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Yeshitila YG, Gold L, Riggs E, Abimanyi-Ochom J, Sweet L, Le HND. Trends and disparities in perinatal health outcomes among women from refugee backgrounds in Victoria, Australia: A population-based study. Midwifery 2024; 132:103980. [PMID: 38547597 DOI: 10.1016/j.midw.2024.103980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Women from refugee backgrounds generally experience poorer pregnancy-related outcomes compared to host populations. AIM To examine the trend and disparities in adverse perinatal outcomes among women of refugee background using population-based data from 2003 to 2017. METHODS A population-based cross-sectional study of 754,270 singleton births in Victoria compared mothers of refugee backgrounds with Australian-born mothers. Inferential statistics, including Pearson chi-square and binary logistic regression, were conducted. Multiple logistic regression was conducted to explore the relationship between adverse perinatal outcomes and the women's refugee status. FINDINGS Women of refugee background had higher odds of adverse neonatal and maternal outcomes, including stillbirth, neonatal death, low APGAR score, small for gestational age, postpartum haemorrhage, abnormal labour, perineal tear, and maternal admission to intensive care compared to Australian-born women. However, they had lower odds of neonatal admission to intensive care, pre-eclampsia, and maternal postnatal depression. The trend analysis showed limited signs of gaps closing over time in adverse perinatal outcomes. DISCUSSION AND CONCLUSION Refugee background was associated with unfavourable perinatal outcomes, highlighting the negative influence of refugee status on perinatal health. This evidences the need to address the unique healthcare requirements of this vulnerable population to enhance the well-being of mothers and newborns. Implementing targeted interventions and policies is crucial to meet the healthcare requirements of women of refugee backgrounds. Collaborative efforts between healthcare organisations, government agencies and non-governmental organisations are essential in establishing comprehensive support systems to assist refugee women throughout their perinatal journey.
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Affiliation(s)
- Yordanos Gizachew Yeshitila
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia; School of Nursing, College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia; Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Lisa Gold
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Elisha Riggs
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of General Practice, The University of Melbourne, Victoria, Melbourne, Australia
| | - Julie Abimanyi-Ochom
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Institute for Health Transformation, Victoria, Australia
| | - Ha N D Le
- Institute for Health Transformation, Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 1Gheringhap Street, Geelong, Victoria 3220, Australia
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Willey SM, Gibson ME, Blackmore R, Goonetilleke L, McBride J, Highet N, Ball N, Gray KM, Melvin G, Boyd LM, East CE, Boyle JA. Perinatal mental health screening for women of refugee background: Addressing a major gap in pregnancy care. Birth 2024; 51:229-241. [PMID: 37859580 DOI: 10.1111/birt.12782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/24/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Perinatal mental health disorders affect up to 20% of all women. Women of refugee background are likely to be at increased risk, yet little research has explored this. This study aimed to assess if women of refugee background are more likely to screen risk positive for depression and anxiety than non-refugee women, using the Edinburgh Postnatal Depression Scale (EPDS); and if screening in pregnancy using the EPDS enables better detection of depression and anxiety symptoms in women of refugee background than routine care. METHODS This implementation study was conducted at an antenatal clinic in Melbourne, Australia. Women of refugee and non-refugee backgrounds were screened for depression using English or translated versions of the EPDS and a psychosocial assessment on a digital platform. The psychosocial assessment records of 34 women of refugee background receiving routine care (no screening) were audited. RESULTS Overall, 274 women completed the EPDS; 43% of refugee background. A similar proportion of women of refugee and non-refugee backgrounds had EPDS scores of ≥9 (39% vs. 40% p = 0.93). Women receiving the combined EPDS and psychosocial screening were more likely to receive a referral for further support than women receiving routine care (41% vs. 18%, p = 0.012). CONCLUSION Similarly, high proportions of women of refugee and non-refugee backgrounds were at increased risk of experiencing a current depressive disorder in early pregnancy, suggesting pregnancy care systems should acknowledge and respond to the mental health needs of these women. Screening appeared to facilitate the identification and referral of women compared to routine care.
