, describe timing of vaccine delivery and examine variations in uptake. Methods Cross-sectional survey of vaccine uptake in women delivering in maternity units in England. Variation in uptake described according to geography, maternal age, ethnicity and parity as reported by the midwife completing the survey. Results A total of 1325 surveys were returned, 85% of which (1128) contained information about vaccination. Vaccine uptake was 61.8% (95% CI: 56.8-66.5) and was higher in the White British ethnic group than any other (67.7%, 95% CI: 63.5 to 71.5). Uptake was higher outside London (65.3%, 95% CI: 61.1-69.3) than within London (31.0%, 95% CI: 24.9-38.0). Reported uptake was lower in areas of high deprivation, and in women of higher parity, observations that were not statistically significant in the multivariable model. Overall, 74% of women were vaccinated between 28 and 32 weeks. Conclusions Pertussis vaccine uptake in pregnant women varies significantly across the country and is affected by ethnicity, deprivation and parity. Variations should be addressed through service delivery models designed to reduce potential inequalities in infant protection.
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Affiliation(s)
- H McAuslane
- Yorkshire and the Humber Health Protection Team, Public Health England, Blenheim House, West One, Duncombe St, Leeds LS1 4PL, UK
| | - L Utsi
- Field Epidemiology Service, Public Health England, Blenheim House, West One, Duncombe St, Leeds LS1 4PL, UK
| | - A Wensley
- Field Epidemiology Service, Public Health England, Blenheim House, West One, Duncombe St, Leeds LS1 4PL, UK
| | - L Coole
- Field Epidemiology Service, Public Health England, Blenheim House, West One, Duncombe St, Leeds LS1 4PL, UK
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15
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Skin Color and Severe Maternal Outcomes: Evidence from the Brazilian Network for Surveillance of Severe Maternal Morbidity. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2594343. [PMID: 31467877 PMCID: PMC6699272 DOI: 10.1155/2019/2594343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/28/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022]
Abstract
Background Taking into account the probable role that race/skin color may have for determining outcomes in maternal health, the objective of this study was to assess whether maternal race/skin color is a predictor of severe maternal morbidity. Methods This is a secondary analysis of the Brazilian Network for Surveillance of Severe Maternal Morbidity, a national multicenter cross-sectional study of 27 Brazilian referral maternity hospitals. A prospective surveillance was performed to identify cases of maternal death (MD), maternal near miss (MNM) events, and potentially life-threatening conditions (PLTC), according to standard WHO definition and criteria. Among 9,555 women with severe maternal morbidity, data on race/skin color was available for 7,139 women, who were further divided into two groups: 4,108 nonwhite women (2,253 black and 1,855 from other races/skin color) and 3,031 white women. Indicators of severe maternal morbidity according to WHO definition are shown by skin color group. Adjusted Prevalence Ratios (PRadj - 95%CI) for Severe Maternal Outcome (SMO=MNM+MD) were estimated according to sociodemographic/obstetric characteristics, pregnancy outcomes, and perinatal results considering race. Results Among 7,139 women with severe maternal morbidity evaluated, 90.5% were classified as PLTC, 8.5% as MNM, and 1.6% as MD. There was a significantly higher prevalence of MNM and MD among white women. MNMR (maternal near miss ratio) was 9.37 per thousand live births (LB). SMOR (severe maternal outcome ratio) was 11.08 per 1000 LB, and MMR (maternal mortality ratio) was 170.4 per 100,000 LB. Maternal mortality to maternal near miss ratio was 1 to 5.2, irrespective of maternal skin color. Hypertension, the main cause of maternal complications, affected mostly nonwhite women. Hemorrhage, the second more common cause of maternal complication, predominated among white women. Nonwhite skin color was associated with a reduced risk of SMO in multivariate analysis. Conclusion Nonwhite skin color was associated with a lower risk for severe maternal outcomes. This result could be due to confounding factors linked to a high rate of Brazilian miscegenation.
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16
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Lee IL, Purbrick B, Barzi F, Brown A, Connors C, Whitbread C, Moore E, Kirkwood M, Simmonds A, van Dokkum P, Death E, Svenson S, Graham S, Hampton V, Kelaart J, Longmore D, Titmuss A, Boyle J, Brimblecombe J, Saffery R, D'Aprano A, Skilton MR, Ward LC, Corpus S, Chitturi S, Thomas S, Eades S, Inglis C, Dempsey K, Dowden M, Lynch M, Oats J, McIntyre HD, Zimmet P, O'Dea K, Shaw JE, Maple-Brown LJ. Cohort Profile: The Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) Study. Int J Epidemiol 2019; 47:1045-1046h. [PMID: 29618003 DOI: 10.1093/ije/dyy046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- I-Lynn Lee
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Brydie Purbrick
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Federica Barzi
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
| | | | - Cherie Whitbread
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Elizabeth Moore
- Public Health Unit, Aboriginal Medical Services Alliance of Northern Territory, Darwin, NT, Australia
| | - Marie Kirkwood
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Alison Simmonds
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Paula van Dokkum
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Elizabeth Death
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Stacey Svenson
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Sian Graham
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Vanya Hampton
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Joanna Kelaart
- Aboriginal Health Domain, Baker Heart and Diabetes Institute, Alice Springs, NT, Australia
| | - Danielle Longmore
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Angela Titmuss
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Jacqueline Boyle
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Richard Saffery
- Cancer and Disease Epigenetics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Anita D'Aprano
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, VIC, Australia
| | - Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, QLD, Australia
| | - Sumaria Corpus
- Clinical Services, Danila Dilba Health Service, Darwin, NT, Australia
| | - Shridhar Chitturi
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sujatha Thomas
- Department of Obstetrics and Gynaecology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Sandra Eades
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Karen Dempsey
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia
| | | | - Michael Lynch
- Pathology Network, Top End Health and Hospital Services, Darwin, NT, Australia
| | - Jeremy Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Harold D McIntyre
- Faculty of Medicine, Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Paul Zimmet
- Monash University, Medicine, Nursing and Health Sciences, Melbourne, VIC, Australia
| | - Kerin O'Dea
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Sansom Institute of Health Research, University of South Australia, Adelaide, SA, Australia
| | - Jonathan E Shaw
- Clinical and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Louise J Maple-Brown
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.,Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
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17
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Chinouya MJ, Madziva C. Late booking amongst African women in a London borough, England: implications for health promotion. Health Promot Int 2019; 34:123-132. [PMID: 29040505 DOI: 10.1093/heapro/dax069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The National Institute for Health and Clinical Excellence guidance is that a pregnant woman should see a midwife within the first 13 weeks into her pregnancy, in what is known as the 'booking appointment' or the 'full assessment' where she discusses with the midwife her care plan, medical and family histories and social circumstances. Significant numbers of black African women present after 13 weeks into the pregnancy. This study explores why black African women access the booking appointment after 13 weeks of pregnancy in a London borough. The study took a qualitative approach and used semi-structured interviews with 23 women who self-identified as black African migrants born in a sub-Saharan African country, and had experience of using ante-natal services in the borough. Participants discussed how their cultural understandings of pregnancy influenced timing of the booking appointment. The data was analysed using the thematic approach. Cultural, economic and political contexts within which they experienced pregnancy influenced the timing. Whilst acknowledging the benefits of early booking, this was said to be at odds with their cultural beliefs where pregnancy disclosure within 13 weeks was considered inappropriate. Lack of information about the booking appointment and unresolved immigration issues led to perceptions that they were being brought under the Immigration Department's radar through the booking appointment. Whilst most health promotion information regarding the booking appointment is designed in a top-down fashion, health planners should also recognize ethnic diversities so as to market the booking appointment using downstream approaches that take account of the cultural, political and economic contexts in which migrants/ethnic minority populations live.
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Affiliation(s)
- Martha J Chinouya
- Department of Public Health and Policy, The University of Liverpool, London Campus, Finsbury Square, London, UK
| | - Cathrine Madziva
- Department of Health, Faculty of Social Sciences & Humanities, London Metropolitan University, 166-220 Holloway Road, London, UK
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18
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Wang Y, Honeyford K, Aylin P, Bottle A, Giuliani S. One-year outcomes for congenital diaphragmatic hernia. BJS Open 2019; 3:305-313. [PMID: 31183446 PMCID: PMC6551417 DOI: 10.1002/bjs5.50135] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/27/2018] [Indexed: 11/20/2022] Open
Abstract
Background Congenital diaphragmatic hernia (CDH) is a congenital anomaly with high mortality and long‐term morbidity. The aim of this study was to benchmark trends in 1‐year and hospital volume outcomes for this condition. Methods This study included all infants born with CDH in England between 2003 and 2016. This was a retrospective analysis of the Hospital Episode Statistics database. The main outcomes were: 1‐year mortality, neonatal length of hospital stay (nLOS), total bed‐days at 1 year and readmission rate. The association between hospital volume and outcomes was assessed for specialist paediatric surgery centres. Results A total of 2336 infants were included (incidence 2·5 per 10 000 live births). No significant time trends were found in incidence and main outcomes. Some 1491 infants (63·8 per cent) underwent surgical repair. The 1‐year mortality rate was 31·2 per cent. Median nLOS and total bed‐days were 17 and 19 days respectively. The readmission rate in specialist paediatric centres was 6·3 per cent. Higher mortality was associated with birthweight lower than 1 kg (OR 5·90, 95 per cent c.i. 1·03 to 33·75), gestational age of 36 weeks or less (OR 1·75, 1·12 to 2·75) and black ethnicity (OR 2·13, 1·03 to 4·48). Only 4·0 per cent had extracorporeal membrane oxygenation, which was associated with higher mortality (OR 5·34, 3·01 to 9·46), longer nLOS (OR 3·70, 2·14 to 6·14) and longer total bed‐days (OR 3·87, 2·19 to 6·83). Specialist paediatric centres showed variation in 30‐day mortality (4·6 per cent with 84 per cent coefficient of variation), nLOS (median 25 (i.q.r. 15–42) days) and total bed‐days (median 28 (i.q.r. 16–51) days), but no significant volume–outcome relationship. Conclusion Key outcomes for CDH were similar to those of other developed countries. High variation among specialist paediatric centres was found and should be investigated further to explore the value of regionalization of care.
