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Thousands of adverse birth outcomes in England down to ‘alarming’ inequality

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Thousands of adverse birth outcomes in England down to ‘alarming’ inequality

Thousands of babies in England are being born prematurely, smaller than expected or stillborn because of “alarming” and “devastating” socioeconomic and racial inequality across the country, a landmark study has suggested.

Both are known risk factors for poor pregnancy outcomes. However, until now, little has been known about the scale of their “heartbreaking” impact on women and babies.

Now research involving more than 1m births suggests socioeconomic inequalities account for a quarter of all stillbirths, a fifth of preterm births, and a third of cases of foetal growth restriction (FGR), a condition in which babies are smaller than expected for their gestational age.

At the same time, one in 10 stillbirths and almost one in five FGR cases are due to racial inequalities, the study suggests. The findings, which have prompted calls for urgent action, were published in the medical journal the Lancet.

Dr Jennifer Jardine of the Royal College of Obstetrics and Gynaecologists (RCOG), one of the study’s co-lead authors, said: “I think that people will be shocked. The stark reality is that across England, women’s socioeconomic and ethnic background are still strongly related to their likelihood of experiencing serious adverse outcomes for their baby.”

The review, which was conducted by a team from the National Maternity and Perinatal Audit, analysed 1,155,981 birth records between April 2015 and March 2017 in NHS hospitals in England.

The analysis estimates that 24% of stillbirths, 19% of preterm births, and 31% of FGR cases were attributed to socioeconomic inequality and would not have occurred if all women had the same risk of adverse pregnancy outcomes as women in the least-deprived group.

Adjusting for ethnicity, maternal smoking and body mass index (BMI) substantially reduced these inequalities. That suggests that these characteristics can explain a considerable part of the socioeconomic inequalities in pregnancy outcomes.

Pregnancy complications disproportionately affected Black and minority-ethnic women: 12% of all stillbirths, 1% of preterm births, and 17% of FGR cases were attributed to ethnic inequality.

Prof Jan van der Meulen of the London School of Hygiene & Tropical Medicine, another co-lead author, told the Guardian the disparities were unacceptable but said there were no quick fixes that could immediately solve the problem.

The NHS has set a target of halving stillbirth and neonatal death rates and reducing levels of preterm birth by 25% by 2025.

However, the study findings suggest that current national programmes to make pregnancy safer, which focus on an individual woman’s risk and behaviour and their antenatal care, will not be enough to improve outcomes for babies born in England.

To reduce disparities in birth outcomes at a national level, Van der Meulen said, politicians, public health professionals and healthcare providers must work together to tackle racism and discrimination and improve women’s social circumstances, social support and health throughout their lives.

“National targets to make pregnancy safer will only be achieved if there is a concerted effort by midwives, obstetricians, public health professionals and politicians to tackle the broader socioeconomic and ethnic inequalities,” he said.

The largest increases in excess risk of complications among the most socioeconomically disadvantaged Black and south Asian and women.

Half of stillbirths (53.5%) and seven in 10 FGR cases (71.7%) among south Asian women living in the most deprived fifth of neighbourhoods in England could be avoidable if they had the same risks as white women in the most affluent fifth, the study suggests.

This was similarly the case for nearly two-thirds of stillbirths (63.7%) and half of FGR cases (55%) among Black women from the most deprived neighbourhoods.

“There are many possible reasons for these disparities,” said Van der Meulen. “Women from deprived neighbourhoods and Black and minority ethnic groups may be at a disadvantage because of their environment, for example, because of pollution, poor housing, social isolation, limited access to maternity and health care, insecure employment, poor working conditions, and stressful life events.”

Dr Edward Morris, the president of the RCOG, said the findings of the study were alarming, adding: “They provide more evidence that poverty, racism and discrimination can affect women throughout their lives and ultimately lead to devastating incidences of pregnancy complications and baby loss.”

Dr Christine Ekechi, a consultant obstetrician and gynaecologist and co-chair of RCOG’s race equality taskforce, said the disparities were heartbreaking.

“These women are being let down by a healthcare system that is supposed to protect them. Reducing the occurrence of potentially avoidable adverse pregnancy outcomes needs to be a national priority,” she said.