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Affiliation(s)
- Suzanne M Willey
- School of Nursing and Midwifery, Peninsula Campus, Monash University, Victoria, Clayton, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Clayton, Australia
| | - Melanie E Gibson
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Clayton, Australia
- Te Tātai Hauora o Hine - National Centre for Women's Health Research Aotearoa, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Rebecca Blackmore
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Clayton, Australia
- Centre for Mental Health, Swinburne University of Technology, Victoria, Hawthorn, Australia
| | | | - Jacqueline McBride
- Monash Refugee Health and Wellbeing, Monash Health, Victoria, Melbourne, Australia
| | - Nicole Highet
- Centre of Perinatal Excellence, Victoria, Flemington, Australia
| | - Natahl Ball
- Monash Health, Maternity Services, Victoria, Clayton, Australia
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, UK
- Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Clayton, Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Victoria, Burwood, Australia
| | | | - Christine E East
- School of Nursing and Midwifery/Judith Lumley Centre & Mercy Health, La Trobe University, Victoria, Bundoora, Australia
| | - Jacqueline A Boyle
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Victoria, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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3
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Blackmore R, Gibson-Helm M, Melvin G, Boyle JA, Fazel M, Gray KM. Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic. Aust N Z J Psychiatry 2022; 56:525-534. [PMID: 34250839 DOI: 10.1177/00048674211025687] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Identifying women at risk of depression and anxiety during pregnancy provides an opportunity to improve health outcomes for women and their children. One barrier to screening is the availability of validated measures in the woman's language. Afghanistan is one of the largest source countries for refugees yet there is no validated measure in Dari to screen for symptoms of perinatal depression and anxiety. The aim of this study was to assess the screening properties of a Dari translation of the Edinburgh Postnatal Depression Scale. METHODS This cross-sectional study administered the Edinburgh Postnatal Depression Scale Dari version to 52 Dari-speaking women at a public pregnancy clinic in Melbourne, Australia. A clinical interview using the depressive and anxiety disorders modules from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) was also conducted. Interview material was presented to an expert panel to achieve consensus diagnoses. The interview and diagnostic process was undertaken blind to Edinburgh Postnatal Depression Scale screening results. RESULTS Cronbach's alpha coefficient for the Edinburgh Postnatal Depression Scale Dari version was good (α = 0.79). Criterion validity was assessed using the receiver operating characteristics curve and generated excellent classification accuracy for depression diagnosis (0.90; 95% confidence interval [0.82, 0.99]) and for anxiety diagnosis (0.94; 95% confidence interval [0.88, 1.00]). For depression, a cut-off score of 9, as recommended for culturally and linguistically diverse groups, demonstrated high sensitivity (1.00; 95% confidence interval [0.79, 1.00]) and specificity (0.88; 95% confidence interval [0.73, 0.97]). For anxiety, a cut-off score of ⩾5 provided the best balance of sensitivity (1.00; 95% confidence interval [0.72, 1.00]) and specificity (0.80; 95% confidence interval [0.65, 0.91]). CONCLUSION These results support the use of this Edinburgh Postnatal Depression Scale Dari version to screen for symptoms of depression and anxiety during pregnancy as well as the use of a lowered cut-off score.
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Affiliation(s)
- Rebecca Blackmore
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Glenn Melvin
- Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health, Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mina Fazel
- Department of Psychiatry, Oxford University, Oxford, UK
| | - Kylie M Gray
- Centre for Educational Development, Appraisal and Research (CEDAR), Faculty of Social Sciences, University of Warwick, Coventry, UK.,Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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4
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Dunlavy A, Cederström A, Katikireddi SV, Rostila M, Juárez SP. Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study. Eur J Public Health 2022; 32:226-232. [PMID: 35040957 PMCID: PMC8975526 DOI: 10.1093/eurpub/ckab222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Studies of migration and health have hypothesized that immigrants may emigrate when they develop poor health (salmon bias effect), which may partially explain the mortality advantage observed among immigrants in high-income countries. We evaluated the salmon bias effect by comparing the health of immigrants in Sweden who emigrated with those who remained, while also exploring potential variation by macro-economic conditions, duration of residence and region of origin. Methods A longitudinal, open cohort study design was used to assess risk of emigration between 1992 and 2016 among all adult (18+ years) foreign-born persons who immigrated to Sweden between 1965 and 2012 (n = 1 765 459). The Charlson Comorbidity Index was used to measure health status, using information on hospitalizations from the Swedish National Patient Register. Poisson regression models were used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs) for emigrating from Sweden. Results Immigrants with low (RR = 0.83; 95% CI: 0.76–0.90) moderate (RR = 0.70; 95% CI: 0.62–0.80) and high (RR = 0.62; 95% CI: 0.48–0.82) levels of comorbidities had decreased risk of emigration relative to those with no comorbidities. There was no evidence of variation by health status in emigration during periods of economic recession or by duration of residence. Individuals with low to moderate levels of comorbidities from some regions of origin had an increased risk of emigration relative to those with no comorbidities. Conclusions The study results do not support the existence of a salmon bias effect as a universal phenomenon among international immigrants in Sweden.