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Affiliation(s)
- Y Wang
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - K Honeyford
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - P Aylin
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - A Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London London UK
| | - S Giuliani
- Department of Specialist Neonatal and Paediatric Surgery Great Ormond Street Hospital for Children NHS Foundation Trust London UK
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19
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Heaman MI, Martens PJ, Brownell MD, Chartier MJ, Thiessen KR, Derksen SA, Helewa ME. Inequities in utilization of prenatal care: a population-based study in the Canadian province of Manitoba. BMC Pregnancy Childbirth 2018; 18:430. [PMID: 30382911 PMCID: PMC6211437 DOI: 10.1186/s12884-018-2061-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/16/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ensuring high quality and equitable maternity services is important to promote positive pregnancy outcomes. Despite a universal health care system, previous research shows neighborhood-level inequities in utilization of prenatal care in Manitoba, Canada. The purpose of this population-based retrospective cohort study was to describe prenatal care utilization among women giving birth in Manitoba, and to determine individual-level factors associated with inadequate prenatal care. METHODS We studied women giving birth in Manitoba from 2004/05-2008/09 using data from a repository of de-identified administrative databases at the Manitoba Centre for Health Policy. The proportion of women receiving inadequate prenatal care was calculated using a utilization index. Multivariable logistic regressions were used to identify factors associated with inadequate prenatal care for the population, and for a subset with more detailed risk information. RESULTS Overall, 11.5% of women in Manitoba received inadequate, 51.0% intermediate, 33.3% adequate, and 4.1% intensive prenatal care (N = 68,132). Factors associated with inadequate prenatal care in the population-based model (N = 64,166) included northern or rural residence, young maternal age (at current and first birth), lone parent, parity 4 or more, short inter-pregnancy interval, receiving income assistance, and living in a low-income neighborhood. Medical conditions such as multiple birth, hypertensive disorders, antepartum hemorrhage, diabetes, and prenatal psychological distress were associated with lower odds of inadequate prenatal care. In the subset model (N = 55,048), the previous factors remained significant, with additional factors being maternal education less than high school, social isolation, and prenatal smoking, alcohol, and/or illicit drug use. CONCLUSION The rate of inadequate prenatal care in Manitoba ranged from 10.5-12.5%, and increased significantly over the study period. Factors associated with inadequate prenatal care included geographic, demographic, socioeconomic, and pregnancy-related factors. Rates of inadequate prenatal care varied across geographic regions, indicating persistent inequities in use of prenatal care. Inadequate prenatal care was associated with several individual indicators of social disadvantage, such as low income, education less than high school, and social isolation. These findings can inform policy makers and program planners about regions and populations most at-risk for inadequate prenatal care and assist with development of initiatives to reduce inequities in utilization of prenatal care.
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Affiliation(s)
- Maureen I. Heaman
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Patricia J. Martens
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Marni D. Brownell
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Mariette J. Chartier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Kellie R. Thiessen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Shelley A. Derksen
- Manitoba Centre for Health Policy, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 Canada
| | - Michael E. Helewa
- Department of Obstetrics, Gynecology and Reproductive Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, WR120-735 Notre Dame Avenue, Winnipeg, MB R3E 0L8 Canada
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Zong Z, Huang J, Sun X, Mao J, Shu X, Hearst N. Prenatal care among rural to urban migrant women in China. BMC Pregnancy Childbirth 2018; 18:301. [PMID: 30005631 PMCID: PMC6044009 DOI: 10.1186/s12884-018-1934-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a very large population of internal migrants in China, and the majority of migrant women are of childbearing age. Little is known about their utilization of prenatal care and factors that influence this. We examined this using data from a large national survey of migrants. METHODS 5372 married rural to urban migrant women aged 20-34 who were included in the 2014 National Dynamic Monitoring Survey on Migrants and who delivered a baby within the previous two years were studied. We examined demographic and migration experience predictors of prenatal care in the first trimester and of adequate prenatal visits. RESULTS 12.6% of migrant women reported no examination in the first trimester and 27.6% had less than 5 prenatal visits during their latest pregnancy. Multivariate analysis indicated that demographic predictors of delayed and inadequate care included lower educational level, lower income and not having childbearing insurance. Migrating before pregnancy, longer time since migration, having migrated a greater distance, and not returning to their home town for delivery were correlated with better prenatal care. CONCLUSIONS Many internal migrant women in China do not receive adequate prenatal care. While internal migration before pregnancy seems to promote adequate prenatal care, it also creates barriers to receiving care. Strategies to improve prenatal care utilization include expanding access to childbearing insurance and timely education for women before and after they migrate.
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Affiliation(s)
- Zhanhong Zong
- School of Public Administration, Hohai University, Nanjing, China
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jianyuan Huang
- School of Public Administration, Hohai University, Nanjing, China
| | - Xiaoming Sun
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Jingshu Mao
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Xingyu Shu
- School of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Norman Hearst
- Department of Family and Community Medicine, University of California, San Francisco, CA USA
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Anjos JCD, Boing AF. Regional differences and factors associated with the number of prenatal visits in Brazil: analysis of the Information System on Live Births in 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 19:835-850. [PMID: 28146172 DOI: 10.1590/1980-5497201600040013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/31/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: To investigate factors associated with seven or more prenatal visits, in Brazil, in 2013. Methods: Cross-sectional study from the database of Information System on Live Births. The association of explanatory variables was tested with prenatal visits by means of the analysis of single and multiple multinomial regressions. The spatial distribution of prenatal visits according to the Brazilian municipalities was also analyzed. Results: It was found that 2.7% of pregnant women attended no prenatal visit and 63.1% attended 7 or more. The chance to attend 7 or more prenatal visits was higher among pregnant women aged 40 years or more, with 12 years or more of schooling, living with a roommate, living in the South and Southeast regions, who had a triplet or more pregnancy, with gestational age of 42 weeks or more, and who had children with normal birth weight. Significant regional disparities were identified in the prevalence of women with seven or more prenatal visits. Conclusion: Although Brazil has a Unified Health System that provides universal prenatal care, the use of this service is uneven according to geographic, demographic, and socioeconomic characteristics.
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Affiliation(s)
- Juliana Cristine Dos Anjos
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
| | - Antonio Fernando Boing
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal de Santa Catarina - Florianópolis (SC), Brasil
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Amo-Adjei J, Aduo-Adjei K, Opoku-Nyamah C, Izugbara C. Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs). PLoS One 2018; 13:e0192513. [PMID: 29474362 PMCID: PMC5825027 DOI: 10.1371/journal.pone.0192513] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 01/24/2018] [Indexed: 12/02/2022] Open
Abstract
The desired results of increasing access and availability of antenatal care (ANC) services may not be realized if the quality of care offered is not adequate. We analyzed the content/quality of antenatal care to determine whether there are socioeconomic (education and wealth) inequalities in the services provided in 59 low and middle income countries in six WHO regions–Africa, East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and South Asia. We aggregated the most recent (2005–2015) Demographic and Health Survey for each country. The quality of content was measured on eight recommended ANC services–(1) monitoring of blood pressure; (2) tetanus injection; (3) urine analysis for protein; (4) blood test; (5) information about danger signs (6); weight (7); height measurements and (8) provision of iron-folate supplement. Descriptive and Poisson regression techniques were applied to analyse the data. We found considerable wealth and educational differences prior to controlling for known covariates. Between wealth and education, however, the disparities in the latter are larger than the former. Whereas the socioeconomic differences remained at post adjusting for residence, place and number of antenatal care, parity and region, the magnitude of change was minimal. Higher number of ANC content was provided in “other” forms of private facilities; the Latin America and Caribbean region recorded the highest number of content compared to the other regions. The hypothesized socioeconomic status on content/number of ANC services was generally supported, although the associations are substantially constrained to other variables. Efforts are made to increase the number and timing of ANC services; due recognition is needed for the content offered.
