Disparities in Health Care Research Study, Article Critique Example

Introduction

Alaska Native population comprises of the largest racial minority community group in Alaska. It forms 24% of the entire population in the state. Surprisingly, it happens that the Alaska Natives community has the worst health as compared to the non-Native residents in Alaska. The great disparity is not a surprise in America amongst the American Indian persons. However, in Alaska, it marks a subject of discussion. In between 1992 and 2001, reports show that the Alaska Native infant mortality rate was 1.9 times higher than that of the non-Native.  The Alaska Infant Mortality Review committee studied this and discovered that the Alaska Natives were prone to infant mortality rates compared to the non- Natives.  There was even a greater difference in post neonatal than neonatal mortality.  Initially, there were doubts in these results; however, they tallied with the national data, thus doubts sidelined, and investigations started.

Objectives of the research

The study sought to investigate and identify variables that account for this elevated risk.  In spite of the knowledge behind the causes of the disparity, the specific reason bringing in the infant mortality gap not yet elucidated. Previous studies that investigated the variables causing health disparities came up with obvious results; socioeconomic factors, genetic factors, and the behavioral factors. The results are not truly convincing, thus called for further studies. This study further sought to determine whether differences as identifiable in the birth certificate could give some explanation behind the subject of interest- the long outstanding discrepancy in post-neonatal mortality rates occurring between the Alaska Natives and non-Natives in Alaska.

Explain the Methodology

To obtain the relevant data, there was the use of a dataset that contained birth and death certificate records for Alaska-residents. The live births and infant deaths were for the period between 1992–2004. Record showed that during that period, approximately 10,300 births occurred, with an average of 72 infant deaths annually.

Hypothesis for the study:  The increased risk of post neonatal death among Alaska Native infants was because of higher prevalence of risk factors as race and mortality.

Since the major risk reported as race, it marked a test variable in the hypothesis.  All non-Native races combined into one category comprising of the Whites (87%), the Blacks (6%), the Asians (7%), and other races (1%). There was a measure of association between the race and post-neonatal mortality using regression, univariate, and stratified analyses. However, attempts to explain the racial differences bore no fruits, since, for a sample consisting of 0.8% of births and 0.6% of post neonatal deaths, there was no repot of maternal race.  It was felt that race would not offer viable results, thus scrubbed off for ant further analysis. The hypothesis rejected.

The other variables of interest included the age, sex, parity, education level, prenatal care, tobacco cigarette smoking, reports of alcohol consumption, or the place of residence. In considering the place of residence, three sub-variables formed; whether one resided in the primary urban center in Alaska, or from any other region of Alaska. Those from the urban centre region comprised of 54% of the population of the states.

A second composite variable created on the marital status and presence of father’s name on birth certificate, thus had three sub-variables: married, not married and father’s name missing, and not married with fathers name present.

Assumptions made to consider study variables as confounding once they gave a change of approximately 10% in odds ratio between the variable itself, and the mortality rate. This assumption occurred any time a variable added to a bivariate model, or whenever removed from a multivariate model.

Describe the population

The population of study was comprised of Alaska Native and Non-Alaska races. The Non Alaska divided into Whites (87%), the Blacks (6%), Asians (7%), and other races (1%). There was further division of the population in terms of sex, age, education level, place of residence and those with reported cases of tobacco, cigarette smoking, or alcohol consumption among other variables. Yet another sub-division of the population comprised of the married and the unmarried mothers.

Briefly describe the results and conclusions reached by the author

There were 471 post-neonatal deaths of Alaskan residents during the period of study, i.e.  1992-2004. The ratio of births of Alaska Native to non-Native post neonatal mortality 6:2..

In the 3 years, Alaska Native post neonatal mortality rate was twice higher than the non-Natives were. The main causes of death related to SIDS or asphyxia of unknown etiology accounted to 51% all post-neonatal deaths.19percentage of the deaths that occurred during that time were due to congenital anomalies, 10% due to injury, 17% due to infections, 2% to due to perinatal events, and7percentage due to preterm birth. It happened that of the eleven percent of infants that died in the post neonatal, a considerable percentage had birth weight under 1,500.

All the evaluated risk factors with the exemption of area of residence were associated with post neonatal mortality in the univariate analysis. There was a higher proportion of Alaska Native than non-Native live births occurrence to women with less education. The children at risk included those who received inadequate prenatal care.

Healthy People 2020 objective addressed in the research

• Access to Health Services – research shows that limited access to health care services contributes less to poorer health among indigenous populations, thus less contributing to post prenatal deaths
• Educational and Community-Based Programs- maternal education is a very essential community based program that helps women, more especially from remote areas, and those with no formal education in preventing prenatal and postnatal deaths.
• Healthcare-Associated Infections – research shows that prenatal tobacco exposure contributes to respiratory tract infections and low birth weight, which causes infant death and morbidity.
• Maternal, Infant, and Child Health – maternal care and education, infant care, and child health are very much interrelated and they all play a role in preventing infant morbidity.
• Nutrition and Weight Status- the nutrition status of an expectant mother determines the birth weight of a child, thus determine the health status of the child, which determines the morbidity rate
• Respiratory Diseases –prenatal tobacco exposure contributes to infant death and morbidity
• Social Determinants of Health – Social factors such as lack of an involved male partner, low education, and alcohol and tobacco use are contributors of post neonatal deaths
• Substance Abuse – prenatal substance use contributes to post neonatal deaths
• Tobacco Use – prenatal use of tobacco leads to respiratory problems and plays a major role in causing post neonatal deaths

Explain how the findings of this article can guide nurses in their practice with this population of people

Nurses are the great caretakers both at the hospital and on outreach programs. They offer not only nursing services, but also education and advisory services. In the hospital setup, the nurses can use this guide in doing a medical examination. If a child is under a certain condition, for example, the nurse can start by investigating the mother. Probably the mother had problems while expectant. The mother could have abused substances while expectant or even while breastfeeding. There could also be a social problem at home. The guide notes in this study would help the nurse with a systematic guide in determining the root cause of a health condition.

Secondly, the guide presented in the study is essential in offering advice. A nurse can use the guide to state the effect of every mistake done by a mother. Take for example consumption of cigarettes, alcohol, or chewable substances. A nurse can easily explain while adding some more information from previous knowledge on the systematic manner this substances does affect the normal growth of the fetus (in case of an expectant mother), and at the same time explaining the impact to the mother’s health.

The study findings can also act as a guide while carrying out outreach programs. The nurses can determine the truthiness of the information inside the guide practically. They can use the guide as a basis for another study to determine the truth of every listed explanation. The nurses can use data distinguishing the lifestyle of those people living in the rural and urban areas. Say, for example if those from urban areas are prone to obesity diseases and those from rural prone to cholera, then a study can be picked from there. The study guide presents a particularly essential guide in the nursing field.

Reference

Margaret H. Blabey & Bradford D. Gessner (2009). Maternal Child Health Journal 13:222–230