Natalie Ann Strobel

Evidence-based global guidance on safe travel time for small or sick newborns who require transfer to health facilities after birth is lacking. A two-hour threshold is frequently cited in low- and middle-income countries (LMICs), while 30 minutes is commonly used in high-income countries (HICs). Although these thresholds are widely referenced, their empirical basis and consistency across levels of newborn care and journey types have not been systematically examined. This study synthesises the evidence linking travel time and perinatal outcomes. We conducted a systematic review with narrative synthesis and meta-analysis to assess the impact of travel time or distance (home-to-facility or interfacility) on stillbirth, perinatal mortality, and neonatal mortality. We searched Embase, MEDLINE, and Cochrane Central Register of Controlled Trials for published studies from 2014 to 2023. Given substantial methodological heterogeneity, we used narrative synthesis as the primary analytical approach and conducted random-effects meta-analyses where studies were sufficiently comparable (≥2 with similar definitions and outcome windows), pooling effect estimates for travel time thresholds of 30 minutes, 1 hour, or 2 hours and travel distances of 5, 10, and 15 km. We assessed bias using the Newcastle-Ottawa Scale for cohort and case-control studies. Of 8317 screened records, 166 were eligible for full-text review, with 37 studies meeting the inclusion criteria- All but two had low or moderate risk of bias. Most studies (n = 26) came from LMICs and documented higher perinatal survival with shorter journeys. Studies from HICs demonstrated lower out-of-hospital birth, lower morbidity, and lower mortality with shorter journeys though associations were weaker. Across the narrative synthesis, shorter travel times were consistently associated with better outcomes. Exploratory pooling suggested a greater than 3-fold higher odds of survival for interfacility journeys under 30 minutes (odds ratio (OR) = 3.25; 95% confidence interval (CI) = 1.90-5.57) and over 2-fold higher odds of survival for journeys from any location to hospitals at all thresholds (OR = 2.06; 95% CI = 1.60-2.65 for 2 hours; OR = 2.20; 95% CI = 1.46-3.33 for 1 hour; OR = 1.92; 95% CI = 1.10-3.34 for 30 minutes), though prediction intervals were wide, reflecting methodological and contextual diversity. We found that shorter journeys were associated with better perinatal outcomes, with the highest survival rates observed for journeys under 30 minutes to the hospital. Due to substantial contextual and methodological heterogeneity, pooled estimates should be interpreted as illustrative, rather than definitive. A travel time norm of 30 minutes or one hour is preferable to the two-hour threshold currently used in LMICs. To safeguard perinatal survival rates, any travel-time standard should be balanced with corresponding quality of care standards. PROSPERO: CRD42023460423.

Small and sick newborn (SSN) care is defined as care for the infant who is born preterm (<37 weeks), with low birth weight (<2.5kg), or who becomes sick with medical or surgical conditions throughout the first 28 days of life [1]. The global Every Newborn Action Plan (ENAP) defines three levels of newborn care [2] […]

Human papillomavirus (HPV) is a common sexually transmitted infection that can lead to HPV-related cancers such as cervical cancer and other cancers such as anal, vaginal, and penile cancer. HPV rarely produces symptoms and cannot be cured or treated; therefore, vaccination is essential to protect against HPV and HPV-related diseases. However, young Aboriginal and Torres Strait Islander (hereafter, respectfully, ‘Aboriginal’) people are not receiving their HPV vaccine dose, resulting in missed opportunities to be protected from HPV-related cancers. Health promotion is a critical way to empower people to take ownership over and control their health and is a core function of public health. One way to deliver health promotion is through social media platforms. In recent COVID-19 times, we have seen the effect of social media on public health messaging, both positive and harmful. In particular, Instagram influencers have had a profound impact on pro- and anti-vaccination messages. Aboriginal adolescents aged 13-15 years old have strong engagement with social media platforms. Combining co-created health promotion messages with local ‘micro-Influencers’ is a novel way to improve HPV vaccination rates. The overall aim of this project is to improve the rates of HPV vaccination amongst young Aboriginal people. We will achieve this through: i) co-creation of health promotion messages, ii) developing and delivering a social media campaign and iii) evaluating the effectiveness of the campaign through an interrupted time-series design. We hypothesise that the co-creation of health promotion messages with young Aboriginal people and their families and utilising the skills of micro-Influencers to engage and influence their followers will result in improvements HPV vaccination rates amongst this population.