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Affiliation(s)
- Joshua Amo-Adjei
- African Population and Health Research Centre, Nairobi, Kenya
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Kofi Aduo-Adjei
- Institute of Demography, National Research University Higher School of Economics, Moscow, Russia
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Barber C, Rankin J, Heslehurst N. Maternal body mass index and access to antenatal care: a retrospective analysis of 619,502 births in England. BMC Pregnancy Childbirth 2017; 17:290. [PMID: 28877677 PMCID: PMC5588551 DOI: 10.1186/s12884-017-1475-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/28/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Late access to antenatal care increases risks of adverse outcomes including maternal and perinatal mortality. There is evidence that BMI influences patient engagement with health services, such as cancer screening services and delayed access to treatment; this association has not been fully explored in the context of antenatal care. This study investigated the association between the stage of pregnancy women access antenatal care, BMI, and other socio-demographic factors. METHODS Retrospective analysis of routine hospital data from 34 NHS maternity units in England, UK, including 619,502 singleton births between 1989 and 2007. Analyses used logistic regression to investigate the association between maternal BMI categories and stage of pregnancy women accessed antenatal care. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were used to estimate associations, adjusting for maternal age, ethnic group, parity, Index of Multiple Deprivation score and employment status. The primary outcome was late access to antenatal care (>13+6 weeks). Secondary outcomes were trimester of access, and the association between late access and other socio-demographic variables. RESULTS Women with an overweight or obese BMI accessed antenatal care later than women with a recommended BMI (aOR 1.11, 95%CI 1.09-1.12; aOR 1.04, 95%CI 1.02-1.06 respectively), and underweight women accessed care earlier (aOR 0.77, 95%CI 0.74-0.81). Women with obesity were 42% more likely to access care in the third trimester compared with women with a recommended BMI. Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation. The greatest association was observed among Black/Black British women accessing care in the third trimester (aOR 5.07, 95% CI 4.76, 5.40). CONCLUSIONS There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women. These populations are at increased risk of adverse maternal and fetal outcomes and require support to address inequalities in access to antenatal care. Interventions to facilitate earlier access to care should address the complex and inter-related nature of these inequalities to improve pregnancy outcomes among high-risk groups.
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Affiliation(s)
- Charlotte Barber
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
| | - Nicola Heslehurst
- Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX UK
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French CE, Thorne C, Byrne L, Cortina‐Borja M, Tookey PA. Presentation for care and antenatal management of HIV in the UK, 2009-2014. HIV Med 2017; 18:161-170. [PMID: 27476457 PMCID: PMC5298001 DOI: 10.1111/hiv.12410] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Despite very low rates of vertical transmission of HIV in the UK overall, rates are higher among women starting antenatal antiretroviral therapy (ART) late. We investigated the timing of key elements of the care of HIV-positive pregnant women [antenatal care booking, HIV laboratory assessment (CD4 count and HIV viral load) and antenatal ART initiation], to assess whether clinical practice is changing in line with recommendations, and to investigate factors associated with delayed care. METHODS We used the UK's National Study of HIV in Pregnancy and Childhood for 2009-2014. Data were analysed by fitting logistic regression and Cox proportional hazards models. RESULTS A total of 5693 births were reported; 79.5% were in women diagnosed with HIV prior to that pregnancy. Median gestation at antenatal booking was 12.1 weeks [interquartile range (IQR) 10.0-15.6 weeks] and booking was significantly earlier during 2012-2014 vs. 2009-2011 (P < 0.001), although only in previously diagnosed women. Overall, 42.2% of pregnancies were booked late (≥ 13 gestational weeks). Among women not already on treatment, antenatal ART commenced at a median of 21.4 (IQR18.1-24.5) weeks and started significantly earlier in the most recent time period (P < 0.001). Compared with previously diagnosed women, those newly diagnosed during the current pregnancy booked later for antenatal care and started antenatal ART later (both P < 0.001). Multivariable analyses revealed demographic variations in access to or uptake of care, with groups including migrants and parous women initiating care later. CONCLUSIONS Although women are accessing antenatal and HIV care earlier in pregnancy, some continue to face barriers to timely initiation of antenatal care and ART.
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Affiliation(s)
- CE French
- Population, Policy and Practice ProgrammeUCL Institute of Child HealthUniversity College LondonLondonUK
| | - C Thorne
- Population, Policy and Practice ProgrammeUCL Institute of Child HealthUniversity College LondonLondonUK
| | - L Byrne
- Population, Policy and Practice ProgrammeUCL Institute of Child HealthUniversity College LondonLondonUK
| | - M Cortina‐Borja
- Population, Policy and Practice ProgrammeUCL Institute of Child HealthUniversity College LondonLondonUK
| | - PA Tookey
- Population, Policy and Practice ProgrammeUCL Institute of Child HealthUniversity College LondonLondonUK
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Sinyange N, Sitali L, Jacobs C, Musonda P, Michelo C. Factors associated with late antenatal care booking: population based observations from the 2007 Zambia demographic and health survey. Pan Afr Med J 2016; 25:109. [PMID: 28292072 PMCID: PMC5325499 DOI: 10.11604/pamj.2016.25.109.6873] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 10/18/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In spite of the extreme importance of an early antenatal care visit, more than 50% of Zambian pregnant women book for antenatal care late. We aimed to determine factors associated with late antenatal care booking in Zambia. METHODS Data stem from the 2007 Zambia Demographic and Health Survey where information on socio-demographic, social-economic, obstetrical characteristics and timing of the first antenatal visit were extracted on all women aged 15 to 49 years. A weighted survey analysis using STATA version 12 was applied. Firstly, we explored proportions of ANC booking at 0-3 months, 4-5 month and 6-9 months. Secondly, we investigated the association between predictor variables and late antenatal care booking using univariate and multivariate logistic regression. RESULTS Overall (n= 3979), the proportion of late ANC booking (booking between 4th to 9th month) was 81% disaggregated as 56% and 19% at 4 to 5 months and 6 to 9 months respectively. Women who wanted their last child later were more likely to book late than those with wanted pregnancies then (AOR: 1.35 95% CI 1.10-1.66). Women with higher education were 55% less likely to book for ANC late compared to women with no education (AOR: 0.45 95%CI: 0.27-0.74). Women aged 20-34 years were 30% more likely to book earlier than women younger than 20 years (AOR: 0.69 95% CI 0.50-0.97). CONCLUSION We found high proportion of late ANC booking associated with presence of unplanned or unwanted pregnancies in this population. The concentration of this problem in lower or no education groups may be an illustration of existing inequalities which might further explain limitations in health promotion messages meant to mitigate this challenge. There is thus urgent need to re-pack health promotion message to specifically target this and related poor groups.
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Affiliation(s)
- Nyambe Sinyange
- School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia; Ministry of Health, Republic of Zambia
| | - Lungowe Sitali
- School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Patrick Musonda
- School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
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Differences in timely antenatal care between first and second-generation migrants in the Netherlands. J Immigr Minor Health 2016; 16:631-7. [PMID: 23702785 DOI: 10.1007/s10903-013-9841-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To assess whether there are differences in the timing of first antenatal care visit between 1st and 2nd-generation migrants, and if so, how such differences could be explained. The study has been conducted in the framework of Generation R Study, a multi-ethnic population-based study conducted in Rotterdam, the Netherlands. The study population consists of 845 women of the six largest ethnic groups. Data were derived from the electronic antenatal charts of the participating midwives and from written questionnaires. Logistic regression analyses have been carried out to investigate whether difference could be explained by need, predisposing and enabling factors. More first than second generation women enter antenatal care after 14 weeks of pregnancy (28.1 vs. 18.7 %). Women who were not likely to adopt healthy behaviour regarding pregnancy--such as timely taking folic acid--equally were not inclined to enter antenatal care early in pregnancy. The role of Dutch language mastery was limited. Given our results, first generation women are less likely to receive timely health educational advice or to benefit from screening opportunities than second generation women. Future studies should pay more attention to adequate assessment of proficiency of the host language.
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Individual and Area Level Factors Associated with Prenatal, Delivery, and Postnatal Care in Pakistan. Matern Child Health J 2016; 19:2138-46. [PMID: 25874879 DOI: 10.1007/s10995-015-1726-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57 % had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U.N.'s Millennium Development Goal 5.
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Hatherall B, Morris J, Jamal F, Sweeney L, Wiggins M, Kaur I, Renton A, Harden A. Timing of the initiation of antenatal care: An exploratory qualitative study of women and service providers in East London. Midwifery 2016; 36:1-7. [PMID: 27106937 PMCID: PMC4853798 DOI: 10.1016/j.midw.2016.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/15/2016] [Accepted: 02/23/2016] [Indexed: 11/25/2022]
Abstract
Objective to explore the factors which influence the timing of the initiation of a package of publically-funded antenatal care for pregnant women living in a diverse urban setting Design a qualitative study involving thematic analysis of 21 individual interviews and six focus group discussions. Setting Newham, a culturally diverse borough in East London, UK Participants individual interviews were conducted with 21 pregnant and postnatal women and focus group discussions were conducted with a total of 26 health service staff members(midwives and bilingual health advocates) and 32 women from four community groups (Bangladeshi, Somali, Lithuanian and Polish). Findings initial care-seeking by pregnant women is influenced by the perception that the package of antenatal care offered by the National Health Service is for viable and continuing pregnancies, as well as little perceived urgency in initiating antenatal care. This is particularly true when set against competing responsibilities and commitments in women’s lives and for pregnancies with no apparent complications or disconcerting symptoms. Barriers to access to this package of antenatal care include difficulties in navigating the health service and referral system, which are compounded for women unable to speak English, and service provider delays in the processing of referrals. Accessing antenatal care was sometimes equated with relinquishing control, particularly for young women and women for whom language barriers prohibit active engagement with care. Conclusions and implications for practice if women are to be encouraged to seek antenatal care from maternity services early in pregnancy, the purpose and value to all women of doing so need to be made clear across the communities in which they live. As a woman may need time to accept her pregnancy and address other priorities in her life before seeking antenatal care, it is crucial that once she does decide to seek such care, access is quick and easy. Difficulties found in navigating the system of referral for antenatal care point to a need for improved access to primary care and a simple and efficient process of direct referral to antenatal care, alongside the delivery of antenatal care which is woman-centred and experienced as empowering. Antenatal care provided by the maternity services is viewed as being specifically for viable and continuing pregnancies. Antenatal care needs to be considered within the contexts of competing priorities in women’s lives. Difficulties navigating the health service and referral system featured prominently as a barrier to initiating care. For some women, receiving antenatal care equates to relinquishing control over their pregnancies.
