Breastfeeding has many health, economic and environmental benefits for both the infant and pregnant individual. Due to these benefits, the World Health Organization and Health Canada recommend ...exclusive breastfeeding for the first six months of life. The purpose of this study is to examine the prevalence of exclusive and any breastfeeding in Canada for at least six months, and factors associated with breastfeeding cessation prior to six months.
We performed a secondary analysis of breastfeeding-related questions asked on the cross-sectional 2017-2018 Canadian Community Health Survey. Our sample comprised 5,392 females aged 15-55 who had given birth in the five years preceding the survey. Descriptive statistics were carried out to assess the proportion of females exclusively breastfeeding and doing any breastfeeding for at least six months by demographic and behavioural factors. We also assessed, by baby's age, trends in the introduction of solids and liquids, breastfeeding cessation and the reasons females stopped breastfeeding. Multivariate log binominal regression was used to examine the association between breastfeeding at six months and selected maternal characteristics hypothesized a priori to be associated with breastfeeding behaviour.
Overall, for at least six months, 35.6% (95% confidence interval (CI): 33.3%-37.8%) of females breastfed exclusively and 62.2% (95% CI: 60.0%-64.4%) did any breastfeeding. The largest decline in exclusive breastfeeding occurred in the first month. Factors most strongly associated with breastfeeding for at least six months were having a bachelor's or higher degree, having a normal body mass index, being married and daily co-sleeping. Insufficient milk supply was given as the most common reason for breastfeeding cessation irrespective of when females stopped breastfeeding.
Six-month exclusive breastfeeding rates in Canada remain below targets set by the World Health Assembly. Continued efforts, including investment in monitoring of breastfeeding rates, are needed to promote and support exclusive breastfeeding, especially among females vulnerable to early cessation.
Many sub-Saharan countries, including Ghana, have introduced policies to provide free medical care to pregnant women. The impact of these policies, particularly on access to health services among the ...poor, has not been evaluated using rigorous methods, and so the empirical basis for defending these policies is weak. In Ghana, a recent report also cast doubt on the current mechanism of delivering free care--the National Health Insurance Scheme. Longitudinal surveillance data from two randomized controlled trials conducted in the Brong Ahafo Region provided a unique opportunity to assess the impact of Ghana's policies.
We used time-series methods to assess the impact of Ghana's 2005 policy on free delivery care and its 2008 policy on free national health insurance for pregnant women. We estimated their impacts on facility delivery and insurance coverage, and on socioeconomic differentials in these outcomes after controlling for temporal trends and seasonality.
Facility delivery has been increasing significantly over time. The 2005 and 2008 policies were associated with significant jumps in coverage of 2.3% (p = 0.015) and 7.5% (p<0.001), respectively after the policies were introduced. Health insurance coverage also jumped significantly (17.5%, p<0.001) after the 2008 policy. The increases in facility delivery and insurance were greatest among the poorest, leading to a decline in socioeconomic inequality in both outcomes.
Providing free care, particularly through free health insurance, has been effective in increasing facility delivery overall in the Brong Ahafo Region, and especially among the poor. This finding should be considered when evaluating the impact of the National Health Insurance Scheme and in supporting the continuation and expansion of free delivery care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Diabetes mellitus in pregnancy across Canada Nelson, Chantal Rm; Dzakpasu, Susie; Moore, Aideen M ...
BMC pregnancy and childbirth,
05/2024, Letnik:
24, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Contemporary estimates of diabetes mellitus (DM) rates in pregnancy are lacking in Canada. Accordingly, this study examined trends in the rates of type 1 (T1DM), type 2 (T2DM) and gestational (GDM) ...DM in Canada over a 15-year period, and selected adverse pregnancy outcomes.
This study used repeated cross-sectional data from the Canadian Institute of Health Information (CIHI) hospitalization discharge abstract database (DAD). Maternal delivery records were linked to their respective birth records from 2006 to 2019. The prevalence of T1DM, T2DM and GDM were calculated, including relative changes over time, assessed by a Cochrane-Armitage test. Also assessed were differences between provinces and territories in the prevalence of DM.
Over the 15-year study period, comprising 4,320,778 hospital deliveries in Canada, there was a statistically significant increase in the prevalence of GDM and T1DM and T2DM. Compared to pregnancies without DM, all pregnancies with any form of DM had higher rates of hypertension and Caesarian delivery, and also adverse infant outcomes, including major congenital anomalies, preterm birth and large-for-gestational age birthweight.
Among 4.3 million pregnancies in Canada, there has been a rise in the prevalence of DM. T2DM and GDM are expected to increase further as more overweight women conceive in Canada.
