Background
Methods
Study design
Setting
DHF Health District | Darwin Urbana
| Darwin Rural | Katherine | East Arnhem | Barkly | Alice Springs Urban | Alice Springs Rural |
---|---|---|---|---|---|---|---|
Area[19] | 3,122 km2
| 123,053 km2
| 344,957 km2
| 40,376 km2
| 294,640 km2
| 349 km2
| 545,707 km2
|
Estimated Resident Population (2004)[20] | |||||||
Indigenous
| 10,682 (9.9%) | 10,097 (73.0%) | 9,084 (49.2%) | 8,813 (63.1%) | 3,284 (59.5%) | 5,182 (19.0%) | 9,744 (77.5%) |
Non-Indigenous
| 97,637 (90.1%) | 3,728 (27.0%) | 9,390 (50.0%) | 5,153 (36.9%) | 2,239 (40.5%) | 22,050 (81.0%) | 2,830 (22.5%) |
Total
| 108,319 (100%) | 13,825 (100%) | 18,474 (100%) | 13,966 (100%) | 5,523 (100%) | 27,232 (100%) | 12,574 (100%) |
Health service outlets[19] | 4 | 16 | 22 | 13 | 8 | 2 | 32 |
Birthing facilities available[21] | Royal Darwin Hospital (RDH) Darwin Private Hospital (DPH) | Women go to RDH for birth | Katherine District Hospital (KDH) | Gove District Hospital (GDH) | Tennant Creek Hospital (TCH) | Alice Springs Hospital (ASH) | Women go to ASH for birth |
Total number of births per region for 2003-2005
| |||||||
Indigenous
| 636 (12.1%) | 749 (81.9%) | 656 (58.7%) | 690 (74.6%) | 264 (74.8%) | 351 (26.9%) | 600 (90.6%) |
Non-Indigenous
| 4,614 (87.9%) | 165 (18.1%) | 461 (41.3%) | 235 (25.4%) | 89 (25.2%) | 955 (73.1%) | 62 (9.4%) |
Total
| 5,250 (100%) | 914 (100%) | 1,117 (100%) | 925 (100%) | 353 (100%) | 1,306 (100%) | 662 (100%) |
Region
|
TE
|
TE
|
TE
|
TE
|
CA
|
CA
|
CA
|
Urban
|
Remote
| Katherine town – Urban Remainder of cases - Remote
| Nhulunbuy town – Urban Remainder of cases - Remote
| Tennant Creek town - Urban Remainder of cases -Remote
|
Urban
|
Remote
| |
Comments
| RDH serves as a referral centre for the TE, Western Australia and South-East Asia. DPH started operations in 1987. Quality of reporting births to the NTMC stabilised after 1989. | Maternity services were discontinued during 2005 with subsequent births occurring at ASH. | Some ASH cases are referred to Adelaide, South Australia (1,500 km to the south of Alice Springs, Darwin is 1,500 km north of the town.) |
Sample
Comparison groups
Maternal and neonatal characteristics | NT-resident women (N = 7,560) | Indigenous (N = 2,573) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Non-Indigenous (n = 4,987)a
| Indigenous (n = 2,573) | Top End (n = 1,776) | Central Australia (n = 797) | Chi2or Fisher’s Test for trend | ||||||
Remote
A
(n = 334) |
P-value A vs B
|
Remote
B
(n = 1,686) |
Urban
C
(n = 887) |
P-value B vs C
|
Remote
b
(n = 1,217) |
Urban(n = 559) |
Remote(n = 469) |
Urban(n = 328) | ||
Maternal: | ||||||||||
Mean maternal age in years (±SD)[95% Confidence Interval] | 28.4 (±5.7) [27.8, 29.1] |
<0.001
| 23 (±5.8) [23.1, 23.7] | 24.9 (±5.9) [24.5, 25.3] |