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Affiliation(s)
- Bethan Hatherall
- Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK.
| | - Joanne Morris
- Barts Health NHS Trust, Newham University Hospital, Glen Rd, London E13 8SL, UK.
| | - Farah Jamal
- Department of Social Science, UCL Institute of Education, 20 Bedford Way, London WC1H 0AL, UK
| | - Lorna Sweeney
- Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK.
| | - Meg Wiggins
- Department of Social Science, UCL Institute of Education, 20 Bedford Way, London WC1H 0AL, UK.
| | - Inderjeet Kaur
- Barts Health NHS Trust, Royal London Hospital, Women's Services, Whitechapel Road, E1 1BB London, UK.
| | - Adrian Renton
- Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK.
| | - Angela Harden
- Institute for Health and Human Development (IHHD), University of East London, Water Lane, London E15 4LZ, UK; Barts Health NHS Trust, Newham University Hospital, Glen Rd, London E13 8SL, UK.
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Schölmerich VLN, Ghorashi H, Denktaş S, Groenewegen P. Caught in the middle? How women deal with conflicting pregnancy-advice from health professionals and their social networks. Midwifery 2016; 35:62-9. [PMID: 27060402 DOI: 10.1016/j.midw.2016.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 02/16/2016] [Accepted: 02/20/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to investigate how pregnant women deal with conflicting advice from their social networks and their caregivers and how this influenced their pregnancy-related behaviours. DESIGN AND METHODS a qualitative study based on face-to-face interviews and focus-groups. We applied an inductive analysis technique closely following the 'Gioia method'. SETTING impoverished neighbourhoods in Rotterdam, the Netherlands. PARTICIPANTS 40 women who were pregnant, or had given birth within the last 12 months. 12 women were Native Dutch, 16 had a Moroccan background, and 12 had a Turkish background. FINDINGS all women faced a misalignment of advice by health professionals and social networks. For the native Dutch respondents, this misalignment did not seem to present a challenge. They had a strongly articulated preference for the advice of health professionals, and did not fear any social consequences for openly following their advice. For the women with a Turkish/Moroccan background, however, this discrepancy in advice presented a dilemma. Following one piece of advice seemed to exclude also following the other one, which would possibly entail social consequences. These women employed one of the three strategies to deal with this dilemma: a) avoiding the dilemma (secretly not following the advice of one side), b) embracing the dilemma (combining conflicting advice), and c) resolving the dilemma (communicating between both sides). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE we argue that the currently popular interventions geared towards increasing the health literacy of non-Western ethnic minority pregnant women and improving communication between ethnic minority clients and caregivers are not sufficient, and might even exacerbate the dilemma some pregnant women face. As an alternative, we recommend involving not only caregivers but also women's social network in intervention efforts. Interventions could aim to increase the negotiation capacity of the target group, but also to increase the health literacy of the members of their social network to enable the circulation of 'new' information within a rather homogeneous, tight-knit network.
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Affiliation(s)
- Vera L N Schölmerich
- Department of Social & Behavioral Sciences, Erasmus University College, Erasmus University Rotterdam, Nieuwemarkt 1A, 3011HP Rotterdam, The Netherlands.
| | - Halleh Ghorashi
- Department of Sociology, VU University Amsterdam, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands.
| | - Semiha Denktaş
- Department of Social & Behavioral Sciences, Erasmus University College, Erasmus University Rotterdam, Nieuwemarkt 1A, 3011HP Rotterdam, The Netherlands.
| | - Peter Groenewegen
- Department of Organizational Sciences, VU University Amsterdam, De Boelelaan 1081, Amsterdam 1081 HV, The Netherlands.
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Chiavarini M, Lanari D, Minelli L, Pieroni L, Salmasi L. Immigrant mothers and access to prenatal care: evidence from a regional population study in Italy. BMJ Open 2016; 6:e008802. [PMID: 26861935 PMCID: PMC4762153 DOI: 10.1136/bmjopen-2015-008802] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES We addressed the question of whether use of adequate prenatal care differs between foreign-born and Italian mothers and estimated the extent to which unobservable characteristics bias results. SETTING This study is on primary care and especially on adequate access to prenatal healthcare services by immigrant mothers. PARTICIPANTS Approximately 37,000 mothers of both Italian and foreign nationality were studied. Data were obtained from the Standard Certificate of Live Birth between 2005 and 2010 in Umbria. RESULTS Estimates from the bivariate probit model indicate that immigrant mothers are three times more likely to make fewer than four prenatal visits (OR=3.35) and 1.66 times more likely to make a late first visit (OR=1.66). The effect is found to be strongest for Asian women. CONCLUSIONS Standard probit models lead to underestimation of the probability of inadequate use of prenatal care services by immigrant women, whereas bivariate probit models, which allow us to consider immigrant status as an endogenous variable, estimated ORs to be three times larger than those obtained with univariate models.
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Affiliation(s)
- Manuela Chiavarini
- Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Donatella Lanari
- Department of Medicine, University of Perugia, Piazzale Lucio Severi, Perugia, Italy
| | - Liliana Minelli
- Unit of Public Health, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Luca Pieroni
- Department of Political Science, University of Perugia, Perugia, Italy
| | - Luca Salmasi
- Department of Political Science, University of Perugia, Perugia, Italy
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Kapaya H, Mercer E, Boffey F, Jones G, Mitchell C, Anumba D. Deprivation and poor psychosocial support are key determinants of late antenatal presentation and poor fetal outcomes--a combined retrospective and prospective study. BMC Pregnancy Childbirth 2015; 15:309. [PMID: 26608259 PMCID: PMC4660789 DOI: 10.1186/s12884-015-0753-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/21/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Published guidelines emphasise the need for early antenatal care to promote maternal and neonatal health. Inadequate engagement with antenatal care is associated with adverse pregnancy outcomes including maternal death. The factors that influence the uptake and utilisation of maternity care services are poorly understood. We retrospectively explore a large maternity database of births in a large referral UK hospital to capture the socio-demographic factors that influence late pregnancy booking, and then prospectively compare the stress and social support status of consenting early and late-booking women. METHODS Retrospective socio-demographic and clinical outcome data on 59,487 women were collected from the maternity database record of births between 2002 and 2010 at the Jessop Wing Hospital, Sheffield UK. In a follow-on prospective survey between October 2012 and May 2013 a convenience cohort of early and late bookers for antenatal care were then studied using validated scales for fetomaternal attachment, stress and anxiety, and social support. RESULTS In our retrospective study, pregnancy during the teenage years, higher parity, non-white ethnic background, unemployment and smoking were significantly associated with late access to antenatal services and poor fetal outcomes (P < 0.001). However, late booking per se did not predict adverse fetal outcomes, when socio-demographic factors were accounted for. A high index of multiple deprivation (IMD) score remained independently associated with late booking when confounding factors such as ethnicity and employment status were controlled for in the model (P = 0.03). Our prospective data demonstrated that women who book late were more likely to be unmarried (OR: 3.571, 95 % CI: 1.464-8.196, p = .005), of high parity (OR: 1.759, 95 % CI: 1.154-2.684, P = 0.009), and have lower social support than early bookers (P = 0.047). CONCLUSIONS Of the many complex sociocultural factors that influence the timing of maternal engagement with antenatal care, multiple deprivation and poor social support remain key factors. Improving access to prenatal care requires in-depth exploration of the relationship between maternal psychosocial health indices, social support mechanisms and engagement with antenatal care. Findings from these studies should inform interventions aimed at improving access to care.
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Affiliation(s)
- Habiba Kapaya
- Department of Human Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
| | - Erin Mercer
- Department of Human Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
| | - Francesca Boffey
- Department of Human Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
| | - Georgina Jones
- Health Economics & Decision Science, School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Caroline Mitchell
- Academic Unit of Primary Medical Care, The Medical School, University of Sheffield, Sheffield, UK.
| | - Dilly Anumba
- Department of Human Metabolism, Academic Unit of Reproductive & Developmental Medicine, 4th Floor Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK.