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Affiliation(s)
- Andrea Dunlavy
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Agneta Cederström
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Srinivasa Vittal Katikireddi
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden.,Institute of Health & Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Sol P Juárez
- Department of Public Health Sciences, Stockholm University and Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
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5
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Njue C, Nicholas N, Robertson H, Dawson A. Geographical Access to Child and Family Healthcare Services and Hospitals for Africa-Born Migrants and Refugees in NSW, Australia; A Spatial Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413205. [PMID: 34948813 PMCID: PMC8701331 DOI: 10.3390/ijerph182413205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/23/2022]
Abstract
Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney’s inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants.
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Snow G, Melvin GA, Boyle JA, Gibson-Helm M, East CE, McBride J, Gray KM. Perinatal psychosocial assessment of women of refugee background. Women Birth 2020; 34:e302-e308. [PMID: 32571715 DOI: 10.1016/j.wombi.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 05/20/2020] [Accepted: 05/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women of refugee background may be particularly vulnerable to perinatal mental illness, possibly due to increased exposure to psychosocial stressors associated with their forced migration and post-resettlement adjustment. AIM This study aimed to compare psychosocial risk factors reported by women of refugee background receiving maternity services at a public hospital, to those reported by Australian-born women in the same hospital. It further aimed to examine the referrals offered, and accepted, by the women of refugee background reporting psychosocial risk factors for perinatal mental illness. METHODS A retrospective hospital record review was conducted to compare the antenatal and postnatal psychosocial risk factors of 100 women of refugee background and 100 Australian-born women who gave birth at a public hospital in Victoria between 1 July 2015 and 30 April 2016, and who had completed the Maternity Psychosocial Needs Assessment. FINDINGS Women of refugee background were more likely than Australian-born women to report financial concerns and low social support at antenatal assessment, but were less likely to report prior mental health problems than Australian-born women at either assessment point. Both groups reported low rates of family violence compared to published prevalence rates. Of the women of refugee background assessed antenatally, 23% were offered referrals, with 52% take-up. Postnatally, 11.2% were offered referrals, with 93% take-up. DISCUSSION/CONCLUSION This study showed elevated rates of psychosocial risk factors among women of refugee background, however, possible under-reporting of mental health problems and family violence raises questions regarding how to assess psychosocial risk factors with different cultural groups. Lower antenatal referral take-up suggests barriers to acceptance of referrals may exist during pregnancy.
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Affiliation(s)
- Gillian Snow
- Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.
| | - Glenn A Melvin
- School of Psychology, Faculty of Health, Deakin University, Victoria, Australia; Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Monash Women's Maternity Services, Monash Health, Victoria, Australia
| | - Melanie Gibson-Helm
- Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Christine E East
- Monash Centre for Health Research & Implementation, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Monash Women's Maternity Services, Monash Health, Victoria, Australia; School of Nursing and Midwifery, Monash University, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Victoria, Australia
| | | | - Kylie M Gray
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, United Kingdom; Centre for Developmental Psychiatry & Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
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7
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Agbemenu K, Auerbach S, Murshid NS, Shelton J, Amutah-Onukagha N. Reproductive Health Outcomes in African Refugee Women: A Comparative Study. J Womens Health (Larchmt) 2019; 28:785-793. [PMID: 30767694 DOI: 10.1089/jwh.2018.7314] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: African refugee women in the United States are at risk of poor reproductive health outcomes; however, examination of reproductive health outcomes in this population remains inadequate. We compared: (1) prepregnancy health and prenatal behavior; (2) prenatal history and prenatal care utilization; and (3) labor and birth outcomes between African refugee women and U.S.-born Black and White women. Methods: A secondary data analysis of enhanced electronic birth certificate data was used. Univariate comparisons using chi-squared tests for dichotomous variables and analysis of variance and/or Kruskal-Wallis tests for continuous variables were conducted for Refugee versus Black versus White women. A p-value <0.05 was considered statistically significant. Results: From 2007 to 2016, 789 African refugee, 17,487 Black, and 59,615 White women in our population gave birth. African refugees experienced more favorable health outcomes than U.S.-born groups on variables examined. Compared to U.S.-born women, African refugee women had fewer prepregnancy health risks (p < 0.001), fewer preterm births (p < 0.001), fewer low birth weight infants (p < 0.001), and higher rates of vaginal deliveries (p < 0.001). These favorable outcomes occurred despite later initiation of prenatal care (p < 0.001) and lower scores of prenatal care adequacy among refugee women compared to U.S.-born groups (p < 0.001). Conclusions: The healthy immigrant effect appears to extend to reproductive health outcomes in our studied population of African refugee women. However, based on our data, targeted, culturally-congruent education surrounding family planning and prenatal care is recommended. Insight from reproductive health care experiences of African refugee women can provide understanding of the protective factors contributing to the healthy immigrant effect in reproductive health outcomes, and knowledge gained can be utilized to improve outcomes in other at-risk groups.
