Safety, equity and monitoring: a review of the gaps in maternal vaccination strategies for Aboriginal and Torres Strait Islander women.

Influenza and pertussis infections are disproportionately higher among Aboriginal and Torres Strait Islander women and their infants compared to other Australians. These infections are potentially preventable through vaccination in pregnancy; however, there is a lack of systematic monitoring and therefore knowledge of vaccine uptake, safety and effectiveness in Australia, and specifically among Aboriginal and Torres Strait Islander women. The limited data available suggest there is a lower uptake of maternal vaccination among Aboriginal and Torres Strait Islander women compared to non-Aboriginal and Torres Strait Islander women, and this review seeks to explore potential reasons and the knowledge gaps in this regard. Other key gaps include the equitable access to quality antenatal care for Aboriginal and Torres Strait Islander women; and pregnancy loss <20 weeks gestation. Furthermore, our review highlights the importance of addressing these gaps in maternal vaccination strategies in partnership with Aboriginal and Torres Strait Islander peoples.

Uptake of influenza vaccination in pregnancy amongst Australian Aboriginal and Torres Strait Islander women: a mixed-methods pilot study.

BACKGROUND: Influenza infection during pregnancy causes significant morbidity and mortality. Immunisation against influenza is recommended during pregnancy in several countries however, there are limited data on vaccine uptake, and the determinants of vaccination, in pregnant Australian Aboriginal and/or Torres Islander women. This study aimed to collect pilot data on vaccine uptake and attitudes towards, and perceptions of, maternal influenza vaccination in this population in order to inform the development of larger studies. METHODS: A mixed-methods study comprised of a cross-sectional survey and yarning circles (focus groups) amongst Aboriginal and Torres Strait Islander women attending two primary health care services. The women were between 28 weeks gestation and less than 16 weeks post-birth. These data were supplemented by data collected in an ongoing national Australian study of maternal influenza vaccination. Aboriginal research officers collected community data and data from the yarning circles which were based on a narrative enquiry framework. Descriptive statistics were used to analyse quantitative data and thematic analyses were applied to qualitative data. RESULTS: Quantitative data were available for 53 women and seven of these women participated in the yarning circles. The proportion of women who reported receipt of an influenza vaccine during their pregnancy was 9/53. Less than half of the participants (21/53) reported they had been offered the vaccine in pregnancy. Forty-three percent reported they would get a vaccine if they became pregnant again. Qualitative data suggested perceived benefits to themselves and their infants were important factors in the decision to be vaccinated but there was insufficient information available to women to make that choice. CONCLUSIONS: The rates of influenza immunisation may continue to remain low for Aboriginal and/or Torres Strait Islander women during pregnancy. Access to services and recommendations by a health care worker may be factors in the lower rates. Our findings support the need for larger studies directed at monitoring and understanding the determinants of maternal influenza vaccine uptake during pregnancy in Australian Aboriginal and Torres Strait Islander women. This research will best be achieved using methods that account for the social and cultural contexts of Aboriginal and Torres Strait Islander communities in Australia.

Effect of 6-minute colonoscopy withdrawal time policy on polyp detection rate in a community hospital.

In 2002, a U.S. Multi-Society Task Force on colorectal cancer recommended a 6-minute or more withdrawal time as an indicator of a quality colonoscopy. In 2006, found a correlation between longer withdrawal time and an increased rate in the detection of adenomas. In January 2008, the endoscopy department at our institution adopted the Multi-Society Task Force recommendation. The aim of our study was to evaluate the effect of a minimal 6-minute withdrawal time policy at our institution on polyp detection rate. All colonoscopies performed for screening indications from April 2007 to September 2008 were reviewed retrospectively. Group I (pre-policy) was compared with Group II (post-policy). Data collected included age, gender, indication, polyp detection rate, size, and withdrawal time. Unpaired t tests evaluated pre- and postprocedure results. Fisher's exact tests were used to compare detection rates between withdrawal time less than 6 minutes and more than 6 minutes. Mann-Whitney U Tests were performed to analyze the significance between the number of polyps detected for withdrawal time less than 6 minutes versus more than 6 minutes. A total of 1,342 colonoscopies were available for analysis in Group I and 1,316 in Group II. Polyp detection rate was 46.6% in Group I versus 48.2% in Group II (p = .39), a non-statistically significant difference; however, there was a trend toward identifying small- and medium-sized polyps in Group II. Small polyps can carry a risk of severe dysplasia (). Data were then analyzed for withdrawal time. The polyp detection rate was 20.9 in procedures that took less than 6 minutes versus 48.3 in those that took more than 6 minutes (p ≤ .01). In this study, a 6-minute or more withdrawal time increased the polyp detection rate by 133% for all polyp sizes, especially small and medium. Small polyps (5 mm or less) should be removed and not ignored. A 6-minute or more withdrawal time should be mandatory in those patients without a previous colon resection.