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Perinatal outcomes among migrant mothers in the United Kingdom: Is it a matter of biology, behaviour, policy, social determinants or access to health care? Best Pract Res Clin Obstet Gynaecol 2015; 32:39-49. [PMID: 26527304 DOI: 10.1016/j.bpobgyn.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 11/21/2022]
Abstract
This paper examines trends in perinatal outcomes among migrant mothers in the UK, and it explores potential contributors to disparities focusing on pregnancy, birth and the first year of life. Trends in perinatal outcomes indicate that ethnic minority grouping, regardless of migrant status, is a significant risk factor for unfavourable outcomes. It is unclear whether migrant status per se adds to this risk as within-group comparisons between UK-born and foreign-born women show variable findings. The role of biological and behavioural factors in producing excess unfavourable outcomes among ethnic minority mothers, although indicated, is yet to be fully understood. UK policies have salient aspects that address ethnic inequalities, but their wide focus obscures provisions for migrant mothers. Direct associations between socio-economic factors, ethnicity and adverse infant outcomes are evident. Evidence is consistent about differential access to and utilisation of health services among ethnic minority mothers, in particular recently arrived migrants, refugees and asylum seekers.
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Garcia R, Ali N, Papadopoulos C, Randhawa G. Specific antenatal interventions for Black, Asian and Minority Ethnic (BAME) pregnant women at high risk of poor birth outcomes in the United Kingdom: a scoping review. BMC Pregnancy Childbirth 2015; 15:226. [PMID: 26403078 PMCID: PMC4581493 DOI: 10.1186/s12884-015-0657-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/08/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Disparity exists in maternal and infant birth outcomes of Black and Minority Ethnic (BAME) women giving birth in the United Kingdom (UK) compared to the majority. There is therefore a need to reconsider existing maternity service provision to ensure culturally competent services. The purpose of this scoping review was to ascertain what specific maternity interventions have been implemented in the UK for BAME women (2004-2014) so that increased awareness of the need and scope of specific maternity interventions for BAME women can be identified. METHODS A scoping review was conducted in order to determine the evidence base. It was determined that no prior systematic reviews had been conducted and it was apparent that literature in this field was sparse. Scoping review is an ideal method when literature is likely to be heterogeneous and the research field relatively unexplored. A keyword strategy was used implementing population (P), intervention (I), comparison (C) and outcomes (O). RESULTS An initial 2188 papers were identified. Following screening and review, only 5 heterogeneous papers remained suitable and were included. The included interventions employed sample sizes of N = 160-1441, examined a range of different outcome measures and were delivered across different parts of the UK with high numbers of BAME residents. CONCLUSIONS There is a lack of rigorous research interventions and practice interventions which are currently documented, of specific maternity interventions which are aimed to address culturally competent maternity services and the sharing of best practice addressing the increased risks of BAME women delivering in the UK.
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Affiliation(s)
- Rebecca Garcia
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Nasreen Ali
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Chris Papadopoulos
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
| | - Gurch Randhawa
- The Institute For Health Research, University of Bedfordshire, Putteridge Bury, Hitchin Road, Luton, Bedfordshire, LU2 8LE, UK.
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Yelland J, Riggs E, Szwarc J, Casey S, Duell-Piening P, Chesters D, Wahidi S, Fouladi F, Brown S. Compromised communication: a qualitative study exploring Afghan families and health professionals' experience of interpreting support in Australian maternity care. BMJ Qual Saf 2015; 25:e1. [PMID: 26089208 DOI: 10.1136/bmjqs-2014-003837] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/30/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Difficulties associated with communication are thought to contribute to adverse perinatal outcomes experienced by refugee background women living in developed countries. This study explored Afghan women and men's experience of language support during pregnancy, labour and birth, and health professionals' experiences of communicating with clients of refugee background with low English proficiency. METHODS Interviews were conducted with (1) Afghan women and men in the first year after having a baby in Australia, by multilingual, bicultural researchers and (2) midwives and medical practitioners providing care to families of refugee background. Analysis was conducted thematically. RESULTS Sixteen Afghan women, 14 Afghan men, 10 midwives, five medical practitioners and 19 community-based health professionals (refugee health nurses, bicultural workers, counsellors) providing maternity or early postnatal care participated. Midwife and medical informants concurred that accredited interpreters are generally booked for the first pregnancy visit, but not routinely used for other appointments. Very few Afghan participants reported access to on-site interpreters. Men commonly interpreted for their wives. There was minimal professional interpreting support for imaging and pathology screening appointments or during labour and birth. Health professionals noted challenges in negotiating interpreting services when men were insistent on providing language support for their wives and difficulties in managing interpreter-mediated visits within standard appointment times. Failure to engage interpreters was apparent even when accredited interpreters were available and at no cost to the client or provider. CONCLUSIONS Improving identification of language needs at point of entry into healthcare, developing innovative ways to engage interpreters as integral members of multidisciplinary healthcare teams and building health professionals' capacity to respond to language needs are critical to reducing social inequalities in maternal and child health outcomes for refugee and other migrant populations.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | | | - Donna Chesters
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Sayed Wahidi
- Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Fatema Fouladi
- Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia School of Population Health, University of Melbourne, Parkville, Victoria, Australia
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Boerleider AW, Manniën J, van Stenus CMV, Wiegers TA, Feijen-de Jong EI, Spelten ER, Devillé WLJM. Explanatory factors for first and second-generation non-western women's inadequate prenatal care utilisation: a prospective cohort study. BMC Pregnancy Childbirth 2015; 15:98. [PMID: 25895975 PMCID: PMC4409999 DOI: 10.1186/s12884-015-0528-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 04/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Little research into non-western women’s prenatal care utilisation in industrialised western countries has taken generational differences into account. In this study we examined non-western women’s prenatal care utilisation and its explanatory factors according to generational status. Methods Data from 3300 women participating in a prospective cohort of primary midwifery care clients (i.e. women with no complications or no increased risk for complications during pregnancy, childbirth and the puerperium who receive maternity care by autonomous midwives) in the Netherlands (the DELIVER study) was used. Gestational age at entry and the total number of prenatal visits were aggregated into an index. The extent to which potential factors explained non-western women’s prenatal care utilisation was assessed by means of blockwise logistic regression analyses and percentage changes in odds ratios. Results The unadjusted odds of first and second-generation non-western women making inadequate use of prenatal care were 3.26 and 1.96 times greater than for native Dutch women. For the first generation, sociocultural factors explained 43% of inadequate prenatal care utilisation, socioeconomic factors explained 33% and demographic and pregnancy factors explained 29%. For the second generation, sociocultural factors explained 66% of inadequate prenatal care utilisation. Conclusion Irrespective of generation, strategies to improve utilisation should focus on those with the following sociocultural characteristics (not speaking Dutch at home, no partner or a first-generation non-Dutch partner). For the first generation, strategies should also focus on those with the following demographic, pregnancy and socioeconomic characteristics (aged ≤19 or ≥36, unplanned pregnancies, poor obstetric histories (extra-uterine pregnancy, molar pregnancy or abortion), a low educational level, below average net household income and no supplementary insurance. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0528-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Agatha W Boerleider
- Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands.
| | - Judith Manniën
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Cherelle M V van Stenus
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, Amsterdam, the Netherlands.
| | - Therese A Wiegers
- Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands.
| | - Esther I Feijen-de Jong
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
| | - Evelien R Spelten
- Department of Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Walter L J M Devillé
- Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands. .,Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands. .,National Knowledge and Advisory Centre on Migrants, Refugees and Health (Pharos), Utrecht, the Netherlands.
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Posthumus AG, Schölmerich VLN, Steegers EAP, Kawachi I, Denktaş S. The association of ethnic minority density with late entry into antenatal care in the Netherlands. PLoS One 2015; 10:e0122720. [PMID: 25856150 PMCID: PMC4391847 DOI: 10.1371/journal.pone.0122720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 02/12/2015] [Indexed: 11/19/2022] Open
Abstract
In the Netherlands, non-Western ethnic minority women make their first antenatal visit later than native Dutch women. Timely entry into antenatal care is important as it provides the opportunity for prenatal screening and the detection of risk factors for adverse pregnancy outcomes. In this study we explored whether women's timely entry is influenced by their neighborhood. Moreover, we assessed whether ethnic minority density (the proportion of ethnic minorities in a neighborhood) influences Western and non-Western ethnic minority women's chances of timely entry into care differently. We hypothesized that ethnic minority density has a protective effect against non-Western women's late entry into care. Data on time of entry into care and other individual-level characteristics were obtained from the Netherlands Perinatal Registry (2000-2008; 97% of all pregnancies). We derived neighborhood-level data from three other national databases. We included 1,137,741 pregnancies of women who started care under supervision of a community midwife in 3422 neighborhoods. Multi-level logistic regression was used to assess the associations of individual and neighborhood-level determinants with entry into antenatal care before and after 14 weeks of gestation. We found that neighborhood characteristics influence timely entry above and beyond individual characteristics. Ethnic minority density was associated with a higher risk of late entry into antenatal care. However, our analysis showed that for non-Western women, living in high ethnic minority density areas is less detrimental to their risk of late entry than for Western women. This means that a higher proportion of ethnic minority residents has a protective effect on non-Western women's chances of timely entry into care. Our results suggest that strategies to improve timely entry into care could seek to create change at the neighborhood level in order to target individuals likely of entering care too late.