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Affiliation(s)
- Kafuli Agbemenu
- 1 School of Nursing, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Samantha Auerbach
- 1 School of Nursing, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Nadine Shaanta Murshid
- 2 School of Social Work, The State University of New York (SUNY), University at Buffalo, Amherst, New York
| | - James Shelton
- 3 Department of Obstetrics and Gynecology, Jacobs School of Medicine and Biomedical Sciences, The State University of New York (SUNY), University at Buffalo, Buffalo, New York
| | - Ndidiamaka Amutah-Onukagha
- 4 Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
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8
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Abell SK, Boyle JA, Earnest A, England P, Nankervis A, Ranasinha S, Soldatos G, Wallace EM, Zoungas S, J Teede H. Impact of different glycaemic treatment targets on pregnancy outcomes in gestational diabetes. Diabet Med 2019; 36:177-183. [PMID: 30102812 DOI: 10.1111/dme.13799] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2018] [Indexed: 11/27/2022]
Abstract
AIM With no current randomized trials, we explored the impact of tight compared with standard treatment targets on pregnancy outcomes in gestational diabetes mellitus (GDM). METHODS This cohort study of singleton births ≥ 28 weeks' gestation was conducted at two major Australian maternity services (2009-2013). Standardized maternal, neonatal and birth outcomes were examined using routine healthcare data and compared for women with GDM at Service One (n = 2885) and Service Two (n = 1887). Services applied different treatment targets: Service One (standard targets, reference group) fasting < 5.5 mmol/l, 2-h postprandial < 7.0 mmol/l; Service Two (tight targets) fasting < 5.0 mmol/l, 2-h postprandial < 6.7 mmol/l. Multivariable regression with propensity score adjustment was used to examine associations between targets and outcomes. RESULTS GDM prevalence and insulin use were 7.9% and 31% at Service One, and 5.7% and 46% at Service Two. There were no differences in primary outcomes: birthweight > 90th centile [adjusted odds ratio (OR) 1.06, 95% confidence interval (CI) 0.87-1.30] and < 10th centile (OR 0.84, 95% CI 0.70-1.01), or secondary outcomes gestational hypertension, pre-eclampsia, shoulder dystocia or a perinatal composite. Service Two with tight targets had increased induction of labour (OR 3.63, 95% CI 3.17-4.16), elective Caesarean section (OR 1.75, 95% CI 1.37-2.23) and Apgar scores < 7 at 5 min (OR 1.54, 95% CI 1.05-2.25), decreased hypoglycaemia (OR 0.76, 95% CI 0.61-0.94]), jaundice (OR 0.47, 95% CI 0.35-0.63) and respiratory distress (OR 0.68, 95% CI 0.47-0.98). CONCLUSIONS Tight GDM treatment targets were associated with greater insulin use and no difference in primary birthweight outcomes. The service with tight targets had higher obstetric intervention, lower rates of reported hypoglycaemia, jaundice, respiratory distress and lower Apgar scores. High-quality interventional data are required before tight treatment targets can be implemented.
