The maternal and neonatal outcomes for an urban Indigenous population compared with their non-Indigenous counterparts and a trend analysis over four triennia

BMC Pregnancy and Childbirth

Kristen Gibbons¹  Machellee Kosiak¹  Rebecca Murphy²  Helen Stapleton¹  Sue Kildea¹ 

[1] Mater Research, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, QLD 4102, Australia;School of Nursing & Midwifery, Trinity College, 24 D'Olier Street, Dublin 2, Ireland

关键词: Evaluation;    Model of care;    Culturally responsive;    Midwifery;    Maternity;    Antenatal;    Indigenous Australian;    Aboriginal and Torres Strait Islander;   

Others  :  1137903
DOI  :  10.1186/1471-2393-13-167

 received in 2012-06-24, accepted in 2013-08-21,  发布年份 2013

【 摘 要 】

Background

Indigenous Australians experience significantly disproportionate poorer health outcomes compared to their non-Indigenous counterparts. Despite the recognised importance of maternal infant health (MIH), there is surprisingly little empirical research to guide service redesign that successfully addresses the disparities. This paper reports on a service evaluation that also compared key MIH indicators for Indigenous and non-Indigenous mothers and babies over a 12-year period 1998–2009.

Methods

Trend analysis with logistic regression, using the independent variables of ethnicity and triennia, explored changes over time (1998–2009) between two cohorts: 1,523 births to Indigenous mothers and 43,693 births to non-Indigenous mothers. We included bivariate and multivariate analysis on key indicators (e.g. teenage births, preterm birth, low birth weight, smoking) and report odds ratios (ORs), 95% CIs and logistic regression adjusting for important confounders. We excluded transfers in from other areas which are identified within the database.

Results

Bivariate analysis revealed Indigenous women were statistically more likely to have spontaneous onset of labour and a non-instrumental vaginal birth. They were less likely to take epidurals for pain relief in labour, have assisted births, caesarean sections or perineal trauma. Despite better labour outcomes, Indigenous babies were more likely to be born preterm (< 37 weeks) and be low birth weight (< 2500 g); these differences remained significant in multivariate analysis. The trend analysis revealed relatively stable rates for teenage pregnancy, small for gestational age, low birth weight babies, and perinatal mortality for both cohorts, with the gap between cohorts consistent over time. A statistical widening of the gap in preterm birth and smoking rates was found with preterm birth demonstrating a relative increase of 51% over this period.

Conclusions

The comprehensive database from a large urban hospital allowed a thorough examination of outcomes and contributing factors. The gap between both cohorts remains static in several areas but in some cases worsened. Alternative models for delivering care to Indigenous women and their babies have shown improved outcomes, including preterm birth, though not all have been sustained over time and none are available Australia-wide. New models of care, which recognise the heterogeneity of Indigenous communities, incorporate a multiagency approach, and are set within a research framework, are urgently needed.

【 授权许可】

   
2013 Kildea et al.; licensee BioMed Central Ltd.

【 图 表 】

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