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Affiliation(s)
- Anke G. Posthumus
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands
- * E-mail:
| | - Vera L. N. Schölmerich
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands
- VU University Amsterdam, Department of Organization Sciences, Amsterdam, the Netherlands
| | - Eric A. P. Steegers
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands
| | - Ichiro Kawachi
- Harvard School of Public Health, Department of Social and Behavioral Sciences, Boston, Massachusetts, United States of America
| | - Semiha Denktaş
- Erasmus University Medical Centre, Department of Obstetrics and Gynecology, Division of Obstetrics and Prenatal Medicine, Rotterdam, the Netherlands
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Bacci S, Bartolucci F, Chiavarini M, Minelli L, Pieroni L. Differences in birthweight outcomes: a longitudinal study based on siblings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 11:6472-84. [PMID: 25003169 PMCID: PMC4076673 DOI: 10.3390/ijerph110606472] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives: We investigate the differences in birthweight between first- and second-borns, evaluating the impact of changes in pregnancy (e.g., gestational age), demographic (e.g., age), and social (e.g., education level, marital status) maternal characteristics. Data and Methods: All analyses are performed on data collected in Umbria (Italy) taking into account a set of 792 women who delivered twice from 2005 to 2008. Firstly, we use a univariate paired t-test for the comparison between weights of first- and second-borns; Secondly, we use linear and nonlinear regression approaches in order to: (i) evaluate the effect of demographic and social maternal characteristics and (ii) predict the odds-ratio of low and high birthweight infants, respectively. Results: We find that the birthweight of second-borns is significantly higher than that of first-borns. Statistically significant effects are related with a longer gestational age, an increased number of visits during the pregnancy, and the gender of infants. On the other hand, we do not observe any significant effect related with mother’s age and with other characteristics of interest.
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Affiliation(s)
- Silvia Bacci
- Department of Economics, University of Perugia, Via A. Pascoli, 20, 06123 Perugia,
Italy; E-Mail:
| | - Francesco Bartolucci
- Department of Economics, University of Perugia, Via A. Pascoli, 20, 06123 Perugia,
Italy; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-75-585-5227; Fax: +39-75-585-5950
| | - Manuela Chiavarini
- Department of Experimental Medicine, Public Health Section, University of Perugia, P.le Gambuli, 1, 06122 Sant’Andrea delle Fratte, 06156 Perugia,
Italy; E-Mails: (M.C.); (L.M.)
| | - Liliana Minelli
- Department of Experimental Medicine, Public Health Section, University of Perugia, P.le Gambuli, 1, 06122 Sant’Andrea delle Fratte, 06156 Perugia,
Italy; E-Mails: (M.C.); (L.M.)
| | - Luca Pieroni
- Department of Political Sciences, University of Perugia, Via A. Pascoli, 20, 06123 Perugia,
Italy; E-Mail:
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McGovern P, Nazroo JY. Patterns and causes of health inequalities in later life: a Bourdieusian approach. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:143-60. [PMID: 25601070 DOI: 10.1111/1467-9566.12187] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study explores the relationship between social class and health change in older people in a path analysis, using data from the English Longitudinal Study of Ageing (n = 6241) in a Bourdieusian theoretical framework. Bourdieu drew a distinction between the occupational characteristics by which people are classified and the secondary properties of class that relate to lifestyle (economic, cultural and social capitals). Our path model includes both occupational and secondary characteristics of objective social class as well as a measure of subjective social class. We investigate the effects of the predictors on change in three health outcomes (self-rated health, number of symptoms of depression and number of difficulties with the activities of daily living). The analysis adds to Bourdieusian research by showing how the effects of objective social class on health are partially mediated by perceived social status. It also adds to substantive research on the relationship between class and health by suggesting that class-related health inequalities do persist for older people, even for those who are not in paid employment. It suggests that a large amount of the effect of occupation on the health of older people is not direct but indirect; through their personal wealth and lifestyle.
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Affiliation(s)
- Pauline McGovern
- Cathie Marsh Institute for Social Research, School of Social Science, University of Manchester
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Yelland J, Riggs E, Wahidi S, Fouladi F, Casey S, Szwarc J, Duell-Piening P, Chesters D, Brown S. How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families? BMC Pregnancy Childbirth 2014; 14:348. [PMID: 25284336 PMCID: PMC4287513 DOI: 10.1186/1471-2393-14-348] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Refugees have poor mental, social and physical health related to experiences of trauma and stresses associated with settlement, however little is known about how refugee families experience maternity and early childhood services. The aim of this study was to explore the responsiveness of health services to the social and mental health of Afghan women and men at the time of having a baby. METHOD Participatory methods including community engagement and consultation with the Afghan community and service providers in Melbourne, Australia. Bicultural researchers conducted interviews with Afghan women and men who had recently had a baby. Interviews and focus groups were also conducted with health professionals working in the region. RESULTS Thirty interviews were conducted with Afghan women and men who had recently had a baby. Thirty-four health professionals participated in an interview or focus group.Afghan women and men reported significant social hardship during the period before and after having a baby in Australia, but were rarely asked about their social health by maternity and early childhood services.Most health professionals recognised that knowledge and understanding of their client's migration history and social circumstances was relevant to the provision of high quality care. However, inquiring about refugee background, and responding to non-clinical needs of refugee families was challenging for many health professionals. Factors that made it more difficult for health professionals to engage with Afghan families in pregnancy included limited understanding of the context of migration, dependency of many Afghan women on their husband for interpreting, short appointments, and the high likelihood of seeing different health professionals at each antenatal visit. Community-based maternal and child health nurses had more scope to work with interpreters, and build relationships with families, providing a stronger foundation for identifying and responding to complex social circumstances. CONCLUSION There are significant challenges in providing comprehensive, high quality primary health care for Afghan families accessing Australian maternity and early childhood services. The limited capacity of public maternity services to identify families of refugee background and provide tailored service responses are contributing to inequitable maternal and child health outcomes for families of refugee background.
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Affiliation(s)
- Jane Yelland
- />Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052 Australia
- />General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria 3052 Australia
| | - Elisha Riggs
- />Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052 Australia
- />General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria 3052 Australia
| | - Sayed Wahidi
- />Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052 Australia
| | - Fatema Fouladi
- />Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052 Australia
| | - Sue Casey
- />Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria 3056 Australia
| | - Josef Szwarc
- />Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria 3056 Australia
| | - Philippa Duell-Piening
- />Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria 3056 Australia
| | - Donna Chesters
- />Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria 3056 Australia
| | - Stephanie Brown
- />Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052 Australia
- />General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria 3052 Australia
- />School of Population and Global Health, University of Melbourne, Parkville, Victoria 3052 Australia
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Lindquist A, Kurinczuk JJ, Redshaw M, Knight M. Experiences, utilisation and outcomes of maternity care in England among women from different socio‐economic groups: findings from the 2010 National Maternity Survey. BJOG 2014; 122:1610-7. [DOI: 10.1111/1471-0528.13059] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 01/03/2023]
Affiliation(s)
- A Lindquist
- National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
- Department of Obstetrics and Gynaecology Monash Health Melbourne Vic. Australia
| | - JJ Kurinczuk
- National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
| | - M Redshaw
- National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
| | - M Knight
- National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford UK
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Floridia M, Pinnetti C, Ravizza M, Frisina V, Cetin I, Fiscon M, Sansone M, Antoni AD, Guaraldi G, Vimercati A, Guerra B, Placido G, Dalzero S, Tamburrini E. Rate, predictors, and consequences of late antenatal booking in a national cohort study of pregnant women with HIV in Italy. HIV CLINICAL TRIALS 2014; 15:104-15. [PMID: 24947534 DOI: 10.1310/hct1503-104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the prevalence and consequences of late antenatal booking (13 or more weeks gestation) in a national observational study of pregnant women with HIV. METHODS The clinical and demographic characteristics associated with late booking were evaluated in univariate analyses using the Mann-Whitney U test for quantitative data and the chi-square test for categorical data. The associations that were found were re-evaluated in multivariable logistic regression models. Main outcomes were preterm delivery, low birthweight, nonelective cesarean section, birth defects, undetectable (<50 copies/mL) HIV plasma viral load at third trimester, delivery complications, and gender-adjusted and gestational age-adjusted Z scores for birthweight. RESULTS Rate of late booking among 1,643 pregnancies was 32.9%. This condition was associated with younger age, African provenance, diagnosis of HIV during pregnancy, and less antiretroviral exposure. Undetectable HIV RNA at third trimester and preterm delivery were significantly more prevalent with earlier booking (67.1% vs 46.3%, P < .001, and 23.2% vs 17.6, P = .010, respectively), whereas complications of delivery were more common with late booking (8.2% vs 5.0%, P = .013). Multivariable analyses confirmed an independent role of late booking in predicting detectable HIV RNA at third trimester (adjusted odds ratio [AOR], 1.7; 95% CI, 1.3-2.3; P < .001) and delivery complications (AOR, 1.8; 95% CI, 1.2-2.8; P = .005). CONCLUSIONS Late antenatal booking was associated with detectable HIV RNA in late pregnancy and with complications of delivery. Measures should be taken to ensure an earlier entry into antenatal care, particularly for African women, and to facilitate access to counselling and antenatal services. These measures can significantly improve pregnancy management and reduce morbidity and complications in pregnant women with HIV.