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Affiliation(s)
- S K Abell
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Vic., Australia
| | - J A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Monash Women's Services, Monash Health, Melbourne, Vic., Australia
| | - A Earnest
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - P England
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, Melbourne, Vic., Australia
| | - A Nankervis
- Diabetes Unit, Royal Women's Hospital, Melbourne, Vic., Australia
| | - S Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - G Soldatos
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Vic., Australia
| | - E M Wallace
- Monash Women's Services, Monash Health, Melbourne, Vic., Australia
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Vic., Australia
| | - S Zoungas
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Vic., Australia
| | - H J Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Vic., Australia
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9
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Juárez S, Mussino E, Hjern A. Being a refugee or having a refugee status? Birthweight and gestational age outcomes among offspring of immigrant mothers in Sweden. Scand J Public Health 2018; 47:730-734. [PMID: 29807485 DOI: 10.1177/1403494818777432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: to evaluate whether the information on refugee status based on the residence permit is a useful source of information for perinatal health surveillance. Methods: Using the Swedish population registers (1997-2012), we use multinomial regression models to assess the associations between migration status (refugee and non-refugee) and birth outcomes derived from birthweight and gestational age: low birthweight (LBW) (<2500 g), macrosomia (≥4000 g); preterm: (<37 w) and post-term (≥42 w). The Swedish-born population was used as a reference group. Results: Compared to the Swedish-born population, an increased OR (odds ratio) of LBW and post-term was found among migrants with and without refugee status (respectively: OR for refugees: 1.47 [95% CI: 1.33-1.63] and non-refugees:1.27 [95% CI: 1.18-1.38], for refugees: 1.41 [95% CI: 1.35-1.49] and non-refugees:1.04 [95% CI: 1.00-1.08]) with statistically significant differences between these two migrant categories. However, when looking at specific regions of origin, few regions show differences by refugee status. Compared to Swedes, lower or equal ORs of preterm and macrosomia are observed regardless of migratory status. Conclusions: Small or no differences were observed in birth outcomes among offspring of women coming from the same origin with different migratory status, compared to their Swedish counterparts. This suggests that information on migration status is not a relevant piece of information to identify immigrant women at higher risk of experiencing adverse reproductive outcomes. Our results however might be explained by the large proportion of women coming to Sweden for family reunification who are classified as non-refugee migrants.
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Affiliation(s)
- Sol Juárez
- Department of Public Health Sciences, Stockholm University, Sweden.,Stockholm University Demography Unit, Department of Sociology, Stockholm University, Sweden
| | - Eleonora Mussino
- Stockholm University Demography Unit, Department of Sociology, Stockholm University, Sweden
| | - Anders Hjern
- Department of Public Health Sciences, Stockholm University, Sweden.,Clinical Epidemiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
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10
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Straiton ML, Reneflot A, Diaz E. Mental Health of Refugees and Non-refugees from War-Conflict Countries: Data from Primary Healthcare Services and the Norwegian Prescription Database. J Immigr Minor Health 2018; 19:582-589. [PMID: 27328949 PMCID: PMC5399054 DOI: 10.1007/s10903-016-0450-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High rates of mental health problems are consistently found among immigrants from refugee generating countries. While refugees and their family members may have experienced similar traumas, refugees are more likely to have undergone a stressful asylum period. This study aims to determine whether their mental health differs. Using national registry data, refugees and non-refugees from the same countries were compared on primary healthcare service use for mental health problems and purchase of psychotropic medicine. Refugees had higher odds of using primary health care services than non-refugees. Refugee women were more likely to purchase psychotropic medicine than non-refugee women. Refugee men were more likely to purchase anti-depressants. The findings suggest that refugees have poorer mental health than non-refugees. This may be due to a combination of greater pre-migration trauma and post-migration stressors such as enduring a difficult asylum period.
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Affiliation(s)
- Melanie L Straiton
- Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, 0403, Nydalen, Oslo, Norway.
