The Worldwide Wellness of mothers and babies
Program lead: Professor Deborah Loxton
Infant health lead: Dr Catherine Chojenta
Contraceptive use and family planning lead: Dr Melissa Harris
Perinatal mental health lead: Dr Nicole Reilly
Health of Indigenous Mothers and Babies lead: Associate Professor Kym Rae
The Worldwide Wellness of mothers and babies (WWOMB) theme of RCGHA generates new knowledge about health services for maternal and infant wellbeing. In low-middle income nations the 2015 Millennium Development Goals for reductions in maternal and infant mortality were unmet. In Australia, the gap in maternal and infant mortality and morbidity between Indigenous and non-Indigenous Australians remains unclosed. Furthermore, health behaviour during pregnancy, particularly alcohol use, remains a significant issue among Australian women. Perinatal mental health is a challenge that significantly effects women having children across the globe.
The WWOMB program is guided by principles that promote a holistic approach to research and health. Cultural diversity is recognised as a potential asset for effective primary health service delivery and improving health outcomes. Cultural sensitivity is enacted through reciprocal partnerships where cultural, research, policy and practice expertise are equally weighted.
The vision of WWOMB is to eliminate preventable maternal and infant mortality and morbidity. Attention is focused on the preconception, pregnancy, intrapartum and postpartum periods across four critical service areas for maternal and infant wellbeing identified by the United Nations. Family formationincludes access to contraception and fertility treatment. Antenatal care includes a minimum number of consultations with skilled workers, family and social support. Birthing careencompasses skilled delivery attendance in a safe environment and access to emergency care. Postnatal carefor women and infants includes consultations by skilled workers.
The WWOMB theme utilises three research platforms. At the global level, geospatial mapping analyses are used to assess the impact of geographical and topographical factors on service access, and their relationship with maternal and infant mortality and morbidity. Basic needs and gender equality markers and socioeconomic indices will be added to assess their relative impact on service access, and maternal and infant mortality and morbidity. This work will generate understanding of effective health service access at the global level. Community level understanding will involve analyses conducted in selected countries and communities. Using a combination of quantitative and qualitative methods, and existing and newly collected information, data on drivers that facilitate and impede service access will be collected and analysed. The development, implementation and evaluation of health action plans will build on global and community knowledge gained by the research platforms. Community consultation is a critical component of this phase of the research, following a participatory action approach. Plans may include use of technology, such as mobile phone apps; or use of existing cultural events to promote the value of services. All health action plan implementations are evaluated.
Lead: Dr Catherine Chojenta
Dr Chojenta has developed a program of research that is focusing on birth outcomes such as stillbirth, neonatal death, birth weight and congenital conditions. She also has a research interest in issues around breastfeeding as a key determinant of infant health and wellbeing. Dr Chojenta also has an interest in health services research and has been working on a number of projects to examine frequent users of health services, particularly women of reproductive age and their infants. She has employed a number of complex statistical techniques to interrogate both survey and administrative datasets to explore drivers of health services.
Dr Chojenta aims to produce high quality, high impact research into the health and wellbeing of mothers and their children. Her focus is on strengthening the evidence base for early intervention in order to prevent poor health – for example reducing the impact of poor maternal health in preconception and pregnancy on infant outcomes. To do this, she will use a variety of platforms including data linkage and complex quantitative data analysis, and in depth qualitative analysis to determine the factors that enable all children to enjoy the healthiest start to life.
Lead: Dr Melissa Harris
Dr Harris is a Postdoctoral Research Fellow with a significant track record in understanding complex health and social outcomes for women across the lifecourse. As the program lead for the contraception and family planning stream of the WWOMB program she is undertaking research both nationally and internationally that aim to empower women (and men) with knowledge to enable them to make informed reproductive decisions using a range of innovative research methods and statistical techniques. As part of this program she is leading research that combines her interest in both contraception and chronic disease by understanding contraceptive use and unintended pregnancy in this population. Women with chronic disease are not only at increased risk of unintended pregnancy, but also adverse maternal and infant outcomes. The findings of this research will provide a platform for the development of policy guidelines and interventions aimed at reducing the physical, economic and societal costs associated with unintended pregnancy and abortion in this population.