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Affiliation(s)
- M Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - C Pinnetti
- I.N.M.I. Lazzaro Spallanzani, Rome, Italy
| | - M Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - V Frisina
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - I Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - M Fiscon
- Department of Pediatrics, University of Padova, Padova, Italy
| | - M Sansone
- Department of Obstetrics and Gynaecology, University Federico II of Naples, Naples, Italy
| | - A Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy
| | - G Guaraldi
- Department of Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - A Vimercati
- Department of Obstetrics and Gynaecology, University of Bari and Policlinic Hospital, Bari, Italy
| | - B Guerra
- University of Bologna and St. Orsola Malpighi General Hospital, Bologna, Italy
| | - G Placido
- Unit of Infectious Diseases, Pescara General Hospital, Pescara, Italy
| | - S Dalzero
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - E Tamburrini
- Department of Infectious Diseases, Catholic University, Rome, Italy
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Haddrill R, Jones GL, Mitchell CA, Anumba DOC. Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy Childbirth 2014; 14:207. [PMID: 24935100 PMCID: PMC4072485 DOI: 10.1186/1471-2393-14-207] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 06/05/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Delayed access to antenatal care ('late booking') has been linked to increased maternal and fetal mortality and morbidity. The aim of this qualitative study was to understand why some women are late to access antenatal care. METHODS 27 women presenting after 19 completed weeks gestation for their first hospital booking appointment were interviewed, using a semi-structured format, in community and maternity hospital settings in South Yorkshire, United Kingdom. Interviews were transcribed verbatim and entered onto NVivo 8 software. An interdisciplinary, iterative, thematic analysis was undertaken. RESULTS The late booking women were diverse in terms of: age (15-37 years); parity (0-4); socioeconomic status; educational attainment and ethnicity. Three key themes relating to late booking were identified from our data: 1) 'not knowing': realisation (absence of classic symptoms, misinterpretation); belief (age, subfertility, using contraception, lay hindrance); 2) 'knowing': avoidance (ambivalence, fear, self-care); postponement (fear, location, not valuing care, self-care); and 3) 'delayed' (professional and system failures, knowledge/empowerment issues). CONCLUSIONS Whilst vulnerable groups are strongly represented in this study, women do not always fit a socio-cultural stereotype of a 'late booker'. We report a new taxonomy of more complex reasons for late antenatal booking than the prevalent concepts of denial, concealment and disadvantage. Explanatory sub-themes are also discussed, which relate to psychological, empowerment and socio-cultural factors. These include poor reproductive health knowledge and delayed recognition of pregnancy, the influence of a pregnancy 'mindset' and previous pregnancy experience, and the perceived value of antenatal care. The study also highlights deficiencies in early pregnancy diagnosis and service organisation. These issues should be considered by practitioners and service commissioners in order to promote timely antenatal care for all women.
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Affiliation(s)
- Rosalind Haddrill
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Georgina L Jones
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Caroline A Mitchell
- Academic Unit of Primary Medical Care, Samuel Fox House, Northern General Hospital, University of Sheffield, Herries Road, Sheffield S5 7AU, UK
| | - Dilly OC Anumba
- Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, The Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK
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Santibáñez M, Paz-Zulueta M, Ruiz M, Castro I, Llorca J. Factors associated with lack of adherence to antenatal care in African immigrant women and Spanish women in northern Spain: the role of social risk factors in combination with language proficiency. Midwifery 2014; 31:61-7. [PMID: 24972927 DOI: 10.1016/j.midw.2014.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 03/04/2014] [Accepted: 05/27/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE to examine the association and interaction between language proficiency, social risk factors and lack of adherence to antenatal care in African immigrant women (AIW). METHODOLOGY retrospective cohort study. Two hundred and thirty-one AIW with delivery dates from 2007 to 2010 were identified, and data were collected on knowledge of Spanish, referral to a social worker because of social risk factors, and adequacy of antenatal care using the Kessner Index (KI) and the authors' own index (OI). The Spanish-born population sample was obtained by simple random sampling in a 1:3 ratio. Odds ratios (OR) were estimated by non-conditional logistic regression. The term 'language*referral to social worker' was included in the logistic models to study interaction. FINDINGS eighty-four per cent of AIW had insufficient knowledge of Spanish, and 47% had been referred to a social worker. Of the AIW who had not been referred to a social worker, the association between poor knowledge of Spanish and inadequate antenatal care was weak and not significant (OR for KI 1.31). On the contrary, of the AIW who had been referred to a social worker, the association was stronger and significant (OR for KI 8.98; p interaction=0.026). Social risk factors were the main independent factors associated with inadequate antenatal care in Spanish women (adjusted OR 3.17; 95% confidence interval 1.42-7.06). CONCLUSIONS this study found that the main factor associated with inadequate antenatal care in AIW is insufficient language proficiency, but only in the presence of social risk factors, which have also been associated with worse antenatal care in Spanish women.
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Affiliation(s)
- Miguel Santibáñez
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain; IDIVAL-Instituto de Investigación Marqués de Valdecilla, Santander, Spain.
| | - Maria Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain
| | - María Ruiz
- Hospital de Laredo, Servicio Cántabro de Salud, Santander, Spain
| | - Irene Castro
- Gerencia de Atención Primaria, Servicio Cántabro de Salud, Santander, Spain
| | - Javier Llorca
- IDIVAL-Instituto de Investigación Marqués de Valdecilla, Santander, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departamento de Salud Pública, Universidad de Cantabria, Santander, Spain
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Nair M, Kurinczuk JJ, Knight M. Ethnic variations in severe maternal morbidity in the UK- a case control study. PLoS One 2014; 9:e95086. [PMID: 24743879 PMCID: PMC3990615 DOI: 10.1371/journal.pone.0095086] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/23/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Previous studies showed a higher risk of maternal morbidity amongst black and other minority ethnic (BME) groups, but were unable to investigate whether this excess risk was concentrated within specific BME groups in the UK. Our aim was to analyse the specific risks and to investigate reasons for any disparity. METHODS Unmatched case-control analysis using data from the United Kingdom Obstetric Surveillance System (UKOSS), February 2005-January 2013. Cases were 1,753 women who experienced severe morbidity during the peripartum period. Controls were 3,310 women who delivered immediately before the cases in the same hospital. Multivariable logistic regression modelling was used to adjust for known confounders and to understand their effects. RESULTS Compared with white European women, the odds of severe maternal morbidity were 83% higher among black African women (adjusted odds ratio (aOR) = 1.83; 95% Confidence Interval (CI) = 1.39-2.40), 80% higher among black Caribbean (aOR = 1.80; 95% CI = 1.14-2.82), 74% higher in Bangladeshi (aOR = 1.74; 95% CI = 1.05-2.88), 56% higher in other non-whites (non-Asian) (aOR = 1.56; 95% CI = 1.05-2.33) and 43% higher among Pakistani women (aOR = 1.43; 95% CI = 1.07-1.92). There was no evidence of substantial confounding. Anaemia in current pregnancy, previous pregnancy problems, inadequate utilisation of antenatal care, pre-existing medical conditions, parity>3, and being younger and older were independent risk factors but, the odds of severe maternal morbidity did not differ by socioeconomic status, between smokers and non-smokers or by BMI. DISCUSSION This national study demonstrates an increased risk of severe maternal morbidity among women of ethnic minority backgrounds which could not be explained by known risk factors for severe maternal morbidity.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jennifer J. Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Chiavarini M, Lanari D, Minelli L, Salmasi L. Socio-demographic determinants and access to prenatal care in Italy. BMC Health Serv Res 2014; 14:174. [PMID: 24735757 PMCID: PMC3991890 DOI: 10.1186/1472-6963-14-174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 04/11/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many governments have made commitments to examine inequalities in healthcare access based on studies assessing the association between several socio-demographic factors and late initiation or fewer prenatal examinations. This study addressed the question of whether socio-demographic determinants were significant in explaining differences in prenatal care in one administrative region of Italy, Umbria. METHODS Data were obtained from the administrative source of the regional Standard Certificate of Live Births between 2005 and 2010, and were merged with Census data to include a socio-economic deprivation index. Standard and multilevel logistic regression models were used to analyze the magnitude of various individual-level maternal characteristics and socio-demographic indicators, such as nationality, employment status, education with respect to late access to the first examination, and low number of medical visits. RESULTS The study involved approximately 37,000 women. The heterogeneous effects of socio-demographic variables were documented on the prenatal care indicators analyzed. A multivariate model showed that women born outside Italy had a higher probability of making their first visit later than the 12th week of pregnancy and low numbers of prenatal medical visits; the estimated odds ratio for the analyzed indicators range from 2.25 to 3.05. Inadequate prenatal healthcare use was also observed in younger and pluriparous women and those with low education; in addition, having a job improved the use of services, possibly through transmission of information of negative consequences due to delayed or few prenatal visits. Interestingly, this study found a substantial reduction in the number of pregnant women who do not use prenatal healthcare services properly. CONCLUSIONS The aim of this research is to provide more accurate knowledge about the inadequate use of prenatal healthcare in Italy. Results highlight the existence of differences in healthcare use during pregnancy, especially for women from less advantaged social classes (i.e., unemployed or poorly educated). Such inequalities should be examined in all areas of public policy and public services, to ensure equal opportunity for their use.
