Tables
Table 1: Classification of remoteness for mother’s usual place of residence
DHF Health District
Area[19]
Darwin Urbana
Darwin Rural
3,122 km2
Katherine
East Arnhem
Alice Springs
Alice Springs
Urban
Rural
Barkly
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%)
4
16
22
13
8
2
32
Royal Darwin
Women go to
Katherine
Gove District
Tennant Creek
Alice Springs
Women go to
Hospital (RDH)
RDH for birth
District Hospital
Hospital (GDH)
Hospital (TCH)
Hospital (ASH)
ASH for birth
Health service
outlets[19]
Birthing facilities
available
[21]
Darwin Private
(KDH)
Hospital (DPH)
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%)
-1-
Region
Remote/Urban
TE
TE
TE
TE
CA
CA
CA
Urban
Remote
Katherine town –
Nhulunbuy town
Tennant Creek
Urban
Remote
Urban
– Urban
town - Urban
Remainder of
Remainder of
Remainder of
cases - Remote
cases - Remote
cases -Remote
status used in this
study[21]
Comments
a
RDH serves as a referral centre for
Maternity
Some ASH cases are referred to
the TE, Western Australia and South-
services were
Adelaide, South Australia (1,500km
East Asia.
discontinued
to the south of Alice Springs, Darwin
during 2005 with
is 1,500km north of the town.)
DPH started operations in 1987.
subsequent
Quality of reporting births to the
births occurring
NTMC stabilised after 1989.
at ASH.
Includes the capital city, Darwin
-2-
Table 2: Maternal and newborn characteristics and outcomes, by Indigenous status, remoteness, and region; NT 2003-2005
NT-resident women (N=7,560)
Indigenous (N=2,573)
Non-Indigenous
Indigenous
Top End
Central Australia
Chi2 or
(n=4,987)a
(n=2,573)
(n=1,776)
(n=797)
Fisher’s
Maternal and neonatal
characteristics
RemoteA
P-value
RemoteB
UrbanC
P-value
Remoteb
Urban
Remote
Urban
Test for
(n=334)
A vs B
(n=1,686)
(n=887)
B vs C
(n=1,217)
(n=559)
(n=469)
(n=328)
trend
23 (5.8)
24.9 (5.9)
Maternal:
Mean maternal age in years (±SD)
28.4 (5.7)
<0.001
[95% Confidence Interval]
[27.8, 29.1]
23.7 (±5.9) 24.8 (±5.8) 22.7 (±5.8) 25.0 (±6.1)
<0.001
[23.1, 23.7] [24.5, 25.3]
..
[23.3, 24.0] [24.4, 25.3] [22.1, 23.3] [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
-3-
NT-resident women (N=7,560)
Indigenous (N=2,573)
Non-Indigenous
Indigenous
Top End
Central Australia
Chi2 or
(n=4,987)a
(n=2,573)
(n=1,776)
(n=797)
Fisher’s
Maternal and neonatal
characteristics
RemoteA
P-value
RemoteB
UrbanC
P-value
Remoteb
Urban
Remote
Urban
Test for
(n=334)
A vs B
(n=1,686)
(n=887)
B vs C
(n=1,217)
(n=559)
(n=469)
(n=328)
trend
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
<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
Out-of-hospital birthd
-4-
NT-resident women (N=7,560)
Indigenous (N=2,573)
Non-Indigenous
Indigenous
Top End
Central Australia
Chi2 or
(n=4,987)a
(n=2,573)
(n=1,776)
(n=797)
Fisher’s
Maternal and neonatal
characteristics
RemoteA
P-value
RemoteB
UrbanC
P-value
Remoteb
Urban
Remote
Urban
Test for
(n=334)
A vs B
(n=1,686)
(n=887)
B vs C
(n=1,217)
(n=559)
(n=469)
(n=328)
trend
7.2%
0.695
7.5%
5.6%
0.113
6.7%
5.7%
<5
<5
<0.001
<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
<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 (<2,500g)
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
Episiotomy performed (vaginal births)
3rd/4th degree tear (vaginal births)
Neonatal:
Stillbirth (Rate per 1,000 births)
< 5: Less than 5 counts – data not shown
-5-
a
This group includes 4,653 urban-dwelling non-Indigenous mothers for whom relevant data is not shown in Table 2.
a
This group includes Communities 1 and 2 and is subdivided in Tables 4 and 5.
b
Refers to any mention of diabetes in pregnancy, i.e., mother had either pre-existing diabetes or gestational diabetes recorded. We combined the variables pre-existing diabetes and gestational diabetes to
describe ‘diabetes in pregnancy’, because of the small numbers of pre-existing diabetes cases (n=53).
c
Refers to planned home-births, births at community health centres, ‘born-before-arrival’ births, births in hostels, etc.
d
Includes 98 vaginal breech cases. Most were preterm births and three were out-of-hospital births.
e
Refers to resuscitation with mask and bag, external cardiac massage or intubation.