| | - Anne Reneflot
- Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, 0403, Nydalen, Oslo, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Health Care, University of Bergen, Bergen, Norway
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11
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Giallo R, Riggs E, Lynch C, Vanpraag D, Yelland J, Szwarc J, Duell-Piening P, Tyrell L, Casey S, Brown SJ. The physical and mental health problems of refugee and migrant fathers: findings from an Australian population-based study of children and their families. BMJ Open 2017; 7:e015603. [PMID: 29151045 PMCID: PMC5702027 DOI: 10.1136/bmjopen-2016-015603] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 10/06/2017] [Accepted: 10/18/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to report on the physical and mental health of migrant and refugee fathers participating in a population-based study of Australian children and their families. DESIGN Cross-sectional survey data drawn from a population-based longitudinal study when children were aged 4-5 years. SETTING Population-based study of Australian children and their families. PARTICIPANTS 8137 fathers participated in the study when their children were aged 4-5 years. There were 131 (1.6%) fathers of likely refugee background, 872 (10.7%) fathers who migrated from English-speaking countries, 1005 (12.4%) fathers who migrated from non-English-speaking countries and 6129 (75.3%) Australian-born fathers. PRIMARY OUTCOME MEASURES Fathers' psychological distress was assessed using the self-report Kessler-6. Information pertaining to physical health conditions, global or overall health, alcohol and tobacco use, and body mass index status was obtained. RESULTS Compared with Australian-born fathers, fathers of likely refugee background (adjusted OR(aOR) 3.17, 95% CI 2.13 to 4.74) and fathers from non-English-speaking countries (aOR 1.79, 95%CI 1.51 to 2.13) had higher odds of psychological distress. Refugee fathers were more likely to report fair to poor overall health (aOR 1.95, 95% CI 1.06 to 3.60) and being underweight (aOR 3.49, 95% CI 1.57 to 7.74) compared with Australian-born fathers. Refugee fathers and those from non-English-speaking countries were less likely to report light (aOR 0.25, 95% CI 0.15 to 0.43, and aOR 0.30, 95% CI 0.24 to 0.37, respectively) and moderate to harmful alcohol use (aOR 0.04, 95% CI 0.10 to 0.17, and aOR 0.14, 95% CI 0.10 to 0.19, respectively) than Australian-born fathers. Finally, fathers from non-English-speaking and English-speaking countries were less likely to be overweight (aOR 0.62, 95% CI 0.51 to 0.75, and aOR 0.84, 95% CI 0.68 to 1.03, respectively) and obese (aOR 0.43, 95% CI 0.32 to 0.58, and aOR 0.77, 95% CI 0.61 to 0.98, respectively) than Australian-born fathers. CONCLUSION Fathers of refugee background experience poorer mental health and poorer general health than Australian-born fathers. Fathers who have migrated from non-English-speaking countries also report greater psychological distress than Australian-born fathers. This underscores the need for primary healthcare services to tailor efforts to reduce disparities in health outcomes for refugee populations that may be vulnerable due to circumstances and sequelae of forced migration and to recognise the additional psychological stresses that may accompany fatherhood following migration from non-English-speaking countries. It is important to note that refugee and migrant fathers report less alcohol use and are less likely to be overweight and obese than Australian-born fathers.
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Affiliation(s)
- Rebecca Giallo
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Claire Lynch
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Jane Yelland
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
| | - Josef Szwarc
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | | | - Lauren Tyrell
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Sue Casey
- The Victorian Foundation for Survivors of Torture, Brunswick, Australia
| | - Stephanie Janne Brown
- Healthy Mothers Healthy Families Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Royal Children’s Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Department of General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria, Australia
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12
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Post-term surveillance and birth outcomes in South Asian-born compared with Australian-born women. J Perinatol 2017; 37:139-143. [PMID: 27929532 DOI: 10.1038/jp.2016.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if apparently healthy post-term South Asian-born (SA) women were more likely to have abnormal post-term fetal surveillance than Australian- and New Zealand-born (AUS/NZ) women, whether those abnormalities were associated with increased rates of obstetric intervention and adverse perinatal outcomes, and whether SA women and their babies were at higher risk of adverse outcomes in the post-term period irrespective of their post-term surveillance outcomes. STUDY DESIGN Post-term surveillance and perinatal outcomes of 145 SA and 272 AUS/NZ nulliparous women with a singleton post-term pregnancy were compared in a retrospective multicentre cohort analysis. RESULTS Post-term SA women were not significantly more likely to have a low amniotic fluid index (AFI) than AUS/NZ women. However, they were nearly four times more likely (odds ratio 3.75; 95% CI 1.49-9.44) to have an abnormal CTG (P=0.005). Irrespective of maternal region of birth having an abnormal cardiotocography (CTG) or AFI was not associated with adverse intrapartum or perinatal outcomes. However, post-term SA women were significantly more likely than AUS/NZ women to have intrapartum fetal compromise (P=0.03) and an intrapartum cesarean section (P=0.002). Babies of SA women were more also significantly likely to be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (P=0.02). CONCLUSION Post-term SA women experience higher rates of fetal compromise (antenatal and intrapartum) and obstetric intervention than AUS/NZ women. Irrespective of maternal region of birth an abnormal CTG or AFI was not predictive of adverse outcomes.