Abstract Objective The Canadian Perinatal Surveillance System (CPSS) of the Public Health Agency of Canada (PHAC) routinely monitors national perinatal health indicators using available ...administrative databases and population health surveys. Women’s perceptions and assessments of their perinatal experiences are not captured by these data sources. The Maternity Experiences Survey (MES) addresses some of these knowledge gaps, and was designed to examine experiences, practices, perceptions and knowledge during pregnancy, birth and the early postpartum months among women giving birth in Canada. Methods A randomly selected sample of 8542 women, stratified primarily by province and territory, was drawn from the May 2006 Canadian Census. Birth mothers living with their infants at the time of interview were invited to participate in a computer assisted telephone interview conducted by Statistics Canada on behalf of the PHAC. Interviews took approximately 45 minutes and were completed when infants were between five and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6421 women (78%). Results Most women reported being satisfied with the care they received. The findings suggested a higher use of selected interventions in pregnancy, labour and birth than is recommended by current evidence and a lower adherence to several best practices related to family-centred issues and the World Health Organization / United Nations Children’s Fund “Baby Friendly Hospital Initiative.” Conclusion Assessing women’s perceptions of their perinatal care provides a valuable supplement to traditional perinatal surveillance tools. The MES will allow for women’s views to be considered in relation to current maternity care policies and practices in Canada.
IntroductionSevere maternal morbidity (SMM)—an unexpected pregnancy-associated maternal outcome resulting in severe illness, prolonged hospitalisation or long-term disability—is recognised by many, ...as the preferred indicator of the quality of maternity care, especially in high-income countries. Obtaining comprehensive details on events and circumstances leading to SMM, obtained through maternity units, could complement data from large epidemiological studies and enable targeted interventions to improve maternal health. The aim of this study is to assess the feasibility of gathering such data from maternity units across Canadian provinces and territories, with the goal of establishing a national obstetric survey system for SMM in Canada.Methods and analysisWe propose a sequential explanatory mixed-methods study. We will first distribute a cross-sectional survey to leads of all maternity units across Canada to gather information on (1) Whether the unit has a system for reviewing SMM and the nature and format of this system, (2) Willingness to share anonymised data on SMM by direct entry using a web-based platform and (3) Respondents’ perception on the definition and leading causes of SMM at a local level. This will be followed by semistructured interviews with respondent groups defined a priori, to identify barriers and facilitators for data sharing. We will perform an integrated analysis to determine feasibility outcomes, a narrative description of barriers and facilitators for data-sharing and resource implications for data acquisition on an annual basis, and variations in top-5 causes of SMM.Ethics and disseminationThe study has been approved by the Mount Sinai and Hamilton Integrated Research Ethics Boards. The study findings will be presented at annual scientific meetings of the Society of Obstetricians and Gynaecologists of Canada, North American Society of Obstetric Medicine, and International Network of Obstetric Survey Systems and published in an open-access peer-reviewed Obstetrics and Gynaecology or General Internal Medicine journal.
Abstract Objective To compare the maternity experiences of immigrant women (recent, ≤ 5 years in Canada; non-recent > 5 years) with those of Canadian-born women. Methods This study was based on data ...from the Canadian Maternity Experiences Survey of the Public Health Agency of Canada. A stratified random sample of 6421 women was drawn from a sampling frame based on the 2006 Canadian Census of Population. Weighted proportions were calculated using survey sample weights Multivariable logistic regression was used to estimate odds ratios comparing recent immigrant women with Canadian-born women and non-recent immigrant women with Canadian-born women, adjusting for education, income, parity, and maternal age. Results The sample comprised 7.5% recent immigrants, 16.3% non-recent immigrants, and 76.2% Canadian-born women. Immigrant women reported experiencing less physical abuse and stress, and they were less likely to smoke or consume alcohol during pregnancy, than Canadian women; however, they were more likely to report high levels of postpartum depression symptoms and were less likely to have access to social support, to take folic acid before and during pregnancy, to rate their own and their infant’s health as optimal, and to place their infants on their backs for sleeping Recent and non-recent immigrant women also had different experiences, suggesting that duration of residence in Canada plays a role in immigrant women’s maternity experiences. Conclusion These findings can assist clinicians and policy-makers to understand the disparities that exist between immigrant and non-immigrant women in order to address the needs of immigrant women more effectively.
