ORCID Profile
0000-0002-3022-5230
Current Organisations
Murdoch University
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Telethon Kids Institute
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Publisher: Wiley
Date: 14-02-2022
DOI: 10.1111/AJO.13492
Abstract: It is known that a previous preterm birth increases the risk of a subsequent preterm birth, but a limited number of studies have examined this beyond two consecutive pregnancies. This study aimed to assess the risk and patterns of (recurrent) preterm birth up to the fourth pregnancy. We used Western Australian routinely linked population health datasets to identify women who had two or more consecutive singleton births (≥20 weeks gestation) from 1980 to 2015. A log‐binomial model was used to calculate risk ratios (RRs) and 95% confidence interval (CIs) for preterm birth risk in the third and fourth deliveries by the combined outcomes of previous pregnancies. We analysed 255 435 women with 651 726 births. About 7% of women had a preterm birth in the first delivery, and the rate of continuous preterm birth recurrence was 22.9% (second), 44.9% (third) and 58.5% (fourth) deliveries. The risk of preterm birth at the third delivery was highest for women with two prior indicated preterm births (RR 12.5, 95% CI: 11.3, 13.9) and for those whose first pregnancy was 32–36 weeks gestation, and second pregnancy was less than 32 weeks gestation (RR 11.8, 95% CI: 10.3, 13.5). There were similar findings for the second and fourth deliveries. Our findings demonstrate that women with any prior preterm birth were at greater risk of preterm birth in subsequent pregnancies compared with women with only term births, and the risk increased with shorter gestational length, and the number of previous preterm deliveries, especially sequential ones.
Publisher: Wiley
Date: 15-02-2022
DOI: 10.1111/AJO.13494
Abstract: There is scant literature about antepartum stillbirth management but guidelines usually recommend reserving caesarean sections for exceptional circumstances. However, little is known about caesarean section rates following antepartum stillbirth in Australia. We aimed to describe the onset of labour, mode of birth, and use of analgesia and anaesthesia following antepartum stillbirth and to identify factors associated with caesarean section. In this retrospective cohort study, we used a population‐based dataset of all singleton antepartum stillbirths ≥20 weeks gestation in Western Australia between 2010‐2015. The overall, primary and repeat caesarean section rates for antepartum stillbirths were calculated and multivariable Poisson regression analyses were performed to identify associated factors, and to calculate relative risks (RRs) and 95% confidence intervals (CIs). This study included 634 antepartum stillbirths. Labour was spontaneous for 134 (21.1%), induced for 457 (72.1%), and 43 (6.8%) had a prelabour caesarean section. The overall, primary and repeat caesarean section rates were 8.5%, 4.6% and 23.0% respectively and increased with gestation ( P trends all .01). Other factors associated with an increased caesarean section risk included: any placenta praevia or placental abruption, birth at a metropolitan private hospital, large‐for‐gestational‐age birthweight, and any maternal chronic condition. During labour, the most frequently used types of analgesia were systemic narcotics (46.0%) and regional blocks (34.7%) while among those who had a caesarean section, 40.7% had a general anaesthetic. In Western Australia between 2010–2015, the caesarean section rates among women with antepartum stillbirths were low, in line with current guidelines.
Publisher: BMJ
Date: 05-2020
DOI: 10.1136/BMJOPEN-2019-036280
Abstract: Maternal mental health disorders such as anxiety and depression are major public health concerns. Evidence shows a link between maternal mental health disorders and preterm birth and low birth weight. However, the impacts of maternal mental health disorders on stillbirth and infant mortality have been less investigated and inconsistent findings have been reported. Thus, using the available literature, we plan to examine whether prenatal maternal mental health disorders impact the risk of stillbirth and infant mortality. This systematic review and meta-analysis will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and will be registered with the International Prospective Register of Systematic Reviews. Systematic searches will be conducted (from database inception to December 2019) in Medline, Embase, PsycINFO and Scopus for studies examining the association of prenatal mental health disorders and stillbirth and infant mortality. The search will be limited to studies published in English language and in humans only, with no restriction on the year of publication. Two independent reviewers will evaluate records and assess the quality of in idual studies. The Newcastle–Ottawa scales and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach will be used to assess the methodological quality and bias of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I 2 statistics will be used to assess between-study heterogeneity in the estimated effect size. As it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences. 159834.
Publisher: Springer Science and Business Media LLC
Date: 26-09-2013
Publisher: Springer Science and Business Media LLC
Date: 02-01-2021
Publisher: Hindawi Limited
Date: 26-05-2015
DOI: 10.1155/2015/307810
Abstract: Background. The aim of this study was to determine the incidence of tuberculosis and its predictors among HIV positive children. Methods. A six-year retrospective follow-up study was conducted among HIV infected children aged less than 15 years. Life table was used to estimate the cumulative probability of tuberculosis free survival. Cox proportional hazards model was used to identify predictors of tuberculosis. Results. A total of 271 HIV positive children were followed for six years and produced 1100.50 person-years of observation. During the follow-up period 52 new TB cases occurred. The overall incidence density of TB was 4.9 per 100 PY. Inappropriate vaccination [AHR: 8.03 (95% CI 4.61–13.97)], ambulatory functional status [AHR: 1.99 (95% CI 1.04–3.81)], and having baseline anemia [AHR: 2.23 (95% CI 1.19–4.15)] were important predictors of time to TB occurrence. Conclusion. TB incidence rate was high. Early diagnosis and treatment of anemia and strengthening immunization program would reduce the risk of TB occurrence.
