Birth Outcomes and Infant Mortality by the Degree of Rural Isolation Among First Nations and Non-First Nations in Manitoba, Canada

Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada.
The Journal of Rural Health (Impact Factor: 1.45). 03/2010; 26(2):175-81. DOI: 10.1111/j.1748-0361.2010.00279.x
Source: PubMed

ABSTRACT It is unknown whether rural isolation may affect birth outcomes and infant mortality differentially for Indigenous versus non-Indigenous populations. We assessed birth outcomes and infant mortality by the degree of rural isolation among First Nations (North American Indians) and non-First Nations populations in Manitoba, Canada, a setting with universal health insurance.
A geocoding-based birth cohort study of 25,143 First Nations and 125,729 non-First Nations live births to Manitoban residents, 1991-2000. Degree of rural isolation was defined by an indicator of urban influence (no, weak, moderate/strong) based on the percentage of the workforce commuting to urban areas.
Preterm birth and low birth weight rates were somewhat lower in all rural areas regardless of the degree of isolation as compared to urban areas for both First Nations and non-First Nations. Infant mortality rates were not significantly different across areas for First Nations (10.7, 9.9, 7.9, and 9.7 per 1,000 in rural areas with no, weak, moderate/strong urban influence, and urban areas, respectively), but rates were significantly lower in less isolated areas for non-First Nations (7.4, 6.0, 5.6, and 4.6 per 1,000, respectively). Adjusted odds ratios showed similar patterns.
Living in less isolated areas was associated with lower infant mortality only among non-First Nations. First Nations infants do not seem to have similarly benefited from the better health care facilities in urban centers, suggesting a need to improve urban First Nations' infant care in meeting the challenges of increasing urban migration.

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Available from: Patricia Martens, Sep 29, 2015
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    • "Two recent studies of birth outcomes and infant mortality in rural and remote populations in the Canadian provinces of Manitoba (Luo et al., 2010) and British Columbia (Luo et al., 2004) found that, in these provinces, the risk of infant mortality in First Nations populations is almost twice that of non-First Nations populations. In a study of community remoteness, perinatal outcomes, and infant mortality in First Nations communities in the province of Quebec, Wassimi et al. (2010) found similar results: "
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    ABSTRACT: This article reports those findings related to maternal-infant health outcomes of an ethnographic study that explored nursing practice, continuity of care, and health outcomes in one remote First Nations community in northern Canada. Use of multiple data sources within an ethnographic design ensured that quantitative health outcomes data were interpreted within a contextualized understanding of the remote First Nations community.The sample comprised the charts of 65 mothers and 63 infants randomly selected for retrospective chart review. The findings suggest suboptimal maternal-infant health outcomes on several of the health indicator criteria identified for the purposes of this study. The authors discuss long-term sequelae of prenatal and infant health in terms of diabetes and other chronic health conditions in First Nations populations.They explore the implications of these findings in relation to nurses' preparation to offer prenatal and infant primary care in remote First Nations communities.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 06/2013; 45(2):76-100.
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    • "Ages and educational attainments of US American Indian mothers vary by region (Alexander et al., 2008). American Indian births in rural, isolated areas of Canada were less likely to be preterm or LBW compared to urban American Indian births (Luo et al., 2010). American Indian births in counties with a reservation demonstrated lower rates of VLBW (very low birth weight, a birth weight less than 1500g) compared to American Indian births in counties without a reservation suggesting that reporting bias by locale plays a role in the rates (Heck et al., 1999), or that risk factors for poor outcomes are more severe in non-reservation counties. "
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    American Journal of Human Biology 05/2012; 24(3):302-13. DOI:10.1002/ajhb.22257 · 1.70 Impact Factor
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    03/2012; 71:17520. DOI:10.3402/IJCH.v71i0.17520
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