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13
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Gibson-Helm ME, Teede HJ, Cheng IH, Block AA, Knight M, East CE, Wallace EM, Boyle JA. Maternal health and pregnancy outcomes comparing migrant women born in humanitarian and nonhumanitarian source countries: a retrospective, observational study. Birth 2015; 42:116-24. [PMID: 25864573 DOI: 10.1111/birt.12159] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between migration and pregnancy outcomes is complex, with little insight into whether women of refugee background have greater risks of adverse pregnancy outcomes than other migrant women. This study aimed to describe maternal health, pregnancy care, and pregnancy outcomes among migrant women from humanitarian and nonhumanitarian source countries. METHODS Retrospective, observational study of singleton births, at a single maternity service in Australia 2002-2011, to migrant women born in humanitarian source countries (HSCs, n = 2,713) and non-HSCs (n = 10,606). Multivariable regression analysis assessed associations between maternal HSC-birth and pregnancy outcomes. RESULTS Compared with women from non-HSCs, the following were more common in women from HSCs: age < 20 years (0.6 vs 2.9% p < 0.001), multiparity (51 vs 76% p < 0.001), body mass index (BMI) ≥ 25 (38 vs 50% p < 0.001), anemia (3.2 vs 5.9% p < 0.001), tuberculosis (0.1 vs 0.4% p = 0.001), and syphilis (0.4 vs 2.5% p < 0.001). Maternal HSC-birth was independently associated with poor or no pregnancy care attendance (OR 2.5 [95% CI 1.8-3.6]), late first pregnancy care visit (OR 1.3 [95% CI 1.1-1.5]), and postterm birth (> 41 weeks gestation) (OR 2.5 [95% CI 1.9-3.4]). Stillbirth (0.8 vs 1.2% p = 0.04, OR 1.5 [95% CI 1.0-2.4]) and unplanned birth before arrival at the hospital (0.6 vs 1.2% p < 0.001, OR 1.3 [95% CI 0.8-2.1]) were more common in HSC-born women but not independently associated with maternal HSC-birth after adjusting for age, parity, BMI and relative socioeconomic disadvantage. CONCLUSIONS These findings suggest areas where women from HSCs may have additional needs in pregnancy compared with women from non-HSCs. Refugee-focused strategies to support engagement in pregnancy care and address maternal health needs would be expected to improve health outcomes in resettlement countries.
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Affiliation(s)
- Melanie E Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | - I-Hao Cheng
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Dandenong, Victoria, Australia.,South Eastern Melbourne Medicare Local, Dandenong, Victoria, Australia
| | - Andrew A Block
- Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia
| | - Michelle Knight
- Monash Women's Maternity Services, Monash Health, Clayton, Victoria, Australia
| | - Christine E East
- School of Nursing and Midwifery, Monash University Clayton, Victoria, Australia
| | | | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University Clayton, Victoria, Australia
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14
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Yelland J, Riggs E, Szwarc J, Casey S, Dawson W, Vanpraag D, East C, Wallace E, Teale G, Harrison B, Petschel P, Furler J, Goldfeld S, Mensah F, Biro MA, Willey S, Cheng IH, Small R, Brown S. Bridging the Gap: using an interrupted time series design to evaluate systems reform addressing refugee maternal and child health inequalities. Implement Sci 2015; 10:62. [PMID: 25924721 PMCID: PMC4425879 DOI: 10.1186/s13012-015-0251-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/18/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The risk of poor maternal and perinatal outcomes in high-income countries such as Australia is greatest for those experiencing extreme social and economic disadvantage. Australian data show that women of refugee background have higher rates of stillbirth, fetal death in utero and perinatal mortality compared with Australian born women. Policy and health system responses to such inequities have been slow and poorly integrated. This protocol describes an innovative programme of quality improvement and reform in publically funded universal health services in Melbourne, Australia, that aims to address refugee maternal and child health inequalities. METHODS/DESIGN A partnership of 11 organisations spanning health services, government and research is working to achieve change in the way that maternity and early childhood health services support families of refugee background. The aims of the programme are to improve access to universal health care for families of refugee background and build organisational and system capacity to address modifiable risk factors for poor maternal and child health outcomes. Quality improvement initiatives are iterative, co-designed by partners and implemented using the Plan Do Study Act framework in four maternity hospitals and two local government maternal and child health services. Bridging the Gap is designed as a multi-phase, quasi-experimental study. Evaluation methods include use of interrupted time series design to examine health service use and maternal and child health outcomes over a 3-year period of implementation. Process measures will examine refugee families' experiences of specific initiatives and service providers' views and experiences of innovation and change. DISCUSSION It is envisaged that the Bridging the Gap program will provide essential evidence to support service and policy innovation and knowledge about what it takes to implement sustainable improvements in the way that health services support vulnerable populations, within the constraints of existing resources.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia.