-6-
Table 3: Outcomes for different groups of Indigenous mothers and newborns, NT 2003-2005
Outcomes
Groups
Total no.
Count and Per centa
Odds Ratio [95% CI]a
Adjusted odds ratio [95% CI]a
1,194
1,030 (86.3%)
1.33 [0.95, 1.84]
1.31 [0.87, 1.98]
Maternal:
Mothers who gave birth at
TE Remote
32+ weeks gestation who
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
1,217
676 (55.6)
1.33 [1.04, 1.58]
1.47 [1.13, 1.90]
had ≥5 antenatal visitsb
Mothers who reported
TE Remote
smoking in pregnancyc
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
1,103
329 (29.8%)
0.68 [0.52, 0.89]
0.71 [0.53, 0.95]
Mothers who had
TE Remote
epidural/spinal or
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
1,217
605 (49.7%)
0.78 [0.61, 1.00]
0.47 [0.34, 0.66]
narcotic pain relief during
labourd
Mothers who had a
TE Remote
normal birthe
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]
-7-
Outcomes
Total no.
Count and Per centa
Odds Ratio [95% CI]a
Adjusted odds ratio [95% CI]a
328
183 (55.8%)
1.00
1.00
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
1,217
155 (12.7%)
1.69 [1.10, 2.62]
2.09 [1.20,3.64]
Groups
CA Urban
Neonatal:
Healthy babyf
TE Remote
Newborns born preterm
TE Remote
(< 37 weeks gestation)g
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
1,217
144 (11.8%)
1.38 [0.91, 2.10]
1.07 [0.56, 2.03]
Newborns with low
TE Remote
birthweight (<2,500g)h
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
1,217
266 (21.9%)
1.01 [0.75, 1.36]
1.22 [0.75, 1.97]
Newborns admitted to
TE Remote
special care (SC)i
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]
-8-
Outcomes
Groups
Total no.
Count and Per centa
Odds Ratio [95% CI]a
Adjusted odds ratio [95% CI]a
328
71 (21.7%)
1.00
1.00
Total no.
..
Coefficient [95% CI]
CA Urban
Adjusted Coefficient
Outcome
Groups
[95% CI]
Newborns mean
TE Remote
birthweightj
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]
a
Unless otherwise stated.
b
Smoking in pregnancy refers to any reported smoking during pregnancy and combined ‘smoking at first antenatal visit’ and ‘reported smoking at 36 weeks’. Model adjusted for: age of mother (continuous
variable), four or more pregnancies (Yes/No), and reported alcohol use in pregnancy (Yes/No).
c
Antenatal visit model limited to mothers who had a pregnancy duration of 32 weeks or more and model adjusted for: age of mother, first pregnancy (Yes/No), four or more pregnancies, and diabetes in
pregnancy (Yes/No).
d
Pain relief model limited to mothers who experienced labour and model adjusted for: age of mother, first pregnancy, four or more pregnancies, and out-of-hospital birth (Yes/No).
e
Normal birth model adjusted for: age of mother, first pregnancy, four or more pregnancies, smoking, alcohol, diabetes in pregnancy, inadequate number of antenatal visits (Yes/No), out-of-hospital birth,
epidural/spinal pain relief (Yes/No) and augmented labour (Yes/No).
f
Healthy baby model adjusted for: age of mother, first pregnancy, four or more pregnancies, smoking, alcohol, diabetes, out-of-hospital birth, and non-instrumental vaginal birth.
g
Preterm birth model adjusted for: age of mother, first pregnancy, four or more pregnancies, smoking and alcohol use during pregnancy , diabetes in pregnancy.
h
Low birthweight (LBW) model adjusted for same variables as preterm birth model, as well as preterm birth (Yes/No).
i
SC Admission model adjusted for same variables as LBW model, as well as LBW (Yes/No), Apgar score at 5 minutes of less than 7 (Yes/No), serious resuscitation (Yes/No) and non-instrumental vaginal
birth (Yes/No).
-9-
j
Birthweight (as a continuous variable) model adjusted for age same variables as LBW model.
- 10 -
Table 4: Comparing Indigenous mothers and newborns from two remote TE communities with other TE Remote Indigenous mothers and
newborns, 2003-2005
Community 1a
Community 2a
Other TE Remotea
Chi2 or Fisher’s Test
(n=105)
(n=99)
(n=1,013)
for trend
Mean maternal age in years (±SD)
23.1 (±6.3)
24.0 (±5.8)
23.7 (±5.8)
[95% Confidence Interval]
[21.9, 24.3]
[22.8, 25.1]
[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
<5
<5
6.8%
0.05
8.7%
10.3%
11.3%
0.879
Maternal and neonatal characteristics
Maternal:
Mother reported alcohol use at 36 weeks
Diabetes in pregnancyb
- 11 -
Community 1a
Community 2a
Other TE Remotea
Chi2 or Fisher’s Test
(n=105)
(n=99)
(n=1,013)
for trend
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
<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
Maternal and neonatal characteristics
Third/fourth degree tear
- 12 -
Community 1a
Community 2a
Other TE Remotea
Chi2 or Fisher’s Test
(n=105)
(n=99)
(n=1,013)
for trend
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 (<2,500g)
17.4%
14.1%
11.1%
0.140
Admission to special care (SC)
36.2%
28.3%
19.7%
<0.001
Maternal and neonatal characteristics
Neonatal:
Stillbirth (Rate per 1,000 births)
< 5: Less than 5 counts – data not shown.
