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Current Projects - Kaupapa rangahau nāianei

From ethnic inequalities in accessing health care to menopause studies, we have a broad range of research projects across the full spectrum of women’s health issues.

 

Whānau Manaaki

The programme grant, “Whānau Manaaki”, addresses the issue of inequity in Māori maternal and child outcomes. This Kaupapa Māori research programme is set up to address the continuum of care from birth through the first important years of life with the goal of meeting the needs of young Māori pregnant women and their whānau. Fundamental to this research is the right of mother/child/whānau to the best care, and environment for the best possible outcomes. It is a collaboration between the WHRC, Katoa Ltd, University of Illinois and the Kāhui Kaumātu working directly with the communities to effect change in care. There are 3 linked projects focusing on the continuum of the maternal child care pathway:
- He Korowai Manaaki – a Wrap-around Approach
- He Tamariki Kokoti Tau – Tackling Preterm quantitative
- He Tamariki Kokoti Tau – Babies Born Prematurely qualitative longitudinal study

He Tapu te Whare Tangata (HPV)

Research to inform Cervical Screening Strategies for Māori Women: He Tapu te Whare Tangata

Māori women are more than three times more likely to die of cervical cancer than Pākehā women. These cancers are preventable and disproportionately affect young Māori women (2nd leading cause of cancer for death for Māori women aged 25-44). In Aotearoa New Zealand the National Cervical Screening Program is failing Māori women, with 40% of women unscreened compared to 18% of NZ European women unscreened. The present cervical screening program involves cervical cytology and a speculum exam – an invasive procedure that requires attending a clinic (two potential barriers).

The Human Papilloma Virus (HPV) is the causative agent of cervical cancer. HPV testing is new innovative technology for detecting cervical disease. This test is more effective both in detecting pre-cancer changes on the cervix (CIN2,CIN3), and in preventing cervical cancer than cytology. Self-collected specimens (self-testing) can be used for HPV screening, providing sensitivity and specificity comparable with clinician-collected specimens and this method also detects disease of the cervix earlier than cytology.3

By self-testing for HPV instead of utilizing the existing screening of cervical cytology sample using a speculum, we have the potential of bypassing some of the barriers that may be affecting smear uptake including, shyness/whakamā, cost, no transport or time off work, and pain or discomfort.

This initial study funded by the Ministry of Health, New Zealand has now led on to obtaining a new grant with the Health Research Council to inform the National Screening Unit on whether the self-testing for HPV will improve access.

Addressing avoidable harm suffered by Māori Babies (SAMM Kids)

SAMM Kids is part of a wider Kaupapa Māori research programme by Women’s Health Research Centre which includes “SAMM national” an audit of the mothers.

SAMM Kids requires different knowledge and perspectives, adding both medical and nursing neonatal expertise. The findings of SAMM Kids will have local and global implications contributing to improved maternal and neonatal care.

The aim of the SAMM Kids research is to examine the rates, causes, consequences and potential preventability of adverse outcomes for the infants of mothers who have had a Severe Acute Maternal Morbidity (SAMM) event.

Prevention of Severe Acute Maternal Morbidity (SAMM) – a national review

In New Zealand, 60,000 women give birth every year. While maternal mortality (death) is thankfully a rare event, severe illness (morbidity) is not.

Severe acute maternal morbidity (SAMM) refers to cases in which a very ill pregnant or recently-delivered woman would have died were good luck and good care not on her side.

This research builds on a previous Women’s Health Research Centre programme that found 40% of SAMM cases were potentially preventable. The most common causes were blood loss and septicaemia, and the most frequent preventable factors were clinician related – most often a failure to recognise a woman’s high risk status, and delayed or inappropriate treatment.

In this next phase of our work, we will explore how severe illness and death can be greatly reduced through changes to clinical and system factors.

By finding the gaps and problems in the systems and processes, we as clinicians and researchers can create long-term change. While our primary focus is how to reduce New Zealand’s disturbing rates of preventable severe illness for pregnant women, we also want to improve the health outcomes for everyone, and get it right where it’s not working.

Severe Maternal Morbidity - Why and How to Review - Talk by Professor Sarah J. Kilpatrick at University of Otago, Wellington on 22 February 2017


E Hine - Reducing barriers to care for Māori mothers and their whānau

Tamariki Māori under the age of five experience multiple health inequalities including a higher risk of death, more hospitalisations, and poorer access to health care services than babies and young children of European mothers. Our work strives to explore and address these disparities by focusing on the role of health, educational and social services in ensuring both Māori women and their whānau have equitable access to appropriate care.

E Hine is a Kaupapa Māori qualitative study that explores the lived realities of 44 young Māori mothers and their babies through pregnancy, early motherhood and early childhood years.

Our early results already show that pregnant Māori teens are being let down by the system despite positive health-seeking behaviour. Contrary to public perception, young pregnant Māori women are engaging early with health services for maternity care, but system barriers from this first health contact lead to avoidable delays to them accessing a seamless maternity care pathway. Our research explores what changes can be made to ensure they receive adequate information and support as they navigate the steps in their maternity care journey.

E Hine will continue to use the experiences of participants to identify where and at what point the system and services are not working well for this group of women. As with all our research, the focus is particularly on Māori health, but our bigger aim is to reduce inequalities and healthcare disparities for all women, maternity and otherwise.


Wahine Hauroa: Addressing barriers to care

Respiratory diseases are a significant contributor to infant illness and death in New Zealand, with Māori infants twice as likely to be hospitalised than non-Māori infants for illness such as acute bronchitis, bronchiolitis, acute upper respiratory tract infections and pneumonia. Respiratory disease requiring hospital admission in infants under one year of age is a significant cause of severe illness, and a potential indicator of an enduring health burden.

The aim of this study is to determine the rates of respiratory hospitalisations for infants (within one year of birth) of Māori, Pacific, Asian and New Zealand European women. Identifying those families at risk of poor health outcomes prenatally will enable interventions and cross sector support to be mobilised to reduce these risks.

Typical indicators and warning signs aren’t always captured in the system - this important research will help identify ways to improve this.

An early conclusion of the study shows that a young maternal age (less than 25 of age), deprivation and maternal ethnicity (Māori and Pacific) are strongly associated with high rates of respiratory hospital admissions for infants. This evidence supports prenatal identification of infants at risk of hospital admissions for respiratory disease to enable timely interventions to improve infant health outcomes.


Diabetes: The impact of maternal care disparities on Māori mothers and infants

With an increased rate of stillbirth, pre-term delivery, and neonatal death, Māori have significantly poorer health outcomes than non- Māori in New Zealand. Māori infants are also more likely to die in their first year of life than non-Māori, and non-Pacific infants. These disparities need urgent explanation.

Undiagnosed and untreated Gestational Diabetes Mellitus (GDM) ā condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy - is associated with significant morbidity and mortality for both the mother and baby. Māori women are more likely to have gestational diabetes than non-Māori women.

All pregnant women in Aotearoa should have the opportunity to be screened, as undiagnosed and untreated GDM has lifelong consequences for mother and baby. If universal screening is not occurring then maternity care practices need to be changed.

This study aims to investigate whether Māori women diagnosed with GDM (and their babies) are more likely to have adverse outcomes than non-Māori and whether they receive adequate screening, diagnosis and care. In doing so, we will be able to identify the types of women who miss out on screening for GDM and see if outcomes for women who are diagnosed differ between ethnic groups. It’s about finding the gaps and problems in the systems, processes and providers available so we can create a systemic long-term impact for all women in New Zealand.


For information about any of our studies please contact: whrc@otago.ac.nz

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