Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia

Sue Kildea; Yu Gao; Sophie Hickey; Sue Kruske; Carmel Nelson; Renee Blackman; Sally Tracy; Cameron Hurst; Daniel Williamson; Yvette Roe

doi:10.1016/j.eclinm.2019.06.001

Reducing preterm birth amongst Aboriginal and Torres Strait Islander babies: A prospective cohort study, Brisbane, Australia

EClinicalMedicine. 2019 Jun 24:12:43-51. doi: 10.1016/j.eclinm.2019.06.001. eCollection 2019 Jul.

Authors

Sue Kildea^{1

2}, Yu Gao^{1

2}, Sophie Hickey^{1

2}, Sue Kruske^{3

4}, Carmel Nelson^{3

5}, Renee Blackman^{6

7}, Sally Tracy⁸, Cameron Hurst⁹, Daniel Williamson¹⁰, Yvette Roe^{1

2}

Affiliations

¹ Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, 410 Ann Street, Brisbane City, Queensland 4000, Australia.
² Mater Research Institute-University of Queensland, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
³ Institute for Urban Indigenous Health, 22 Cox Rd, Windsor, Queensland 4030, Australia.
⁴ School of Nursing, Midwifery and Social Work, University of Queensland.
⁵ Poche Centre for Indigenous Health, University of Queensland.
⁶ Aboriginal and Torres Strait Islander Community Health Service Brisbane Limited, 55 Annerley Rd, Woolloongabba, Queensland 4102, Australia.
⁷ Gidgee Healing Aboriginal Community Controlled Health Service, 28 Miles Street, Mount Isa, Queensland 4825, Australia.
⁸ The University of Sydney, 88 Mallett Street, Camperdown, New South Wales 2050, Australia.
⁹ QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Queensland 4006, Australia.
¹⁰ Aboriginal and Torres Strait Islander Health Branch, Department of Health, 33 Charlotte Street, Brisbane, Queensland 4001, Australia.

Abstract

Background: Prevention of avoidable preterm birth in Aboriginal and Torres Strait Islander (Indigenous) families is a major public health priority in Australia. Evidence about effective, scalable strategies to improve maternal and infant outcomes is urgently needed. In 2013, a multiagency partnership between two Aboriginal Community Controlled Health Organisations and a tertiary maternity hospital co-designed a new service aimed at reducing preterm birth: 'Birthing in Our Community'.

Methods: A prospective interventional cohort study compared outcomes for women with an Indigenous baby receiving care through a new service (n = 461) to women receiving standard care (n = 563), January 2013-December 2017. The primary outcome was preterm birth (< 37 weeks gestation). One to one propensity score matching was used to select equal sized standard care and new service cohorts with similar distribution of characteristics. Conditional logistic regression calculated the odds ratio with matched samples.

Findings: Women receiving the new service were less likely to give birth to a preterm infant than women receiving standard care (6·9% compared to 11.6%). After controlling for confounders, the new service significantly reduced the odds of having a preterm birth (unmatched, n = 1024: OR = 0·57, 95% CI 0·37, 0·89; matched, n = 690: OR = 0·50, 95% CI 0·31, 0·83).

Interpretation: The short-term results of this service redesign send a strong signal that the preterm birth gap can be reduced through targeted interventions that increase Indigenous governance of, and workforce in, maternity services and provide continuity of midwifery carer, an integrated approach to supportive family services and a community-based hub.

Keywords: Aboriginal Community Controlled Health Organisations; Aboriginal and Torres Strait Islander; Birth cohort; Birthing in Our Community; Birthing on Country; Child mortality; Closing the gap; Co-design; Community; Community investment-ownership-activation; Continuity of midwifery care; Health disparities; Health services research; Indigenous; Maternity; Midwifery; Preterm birth; Propensity score matching; Prospective study; The Indigenous Birthing in an Urban Setting (IBUS) study.