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Prevalence and Risk Factors of Adverse Birth Outcomes in the Pacific Island Region: a Scoping Review Protocol

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Prevalence and Risk Factors of Adverse Birth Outcomes in the Pacific Island Region: a Scoping Review Protocol Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2020-042423 on 8 April 2021. Downloaded from Prevalence and risk factors of adverse birth outcomes in the Pacific Island region: a scoping review protocol Lydia Sandrah Kuman Kaforau ,1,2 Gizachew Assefa Tessema,2,3 Jonine Jancey ,2 Gursimran Kaur Dhamrait ,4,5 Hugo Bugoro,1 G F Pereira2,6 To cite: Kaforau LSK, ABSTRACT Strengths and limitations of this study Tessema GA, Jancey J, et al. Introduction Fetal growth restriction, preterm birth, low Prevalence and risk factors of birth weight and stillbirth are adverse birth outcomes that adverse birth outcomes in the ► The review will provide information to help identify are prevalent in low- income and middle- income settings Pacific Island region: a scoping knowledge gaps and focal points for further investi- such as the Pacific Island region. It is widely accepted review protocol. BMJ Open gation to progress towards evidenced-based mater- that the excess burden of adverse birth outcomes is 2021;11:e042423. doi:10.1136/ nal healthcare in the region. attributable to socioeconomic and environmental factors bmjopen-2020-042423 ► A strength of this study will be consultation with that predispose families to excess risk. Our review seeks stakeholders (health professionals working in ma- ► Prepublication history for to determine the prevalence of adverse birth outcomes in ternal and child health services) as they will provide this paper is available online. the Pacific Island region and to identify the risk factors of To view these files, please visit insights into adverse birth outcomes at a community adverse birth outcomes in the Pacific Island region. the journal online (http:// dx. doi. level. Methods This scoping review will follow the five- staged org/ 10. 1136/ bmjopen- 2020- ► We may not be able to access studies published in Arksey and O’Malley’s framework and consultation with 042423). languages other than English. Solomon Islands’ health stakeholders. A preliminary Received 04 July 2020 literature review was undertaken to understand the scope Revised 16 March 2021 of the review. We will use Medical Subject Heading and Accepted 22 March 2021 keyword terms for adverse birth outcomes to search INTRODUCTION CINAHL, Medline, Scopus, ProQuest and Springer Despite improvements in medical care and Link databases for articles published from 1 January technology, the incidence of adverse birth 2000. The subsequent searches will be undertaken outcomes remains a significant public health http://bmjopen.bmj.com/ via Google Scholar and the internet browser to world issue, particularly in low- income and middle- health organisation and regional health organisations income countries (LMICs).1 2 Adverse birth for published and unpublished reports on non-indexed studies. All articles retrieved will be managed with outcomes include indicators for early gesta- EndNote software. Eligible studies will be screened tion (preterm birth), fetal growth restriction using Preferred Reporting Items for Systematic Reviews and perinatal mortality. Preterm birth is the and Meta- Analyses flow chart for final selection. In most well- accepted benchmark for morbidity the charting phase, we will extract the data into Excel attributable to early gestation and is defined spreadsheets. The results will be presented as numerical as birth before 37 weeks of completed gesta- on September 27, 2021 by guest. Protected copyright. and thematic summaries that map risk factors and tion.2 In LMICs, fetal growth restriction is prevalence to the population and cultures of the Pacific indicated by its proxies ascertained at birth.3 Island region. These proxies include term low birth weight Ethics and dissemination Formal ethical approval is (LBW), defined as birth weight <2500 g from not required as primary or administrative data will not 37 weeks of completed gestation, and small be collected. However, we will seek ethics approval for the stakeholder consultation from the Research Office of for gestational age (SGA), defined as weight Curtin University and the Solomon Islands. The findings in the lowest 10th centile for gestational age © Author(s) (or their of this study will be published in peer- reviewed journals and sex or as a multiple of SD from the sex- employer(s)) 2021. Re- use and presented in national and regional conferences and specific population mean weight. LBW is also permitted under CC BY-NC. No historically used as a proxy for preterm birth commercial re- use. See rights disseminated to stakeholders. and permissions. Published by Ethics approval There will be no direct contact with given the lack of information on gestational BMJ. human or patients in the case of the scoping review; length.4 5 Fetal growth restriction is associ- 1 2 For numbered affiliations see therefore, no ethics will be required. However, we will seek ated with infant mortality and morbidity. end of article. ethical approval from the Research Ethics Office of Curtin