Dr Harris is also committed to research capacity building in this area and currently supervises a number of PhD students within the WWOMB program focused on contraceptive uptake in developed and developing nations. Example projects include the uptake and decision-making practices surrounding long-acting reversible contraceptive use among young Australian women; understanding of the contraceptive practices (and barriers to contraceptive uptake) and reproductive life planning among women with HIV and the implementation of mHealth technologies to improve access and use of sexual and reproductive health services for adolescent girls. Importantly, increasing contraceptive knowledge and uptake by women in developing nations will allow women to effectively space births which may in turn be the key to unlocking the cycle of poverty.
Lead: Dr Nicole Reilly
In Australia, local, state and national initiatives for maternal mental health have focused on prevention and early intervention for over 15 years. Yet the impact of these preventive programs on health service use and mental health outcomes for pregnant women and new mothers remains largely unknown in this country.
In response, a core component of the current research program is evaluation of the impact of key national policy initiatives for maternal mental health. This work utilises twenty years of data from the Australian Longitudinal Study for Women’s Health (ALSWH) – Australia’s largest longitudinal survey of women – and the existing structures for linkage of this rich survey data to state and national administrative datasets, including Medicare. Its unique inclusion of mental health outcome data will fill a significant – and much criticised – gap in the evidence base. In collaboration with RCGHA and Professor Marie-Paule Austin, an internationally recognised expert in the field of perinatal mental health, It will also validate a revised version of the Antenatal Risk Questionnaire – a clinical tool to support the early identification of psychosocial risk during pregnancy and which meets the parallel criteria of updated clinical best practice recommendations (2017) and new MBS items for obstetric services (2018).
This body of work is underpinned by clear pathways for knowledge exchange and research translation.
Name: Shahinoor Akter
Supervisors: Dr Jane Rich, Dr Kate Davies and Dr Kerry Inder
Eleven Indigenous groups reside in the Chittagong Hill Tracts (CHT) of Bangladesh. To date well-designed studies focusing on health issues of these Indigenous groups are rare. While there have been substantial improvements in maternal health in Bangladesh, there is a gap in literature regarding prevalence of accessing antenatal, delivery and post-natal services among Indigenous women in the CHT, and relevant interventions to address the issue. Evident shows that accessing health care services during reproductive age, particularly in pregnancy has positive effects on maternal and child health outcomes. Indigenous women worldwide tend to access health care services less than non-Indigenous women, and they often experience poorer health outcomes than their non-Indigenous counterparts. To ensure the health rights of underprivileged groups including Indigenous people, current global Sustainable Development Goals (SDGs) set two goals, 3 and 10, to improve health and wellbeing and reduce inequalities through an inclusion approach. To relate closely with the SDGs goals, this study aims to examine current situation of accessing to maternal health care services among Indigenous women in the CHT, and to explore culturally appropriate ways to improve access to health care services for Indigenous women at the primary care health level in the CHT of Bangladesh.
Name: Gezahegn Tesfaye Girma
Supervisors: Professor Deborah Loxton, Dr. Catherine Chojenta, Laureate Professor Roger Smith
This research project focuses on maternal mortality and maternal health service utilization in a largely rural district in Eastern Ethiopia. Using both secondary and primary data the project aimed to understand the burden of maternal mortality and the patterns of maternal health service utilization among reproductive-aged women in the study community. To understand the magnitude of maternal mortality, secondary data analysis was implemented while to investigate the drivers or deterrents of maternal health service utilization a combination of quantitative and qualitative research techniques were used. The overall project is intended to provide groundbreaking information and highlight priority intervention areas to improve the uptake of maternal health service utilization which subsequently contributes to a reduction in maternal mortality in the country.
Name: Habtamu Mellie Bizuayehu
Supervisors: Professor Deborah Loxton, Dr Melissa Harris, Dr Catherine Chojenta
About a quarter (25.8%) (11) of pregnancies in Australia end with any adverse pregnancy outcomes, including preterm birth (8.7%), low birth weight (6.5%), section births (33%), labour induction (29%), instrumental delivery (11% - 12%) (30) and macrosomia (9.1% in gestational diabetic and 11.9% none diabetic pregnancies (86)). Adverse pregnancy outcomes have been associated with various socio-demographic factors, life events, behavioural and chronic diseases, such as hypertension, diabetes, and asthma. This study will generate evidence about the occurrence, recurrence, trajectory and geospatial distribution of adverse pregnancy outcomes and the associated socio-demographic, behavioural and chronic diseases factors in Australia. The study will assist with resource planning, and clinical decision making. Furthermore, geospatial and trajectory analysis will used for explaining geographic distribution and momentum/course of adverse pregnancy outcome during the reproductively active years.