<0.001
| 23.7 (±5.9) [23.3, 24.0] | 24.8 (±5.8) [24.4, 25.3] | 22.7 (±5.8) [22.1, 23.3] | 25.0 (±6.1) [24.4, 25.7] | .. |
Maternal age < 20 years | 7.8% |
<0.001
| 31.1% | 19.8% |
<0.001
| 28.6% | 19.5% | 37.5% | 20.4% |
<0.001
|
Maternal age ≥ 35 years | 16.8% |
<0.001
| 5.3% | 7.1% |
0.062
| 5.7% | 7.0% | 4.3% | 7.3% |
0.193
|
First pregnancy | 37.4% |
0.078
| 32.4% | 30.6% |
0.328
| 31.2% | 30.8% | 35.5% | 30.2% |
0.262
|
Fourth + pregnancy | 14.7% |
<0.001
| 26.8% | 24.5% |
0.198
| 29.1% | 24.7% | 20.9% | 24.1% |
0.004
|
Less than four antenatal visits | 6.3% |
0.001
| 12.9% | 15.2% |
0.099
| 9.6% | 17.2% | 21.3% | 11.9% |
<0.001
|
Smoking reported at first visit | 24.0% |
<0.001
| 47.5% | 51.2% |
0.076
| 54.7% | 53.0% | 28.8% | 48.2% |
<0.001
|
Smoking reported at 36 weeks | 21.9% |
<0.001
| 44.5% | 47.6% |
0.142
| 52.4% | 49.4% | 24.1% | 44.5% |
<0.001
|
Alcohol use reported at first visit | 10.5% |
0.522
| 9.4% | 8.0% |
<0.001
| 8.9% | 11.8% | 10.9% | 20.1% |
<0.001
|
Alcohol use reported at 36 weeks | 5.7% |
0.708
| 6.2% | 11.6% |
<0.001
| 5.9% | 8.8% | 7.0% | 16.5% |
<0.001
|
Diabetes in pregnancyc
| 6.5% |
0.009
| 12.7% | 12.5% |
0.948
| 11.0% | 10.9% | 17.0% | 15.5% |
0.017
|
Out-of-hospital birthd
| <5 |
0.019
| 4.2% | 0.7% |
<0.001
| 4.9% | <5 | 2.4% | <5 |
<0.001
|
Epidural/spinal pain relief | 10.8% |
0.003
| 6.2% | 10.3% |
<0.001
| 5.5% | 10.6% | 8.1% | 9.8% |
0.001
|
Narcotics for pain relief | 20.4% |
0.703
| 21.3% | 25.5% |
0.016
| 21.6% | 25.6% | 20.5% | 25.3% |
0.109
|
Augmented labour | 24.3% |
0.137
| 28.2% | 27.5% |
0.697
| 26.5% | 27.7% | 32.8% | 27.1% |
0.071
|
Induced labour | 23.4% |
0.014
| 17.6% | 18.6% |
0.536
| 15.1% | 18.3% | 24.1% | 19.2% |
<0.001
|
Vaginal birthe
| 68.7% |
0.863
| 68.3% | 73.6% |
0.010
| 67.8% | 72.8% | 71.2% | 75.0% |
0.029
|
Instrumental vaginal birth | 7.8% |
0.272
| 6.2% | 5.2% |
0.312
| 6.2% | 5.0% | 6.2% | 5.5% |
0.775
|
Caesarean section (CS) | 24.0% |
0.661
| 25.1% | 21.2% |
0.027
| 26.1% | 22.2% | 22.6% | 19.5% |
0.048
|
Emergency CS as % of all CS | 52.5% |
0.002
| 70.5% | 67.0% |
0.396
| 73.5% | 62.9% | 61.3% | 75.0% |
0.027
|
Fetal distress recorded | 15.2% |
0.087
| 20.1% | 20.0% |
0.973
| 21.2% | 22.5% | 17.2% | 15.5% |
0.096
|
Episiotomy performed (vaginal births) | 7.2% |
0.695
| 7.5% | 5.6% |
0.113
| 6.7% | 5.7% | <5 | <5 |
<0.001
|
3rd/4th degree tear (vaginal births) | <5 |
0.351
| 1.4% | 1.1% |
0.714
| 1.5% | 0.9% | 1.1% | 1.5% |
0.522
|
Mother LOS ≥ 4 days: vaginal births | 33.8% |
0.013
| 45.0% | 23.0% |
<0.001
| 53.2% | 24.6% | 24.6% | 20.3% |
<0.001
|
Mother LOS ≥ 4 days: CS births | 80.0% |
0.052
| 88.9% | 83.5% |
0.154
| 92.1% | 85.5% | 79.3% | 79.7% |
<0.001
|
Neonatal: | ||||||||||
Stillbirth (Rate per 1,000 births) | <5 |
0.489
| 7.7/1,000 | <5 |
0.447