Stillbirth is the most commonly investigated University and the Health Research and Ethics Committee mortality- related outcome and is defined Correspondence to in the Solomon Islands for stakeholder consultation. as birth without signs of life from 28 weeks Lydia Sandrah Kuman Kaforau; Dissemination will be made through regional conferences of completed gestation in LMIC.1 Both l. kaforau@ postgrad. curtin. and publication in peer- reviewed journals. edu. au preterm birth and fetal growth restriction can Kaforau LSK, et al. BMJ Open 2021;11:e042423. doi:10.1136/bmjopen-2020-042423 1 Open access BMJ Open: first published as 10.1136/bmjopen-2020-042423 on 8 April 2021. Downloaded from significantly impact longer term physiological compli- Knowledge of the burden of adverse birth outcomes and cations and well- being of children6 7 and are major risk key risk factors will provide policy makers and health- factors for stillbirth. care practitioners working in the region with evidence The aetiologies of adverse birth outcomes are multifac- that can be used to inform strategies to achieve reduc- torial and not entirely well understood.1 Evidence from tions in adverse birth outcomes and improve overall peri- studies conducted elsewhere show that socioeconomic, natal health. These research findings will help to design health, obstetric and biological factors are linked with targeted interventions and better allocate resources adverse birth outcomes in high-income countries as well to where they are needed. Additionally, findings of the as LMICs.2 6 8–10 Moreover, evidence has also shown that review will inform future aetiological research on the environmental (non- genetic) risk factors are relatively effect of risk factors of adverse birth outcomes in the more prevalent in LMICs resulting in higher infant region. mortality and morbidity in these countries.6 7 More than 96% of the 32 million LBW infants born globally each year occur in LMICs.8 Although adverse birth outcomes METHODS are reasonably well documented in some LMICs, such as This scoping review will follow the Joanna Briggs Insti- 11 India, studies in the Pacific Island region remain sparse. tute Reviewers Manual24 derived from Arksey and The Pacific Island region broadly refers to a group of O’Malley’s five- staged methodological Framework25 and 12 countries and territories that border the Pacific Ocean. further developed by Levac et al.26 Briefly, this includes The region, defined here as the LMICs and territories explicit specification of research questions, reproduc- within the Melanesian, Polynesian and Micronesian ible methods to identify relevant studies, transparent subregions, are culturally and ethnically diverse, with declarations of inclusion and exclusion criteria, docu- varying degrees of economic development and living mented collation of data and standardised summarisa- 12 standards. The indigenous populations of the region tion and reporting of results. The scoping review will not are typically over- represented in national and global involve patients and the public as data will be sourced scales for disease burden for both communicable and from primary studies. However, we will also include an 12 non- communicable diseases. Health indicators also vary optional stage six of stakeholder consultation for addi- considerably across this region; for example, the infant tional insights. The stakeholder consultation exercise will mortality rate in Papua New Guinea is 50 per 1000 births only be involving doctors, midwives and nurses who work 13 compared with 20 per 1000 births in Fiji. Similarly, LBW directly with pregnant women. Ethics and consent will be and SGA also vary within and between countries of the sought from respective authorities and clinicians. Our region with reported prevalence inconsistent and under- reporting will also be compliant with Preferred Reporting 14 reported. A review in 2013 estimated a period preva- Items for Systematic Reviews and Meta- Analyses exten- http://bmjopen.bmj.com/ lence of 8% for preterm birth, 10% for LBW and 19% for sion for scoping reviews checklist.24 A preliminary liter- 15 SGA in the broader region of Oceania, but these preva- ature review was undertaken to understand the extent lence are not well established for the Pacific Island region of literature on exposures of risk factors of adverse birth specifically. Moreover, although it is estimated that 98% outcomes in the Pacific Island region to determine an 16 of stillbirths occur in LMICs, there are no high- quality appropriate search timeframe. Thus, the scoping review estimates for stillbirth prevalence in the Pacific Island will be conducted between December 2020 and February region. In the last two decades, there has been a substan- 2021. tial decline in infant and child mortality by approximately on September 27, 2021 by guest. Protected copyright. 50% in more than half of the Pacific Island countries and Stage 1: specification of the research question territories.14 However, the extent of such improvements We will first identify the research question. A prelimi- remains uncertain due to poor data quality and coverage nary literature review was undertaken to understand the and impacting cultural factors.
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