Name: Tenaw Yimer Tiruye
Supervisors: Prof Deb Loxton, Dr Catherine Chojenta, Dr Melissa Harris and A/Prof Liz Holliday
The aim of this study is to identify the determinants, Maternal and Child Health (MCH) effects of intimate partner violence (IPV) and to explore perceptions of IPV in the health sector, arguably the most likely place that a woman may seek help. It is proposed to identify the hierarchical multi-level determinants of IPV from individual to societal levels. The effect of IPV on selected MCH outcomes, which are major public health problems in Ethiopia, will also be determined. The maternal health outcomes to be assessed will be pregnancy loss, maternal anaemia, and obstetric fistulae, while the child health outcomes will be neonatal mortality and child undernutrition. In addition, it is aimed to explore the perceptions of health care workers and health managers about IPV. The results will inform policy makers, organizations, and stakeholders working on women and child health in general and IPV against women in particular in Ethiopia. Findings will also help health-care providers to be informed and aware of the possibility of IPV as an underlying factor in women and children’s ill health. The study might also provide evidence for the need to integrate IPV interventions in the existing MCH programs and provide the information that will help to facilitate this.
Name: Alemu Sufa Melka
Supervisors: Dr Catherine Chojenta, Professor Deborah Loxton, Dr Elizabeth Holliday
This project will investigate the risk and protective factors associated with substance use and risky sexual behaviours among young Australian women. The findings of this study will be used to make recommendations for policies and interventions aimed at mitigating the problem of substance use and risky sexual behaviours among young Australian women.
Name: Binod Bindu Sharma
Supervisors: Laureate Professor Roger Smith, Professor Deborah Loxton
This research is focussed on addressing the high ratios of maternal mortality conditions in rural Nepal. The project is to design and develop a model of community led intervention for maternal health and implemented in the rural villages of Nepal. The results demonstrated that education through singing messages was highly effective in educating rural villagers of Nepal.
Name: Kelemu T Kibret
Supervisors: Dr Catherine Chojenta, Professor Deborah Loxton, Dr Ellie Gresham
This project will address three main aims:
- To assess the effect of dietary pattern on risk of HDP, gestational diabetes mellitus (GDM) and pregnancy outcomes (low birth weight and preterm birth);
- To assess the spatial distribution and factors associated with maternal anemia in Ethiopia; and
- To determine the effects of maternal dietary patterns on the risk of hypertensive disorder of pregnancy and maternal anemia in North Shewa, Ethiopia.
To address the first aim, a systematic review with meta-analysis will be carried out. For the second aim, detail analysis of the Ethiopian Demographic and Health Survey 2016 (EDHS 2016) data will be performed using spatial analysis and multilevel modelling. The case-control study will be conducted among pregnant women in selected health facilities in North Shewa Zone, Ethiopia to address the third aim.
Name: Teketo Kassaw Tegegne
Supervisors: Dr Catherine Chojenta, Prof Deborah Loxton, Laureate Prof Roger Smith
This project focuses on the spatial analysis of maternal health service use in Ethiopia and its associated factors, investigates the two most important applications of GIS in Health Informatics, namely healthcare access and community health profiling. The study investigates whether women in Ethiopia have access to health facilities providing family planning, antenatal and delivery care and caesarean delivery. In addition to this, it will measure how each of the accessible health facilities are ready to provide the available maternal health services and identify the potential factors associated with service uptake. Moreover, this study will provide important information for program managers and decision makers on health facilities and services, and the communities that need special attention. Mapping of the combined findings of service utilization and health facility distribution is critical for a better understanding of a particular situation, planning programs and services, advocacy, and creating awareness of a particular phenomenon.