Publisher: Springer Science and Business Media LLC
Date: 10-2019
Publisher: Springer Science and Business Media LLC
Date: 16-08-2016
DOI: 10.1038/IJO.2016.140
Abstract: Maternal obesity, usually associated with the adverse birth outcomes, has been a serious public health concern. Studies examining its effect on the physical and cognitive development of children have only recently emerged and the findings are inconsistent. This review aimed to systematically examine the role of maternal obesity on children's physical and cognitive development using the available evidence. The CINAHL, EMBASE, PSYCINFO, PUBMED and SCOPUS databases were searched. Studies addressing children's (⩽12 years) physical and cognitive development as outcome and maternal pre-pregnancy body mass index as an exposure were included. Data were extracted and evaluated for quality by two independent reviewers. A total of 17 articles were eligible for this systematic review 10 of them were birth cohorts from the USA. Nine of the 14 studies supported an adverse association between maternal pre-pregnancy obesity and childhood cognitive development. A few studies also demonstrated a negative association between the maternal obesity and gross motor function in children (5 of 10), but not with fine motor function (none out of five studies). Whether the observed negative association between the maternal obesity and children's cognitive and gross motor abilities is casual or due to residual confounding effects is unclear. The current evidence is based on a limited number of studies with heterogeneous measurement scales and obesity definition. From the available evidence, it seems that exposure to maternal pre-pregnancy obesity in the intrauterine environment has a detrimental effect on children's cognitive development. However, evidence of the association between the maternal obesity and physical development of children is too scarce to offer a conclusion. More research work is required to delineate the intrauterine effect of the maternal obesity from the residual confounding effects.
Publisher: Public Library of Science (PLoS)
Date: 11-11-2013
Publisher: Wiley
Date: 23-11-2021
Abstract: Multidrug‐resistant tuberculosis (MDR‐TB) is a major global public health concern. However, there is a dearth of literature on whether MDR‐TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting. This systematic review and meta‐analysis aimed to examine the impact of MDR‐TB and its medications during pregnancy on maternal and perinatal outcomes. PubMed, Scopus and Web of Science databases were searched from earliest to February 2020. Records were screened based on pre‐defined selection criteria and assessed for quality by two independent reviewers. A meta‐analysis was performed using the random effects model to calculate pooled prevalence for each outcome. Of the 72 records identified, 12 were included in the systematic review and meta‐analysis, consisting of 174 pregnant women with MDR‐TB and 110 adverse outcomes. Maternal death, pregnancy loss, preterm birth and low birthweight were the most common maternal and perinatal adverse outcomes reported in the studies. The overall pooled prevalence was 7.5% (95% CI 3.2–12.8) for maternal death, 10.6% (95% CI 6.0–16.3) for pregnancy loss, 12.9% (95% CI 0.0–38.0) for preterm birth and 23.7% (95% CI 17.0–31.0) for low birthweight. The findings suggest that MDR‐TB is associated with a high risk of adverse maternal and perinatal outcomes, but these should be interpreted cautiously because the evidence is largely preliminary. Adequately powered prospective cohort studies are urgently required to corroborate these findings. Multidrug‐resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes.
Publisher: Springer Science and Business Media LLC
Date: 12-10-2017
Publisher: Wiley
Date: 15-09-2021
Publisher: Wiley
Date: 13-09-2019
DOI: 10.1111/PPE.12580
Abstract: Perinatal mortality rates are typically higher in Aboriginal than non-Aboriginal populations of Australia. This study aimed to examine the pattern of stillbirth and neonatal mortality rate disparities over time in Western Australia, including an evaluation of these disparities across gestational age groupings. All singleton births (≥20 weeks gestation) in Western Australia between 1980 and 2015 were included. Linked data were obtained from core population health datasets of Western Australia. Stillbirth and neonatal mortality rates and percentage changes in the rates over time were calculated by Aboriginal status and gestational age categories. From 1980 to 2015, data were available for 930 926 births (925 715 livebirths, 5211 stillbirths and 2476 neonatal deaths). Over the study period, there was a substantial reduction in both the Aboriginal (19.6%) and non-Aboriginal (32.3%) stillbirth rates. These reductions were evident in most gestational age categories among non-Aboriginal births and in Aboriginal term births. Concomitantly, neonatal mortality rates decreased in all gestational age windows for both populations, ranging from 32.1% to 77.5%. The overall stillbirth and neonatal mortality rate differences between Aboriginal and non-Aboriginal birth decreased by 0.6 per 1000 births and 3.9 per 1000 livebirths, respectively, although the rate ratios (RR 2.51, 95% CI 2.14, 2.94) and (RR 2.94, 95% CI 2.24, 3.85), respectively reflect a persistent excess of Aboriginal perinatal mortality across the study period. Despite steady improvements in perinatal mortality rates in Western Australia over 3½ decades, the gap between Aboriginal and non-Aboriginal rates remains unchanged in relative terms. There is a continuing, pressing need to address modifiable risk factors for preventable early mortality in Aboriginal populations.