| 5.8/1,000 | <5 | 12.8/1,000 | <5 |
0.389
|
Apgar score < 7 at 5 minutes | 2.7% |
0.512
| 3.6% | 3.2% |
0.543
| 3.8% | 2.9% | 3.2% | 3.7% |
0.776
|
Newborn needed serious resuscitationf
| 10.8% |
0.771
| 11.3% | 10.0% |
0.316
| 11.8% | 8.6% | 10.0% | 12.5% |
0.144
|
Preterm birth (<37 weeks gestation) | 3.9% |
<0.001
| 12.2% | 9.1% |
0.020
| 12.7% | 9.8% | 10.7% | 7.9% |
0.054
|
Low birthweight (<2,500 g) | 4.2% |
<0.001
| 10.9% | 8.6% |
0.061
| 11.8% | 8.4% | 8.5% | 8.8% |
0.054
|
Admission to special care (SC) | 12.0% |
<0.001
| 21.7% | 20.0% |
0.300
| 21.9% | 19.0% | 21.3% | 21.7% |
0.567
|
Remote Indigenous community data
Maternal and neonatal characteristics | Community 1a(n = 105) | Community 2a(n = 99) | OtherTE Remote
a(n = 1,013) | Chi2or Fisher’s Test for trend |
---|---|---|---|---|
Maternal:
| ||||
Mean maternal age in years (±SD)[95% Confidence Interval] | 23.1 (±6.3) [21.9, 24.3] | 24.0 (±5.8) [22.8, 25.1] | 23.7 (±5.8) [23.2, 24.0] | |
Maternal age < 20 years | 33.3% | 27.3% | 28.2% |
0.521
|
Maternal age ≥ 35 years | 8.6% | 5.1% | 5.4% |
0.381
|
First pregnancy | 33.3% | 30.3% | 31.0% |
0.876
|
Fourth + pregnancy | 28.6% | 25.3% | 29.5% |
0.667
|
Less than four antenatal visits | 6.7% | 10.1% | 9.9% |
0.600
|
Mother reported smoking at first visit | 62.9% | 42.4% | 55.1% |
0.012
|
Mother reported smoking at 36 weeks | 58.1% | 40.4% | 53.0% |
0.027
|
Mother reported alcohol use at first visit | 4.8% | <5 | 9.8%* |
0.047
|
Mother reported alcohol use at 36 weeks | <5 | <5 | 6.8% |
0.05
|
Diabetes in pregnancyb
| 8.7% | 10.3% | 11.3% |
0.879
|
Out-of-hospital birthc
| 4.8% | 6.1% | 4.7% |
0.773
|
Epidural/spinal pain relief during labour | 4.8% | 6.1% | 5.5% |
0.936
|
Narcotics for pain relief during labour | 29.5% | 25.3% | 20.4% |
0.064
|
Augmented labour | 29.5% | 39.4% | 24.9% |
0.006
|
Induced labour | 13.3% | 10.1% | 15.8% |
0.278
|
Non-instrumental vaginal birthd
| 61.9% | 64.7% | 68.7% |
0.286
|
Instrumental vaginal birth | 11.4% | 7.1% | 5.5% |
0.064
|
Caesarean section (CS) | 26.7% | 28.3% | 25.8% |
0.852
|
Emergency CS as % of all CS | 85.7% | 85.7% | 70.9% |
0.074
|
Fetal distress recorded | 19.7% | 27.1% | 20.8% |
0.439
|
Episiotomy performed | 20.8% | 21.1% | 9.4% |
<0.001
|
Third/fourth degree tear | <5 | <5 | 1.9% |
0.322
|
Mother LOS ≥ 4 days: vaginal births | 50.7% | 39.4% | 55.2% |
0.240
|
Mother LOS ≥ 4 days: CS births | 100.0% | 89.3% | 91.6% |
0.227
|
Neonatal:
| ||||
Stillbirth (Rate per 1,000 births) | 0 | <5 | 4.9/1,000 |
0.152
|
Apgar score < 7 at 5 minutes | 6.7% | <5 | 3.7% |
0.216
|
Newborn needed serious resuscitatione
| 18.1% | 14.1% | 11.0% |
0.074
|
Preterm birth (<37 weeks gestation) | 16.2% | 15.2% | 12.1% |
0.374
|
Low birthweight (<2,500 g) | 17.4% | 14.1% | 11.1% |
0.140
|