Name: Kate Morgan
Supervisors: Dr Catherine Chojenta, Dr Meredith Tavener, Prof Deb Loxton
This research aims to discover how women with pre-existing Postural Orthostatic Tachycardia Syndrome (POTS) experience pregnancy, and also how health care professionals taking care of these women feel about POTS and pregnancy. POTS is a little known condition that predominantly affects women of child bearing age. It affects the entire autonomic nervous system with symptoms that can be very debilitating. POTS is more common than people realise – it's more common than Multiple Sclerosis and as common as Parkinson’s Disease. The most famous person with a type of POTS is Greg Page, aka ‘The Yellow Wiggle’.
Name: Desalegn Markos Shifti
Supervisors: Dr Catherine Chojenta, Professor Deborah Loxton
This research is on spatial variations of birth interval in Ethiopia including its determinants, inequalities, effects on infants and child health outcomes based on national population data.
Name: Tahir Ahmed Hassen
Supervisors: Dr Catherine Chojenta, Prof Deborah Loxton
Neonatal health is one of the unfinished health agenda. Globally, about 2.6 million neonatal deaths occur every year, of which, one million deaths are within the first day of birth. Traditionally, neonatal mortality has been used to measure and evaluate the perinatal health service quality. However, using neonatal mortality is becoming rarely applicable particularly in developed settings where there is low neonatal mortality and another alternative indicator; neonatal near miss is being recommended.
Neonatal near miss (NNM) defined as ‘an infant who nearly died but survived a severe complication that occurred during pregnancy, birth or within 7 days of extra-uterine life’. Though NNM is not well studied, the existing few literature suggested that; when combined with neonatal mortality, NNM is very helpful to evaluate and identify points of deficiencies in obstetrics and newborn care particularly in developed nations. In many developed nations like Australia, Neonatal mortality has been declined to a single digit. However, recently published evidence from different settings suggested that for a single neonatal death there might be as many as severe acute morbidities which calls for the inclusion of neonatal near miss. Nevertheless, despite the recommendations, neonatal near miss concept is not studied in Australia using the recently proposed markers. Therefore, this study aims to bring and contextualize the neonatal near concept to Australia and to further enhance the health of newborns by revealing the magnitude of the problem and its determinants. Further, this study aims to contribute for the worldwide standardization process of neonatal near miss tool.
Name: Girmay Tsegay Kiross
Supervisors: Dr Catherine Chojenta, Professor Deborah Loxton and Dr Daniel Barker
The infant mortality rate in Ethiopia is one of the highest in Africa. In Ethiopia 1 in every 35 children dies within the first month of life and one in every 21 children dies before celebrating the first birthday. Despite a substantial reduction in infant mortality, forty-one percent in the last 16 years, infant mortality remains a serious issue in Ethiopia. Several multi-level factors determine infant mortality. In this study, we will identify individual, community and national level determinants of infant mortality in Ethiopia. In addition, we will identify areas with high infant mortality and exploring mothers’ health-seeking behaviour when their infants are unwell in Ethiopia.
Name: Alexander Suuk Laar
Supervisors: Prof Deborah Loxton and Dr Melissa Harris
Meeting the reproductive health needs of adolescent girls is one of the major challenges facing Ghana. Ghana has a young age structure, with approximately 57% of the population under the age of 25.The adolescent population aged between 10 and 19 years, has consistently accounted for about one in five Ghanaians since 1960. Adolescents’ health has been identified as a major public health concern in Ghana and a major topical issue for governments, non-governmental organizations, policymakers and service providers. It is highlighted as one key area that requires critical attention in the nation's population programs. Adolescents’ sexuality and reproductive health remains a highly charged moral issue in Ghana. It is compounded by the fact that in most cases, reproductive health services are not oriented towards adequately meeting the needs of adolescents. This trend is even higher in rural areas where there is largely limited access to quality reproductive health services. Cognizant of this, some International Non-Governmental Organizations and community-based organizations are working to augment the government of Ghana’s effort to achieving the Sustainable Development Goal 3 by 2030. These organizations partner with the Ghana Health Service to orient sexual and reproductive health service in mHealth. There is a growing interest in the effect of mHealth in Sexual and Reproductive Health care service delivery. My research seeks assess the extent of the implementation of sexual and reproductive health-related mHealth interventions for adolescent girls in rural settings of Ghana to inform policy on the feasibility of using mHealth to improve access and use of sexual and reproductive health services in Ghana.