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJOPEN-2020-039260
Abstract: To assess the scale of ethnic inequalities in severe maternal morbidity (SMM) rates and quantify the contribution of maternal characteristics to these disparities. Retrospective cohort study. Whole-of-population linked administrative data from 2002 to 2015 in Western Australia. Women with 410 043 birth events (includes all births from the same pregnancy) of 20 weeks’ or more gestation, including terminations for congenital anomalies. Women with SMM were identified based on a composite indicator of SMM using diagnosis and procedure codes developed for use in routinely collected data. Mothers were classified into seven ethnic groups, based on their reported ethnic origin. The associations between maternal ethnic origin and SMM were examined using a log-binomial model, which estimates risk ratios (RRs) and 95% CIs. The Blinder-Oaxaca decomposition technique was employed to partition the disparity in SMM between Aboriginal and Caucasian populations into ‘explained’ and ‘unexplained’ components. During the study period, 9378 SMM cases were documented. In the adjusted model, Aboriginal (RR 1.73, 95% CI 1.59 to 1.87), African (RR 1.64, 95% CI 1.43 to 1.89) and ‘other’ ethnicity (RR 1.49, 95% CI 1.37 to 1.63) women were at significantly higher risk of SMM compared with Caucasian women. Teenage and older mothers and socioeconomically disadvantaged women were also at greater risk of SMM. Differences in sociodemographic characteristics explained 33.2% of the disparity in SMM between Aboriginal and Caucasian women. There are distinct disparities in SMM by ethnicity in Western Australia, with a greater risk among Aboriginal and African women. While improvements in SES and a reduction in teenage pregnancy can potentially support a sizeable reduction in SMM rate inequalities, future research should investigate other potential pathways and targeted interventions to close the ethnicity disparity.
Publisher: Public Library of Science (PLoS)
Date: 21-11-2014
Publisher: Springer Science and Business Media LLC
Date: 24-06-2016
Publisher: BMJ
Date: 18-05-2021
Abstract: The health disadvantages faced by Australian Aboriginal peoples are evidenced in early life, although few studies have focused on the reasons for population-level inequalities in more severe adverse outcomes. This study aimed to examine the scale of disparity in severe neonatal morbidity (SNM) and mortality between Aboriginal and non-Aboriginal births and quantify the relative contributions of important maternal and infant factors. A retrospective cohort study with singleton live births (≥32 weeks’ gestation) was conducted using Western Australia linked whole population datasets, from 1999 to 2015. Aboriginal status was determined based on the mothers’ self-reported ethnic origin. An Australian validated indicator was adapted to identify neonates with SNM. The Oaxaca-Blinder method was employed to calculate the contribution of each maternal and infant factor to the disparity in SNM and mortality. Analyses included 425 070 births, with 15 967 (3.8%) SNM and mortality cases. The disparity in SNM and mortality between Aboriginal and non-Aboriginal births was 2.9 percentage points (95% CI 2.6 to 3.2). About 71% of this gap was explained by differences in modelled factors including maternal area of residence (23.8%), gestational age (22.2%), maternal age (7.5%) and antenatal smoking (7.2%). There is a considerable disparity in SNM and mortality between Aboriginal and non-Aboriginal births in Western Australia with the majority of this related to differences in maternal sociodemographic factors, antenatal smoking and gestational age. Public health programmes targeting these factors may contribute to a reduction in early life health differentials and benefit Aboriginal population health through the life course.
Publisher: Springer Science and Business Media LLC
Date: 15-09-2023
DOI: 10.1007/S00404-022-06782-Z
Abstract: There is scant literature about the management of stillbirth and the subsequent risk of severe maternal morbidity (SMM). We aimed to assess the risk of SMM associated with stillbirths compared with live births and whether this differed by the presence of maternal comorbidities. In this retrospective cohort study, we used a population-based dataset of all stillbirths and live births ≥ 20 weeks’ gestation in Western Australia between 2000 and 2015. SMM was identified using a published Australian composite for use with routinely collected hospital morbidity data. Maternal comorbidities were identified in the Hospital Morbidity Data Collection or the Midwives Notification System using a modified Australian chronic disease composite. Multivariable Poisson regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for factors associated with SMM in analyses stratified by the presence of maternal comorbidities. Singleton and multiple pregnancies were examined separately. This study included 458,639 singleton births (2319 stillbirths and 456,320 live births). The adjusted RRs for SMM among stillbirths were 2.30 (95% CI 1.77, 3.00) for those without comorbidities and 4.80 (95% CI 4.11, 5.59) (Interaction P value 0.0001) for those with comorbidities compared to live births without and with comorbidities, respectively. In Western Australia between 2000 and 2015, mothers of stillbirths both with and without any maternal comorbidities had an increased risk of SMM compared with live births. Further investigation into why women who have had a stillbirth without any existing conditions or pregnancy complications develop SMM is warranted.
