Antenatal Midwifery Care and Reduced Prevalence of Small-for-Gestational-Age Birth and Other Adverse Infant Birth Outcomes for Women of Low Socioeconomic Position: A Population Based Cohort Study Comparing Midwifery and Physician-Led Models of Care

Purpose: The purpose of this research was to determine if antenatal midwifery care was associated with reduced odds of small-for-gestational-age (SGA) birth, preterm birth (PTB), large-for-gestational-age (LGA) birth, Apgar score less than seven at one minute (low Apgar score), newborn extended length of hospital stay (ELOS), or low birth weight (LBW) compared to antenatal care provided by general practitioners (GPs) or obstetricians (OBs) for women with low socioeconomic position (SEP). Methods: Prior to the main analysis, I conducted a systematic scoping review investigating if, over the last 25 years in high resource countries, midwives’ clients of low SEP were at more or less risk of adverse infant birth outcomes compared to physicians’ patients. The primary analysis was a population level, retrospective cohort study restricted to women with low to moderate risk pregnancy. Women were included if they had been residing in British Columbia, Canada, had singleton births between January 1, 2005 to December 31, 2012, no more than two provider-types involved in care, did not have registered Indian Status, and received Medical Services Plan (MSP) premium subsidy assistance (n=57,872). Generalized estimating equation logistic regression models were used to control for confounding. Results: For patients receiving antenatal midwifery vs. physician care, adjusted odds of SGA birth were reduced (MW vs. GP: OR 0.73, 95% CI: 0.63-0.84; MW vs. OB: OR 0.60, 95% CI: 0.51-0.70), as were odds of preterm birth (MW vs. GP: OR 0.74, 95% CI: 0.63-0.86; MW vs. OB: OR 0.53, 95% CI: 0.45-0.62). Odds of LGA birth were higher for those in the care of midwives vs. physicians (MW vs. GP: OR 1.28, 95% CI: 1.16-1.40; MW vs. OB: OR 1.46, 95% CI: 1.30-1.63). Odds of low Apgar score were only significantly reduced for midwives’ vs. GPs’ patients (OR 0.85, 95% CI: 0.77-0.95). Odds of newborn ELOS were reduced among midwives’ vs. physicians’ patients (MW vs. GP: OR 0.65, 95% CI: 0.57-0.74; MW vs. OB: OR 0.56, 95% CI: 0.49-0.65). Odds of LBW were reduced for patients receiving antenatal midwifery vs. physician care (MW vs. GP: OR 0.66, 95% CI: 0.53-0.82; MW vs. OB: OR 0.43, 95% CI: 0.34-0.54). Midwifery vs. physician patients with substance use and/or mental health conditions, and substance using teen mothers, had even lower odds of some adverse infant outcomes. A second analysis showed a reduction in odds of PTB for midwives’ vs. GPs’ patients of transient low SEP (OR 0.51, 95% CI: 0.37-0.71), but no difference in odds for patients of chronic low SEP. Conclusion: Changes in physicians’ antenatal models of practice, to align with the midwifery model, may improve newborn outcomes for vulnerable women at a population level. Midwifery care should be equally available and accessible to all women, using intensive outreach for women of low SEP if necessary, to promote the highest level of health for all infants

Participant Recruitment of African American College Students at an Historically Black College and University (HBCU): Challenges and Strategies for Health-Related Research

Lack of research participation among African Americans is problematic for population relevant health disparity research. The purpose of this paper is to identify and describe challenges and strategies in recruitment of African American college students for health related research being conducted at a small Historically Black College or University (HBCU). Upon completion of a recruitment and retention literature review, study investigators constructed and tested a culturally-specific, direct-appeal protocol to recruit participants. Major barriers to recruitment of African American college students included discrete sources of distrust, lack of understanding of the research process, and logistical concerns. Implementation of a culturally-specific, direct appeal protocol led to a significant improvement in recruitment and retention of student participants. It is imperative that researchers demystify scientific investigation as a first step towards building trust between themselves and target populations, particularly those from traditionally underrepresented groups. Reasons for distrust, a need for trust and trust building strategies are offered here

Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis

From BMJ via Jisc Publications RouterHistory: received 2022-05-13, ppub 2022-09, accepted 2022-09-01, epub 2022-09-30Peer reviewed: TrueAcknowledgements: We gratefully acknowledge members of the advisory group including Anayda Portela, Denise Kouri, Jessie Forsyth, João Paulo Souza and Tami Waldron. We also extend sincere thanks to the 12 MWH implementers and policy makers who were interviewed during the PT refinement process, including, Abebe Mamo G/tsadik, Bwalya Misheck, Chipo Chimamise, Cristalina Mahumane, Esther Ngaru, Faith Akovi Cooper, Fernanda Andre, Gebeyehu Bulcha and Thandiwe Ngoma.Publication status: PublishedFunder: University of Saskatchewan; FundRef: http://dx.doi.org/10.13039/100008920Funder: Mozambique-Canada Maternal Health Project; Grant(s): D-002085Introduction: Maternity waiting homes (MWHs) link pregnant women to skilled birth attendance at health facilities. Research suggests that some MWH-facility birth interventions are more success at meeting the needs and expectations of their intended users than others. We aimed to develop theory regarding what resources work to support uptake and scale-up of MHW-facility birth interventions, how, for whom, in what contexts and why. Methods: A four-step realist review was conducted which included development of an initial programme theory; searches for evidence; selection, appraisal and extraction of data; and analysis and data synthesis. Results: A programme theory was developed from 106 secondary sources and 12 primary interviews with MWH implementers. The theory demonstrated that uptake and scale-up of the MWH-facility birth intervention depends on complex interactions between three adopter groups: health system stakeholders, community gatekeepers and pregnant women and their families. It describes relationships between 19 contexts, 11 mechanisms and 31 outcomes accross nine context-mechanism-outcome configurations (CMOCs) which were grouped into 3 themes: (1) Engaging stakeholders to develop, integrate, and sustain MWH-facility birth interventions, (2) Promoting and enabling MWH-facility birth utilisation and (3) Creating positive and memorable MWH-facility birth user experiences. Belief, trust, empowerment, health literacy and perceptions of safety, comfort and dignity were mechanisms that supported diffusion and adoption of the intervention within communities and health systems. Examples of resources provided by implementers to trigger mechanisms associated with each CMOC were identified. Conclusions: Implementers of MWHs cannot merely assume that communities will collectively value an MWH-facility birth experience over delivery at home. We posit that MWH-facility birth interventions become vulnerable to under-utilisation when implementers fail to: (1) remove barriers that hinder women’s access to MWH and (2) ensure that conditions and interactions experienced within the MWH and its affiliated health facility support women to feel treated with compassion, dignity and respect. PROSPERO registration number: CRD42020173595

Aboriginal Status and Neighborhood Income Inequality Moderate the Relationship between School Absenteeism and Early Childhood Development

The negative impact of school absenteeism on children’s academic performance has been documented in the educational literature, yet few studies have used validated development indicators, or investigated individual and neighborhood characteristics to illuminate potential moderating factors. Using cross-sectional Early Development Instrument (EDI) panel data (2001–2005) we constructed multilevel linear and logistic regression models to examine the association between school absenteeism and early childhood development, moderated by Aboriginal status, length of school absence, neighborhood-level income inequality, and children’s sex assigned at birth. Our study included 3572 children aged four to eight in 56 residential neighborhoods in Saskatoon, Canada. Results indicated that Aboriginal children missing an average number of school days (3.63 days) had significantly lower EDI scores compared to non-Aboriginal children, controlling for individual and neighborhood factors. As school absenteeism lengthened, the gap in EDI scores between Aboriginal and non-Aboriginal children narrowed, becoming non-significant for absences greater than two weeks. Children with long-term school absence (>4 weeks of school), living in neighborhoods of low income inequality, had significantly better physical and social development scores compared to children from medium or high income inequality neighborhoods. Across all EDI domains, girls living in neighborhoods with low income inequality had significantly better EDI scores than boys in similar neighborhoods; however, sex-differences in EDI scores were not apparent for children residing in high income inequality neighborhoods. Results add to the literature by demonstrating differences in the relationship between school absenteeism and early developmental outcomes moderated by Aboriginal status, length of school absence, neighborhood income inequality, and sex assigned at birth. These moderating factors show that differential approaches are necessary when implementing policies and programs aimed at improving school attendance

Improving birth outcomes for women who are substance using or have mental illness: a Canadian cohort study comparing antenatal midwifery and physician models of care for women of low socioeconomic position

Background: Some observational studies have shown improved birth outcomes for women of low socioeconomic position (SEP) receiving antenatal midwifery versus physician care. To understand for whom and under what circumstances midwifery care is associated with better birth outcomes we examined whether psychosocial risk including substance use, mental illness, social assistance, residence in a neighbourhood of low/moderate SEP, and teen maternal age modified the association between model of care (midwifery versus physician) and small-for-gestational-age (SGA) or preterm birth (PTB) for women of low SEP. Methods: For this retrospective cohort study, maternity data from the British Columbia Perinatal Data Registry were linked with Medical Services Plan billing data. We report adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for SGA birth (< the 10th percentile) and PTB (< 37 weeks’ completed gestation). For tests of interaction between antenatal models of care and psychosocial risk, p-values < 0.10 were considered statistically significant. Women were eligible for inclusion if they were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, birthed between April 1, 2008 and Dec. 31, 2012, and received a health insurance subsidy (n = 33,937). Results: Midwifery versus obstetrician patients had lower odds of PTB. The difference was 31% larger among substance users (aOR 0.24, 95% CI: 0.11–0.54) compared to non-substance users (aOR 0.55, 95% CI: 0.45–0.68). Additionally, there was a 34% statistically significant absolute difference in odds of PTB for midwifery versus obstetrician patients with both mental illness and substance use (aOR 0.18, 95% CI: 0.06–0.55) compared to women with neither mental illness nor substance use (aOR 0.52, 95% CI: 0.41–.66). Results demonstrated a consistent association between midwifery versus physician care and lower odds of SGA, yet effects were not statistically significantly different for women with higher or lower psychosocial risk. Conclusion: Among low SEP women in British Columbia, Canada, antenatal midwifery compared to obstetrician care was associated with reduced odds of PTB. Odds were lower among women with substance use, and mental illness and substance use, than among women without these risk factors.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult

Understanding the implementation (including women’s use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol

Introduction Maternity waiting homes in low-income and middle-income countries provide accommodation near health facilities for pregnant women close to the time of birth to promote facility-based birth and birth with a skilled professional and to enable timely access to emergency obstetric services when needed. To date, no studies have provided a systematic, comprehensive synthesis explaining facilitators and barriers to successful maternity waiting home implementation and whether and how implementation strategies and recommendations vary by context. This synthesis will systematically consolidate the evidence, answering the question, ‘How, why, for whom, and in what context are maternity waiting homes successfully implemented in low-income and middle-income countries?’.Methods and analysis Methods include standard steps for realist synthesis: determining the scope of the review, searching for evidence, appraising and extracting data, synthesising and analysing the data and developing recommendations for dissemination. Steps are iterative, repeating until theoretical saturation is achieved. Searching will be conducted in 13 electronic databases with results managed in Eppi-Reviewer V.4. There will be no language, study-type or document-type restrictions. Items documented prior to 1990 will be excluded. To ensure our initial and revised programme theories accurately reflect the experiences and knowledge of key stakeholders, most notably the beneficiaries, interviews will be conducted with maternity waiting home users/nonusers, healthcare staff, policymakers and programme designers. All data will be analysed using context–mechanism–outcome configurations, refined and synthesised to produce a final programme theory.Ethics and dissemination Ethics approval for the project will be obtained from the Mozambican National Bioethical Commission, Jimma University College of Health Sciences Institutional Review Board and the University of Saskatchewan Bioethical Research Ethics Board. To ensure results of the evaluation are available for uptake by a wide range of stakeholders, dissemination will include peer-reviewed journal publication, a plain-language brief, and conference presentations to stakeholders’ practice audiences.PROSPERO registration number CRD42020173595

Prehypertensive Risk Among African-American Undergraduates: Do The Extra Pounds Really Matter?

The objective of this study is to examine prehypertension among young African American adults and evaluate the predictive value of easily obtained standard measures of adiposity. Data for this study of 155 primarily African-American undergraduates was collected between April 2010-11. Participants provided family health history and anthropometric measures, including body weight, body mass index (BMI), and waist to hip (WHR) ratio. Percentages were calculated for demographics. The average systolic blood pressure measured over two time periods within a single semester generated prehypertension rates. Univariate and multivariate logistic regression examined the impact of BMI, WHR, weight, and family medical history on prehypertension. A majority of participants (64%) were prehypertensive. Logistic regressions suggest that weight-related measures better predicted prehypertension than family history or WHR. In conclusion, this study showed prehypertensive risk was a significant problem among, young and primarily African-American adults. Furthermore, the best adiposity measure was weight, even when controlling for family history, WHR, and BMI

Stakeholders’ perspectives on the acceptability and feasibility of maternity waiting homes: a qualitative synthesis

Abstract Background Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of stakeholders’ perspectives (women, families, communities and health workers) on the acceptability and feasibility of MWHs. Methods A qualitative evidence synthesis was conducted. Studies that were published between January 1990 and July 2020, containing qualitative data on the perspectives of the stakeholder groups were included. A combination of inductive and deductive coding and thematic synthesis was used to capture the main perspectives in a thematic framework. Results Out of 4,532 papers that were found in the initial search, a total of 38 studies were included for the thematic analysis. Six themes emerged: (1) individual factors, such as perceived benefits, awareness and knowledge of the MWH; (2) interpersonal factors and domestic responsibilities, such as household and childcare responsibilities, decision-making processes and social support; (3) MWH characteristics, such as basic services and food provision, state of MWH infrastructure; (4) financial and geographical accessibility, such as transport availability, costs for MWH attendance and loss of income opportunity; (5) perceived quality of care in the MWH and the adjacent health facility, including regular check-ups by health workers and respectful care; and (6) Organization and advocacy, for example funding, community engagement, governmental involvement. The decision-making process of women and their families for using an MWH involves balancing out the gains and losses, associated with all six themes. Conclusion This systematic synthesis of qualitative literature provides in-depth insights of interrelating factors that influence acceptability and feasibility of MWHs according to different stakeholders. The findings highlight the potential of MWHs as important links in the maternal and neonatal health (MNH) care delivery system. The complexity and scope of these determinants of utilization underlines the need for MWH implementation strategy to be guided by context. Better documentation of MWH implementation, is needed to understand which type of MWH is most effective in which setting, and to ensure that those who most need the MWH will use it and receive quality services. These results can be of interest for stakeholders, implementers of health interventions, and governmental parties that are responsible for MNH policy development to implement acceptable and feasible MWHs that provide the greatest benefits for its users. Trial registration Systematic review registration number: PROSPERO 2020, CRD42020192219