Name: Melissa Sherrel Pereira
Supervisors: Dr Catherine Chojenta, Prof Deborah Loxton
Depression and/or anxiety disorders are said to affect each and every individual at any one time point of their life. The impact of these common mental health disorders in the perinatal period is huge and has negative consequences for the woman, the infant, the partner and the immediate family. The aim of our research is to investigate the preventative factors associated with poor perinatal mental health in women with a history of mental illness, particularly depression and anxiety. A qualitative analysis will also be undertaken exploring the lives of young women with a history of depression or anxiety and their transition to motherhood. This research will utilize data from the Australian Longitudinal Study on Women’s Health (ALSWH). Therefore, this study will influence health policy development and practice in women’s health and health services in the state and federal governments.
Name: Md Nuruzzaman Khan
Supervisors: Prof Deborah Loxton, Dr Melissa Harris
Unintended pregnancy is now a global concern not only recognized as a risk factor for mothers and their newborns, but a vital development issue for any society. It has been considered one of the major causes of adverse outcomes, including maternal and neonatal mortality. Adverse outcomes for women who have experienced an unintended pregnancy may be associated with access to, and quality of, family planning and maternal health care services. The purpose of this study is to build on this knowledge by examining access to, and outcomes of, health care service use among women who have experienced unintended pregnancy. To fulfill this purpose, a mixed method technique will be used. A systematic review and meta-analysis will be conducted by covering low- and lower-middle income countries. Thereafter, data collected from Bangladesh will be analysed quantitatively. Finally a qualitative study will be conducted in Bangladesh.
Name: Tesfaye Regassa Feyissa
Supervisors: Dr Melissa Harris and Professor Deborah Loxton
The aim of this research is to generate evidence to improve understanding of the contraceptive practices (and barriers to contraceptive uptake) among women living with HIV in western Ethiopia. With improved drug therapy and care and support programs, women living with HIV are living longer and healthier life and therefore require appropriate family planning strategies. Unintended pregnancies in women with HIV are currently occurring at a rate of 50%. Survey and interviews are being undertaken to explore contraceptive use and fertility in women living with HIV in western Ethiopia. The outcome of this research is to use this evidence to design family planning and to prevent transmission of HIV from mum to child by providing knowledge base for the design of family planning and support programs.
Name: Karen E Beattie
Supervisors: Professor Deborah Loxton, Associate Professor Kym Rae, Dr Nicole Reilly
The differences in health and well-being outcomes for Aboriginal and non-Aboriginal Australians across the lifespan are well-documented, complex and multi-faceted, with Aboriginal women recognised to be at higher risk than non-Aboriginal women during the perinatal and early childhood periods. Maternal health during the perinatal and the early childhood periods significantly influences both the short and long term health and well-being outcomes for the woman, her infant, family and community. During this time health professionals are expected and in some instances mandated to undertake health screening or conversations with women including psycho-social, mental health, substance use including alcohol, and domestic violence assessments; with health professionals reporting feeling challenged, unprepared, untrained and ill equipped to have these conversations with women. There is little literature which specifically reflects and addresses Aboriginal women’s voices, views, needs, and experiences of these health screening conversations, or those health professionals who work with Aboriginal women. Findings from this research will be used to inform best practice and policy development, strengthening health system knowledge and capacity in the provision of culturally safe and responsive perinatal and early childhood health care, and improve health outcomes for Aboriginal women, children and families.
Name: Shalik Ram Dhital
Supervisors: Prof. Deborah Loxton and Dr. Catherine Chojenta
Communicable diseases are significant public health challenges and create endemic problems in developing countries. About 99% of infectious diseases occur in developing countries. Poor handwashing contributes to about 10% of the global burden of communicable diseases. Lack of maternal knowledge is the significant determinant for household handwashing. Proper hand washing with soap at household level reduces the risk of diarrhoea and pneumonia by 50% and skin infection by more than 30%. Nepal demographic health survey 2016 showed that only 47% of people wash their hand effectively. Poor maternal handwashing knowledge, improper utilization of available resources like soap, water, tippy taps and so on, as well as psychological, cultural, and other contextual factors play significant roles for handwashing with soap at household levels. Therefore, having knowledge about handwashing with soap during critical moments is highly significant. The primary aim of this study is to assess the impacts of a street drama health promotion intervention on handwashing at household levels to improve maternal knowledge of hand washing in rural Nepal.