Publisher: Wiley
Date: 04-11-2023
DOI: 10.1111/PPE.12929
Abstract: Having a preterm ( weeks' gestation) birth may increase a woman's risk of early mortality. Aboriginal and Torres Strait Islander (hereafter Aboriginal) women have higher preterm birth and mortality rates compared with other Australian women. We investigated whether a history of having a preterm birth was associated with early mortality in women and whether these associations differed by Aboriginal status. This retrospective cohort study used population‐based perinatal records of women who had a singleton birth between 1980 and 2015 in Western Australia linked to Death Registry data until June 2018. The primary and secondary outcomes were all‐cause and cause‐specific mortality respectively. After stratification by Aboriginal status, rate differences were calculated, and Cox proportional hazard regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for all‐cause and cause‐specific mortality. There were 20,244 Aboriginal mothers (1349 deaths) and 457,357 non‐Aboriginal mothers (7646 deaths) with 8.6 million person‐years of follow‐up. The all‐cause mortality rates for Aboriginal mothers who had preterm births and term births were 529.5 and 344.0 (rate difference 185.5, 95% CI 135.5, 238.5) per 100,000 person‐years respectively. Among non‐Aboriginal mothers, the corresponding figures were 125.5 and 88.6 (rate difference 37.0, 95% CI 29.4, 44.9) per 100,000 person‐years. The HR for all‐cause mortality for Aboriginal and non‐Aboriginal mothers associated with preterm birth were 1.48 (95% CI 1.32, 1.66) and 1.35 (95% CI 1.26, 1.44), respectively, compared with term birth. Compared with mothers who had term births, mothers of preterm births had higher relative risks of mortality from diabetes, cardiovascular, digestive and external causes. Both Aboriginal and non‐Aboriginal women who had a preterm birth had a moderately increased risk of mortality up to 38 years after the birth, reinforcing the importance of primary prevention and ongoing screening.
Publisher: SAGE Publications
Date: 16-03-2023
DOI: 10.1177/00048674231160986
Abstract: Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births. We used whole population-based linked data to conduct a retrospective cohort study ( N = 38,592) using all Western Australia singleton Aboriginal births (1990–2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals. After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder. This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.
Publisher: Springer Science and Business Media LLC
Date: 18-04-2016
Publisher: Springer Science and Business Media LLC
Date: 22-07-2020
Publisher: Hindawi Limited
Date: 07-06-2016
DOI: 10.1155/2016/6308617
Abstract: Introduction. Patient satisfaction with nursing care is considered as an important factor in explaining patients’ perceptions of service quality. Care assessed to be high quality according to clinical, economic, or other provider-defined criteria is far from ideal if as a result of that care the patient is unhappy or dissatisfied. Objective. The aim of this study was to assess adult patients’ satisfaction with inpatient nursing care and associated factors in Dessie Referral Hospital, Northeast Ethiopia. Methods. Institution based quantitative cross-sectional study was conducted among patients admitted in medical, surgical, orthopedics, gynecology, and ophthalmology wards of the hospital from March 24 to April 30, 2013. All admitted patients who stayed in the study wards for at least two days during the data collection time were interviewed. Newcastle Satisfaction with Nursing Scale questionnaire was used to collect the data and was analyzed using SPSS version 20. Odds ratios with their 95% confidence intervals and p values in a multiple logistic regression were used to identify factors associated with patient satisfaction with nursing care. Result. The overall patient satisfaction was 52.5%. Respondents’ sex, age, admission ward, self-reported health status, and class of admission were the variables significantly associated with patient satisfaction with nursing care. Conclusion and Recommendation. The rate of patient satisfaction with nursing care was found to be low in this study. Being female, younger age group (18–30 years), good self-reported current health status, being admitted in ophthalmology ward, and first class of admission were significantly associated with better patient satisfaction with nursing care. In-service training programs for nurses, with special emphasis on communication skills, are recommended.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-044606
Abstract: COVID-19 has caused a global public health crisis affecting most countries, including Ethiopia, in various ways. This study maps the vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. Thirty-eight potential indicators of vulnerability to COVID-19 infection, case severity and likelihood of death, identified based on a literature review and the availability of nationally representative data at a low geographic scale, were assembled from multiple sources for geospatial analysis. Geospatial analysis techniques were applied to produce maps showing the vulnerability to infection, case severity and likelihood of death in Ethiopia at a spatial resolution of 1 km×1 km. This study showed that vulnerability to COVID-19 infection is likely to be high across most parts of Ethiopia, particularly in the Somali, Afar, Amhara, Oromia and Tigray regions. The number of severe cases of COVID-19 infection requiring hospitalisation and intensive care unit admission is likely to be high across Amhara, most parts of Oromia and some parts of the Southern Nations, Nationalities and Peoples’ Region. The risk of COVID-19-related death is high in the country’s border regions, where public health preparedness for responding to COVID-19 is limited. This study revealed geographical differences in vulnerability to infection, case severity and likelihood of death from COVID-19 in Ethiopia. The study offers maps that can guide the targeted interventions necessary to contain the spread of COVID-19 in Ethiopia.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2014
Abstract: Access to sufficient food is essential for household welfare as well as for accomplishing other development activities. Households with insufficient access to food often face other challenges related to food insecurity including poor health and a decline in productivity. These challenges can often create a vicious circle whereby households are unable to produce enough food even during a good crop season. Thus, this study aimed to determine the magnitude of food insecurity and its determinants in rural households of Farta District, Northwest Ethiopia. A community based cross-sectional study was conducted from September to October 2012. Household heads were recruited using a multistage random s ling technique. Data were collected by face-to-face interviews using the Household Food Insecurity Access Scale (HFIAS) tool after verbal informed consent. Data were entered to Epi info 2002 and exported to SPSS version 16 for analysis. Multiple logistic regressions were fitted and odds ratios with 95% confidence intervals were calculated to identify associated factors and control confounding effect. A total of 836 households were included in this study. Nearly three quarters of the households (70.7%) had food insecurity. Households headed by females (AOR = 3.18, 95% CI:1.08, 15.21), lack of education (AOR = 2.59, 95% CI: 1.46, 4.60), family size of 4-7 (AOR = 2.39, 95% CI: 1.21,4.70), family size of (AOR = 13.23,95% CI:6.18, 28.32), few or absence of livestock (AOR = 5.60, 95% CI:1.28, 24.43), absence of income from off-farm activities (AOR = 3.12, 95% CI:1.53, 6.36), lack of irrigation (AOR = 3.54, 95% CI:2.14, 5.18) and lack of perennial income (AOR = 3.15, 95% CI:1.88, 5.27) were factors associated with food insecurity. This study revealed that most households of the district were food insecure. Hence, the promotion of contraceptive use, off-farm employment activities and the development of small scale irrigation are important recommendations to reduce food insecurity.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.DIABRES.2016.12.014