Admission to special care (SC) | 36.2% | 28.3% | 19.7% |
<0.001
|
Outcomes
Statistical analysis
Outcomes | Groups | Total no. | Count and Per centa
| Odds Ratio [95% CI]a
| Adjusted odds ratio [95% CI]a
|
---|---|---|---|---|---|
Maternal: | |||||
Mothers who gave birth at 32+ weeks gestation who had ≥5 antenatal visitsb
| TE Remote
| 1,194 | 1,030 (86.3%) | 1.33 [0.95, 1.84] | 1.31 [0.87, 1.98] |
TE Urban
| 551 | 425 (77.1%) | 0.71 [0.50, 1.01] | 0.68 [0.44, 1.04] | |
CA Remote
| 462 | 325 (70.4%) | 0.50 [0.35, 0.71] | 0.55 [0.36, 0.86] | |
CA Urban
| 327 | 270 (82.6%) | 1.00 | 1.00 | |
Mothers who reported smoking in pregnancyc
| TE Remote
| 1,217 | 676 (55.6) | 1.33 [1.04, 1.58] | 1.47 [1.13, 1.90] |
TE Urban
| 559 | 296 (53.0%) | 1.20 [0.91, 1.57] | 1.36 [1.02, 1.80] | |
CA Remote
| 469 | 135 (28.8%) | 0.43 [0.32, 0.58] | 0.43 [0.31, 0.58] | |
CA Urban
| 328 | 159 (48.5%) | 1.00 | 1.00 | |
Mothers who had epidural/spinal or narcotic pain relief during labourd
| TE Remote
| 1,103 | 329 (29.8%) | 0.68 [0.52, 0.89] | 0.71 [0.53, 0.95] |
TE Urban
| 501 | 202 (40.3%) | 1.09 [0.81, 1.46] | 1.12 [0.82, 1.53] | |
CA Remote
| 421 | 134 (31.8%) | 0.75 [0.55, 1.02] | 0.68 [0.49, 0.95] | |
CA Urban
| 300 | 115 (38.3%) | 1.00 | 1.00 | |
Mothers who had a normal birthe
| TE Remote
| 1,217 | 605 (49.7%) | 0.78 [0.61, 1.00] | 0.47 [0.34, 0.66] |
TE Urban
| 559 | 301 (53.9%) | 0.92 [0.70, 1.22] | 0.67 [0.46, 0.96] | |
CA Remote
| 469 | 222 (47.3%) | 0.71 [0.54, 0.95] | 0.52 [0.35, 0.76] | |
CA Urban
| 328 | 183 (55.8%) | 1.00 | 1.00 | |
Neonatal: | |||||
Healthy babyf
| TE Remote
| 1,217 | 966 (79.4%) | 0.78 [0.60, 1.01] | 0.79 [0.58,1.10] |
TE Urban
| 559 | 465 (83.2%) | 0.89 [0.62, 1.26] | 1.00 [0.64, 1.57] | |
CA Remote
| 469 | 373 (79.5%) | 0.79 [0.57, 1.08] | 0.83 [0.56, 1.23] | |
CA Urban
| 328 | 267 (81.4%) | 1.00 | 1.00 | |
Newborns born preterm (< 37 weeks gestation)g
| TE Remote
| 1,217 | 155 (12.7%) | 1.69 [1.10, 2.62] | 2.09 [1.20,3.64] |
TE Urban
| 559 | 55 (9.8%) | 1.27 [0.78, 2.07] | 1.48 [0.81, 2.70] | |
CA Remote
| 469 | 50 (10.7%) | 1.39 [0.84, 2.28] | 1.40 [0.75, 2.61] | |
CA Urban
| 328 | 26 (7.9%) | 1.00 | 1.00 | |
Newborns with low birthweight (<2,500 g)h
| TE Remote
| 1,217 | 144 (11.8%) | 1.38 [0.91, 2.10] | 1.07 [0.56, 2.03] |
TE Urban
| 559 | 47 (8.4%) | 0.95 [0.58, 1.54] | 0.78 [0.38, 1.60] | |
CA Remote
| 469 | 40 (8.5%) | 0.96 [0.58, 1.59] | 0.82 [0.38, 1.75] | |
CA Urban
| 328 | 29 (8.8%) | 1.00 | 1.00 | |
Newborns admitted to special care (SC)i
| TE Remote
| 1,217 | 266 (21.9%) | 1.01 [0.75, 1.36] | 1.22 [0.75, 1.97] |
TE Urban
| 559 | 106 (19.0%) | 0.85 [0.61, 1.19] | 1.47 [0.87, 2.48] | |
CA Remote
| 469 | 100 (21.3%) | 0.98 [0.70, 1.38] | 1.11 [0.64, 1.9] | |
CA Urban
| 328 | 71 (21.7%) | 1.00 | 1.00 | |
Outcome
|
Groups
|
Total no.
|
..