Name: Dr Tanmay Subhash Bagade
Supervisors: Dr Catherine Chojenta, Dr Melissa Harris, Prof Deborah Loxton
The aim of the research is to understand and analyse the association of gender development markers and contraception on maternal and child mortality globally.
Name: Tesfalidet Tekelab Beyene
Supervisors: Professor Deborah Loxton, Laureate Professor Roger Smith, Dr Catherine Chojenta
Maternal death is only the tip of an iceberg; the base of the iceberg is the maternal morbidities and maternal near miss. For every mother who dies due to pregnancy-related causes, almost 30 mothers experience acute or chronic morbidities with severe maternal complications that affect the life of the mother physically and psychologically. Our aims is to identify the near miss cases in south Ethiopia. Assessing the near miss cases and deaths provides health workers and managers with a learning opportunity to use specific evidence based intervention to prevent and treat maternal and newborn morbidities. The findings of the study will be used as an evidence base for policy makers and stakeholders to inform the design of intervention strategies to tackle the problems of near miss cases. By addressing near miss events, maternal and infant mortality will also be reduced. It is also important to evaluate the quality of obstetric care by showing the maternal and neonatal mortality index and case fatality rate (CFR).
Name: Jacqueline Coombe
Supervisors: Prof Deborah Loxton, Dr Melissa Harris
In Australia, the uptake of long-acting reversible contraception (LARC; intrauterine devices, contraceptive implants) is quite low, particularly among younger women. My research aimed to examine this phenomenon using data from the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) Study. My thesis employed a mixed-methods approach, comprising a systematic review, quantitative analysis and two qualitative analyses, the first utilising free-text comments and the second semi-structured interviews. Overall, I found that although there are barriers to LARC use among women who would benefit or desire them, these methods are not the only options available to women who will continue to use whichever method best suits her needs.
Name: Abdulbasit Musa Seid
Supervisors: Prof Deborah Loxton and Dr Catherine Chojenta
The overall aim of the research is to assess determinants of intimate partner violence during pregnancy, and its effect on adverse pregnancy outcomes including postnatal maternal mental health. It will investigate the factors that contribute to partner violence during pregnancy, whether partner violence has an association with adverse pregnancy outcomes (both for mother and fetus) and postnatal mental health (specifically postnatal depression and anxiety). The study participants will be women who gave birth at public hospitals in Harari region, east Ethiopia. Participants will be asked about their exposure to intimate partner violence, socio-demographic factors, social-relationship factors, marital, sexual and behavioural factors, reproductive history, adverse childhood experiences, and their mental health status. Consent will be obtained to access participants medical records in order to ascertain information related to adverse pregnancy outcomes.
Name: Ayele Bali
Supervisors: Dr Catherine Chojenta, Prof Deborah Loxton
All pregnant mothers are at risk of obstetric complications and nearly 15 percent of pregnancies end in unpredictable obstetric complications. Thus, improving maternal health and reducing maternal mortality, which could be achieved through the provision of high quality emergency obstetric care, became one of the global health priority. Therefore, this research is aimed at assessing the effect of performance of the signal functions of emergency obstetric care and motivation of healthcare providers on maternal deaths in Ethiopia. To achieve this aim, mixed method design will be employed to analyse secondary data that have been collected by the Ethiopian Public Health Institute and will be supplemented with generation and analysis of qualitative data. Data from 293 hospitals will be included to analyse the effect of performance of the signal functions of emergency obstetric care and its effect on maternal mortality. Level of motivation of healthcare providers and its correlation with maternal mortality will also be assessed. Chi-squared test, linear regression, logistic regression models will be employed to assess the effect of independent variables on maternal mortality. A supplementary qualitative study will also be conducted among public and private hospitals in Harari region to assess facility readiness to provide emergency obstetric care in terms of availability of infrastructure, competence of human resources, medical supplies and management of obstetric care. The qualitative data will be thematically analysed using Nvivo 11 software.
The University of Newcastle acknowledges the traditional custodians of the lands within our footprint areas: Awabakal, Darkinjung, Biripai, Worimi, Wonnarua, and Eora Nations. We also pay respect to the wisdom of our Elders past and present.