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Health

Kwara approves 100% consolidated health salary structure for nurses

The Kwara State government has approved and implemented a 100% Consolidated Health Salary Structure, (CONHESS) for nurses in the state.

Also, the state government has recruited about 63 nurses to fill the vacuum created by the brain drain in the country to improve the quality and standard of nursing care in line with the global best practices.

The Chairman and Secretary of the Kwara State Council of the National Association of Nigeria Nurses and Midwives, Aminu Shehu and Markus Luka respectively, disclosed this in a statement in Ilorin made available to journalists.

The association appreciated the Executive Secretary of the state Hospital Management Bureau for playing a vital role in the struggle towards ensuring that its demands were met by the government.

The body also commended Governor Abdulrahman Abdulrazaq for the approval and implementation of the 100% CONHESS and the recruitment of more nurses to boost healthcare delivery in the state.

 

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Health

More than 400 consultant anesthetists left Nigeria in 2yrs – Society

More than 400 consultant anesthetists left the shores of Nigeria for greener pastures in the last two years, President of the Nigerian Society of Anesthetists, Dr Olubusola Alagbe-Briggs said in Gombe on Wednesday.

Alagbe-Briggs told newsmen on the side-line of the society’s 31st annual scientific conference that the immigrant anesthetists left Nigeria in search of better practice environment.

She said anesthetists were the most sought-after specialists in foreign lands because of the peculiarity of their services.

“There is a global shortage of anesthetists because of the nature of the job which is intensive, acute and focused.

“We had about 1,200 members in the past, but today we have only 800 members.

“Those countries that are short of anesthetists are pulling those here in Nigeria to their countries.

“Nigerian professionals are the best. They are highly sought-after by other countries.

“Medical practitioners and other professionals will continue to emigrate until their welfare and available equipment are improved upon,’’ she said.

Alagbe-Briggs stressed that availability appropriate equipment and improved welfare were essential to improve medical practice and services.

She said the conference itself sought to ensure continuous enhancement of the knowledge of the society’s members to help to improve their services.

“We are looking at how we can help to improve on cancer care; we are involved in the operational stage, pain relief, emergency care and intensive care.

“We are in Gombe to brainstorm on how to improve our specialty in line with the theme of the conference, learn from one another and share research outcomes,’’ Alagbe-Briggs said.

The conference has: “Anesthesia and the pre-operative care of patients with cancers’’ as its theme.

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Health

WHO Demands Fresh Data from China amid Outbreak of Pneumonia in Children

The World Health Organization (WHO) is requesting more data from China amid an outbreak of pneumonia in children.

Dr Maria Van Kerkhove, a WHO epidemiologist, said the agency was ‘following up with China’ as hospitals across the country continue to be overwhelmed.

Face masks and social distancing are again being recommended in the country.

The country is said to be grappling with a spike in pneumonia, dubbed ‘white lung syndrome’ because of the way lung damage shows up on scans, among children that has been attributed to a rebound in respiratory illnesses rather than an entirely new virus.

 

 

China had one of the most brutal and longest lockdowns of any country in the world which the WHO says robbed children of vital immunity against seasonal illnesses. 

Dr Van Kerkhove told the conference today: ‘Yes, we are seeing an increase in respiratory infections around the world.

‘We’re in autumn and entering winter months, so we are expecting to see rises in respiratory infections regardless.

We are following up with China. They are seeing an increase due a number of different infections

We are following up with our clinical network and following up with clinicians in China.

‘In terms of acute respiratory infections, we are looking at the burden on healthcare systems and looking at the healthcare capacities of systems.’

It comes after Chinese Health Ministry spokesman Mi Feng urged people in the country to again consider wearing face masks and distancing.

Speaking at a press conference on Sunday, he said: ‘Efforts should be made to increase the opening of relevant clinics and treatment areas, extend service hours and increase the supply of medicines.

‘It is necessary to do a good job in epidemic prevention and control in key crowded places.

‘[This includes] in schools, childcare institutions and nursing homes, and to reduce the flow of people and visits.’

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