Abstract: In a population-based cohort study we examined the associations between early adult pre-pregnancy weight change and the risk of gestational diabetes mellitus (GDM). The study included 3111 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. These women have been surveyed regularly since 1996. Women without diabetes and GDM were followed-up between 2003 and 2012. Generalized estimating equations were used to assess the effect of baseline (1996, mean age 20years) and pre-pregnancy body mass index (BMI) and the pre-pregnancy weight changes on the incidence of GDM. The full models were adjusted for sociodemographic and lifestyle factors. From 2003 to 2012, 229GDM cases (4.4%) were reported in 5242 pregnancies. Relative to normal BMI women, obese women at baseline (RR: 1.8, 95% CI: 1.1, 2.8) and prior to pregnancy (RR: 2.7, 95% CI: 2.0, 3.6) were at greater risk of GDM. Weight gains prior to each study pregnancy were strongly associated with increased GDM risk with an adjusted RR ranging from 2.0 to 2.9. Within under/normal range of BMI, women with a moderate/high (>2.5%/year) weight gain had 2.7 (95% CI: 1.3, 5.5) times the risk of GDM compared with women with stable weight. Early adult weight gain, even within normal BMI range, is an important risk factor for the development of GDM. Weight gain prevention from early adulthood to prior to pregnancy appears to be the main strategy to prevent the incidence of GDM.
Publisher: Cambridge University Press (CUP)
Date: 14-08-2018
DOI: 10.1017/S2040174418000570
Abstract: There is limited evidence on the association between maternal preconception body mass index (BMI) trajectories and pregnancy complications and child development. This study examined the relationships of maternal BMI trajectories, diabetes and hypertensive disorders during pregnancy and offspring’s childhood physical and cognitive development. Data were from the Australian Longitudinal Study on Women’s Health and the Mothers and their Children’s Health study ( n =771). Women’s preconception BMI trajectories were identified using group-based trajectory modelling. Children’s physical and cognitive development (up to the average age of 5 years) were obtained from the Ages and Stages Questionnaire (suspected gross motor delay) and the Australian Early Development Census (AEDC). Generalized estimating equation models, adjusted for maternal sociodemographic and lifestyle factors, were used for analyses. Three distinct BMI trajectories were identified (normative, chronically overweight and chronically obese). Children born to chronically obese women were more likely to be classified as developmentally vulnerable/at-risk on AEDC domains gross and fine motor skills [risk ratio (RR)=1.64, 95% confidence interval (CI): 1.04, 2.61] and communication skills and general knowledge (RR=1.71, 95% CI: 1.09, 2.68). They also had an elevated risk of suspected gross motor delay (RR=2.62, 95% CI: 1.26, 5.44) compared with children born to women with a normative BMI trajectory. Maternal diabetes or hypertensive disorders during pregnancy were not associated with child outcomes. Maternal preconception BMI trajectories were associated with poorer childhood development. This study finding underscores the importance of excessive weight gain prevention throughout the reproductive stage of life.
Publisher: Elsevier BV
Date: 10-2023
Publisher: Science Publishing Group
Date: 2014
Publisher: Springer Science and Business Media LLC
Date: 09-10-2017
Publisher: Springer Science and Business Media LLC
Date: 21-04-2020
Publisher: Hindawi Limited
Date: 13-12-2012
DOI: 10.5402/2012/485720
Abstract: Introduction . Clinical reports have indicated positive outcomes associated with disclosure of HIV-positive status in children. This study assessed the level and associated factors of HIV-positive status disclosure to HIV-infected children in northwest Ethiopia. Methods . Institution-based cross-sectional study was conducted among HIV-positive children from March to April 2012. Data were collected using a structured questionnaire by face-to-face interview technique. Bivariate and multivariate analyses were performed. Results . Of the 428 children, 169 (39.5%) were disclosed their HIV-positive status. The mean age of HIV-positive status disclosure was at 10.7 (±2.3) years. Having a nonbiological parent (, 95% CI: 1.22, 14.04), child’s age older than 10 years (, 95% CI: 4.5, 15.53), and death of a family member (, 95% CI: 1.16, 3.6) were significantly and independently associated with disclosure of HIV-positive status to infected children. Conclusions . The rate of disclosure of HIV-positive status to infected children still remains low in North Gondar. Hence, it is important to target children living with their biological parents and having young parents and children younger than 10 years. The guideline for disclosure of children with HIV/AIDS should be established in an Ethiopian context.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.WOMBI.2021.06.008
Abstract: The prevalence of stillbirth in many high income countries like Australia has remained unchanged for over 30 years. The 2018 Australian government Senate Select Committee on Stillbirth Research and Education highlighted the need for a public health c aign to encourage public conversations and increase awareness. However, there is little evidence about the community's knowledge and perceptions towards pregnancy and stillbirth, nor their aspirations for a public health c aign. To assess the general knowledge, perceptions, myths and attitudes towards stillbirth to inform future public health c aigns. Australian participants (n = 344 predominately women n = 294 (85.5%)) were recruited via Facebook.com. They completed a cross-sectional online survey designed to assess their knowledge of pregnancy and stillbirth, with additional questions on socio-demographic characteristics. Stillbirth knowledge and awareness of incidence was low in this s le. Prominent myths, such as baby runs out of room in the uterus (n = 112, 33%) and baby slows down when preparing for labour (n = 24, 27%) were endorsed. Only 25% (n = 85) knew the prevalence of stillbirth in Australia (six per day). Almost two-thirds (n = 205 62%) agreed that there needs to be a public health c aign, however one in five (n = 65 20%) were concerned that talking about stillbirth with pregnant women may cause them to worry. Our findings reinforce the need for a targeted c aign, which educates the general population about the definition and prevalence of stillbirth, stillbirth risks and modifiable health behaviours. Appropriate messaging should target pregnant women during antenatal care as well as their support and care systems (family, friends, and care providers).