Abstract Objective The Maternity Experiences Survey (MES) is an initiative of the Canadian Perinatal Surveillance System. Its primary objective is to provide representative, pan-Canadian data on ...women’s experiences during pregnancy, birth, and the early postpartum period. Methods The development of the survey involved input from a multidisciplinary study group, an extensive consultation process and two pilot studies. The MES population consisted of birth mothers 15 years of age and over who had a singleton live birth in Canada during a three-month period preceding the 2006 Canadian Census of Population and who lived with their infants at the time of data collection. Experiences of teenage, immigrant, First Nations, Inuit, and Métis mothers were of particular interest. The sample was drawn from the 2006 Canadian Census. A 45-minute interview was conducted at five to 14 months post partum, primarily by telephone by female professional Statistics Canada interviewers. Results A response rate of 78% was achieved, corresponding to 6421 women who were weighted to represent an estimated 76 508 women. The cooperation rate was 92% and the refusal rate was 1.0%. Item non-response was low, and few data errors were identified. The final MES sample was judged to be representative of the corresponding Census population for all characteristics investigated. Conclusion The MES marks an important milestone in the availability of information on maternity experiences in Canada. For the first time, it is possible to provide high quality data at national, provincial, and territorial levels on a wide spectrum of maternity experiences as reported by women.
Prenatal maternal stress has been linked to multiple adverse outcomes. Researchers have used a variety of methods to assess maternal stress. The purpose of this study was to explore and compare ...factors associated with stress in pregnancy as measured by perceived stress and stressful life events. We analyzed data from the Canadian Maternity Experiences Survey. A randomly selected sample of 8,542 women who had recently given birth was drawn from the 2006 Canadian Census. Women were eligible if they were at least 15 years of age, had delivered a live, singleton infant, and were living with their infant at the time of the interview (5–14 months postpartum). Prevalence estimates and odds ratios were calculated using sample weights of the survey and their variances were calculated using bootstrapping methods. Bivariate analyses identified statistically significant factors associated with each stress measure. Backward stepwise multivariate logistic regression models were constructed. A total of 6,421 women (78%) participated in the computer assisted telephone interview. Twelve percent of women experienced high levels of perceived stress and 17.1% reported having three or more stressful life events in the year prior to the birth of their baby. In the final model, psychosocial variables were associated with both outcomes, whereas demographic factors were associated only with life event stress. Different factors contributed to perceived stress and life event stress, suggesting that these concepts measure different aspects of stress. These findings can inform routine psychosocial risk assessment in pregnancy.
The database autopsy method was developed to determine probable causes of maternal deaths in the Canadian Institute for Health Information’s hospital discharge abstract database; however, the method ...has yet to be validated. Using immediate cause of death information from Québec’s hospitalization database as the gold standard, this study assessed the validity and reliability of the database autopsy method for pregnancy-associated deaths. The method had high sensitivity and specificity for identifying the most common causes of these deaths, as well as high interobserver agreement. We conclude that the database autopsy method is valid and reliable overall.
La méthode d’autopsie de la base de données a été développée pour déterminer les causes probables des décès maternels dans la Base de données sur les congés des patients de l’Institut canadien d’information sur la santé, mais la méthode n’a pas encore été validée. Utilisant les informations sur la cause de décès immédiate tirées de la base de données des hospitalisations du Québec comme données de référence, cette étude a évalué la validité et la fiabilité de la méthode d’autopsie de la base de données pour les décès associés à la grossesse. La méthode présentait une sensibilité et une spécificité élevées pour l’identification des causes de décès les plus fréquentes en plus de montrer une grande concordance interobservateur. Nous concluons que la méthode d’autopsie de la base de données est globalement valable et fiable.
Objective: To examine whether interventions in labour and birth contributed to ratings of satisfaction with these experiences, in women giving birth vaginally or attempting a vaginal birth prior to ...giving birth by caesarean section. Background: Ratings of satisfaction with women's overall experience of labour and birth have long been encouraged, yet remain challenging to assess or to interpret. Methods: Data from the Canadian Maternity Experiences Survey (MES) - a nationally representative sample of women who had a singleton live birth in 2005-2006 - were analysed. Associations between the number of and type of labour and birth interventions, and women's satisfaction with the overall labour and birth experience and six aspects of caregiver interactions, were assessed. Results: Among women having vaginal births, fewer interventions during labour was significantly associated with higher overall satisfaction with the labour and birth experience (ranging from 75% of women having no interventions to 46.4% having eight or more interventions rating their experiences as 'very postive'). The same pattern was observed for satisfaction with women's perceptions of caregiver's respect, concern for dignity, compassion shown to them, the information given to them, their involvement in decision making, and caregiver's competence. Among women having unplanned caesarean sections following attempted vaginal birth, the number of interventions was not associated with satisfaction ratings; however, satisfaction ratings were consistently lower than among women giving birth vaginally. Conclusion: These findings provide support for demedicalising vaginal labour and birth as well as for optimising the potential for a vaginal birth rather than caesarean section.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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