|
Coefficient [95% CI]
|
Adjusted Coefficient[95% CI]
|
Newborns mean birthweight (in grams)j
| TE Remote
| 1,217 | .. | −179 [−254, −105] | −137 [−216, −59] |
TE Urban
| 559 | .. | −30 [−113, 54] | 15 [−71,101] | |
CA Remote
| 469 | .. | −76 [−162, 11] | −73 [−163, 17] | |
CA Urban
| 328 | Constant: | 3,282 [3,216, 3,349] | 3,494 [3,342, 3,646] |
Outcomes | Groups (n = 1,217) | Total no. | Proportiona
| Odds Ratio [95% CI]a
| Adjusted odds ratio [95% CI]a
|
---|---|---|---|---|---|
Maternal: | |||||
Mothers who gave birth at 32+ weeks gestation who had ≥5 antenatal visitsb
| Community 1 | 104 | 92 (88.5%) | 1.29 [0.69, 2.41] | 0.97 [0.49, 1.93] |
Community 2 | 94 | 85 (90.4%) | 1.58 [0.79, 3.22] | 1.98 [0.83, 4.71] | |
Reference group | 996 | 853 (85.6%) | 1.00 | 1.00 | |
Mothers who reported smoking in pregnancyc
| Community 1 | 105 | 66 (62.9%) | 1.33 [0.88, 2.01] | 1.42 [0.94, 2.16] |
Community 2 | 99 | 42 (42.4%) | 0.58 [0.38, 0.88] | 0.62 [0.41, 0.95] | |
Reference group | 1,013 | 568 (56.1%) | 1.00 | 1.00 | |
Mothers who had epidural/spinal or narcotic pain relief during labourd
| Community 1 | 99 | 36 (36.4%) | 1.42 [0.92, 2.19] | 1.47 [0.92, 2.35] |
Community 2 | 91 | 31 (34.1%) | 1.28 [0.81, 2.03] | 1.30 [0.80, 2.13] | |
Reference group | 913 | 263 (28.7%) | 1.00 | 1.00 | |
Mothers who had a normal birthe
| Community 1 | 105 | 47 (44.8%) | 0.80 [0.54, 1.20] | 0.58 [0.34, 0.99] |
Community 2 | 99 | 49 (49.5%) | 0.97 [0.64, 1.47] | 1.00 [0.59, 1.70] | |
Reference group | 1,013 | 509 (50.2%) | 1.00 | 1.00 | |
Neonatal: | |||||
Healthy babyf
| Community 1 | 105 | 78 (74.3%) | 0.74 [0.46, 1.17] | 0.63 [0.35, 1.11] |
Community 2 | 99 | 81 (81.8%) | 1.14 [0.67, 1.96] | 1.78 [0.83, 3.88] | |
Reference group | 1,013 | 807 (79.7%) | 1.00 | 1.00 | |
Newborns born preterm (< 37 weeks gestation)g
| Community 1 | 105 | 17 (16.2%) | 1.40 [0.81, 2.43] | 1.63 [0.82, 3.26] |
Community 2 | 99 | 15 (15.5%) | 1.29 [0.72, 2.31] | 0.93 [0.42, 2.08] | |
Reference group | 1,013 | 113 (12.1%) | 1.00 | 1.00 | |
Newborns with low birthweight (<2,500 g)h
| Community 1 | 105 | 18 (17.1%) | 1.66 [0.97, 2.87] | 1.71 [0.69, 4.23] |
Community 2 | 99 | 14 (14.1%) | 1.33 [0.73, 2.41] | 0.84 [0.28, 2.51] | |
Reference group‡
| 1,013 | 112 (11.1%) | 1.00 | 1.00 | |
Newborns admitted to special care (SC)i
| Community 1 | 105 | 38 (36.2%) | 2.31 [1.50, 3.53] | 1.62 [0.78, 3.37] |
Community 2 | 99 | 28 (28.3%) | 1.60 [1.01, 2.55] | 0.68 [0.28, 1.64] | |
Reference group‡
| 1,013 | 200 (19.7%) | 1.00 | 1.00 | |
Outcome
|
Groups
|
Total no.
|
..
|
Coefficient [95% CI]
|
Adjusted Coefficient[95% CI]
|
Birthweight (in grams)j
| Community 1 | 105 | .. | −134 [−259, −8] | −71 [−197, 54] |
Community 2 | 99 | .. | −52 [−181, 77] | −17 [−143, 110] | |
Reference group | 1,013 | .. | 3,119 [3,080, 3,157] | 3,457 [3,270, 3,643] |