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Wiley
Date: 07-04-2017
DOI: 10.1111/PPE.12353
Abstract: While the association of pre-pregnancy body mass index (BMI) and hypertensive disorders in pregnancy (HDP) is well documented, little is known about the relationship between pre-pregnancy weight change and HDP. We examined the impact of adult pre-pregnancy weight change on the development of HDP. We included 2914 women, surveyed about every three years since 1996, from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Women without hypertension or HDP were followed-up between 2003 and 2012. Generalised estimating equations were used to assess the effect of baseline BMI (mean age 20 years) and pre-pregnancy weight change on the incidence of HDP. Over 9 years of follow up, 301 incident HDP cases (6.3%) were reported from 4813 pregnancies. Overweight and obese women at the baseline survey were 1.67 (95% CI 1.3, 2.2) and 2.15 (95% CI 1.4, 3.3) times more likely to develop HDP than normal weight women, respectively. Compared with stable weight women, women with small (>1.5-2.5%) or moderate/high (>2.5%) annual weight gain had elevated risk of HDP (RR 1.67 95% CI 1.3, 2.2 RR 2.31, 95% CI 1.8, 3.0, respectively). Women who reported annual weight loss (>1.5%) between baseline and the average age of 24 years were 46% (95% CI 0.4, 0.8) less likely to develop HDP. Pre-pregnancy weight gain is associated with an increased risk of HDP, whereas early adult weight loss is associated with lower risk of HDP.
Publisher: Springer Science and Business Media LLC
Date: 28-11-2012
Publisher: BMJ
Date: 12-2019
DOI: 10.1136/BMJOPEN-2019-034821
Abstract: Multidrug-resistant tuberculosis (MDR-TB) is a common public health problem affecting pregnant women. However, the impact of MDR-TB and its medication on pregnancy and perinatal outcomes has been poorly understood and inconsistently reported. Therefore, using the available literature, we aim to determine whether MDR-TB and its medications during pregnancy impact maternal and perinatal outcomes. This systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be conducted in PubMed, Scopus and Web of Science on 10 February 2020 for studies that reported adverse maternal and perinatal outcomes due to MDR-TB and/or its medication. The search will be performed without language and time restrictions. Adverse birth outcomes include miscarriage or abortion, stillbirth, preterm birth, low birth weight, small and large for gestational age, and neonatal death. Two independent reviewers will screen search records, extract data and assess the quality of the studies. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the methodological quality of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I 2 statistics will be used to assess the heterogeneity between studies. As it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences.
Publisher: BMJ
Date: 12-2022
DOI: 10.1136/BMJOPEN-2022-065318
Abstract: This study aimed to map the national, regional and local prevalence of hypertension and diabetes in Ethiopia. Nationwide cross-sectional survey in Ethiopia combined with georeferenced ecological level data from publicly available sources. 9801 participants aged between 15 and 69 years. Prevalence of hypertension and diabetes were collected using the WHO’s STEPS survey approach. Bayesian model-based geostatistical techniques were used to estimate hypertension and diabetes prevalence at national, regional and pixel levels (1×1 km 2 ) with corresponding 95% credible intervals (95% CrIs). The national prevalence was 19.2% (95% CI: 18.4 to 20.0) for hypertension and 2.8% (95% CI: 2.4 to 3.1) for diabetes. Substantial variation was observed in the prevalence of these diseases at subnational levels, with the highest prevalence of hypertension observed in Addis Ababa (30.6%) and diabetes in Somali region (8.7%). Spatial overlap of high hypertension and diabetes prevalence was observed in some regions such as the Southern Nations, Nationalities and People’s region and Addis Ababa. Population density (number of people/km 2 ) was positively associated with the prevalence of hypertension (β: 0.015 95% CrI: 0.003–0.027) and diabetes (β: 0.046 95% CrI: 0.020–0.069) whereas altitude in kilometres was negatively associated with the prevalence of diabetes (β: –0.374 95% CrI: –0.711 to –0.044). Spatial clustering of hypertension and diabetes was observed at subnational and local levels in Ethiopia, which was significantly associated with population density and altitude. The variation at the subnational level illustrates the need to include environmental drivers in future NCDs burden estimation. Thus, targeted and integrated interventions in high-risk areas might reduce the burden of hypertension and diabetes in Ethiopia.