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Affiliation(s)
- Manuela Chiavarini
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| | - Donatella Lanari
- Department of Economics, Statistics and Finance, University of Perugia, Perugia, Italy
| | - Liliana Minelli
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
| | - Luca Salmasi
- Department of Experimental Medicine, Public Health Section, University of Perugia, Perugia, Italy
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Heaman M, Bayrampour H, Kingston D, Blondel B, Gissler M, Roth C, Alexander S, Gagnon A. Migrant women's utilization of prenatal care: a systematic review. Matern Child Health J 2014; 17:816-36. [PMID: 22714797 DOI: 10.1007/s10995-012-1058-z] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Our objectives were to determine whether migrant women in Western industrialized countries have higher odds of inadequate prenatal care (PNC) compared to receiving-country women and to summarize factors that are associated with inadequate PNC among migrant women in these countries. We conducted searches of electronic databases (MEDLINE, EMBASE, and PsycINFO), reference lists, known experts, and an existing database of the Reproductive Outcomes And Migration international research collaboration for articles published between January, 1995 and April, 2010. Title and abstract review and quality appraisal were conducted independently by 2 reviewers using established criteria, with consensus achieved through discussion. In this systematic review of 29 studies, the majority of studies demonstrated that migrant women were more likely to receive inadequate PNC than receiving-country women, with most reporting moderate to large effect sizes. Rates of inadequate PNC among migrant women varied widely by country of birth. Only three studies explored predictors of inadequate PNC among migrant women. These studies found that inadequate PNC among migrant women was associated with being less than 20 years of age, multiparous, single, having poor or fair language proficiency, education less than 5 years, an unplanned pregnancy, and not having health insurance. We concluded that migrant women as a whole were more likely to have inadequate PNC and the magnitude of this risk differed by country of origin. Few studies addressed predictors of PNC utilization in migrant women and this limits our ability to provide effective PNC in this population.
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Affiliation(s)
- M Heaman
- CIHR Chair in Gender and Health, Faculty of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Room 268, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
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Henderson J, Gao H, Redshaw M. Experiencing maternity care: the care received and perceptions of women from different ethnic groups. BMC Pregnancy Childbirth 2013; 13:196. [PMID: 24148317 PMCID: PMC3854085 DOI: 10.1186/1471-2393-13-196] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/07/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND According to the Office for National Statistics, approximately a quarter of women giving birth in England and Wales are from minority ethnic groups. Previous work has indicated that these women have poorer pregnancy outcomes than White women and poorer experience of maternity care, sometimes encountering stereotyping and racism. The aims of this study were to examine service use and perceptions of care in ethnic minority women from different groups compared to White women. METHODS Secondary analysis of data from a survey of women in 2010 was undertaken. The questionnaire asked about women's experience of care during pregnancy, labour and birth, and the postnatal period, as well as demographic factors. Ethnicity was grouped into eight categories: White, Mixed, Indian, Pakistani, Bangladeshi, Black Caribbean, Black African, and Other ethnicity. RESULTS A total of 24,319 women completed the survey. Compared to White women, women from minority ethnic groups were more likely to be younger, multiparous and without a partner. They tended to access antenatal care later in pregnancy, have fewer antenatal checks, fewer ultrasound scans and less screening. They were less likely to receive pain relief in labour and, Black African women in particular, were more likely to deliver by emergency caesarean section. Postnatally, women from minority ethnic groups had longer lengths of hospital stay and were more likely to breastfeed but they had fewer home visits from midwives. Throughout their maternity care, women from minority ethnic groups were less likely to feel spoken to so they could understand, to be treated with kindness, to be sufficiently involved in decisions and to have confidence and trust in the staff. CONCLUSION Women in all minority ethnic groups had a poorer experience of maternity services than White women. That this was still the case following publication of a number of national policy documents and local initiatives is a cause for concern.
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Affiliation(s)
- Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Haiyan Gao
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Old Road, Oxford OX3 7LF, UK
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Cresswell JA, Yu G, Hatherall B, Morris J, Jamal F, Harden A, Renton A. Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK. BMC Pregnancy Childbirth 2013; 13:103. [PMID: 23642084 PMCID: PMC3652742 DOI: 10.1186/1471-2393-13-103] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 04/05/2013] [Indexed: 11/26/2022] Open
Abstract
Background In the UK, women are recommended to engage with maternity services and establish a plan of care prior to the 12th completed week of pregnancy. The aim of this study was to identify predictors for late initiation of antenatal care within an ethnically diverse cohort in East London. Methods Cross-sectional analysis of routinely collected electronic patient record data from Newham University Hospital NHS Trust (NUHT). All women who attended their antenatal booking appointment within NUHT between 1st January 2008 and 24th January 2011 were included in this study. The main outcome measure was late antenatal booking, defined as attendance at the antenatal booking appointment after 12 weeks (+6 days) gestation. Data were analysed using multivariable logistic regression with robust standard errors. Results Late initiation of antenatal care was independently associated with non-British (White) ethnicity, inability to speak English, and non-UK maternal birthplace in the multivariable model. However, among those women who both spoke English and were born in the UK, the only ethnic group at increased risk of late booking were women who identified as African/Caribbean (aOR: 1.40: 95% CI: 1.11, 1.76) relative to British (White). Other predictors identified include maternal age younger than 20 years (aOR: 1.32; 95% CI: 1.13-1.54), high parity (aOR: 2.09; 95% CI: 1.77-2.46) and living in temporary accommodation (aOR: 1.71; 95% CI: 1.35-2.16). Conclusions Socio-cultural factors in addition to poor English ability or assimilation may play an important role in determining early initiation of antenatal care. Future research should focus on effective interventions to encourage and enable these minority groups to engage with the maternity services.
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Affiliation(s)
- Jenny A Cresswell
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Zhao Q, Huang ZJ, Yang S, Pan J, Smith B, Xu B. The utilization of antenatal care among rural-to-urban migrant women in Shanghai: a hospital-based cross-sectional study. BMC Public Health 2012; 12:1012. [PMID: 23170773 PMCID: PMC3577466 DOI: 10.1186/1471-2458-12-1012] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 11/12/2012] [Indexed: 12/02/2022] Open
Abstract
Background Improving utilization of antenatal care is a critical strategy for achieving China’s Millennium Development Goal of decreasing the maternal mortality ratio (MMR). While overall utilization has increased recently in China, an urban vs. rural disparity in access remains. Here we aim to assess utilization of antenatal care in rural-to-urban migrant women and identify its risk and protective factors. Methods Migrant women who had been living in Shanghai for more than six months, delivered in one of the two study hospitals between August 2009 and February 2010, and provided written consent were interviewed using a structured questionnaire. Results Of 767 women, 90.1% (691) made at least one antenatal care visit, while 49.7% (381) had adequately utilized antenatal care (i.e., made five or more antenatal care visits). Only 19.7% of women visited an antenatal care center during the first trimester (12 weeks). Women between the ages of 25 and 30 and women older than 30 were more likely than younger women to have adequately utilized antenatal care (AOR=2.2 and 1.9, 95%CI=1.4-3.5 and 1.1-3.2, respectively). Women whose husbands held Shanghai residency status (AOR=4.9, 95%CI=2.2-10.9) or who had more than 10 years of education (AOR=1.8, 95%CI=1.2-2.9), previously experienced a miscarriage or abortion (AOR=2.2, 95%CI=1.3-3.8), had higher household income (AOR=1.6, 95%CI=1.0-2.5) were more likely to have adequately utilized antenatal care. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks (AOR=3.5, 95%CI=1.7-5.5). Conclusions Many migrant women in Shanghai did not receive adequate antenatal care and initiated antenatal care later than the optimal first 12 weeks of pregnancy. Poor antenatal care utilization was associated with low socioeconomic status, education, and certain demographic factors. Tailored health education for both migrant women and their husbands should be strengthened to improve maternal health. Financing supports should be provided to improve the utilization of antenatal care.
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Affiliation(s)
- Qi Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
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Yu J. A systematic review of issues around antenatal screening and prenatal diagnostic testing for genetic disorders: women of Asian origin in western countries. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:329-346. [PMID: 22067008 DOI: 10.1111/j.1365-2524.2011.01036.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Antenatal screening has become standard practice in many countries. However, not all pregnant women choose to be tested. In the UK, the incidence of some birth defects is found to be higher in babies of Asian women than in those of women from other ethnic groups, while there is some evidence suggesting that ethnic minorities, especially Asian women, are less likely to undergo antenatal screening and prenatal diagnosis, the reasons for which are unclear. This study aims to identify and describe the literature on issues around antenatal screening and prenatal diagnostic testing for genetic disorders among women of Asian descent in western countries. The Medline, CINAHL, ASSIA and PsycInfo databases were searched for the period of 1995 and 2010. Twenty-one studies met the inclusion criteria and were therefore reviewed. In general, Asian women were found to hold favourable attitudes towards testing. However, they reported a poorer understanding of testing than white women and not being offered a test, and were less able to make informed choices. Asian women in the UK and Australia were found to be less likely than their white counterparts to have undergone prenatal diagnosis, while such differences were not found in the USA and Canada. The equity of access to quality antenatal care, alongside comprehensive well thought out antenatal screening programmes, can be assured if strategies are in place which actively involve all ethnic groups and take account of social and cultural appropriateness for the population served. An understanding of broad factors that inform women's decision-making on test uptake would help health professionals provide women and their families with more culturally sensitive information and support that they may additionally need to make more informed choices.
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Affiliation(s)
- Juping Yu
- University of Glamorgan, Pontypridd, Mid Glamorgan, UK.
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