a
Unless otherwise stated.
b
Refers to any mention of diabetes in pregnancy, i.e., mother had either pre-existing diabetes or gestational diabetes recorded.
c
Refers to planned home-births, births at community health centres, ‘born-before-arrival’ births, births in hostels, etc.
d
Includes vaginal breech cases.
e
Refers to resuscitation with mask and bag, external cardiac massage or intubation.
- 13 -
Table 5: Outcomes for Indigenous mothers and newborns from two TE communities and with other TE Indigenous mothers and newborns,
2003-2005
Outcomes
Groups (n=1,217)
Total no.
Proportiona
Odds Ratio [95% CI]a
Adjusted odds ratio [95% CI]a
Maternal:
Mothers who gave
Community 1
104
92 (88.5%)
1.29 [0.69, 2.41]
0.97 [0.49, 1.93]
birth at 32+ weeks
Community 2
94
85 (90.4%)
1.58 [0.79, 3.22]
1.98 [0.83, 4.71]
996
853 (85.6%)
1.00
1.00
gestation who had
≥5 antenatal
Reference group
visitsb
Mothers who
Community 1
105
66 (62.9%)
1.33 [0.88, 2.01]
1.42 [0.94, 2.16]
reported smoking
Community 2
99
42 (42.4%)
0.58 [0.38, 0.88]
0.62 [0.41, 0.95]
1,013
568 (56.1%)
1.00
1.00
in
pregnancyc
Reference group
Mothers who had
Community 1
99
36 (36.4%)
1.42 [0.92, 2.19]
1.47 [0.92, 2.35]
epidural/spinal or
Community 2
91
31 (34.1%)
1.28 [0.81, 2.03]
1.30 [0.80, 2.13]
913
263 (28.7%)
1.00
1.00
narcotic pain relief
during
Reference group
labourd
Mothers who had a
Community 1
105
47 (44.8%)
0.80 [0.54, 1.20]
0.58 [0.34, 0.99]
normal birthe
Community 2
99
49 (49.5%)
0.97 [0.64, 1.47]
1.00 [0.59, 1.70]
1,013
509 (50.2%)
1.00
1.00
Reference group
Neonatal:
- 14 -
Outcomes
Healthy babyf
Total no.
Proportiona
Odds Ratio [95% CI]a
Adjusted odds ratio [95% CI]a
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]
1,013
807 (79.7%)
1.00
1.00
Groups (n=1,217)
Reference group
Newborns born
Community 1
105
17 (16.2%)
1.40 [0.81, 2.43]
1.63 [0.82, 3.26]
preterm (< 37
Community 2
99
15 (15.5%)
1.29 [0.72, 2.31]
0.93 [0.42, 2.08]
1,013
113 (12.1%)
1.00
1.00
weeks gestation)g
Reference group
Newborns with low
Community 1
105
18 (17.1%)
1.66 [0.97, 2.87]
1.71 [0.69, 4.23]
birthweight
Community 2
99
14 (14.1%)
1.33 [0.73, 2.41]
0.84 [0.28, 2.51]
1,013
112 (11.1%)
1.00
1.00
(<2,500g)h
Reference group‡
Newborns admitted
Community 1
105
38 (36.2%)
2.31 [1.50, 3.53]
1.62 [0.78, 3.37]
to special care
Community 2
99
28 (28.3%)
1.60 [1.01, 2.55]
0.68 [0.28, 1.64]
1,013
200 (19.7%)
1.00
1.00
Total no.
..
Coefficient [95% CI]
(SC)i
Reference group‡
Adjusted Coefficient
Outcome
Groups
[95% CI]
Birthweight
Community 1
105
..
-134 [-259, -8]
-71 [-197, 54]
(in grams)j
Community 2
99
..
-52 [-181, 77]
-17 [-143, 110]
1,013
..
3,119 [3,080, 3,157]
3,457 [3,270, 3,643]
Reference group
- 15 -
a
Unless otherwise stated.
b-h, j
i
Models adjusted for the same variables as in Table 3.
SC Admission model adjusted for same variables as in Table 3, as well as the dichotomous variable as to whether the birth occurred in Royal Darwin Hospital or not.
- 16 -