Publisher: Cambridge University Press (CUP)
Date: 10-01-2019
DOI: 10.1017/S2040174418001137
Abstract: While birthweight of offspring is associated with pre-pregnancy body mass index (BMI) and later risk of obesity, its mediating effect between the association of maternal pre-pregnancy BMI and offspring’s childhood anthropometrics has rarely been investigated. This study aimed to examine whether offspring birthweight is a mediator in the association between pre-pregnancy BMI and offspring’s childhood anthropometrics. The study included 1,618 mother–child pairs from the Australian Longitudinal Study on Women’s Health and Mothers and their Children’s Health Study. Children’s anthropometrics [mean age 8.6 ( s . d . =3.0) years] were calculated from the mothers’ self-reported child weight and height measures. G-computation was used to estimate the natural direct and indirect (via birthweight) effects of pre-pregnancy BMI. In the fully adjusted model for maternal sociodemographic and lifestyle factors, the natural direct effects of pre-pregnancy obesity on child BMI-for-age, height-for-age, weight-for-age and weight-for-height outcomes were, β (95% confidence interval, CI), 0.75 (0.55, 0.95), 0.13 (−0.07, 0.32), 0.62 (0.44, 0.80) and 0.57 (0.24, 0.90), respectively. The corresponding natural indirect effects were 0.04 (−0.04, 0.12), −0.01 (−0.09, 0.07), −0.01 (−0.08, 0.07) and 0.09 (−0.05, 0.23). Similar results were observed for pre-pregnancy overweight and pre-pregnancy BMI as a continuous scale. Most of the effect of pre-pregnancy obesity on childhood weight-related anthropometric outcomes appears to be via a direct effect, not mediated through offspring’s birthweight.
Publisher: American Academy of Pediatrics (AAP)
Date: 05-2016
Abstract: The effect of diabetes during pregnancy on the cognitive development of offspring is unclear because of inconsistent findings from limited studies. This review was aimed to provide the best available scientific evidence on the associations between maternal pregnancy diabetes and the cognitive development of offspring. A search was conducted in the Embase, CINAHL, PubMed, PsycINFO, and Scopus databases. Studies addressing the cognitive development of offspring (aged ≤12 years) as outcome and any diabetes in pregnancy as an exposure were included. Data were extracted and evaluated for quality by 2 independent reviewers. Fourteen articles were eligible for the review. Ten studies investigated the associations between maternal pregestational diabetes or both pregestational and gestational diabetes and offspring’s cognitive development 6 studies found at least 1 negative association. Four studies exclusively examined the relationships between gestational diabetes and offspring’s cognitive development 2 studies found a negative association, 1 a positive association, and 1 a null association. The use of erse cognitive and diabetes assessment tools/criteria, as well as statistical power, contributed to the inconsistent findings. The English-language restriction and publication bias in the included studies are potential limitations. Although there are few data available regarding the associations between maternal pregnancy diabetes and offspring’s cognitive development, this review found that maternal diabetes during pregnancy seems to be negatively associated with offspring’s cognitive development. Large prospective studies that address potential confounders are needed to confirm the independent effect of maternal diabetes during pregnancy.
Publisher: University of Queensland Library
Date: 2019
DOI: 10.14264/UQL.2019.55
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJOPEN-2020-044618
Abstract: The aim of this study was to provide a comprehensive evidence on risk factors for transmission, disease severity and COVID-19 related deaths in Africa. A systematic review has been conducted to synthesise existing evidence on risk factors affecting COVID-19 outcomes across Africa. Data were systematically searched from MEDLINE, Scopus, MedRxiv and BioRxiv. Studies for review were included if they were published in English and reported at least one risk factor and/or one health outcome. We included all relevant literature published up until 11 August 2020. We performed a systematic narrative synthesis to describe the available studies for each outcome. Data were extracted using a standardised Joanna Briggs Institute data extraction form. Fifteen articles met the inclusion criteria of which four were exclusively on Africa and the remaining 11 papers had a global focus with some data from Africa. Higher rates of infection in Africa are associated with high population density, urbanisation, transport connectivity, high volume of tourism and international trade, and high level of economic and political openness. Limited or poor access to healthcare are also associated with higher COVID-19 infection rates. Older people and in iduals with chronic conditions such as HIV, tuberculosis and anaemia experience severe forms COVID-19 leading to hospitalisation and death. Similarly, high burden of chronic obstructive pulmonary disease, high prevalence of tobacco consumption and low levels of expenditure on health and low levels of global health security score contribute to COVID-19 related deaths. Demographic, institutional, ecological, health system and politico-economic factors influenced the spectrum of COVID-19 infection, severity and death. We recommend multidisciplinary and integrated approaches to mitigate the identified factors and strengthen effective prevention strategies.