Objectives The primary objective was to determine whether a behaviour change intervention delivered to hospital staff would (1) improve the proportion of Aboriginal and/or Torres Strait Islander (Aboriginal) babies being registered and (2) reduce hospital admissions and emergency presentations for babies Design Quasi-experimental design and cohort study. Setting Five tertiary birthing hospitals in WA. Participants The intervention was delivered to health service providers who were in the five tertiary birthing hospitals. Outcome data were collected on Aboriginal babies born between 1 January 2016 and 30 June 2018 who were delivered within these hospitals. Babies in the control group (n=226) were born 6 months before the intervention and intervention babies (n=232) were born 6 months following the intervention. For the secondary objective, there were 4573 babies included in the analysis. Interventions A behaviour change intervention delivered to hospital staff in five hospitals. Primary and secondary outcome measures The primary outcomes were the proportion of babies who were registered and whether a baby had been admitted to hospital or an emergency department by 3 and 6 months old. The secondary outcome was to determine factors that might influence the proportion of registered Aboriginal births in WA (cohort study). Results There was evidence of a 38% reduction in emergency presentations within 6 months for babies born to hospitals 6 months following the staff training (OR 0.62, 95% CI 0.42 to 0.91), and little evidence of improvements in birth registrations, hospital admissions within 3 or 6 months of birth or emergency department presentations within 3 months of birth. Of the 4573 babies included in the cohort study, 3769 (82.4%) babies had their births registered and 804 (17.6%) babies did not. Factors that were associated with not having a birth registered included low birth weight babies with a 34% decrease in odds of having a registered birth compared with those with a normal birth weight (adjusted OR (aOR) 0.66, 95% CI 0.51 to 0.86). Timing of first antenatal visit was associated with reduced odds of having a birth registered if this occurred in the second (aOR 0.77, 95% CI 0.64 to 0.93) or third trimester (aOR 0.59, 95% CI 0.45 to 0.77) compared with the first trimester. Conclusions Our study identifies the complexities surrounding birth registrations and improved hospital utilisation for Aboriginal babies, the importance of targeted interventions and ongoing efforts needed to address this issue comprehensively. Trial registration number ACTRN12615000976583.

Small and sick newborns (SSNs) are neonates who are born premature (<37 weeks), low birthweight (<2.5 kg), small for gestational age, or have neurological conditions (e.g. birth asphyxia, hypoxic ischaemic encephalopathy, neonatal seizures), infections (e.g. meningitis or sepsis), or nutritional problems (e.g. growth faltering and failure or feeding difficulties) [1,2]. Their survival, health, and development […]

Small and/or sick newborns (SSNs) are infants who are either born preterm (before 37 weeks), have low birth weight (less than 2.5 kg), or become ill due to medical or surgical conditions within the first 28 days of life [1–3]. Target 4 of the global Every Newborn Action Plan aims to establish at least one […]

Background In Australia, we are not meeting our goals in relation to breastfeeding overall, and in particular, promoting and supporting breastfeeding rates for Aboriginal and Torres Strait Islander babies especially breastfeeding to at least six months. The WHO has recognised the importance of exclusively breastfeeding a baby for a minimum of six months to ensure a healthy start to life. Breastfeeding has been shown to be a protective factor against asthma and allergy development, ear disease, infections, respiratory illness and gastrointestinal issues. This study aims to improve predominant breastfeeding rates of Aboriginal and Torres Strait Islander babies in the Perth Metropolitan area (Western Australia, Australia). Methods and analysis We will use an interrupted time series design to determine the effectiveness of a continuous quality improvement (CQI) program delivered over 6 months by selected community health staff. The intervention will be delivered at two community health regions and the remaining 17 community health regions will be the control group. The primary outcomes will be predominant breastfeeding rates at two and four months, and secondary outcomes will include any breastfeeding at two and four months, and hospital admissions, emergency department presentations and immunisation data at 6 months. Discussion The study will allow us to determine the breastfeeding rates of Aboriginal babies, identify the barriers and enablers to initiating and maintaining breastfeeding and determine whether a CQI program can achieve improvements in breastfeeding rates.

Background: Discharge against medical advice (DAMA) is a priority issue for the health system. Little is known about the factors associated with DAMA for Aboriginal and/or Torres Strait Islander (Aboriginal) children in Australia.Objectives: Investigate the associations between DAMA for hospital admissions and emergency department (ED) presentations and: (i) child, family and episode of service characteristics and (ii) 30‐day readmission/ re‐presentation.Methods: We conducted a cohort study of Aboriginal children born in Western Australia (2002–2013) who had ≥1 hospital admissions (n = 16,931) or ED presentations (n = 26,546) within the first 5 years of life. The outcome of interest was hospital and ED DAMA and adjusted odds ratio were derived using multilevel mixed‐effects logistic regression.Results: In the Hospital Cohort, there were 43,149 hospitalisations for 16,931 children, with 684 hospitalisations (1.6%) recorded as DAMA. In the ED Cohort, there were 232,082 ED presentations in 26,546 children, with 10,918 ED presentations (4.7%) recorded as DAMA. DAMA occurring in hospitals between 2014 and 2018, the adjusted odds decreased by 75% compared to the period between 2002 and 2005. The adjusted odds of ED DAMA increased by 46% over the same period. Hospital admissions in regional and remote hospitals were almost seven times the adjusted odds of DAMA compared with hospital admissions in Perth metropolitan hospitals. The adjusted odds of ED DAMA decreased by 12% for ED presentations in regional and remote hospitals compared to those in Perth metropolitan hospitals. There was no evidence of hospital DAMA being associated with hospital readmission within 30 days and limited evidence of ED DAMA being associated with re‐presenting to an ED within 30 days.Conclusions: The study identified several important determinants of DAMA, including admission status, triage status, location and calendar year. These findings could inform targeted measures to decrease DAMA, particularly in regional and remote communities.