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, VIC, Australia.
| | - Wendy Dawson
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
| | - Chris East
- Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia.
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
| | - Euan Wallace
- Monash Women's Maternity Services, Monash Health, Clayton, VIC, Australia.
- The Ritchie Centre, Monash University, Clayton, VIC, Australia.
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia.
| | - Glyn Teale
- Women's and Children's Services, Western Health, Sunshine, VIC, Australia.
- Department Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia.
| | - Bernie Harrison
- Maternal and Child Health, City of Greater Dandenong, Dandenong, VIC, Australia.
| | - Pauline Petschel
- Maternal and Child Health, City of Wyndham, Wyndham, VIC, Australia.
| | - John Furler
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
| | - Sharon Goldfeld
- Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Fiona Mensah
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
| | - Sue Willey
- School of Nursing and Midwifery, Monash University, Clayton, VIC, Australia.
| | - I-Hao Cheng
- South Eastern Melbourne Medicare Local, Dandenong, VIC, Australia.
- Southern Academic Primary Care Research Unit, Monash University, Dandenong, VIC, Australia.
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia.
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Parkville, 3052, , VIC, Australia.
- Department of General Practice and Primary Health Care Academic Unit, University of Melbourne, Parkville, VIC, Australia.
- School of Population Health, University of Melbourne, Parkville, VIC, Australia.
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15
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Gibson-Helm M, Teede H, Block A, Knight M, East C, Wallace EM, Boyle J. Maternal health and pregnancy outcomes among women of refugee background from African countries: a retrospective, observational study in Australia. BMC Pregnancy Childbirth 2014; 14:392. [PMID: 25427757 PMCID: PMC4251928 DOI: 10.1186/s12884-014-0392-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/11/2014] [Indexed: 11/16/2022] Open
Abstract
Background Women of refugee background from Africa are reported to have a greater risk of adverse pregnancy outcomes compared to women born in resettlement countries. However, there is currently little insight into whether adverse pregnancy outcomes are more common among migrant women of refugee background, compared to women who have migrated for non-humanitarian reasons. To inform whether women of refugee background require additional services in pregnancy compared to non-refugee migrant women from similar world regions we aimed to describe and compare maternal health, pregnancy care attendance and pregnancy outcomes among migrant women from Africa with or without a refugee background. Methods Retrospective, observational study of singleton births at a single, metropolitan, maternity service in Australia 2002–2011, to women born in humanitarian source countries (HSC) and non-HSC from North Africa (n = 1361), Middle and East Africa (n = 706) and West Africa (n = 106). Results Compared to non-HSC groups, age < 20 years (0–1.4% vs 2.3-13.3%), living in relatively socio-economically disadvantaged geographic areas (26.2-37.3% vs 52.9-77.8%) and interpreter need (0–23.9% vs 9.7-51.5%) were generally more common in the HSC groups. Compared to non-HSC groups, female genital mutilation (0.3-3.3% vs 5.1-13.8%), vitamin D insufficiency (8.7-21.5% vs 23.3-32.0%), syphilis (0–0.3% vs 1.2-7.5%) and hepatitis B (0–1.1% vs 1.2-18%) were also generally more common among the HSC groups. Unplanned birth before arrival at the hospital (3.6%) was particularly high in the North African HSC group. HSC-birth was associated with gestational diabetes mellitus (odds ratio = 3.5, 95% confidence interval: 1.8-7.1) among women from Middle and East Africa, after adjusting for maternal age, parity, body mass index and relative socio-economic disadvantage of area of residence. The West African HSC group had the highest stillbirth incidence (4.4%). Conclusions Migrant women of refugee background from different African regions appear to be at greater risk of specific adverse pregnancy outcomes compared to migrant women without a refugee background. Awareness of differing risks and health needs would assist provision of appropriate pregnancy care to improve the health of African women and their babies.
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