Publisher: BMJ
Date: 02-2019
DOI: 10.1136/BMJOPEN-2018-022948
Abstract: The aim of this study was to assess the knowledge and practice of health workers about multidrug-resistant tuberculosis (MDR-TB) prevention and control. A cross-sectional study was conducted at Gondar University Referral Hospital and Felege Hiwot Referral Hospital. Randomly selected health workers (ie, medical doctor, nurse, health officer, pharmacy, medical laboratory and midwifery) were the study participants. The main outcomes were knowledge and self-reported practice of health workers about MDR-TB. A total of 377 health workers (with a response rate of 93.7%) participated in the study. The majority of respondents were nurses (52.5%, n=198) and medical doctors (15.6%, n=59). The mean knowledge score was seven out of 10 149 (39.5%) of respondents scored seven or more which was considered as good knowledge. MDR-TB knowledge of health workers was significantly associated with having a postgraduate degree (adjusted odds ratio (AOR)=5.78 95% CI 2.33 to 14.33), taking infection prevention training (AOR=1.79 95% CI 1.00, to 3.17) and having a history of tuberculosis (TB) (AOR=1.85 95% CI 1.12, to 3.03). The mean self-reported practice score was four out of seven one-fifth (19.6%) of respondents scored four or more which was considered as good practice. Self-reported practice of health workers was significantly associated with working at internal medicine (AOR=4.64 95% CI 1.99, to 10.81) and paediatrics (AOR=3.85 95% CI 1.11, to 13.34) wards, being in the age groups of 26–30 years (AOR=2.70 95% CI 1.27, to 5.76), and 30 years and above (AOR=4.42 95% CI 1.77, to 11.00). This study found low knowledge and self-reported practice score among health workers. MDR-TB knowledge of health workers was significantly associated with educational status, infection prevention training and previous history of TB. This finding highlights the potential of providing MDR-TB training for health workers to increase their knowledge about MDR-TB.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2014
Publisher: Springer Science and Business Media LLC
Date: 24-05-2018
DOI: 10.1038/S41366-018-0078-1
Abstract: This study aimed to examine the associations between (1) mothers' preconception body mass index (BMI) trajectories over 6-7 years and offspring childhood BMI, and (2) mothers' BMI changes between first and second pregnancy and the second-born child's BMI. We used data (1606 mothers with 2733 children with mean age 7.7 years, SD 2.9) from the Australian Longitudinal Study on Women's Health and the Mothers and their Children's Health study. Preconception BMI trajectories were identified using latent class growth modeling. Children were categorized as underweight, normal, overweight or obese based on age and sex-specific BMI cut-off points for children. Multinomial and binary logistic regression were used for analyses. We identified three preconception BMI trajectories, named as 'normative' (61.2%), 'chronically overweight' (30.7%), and 'chronically obese' (8.1%). Children born to 'chronically overweight' and 'chronically obese' mothers were more likely to be overweight than normal weight relative to children born to women with a 'normative' BMI trajectory. The corresponding adjusted relative risk ratios (RRRs) (95% confidence interval [CI]) of childhood overweight were 1.75 (1.33, 2.31) for chronically overweight mothers and 2.48 (1.65, 3.73) for chronically obese mothers. Similarly, we found a much stronger association between 'chronically overweight' and 'chronically obese' BMI trajectories and childhood risk of obesity RRR (95% CI), 2.49 (1.41, 4.40) and 6.65 (3.40, 13.01), respectively. Second-born children of mothers with high interpregnancy weight gain (≥4 BMI units) were also at higher risk of being overweight or obese (OR = 2.20, 95% CI: 1.02, 4.75) compared with children of mothers with stable interpregnancy weight (gain or loss of 1 BMI unit or less). In this population-based prospective cohort study, we found strong dose-response associations between preconception BMI trajectories and offsprings' childhood BMI.
Publisher: Wiley
Date: 05-03-2021
DOI: 10.1111/PPE.12739
Abstract: Stillbirth is a critical public health issue worldwide. While the rates in high‐income countries are relatively low, there are persistent between‐country disparities. To compare stillbirth rates and trends in Wales and the State of Western Australia (WA), Australia, and provide insights into any differences. In this international retrospective cohort study, we pooled population‐based data collections of all births ≥24 weeks’ gestation (excluding terminations for congenital anomalies) between 1993 and 2015, ided into six time periods. The stillbirth rate per 1000 births was estimated for each cohort in each time period. Multivariable Poisson regression analyses, adjusted for appropriateness of growth, socio‐economic status, maternal age, and multiple birth, were performed to evaluate the interaction between cohort and time period. Relative risk (RR) and 95% confidence interval (CI) for each time period and cohort were calculated. There were 767 731 births (3725 stillbirths) in Wales and 648 373 (2431 stillbirths) in WA. The overall stillbirth rate declined by 15.9% over the study period in Wales (from 5.3 in 1993‐96 to 4.5 per 1000 births in 2013‐15 P trend .01) but by 40.4% in WA (from 4.9 to 2.9 per 1000 births in WA P trend .01). Using 1993‐96 in WA as the reference group, the adjusted RRs for stillbirths at 37‐38 weeks' gestation in the most recent study period (2013‐15) were 0.85 (95% CI 0.64, 1.13) in Wales and 0.51 (95% CI 0.36, 0.73) in WA. The stillbirth rates between Wales and WA have widened in the last two decades (especially among late‐term births), although the absolute rates for both are distinctly higher than the best‐performing nations. While the differences may be partly explained by timing of birth and maternal life style behaviours such as smoking, it is important to identify and ameliorate the associated risk factors to support a reduction in preventable stillbirths.
No related grants have been discovered for Akilew Awoke Adane.