John Waldon

Indigenous Mortality (Revealed): The Invisible Illuminated

Inaccuracies in the identification of Indigenous status and the collection of and access to vital statistics data impede the strategic implementation of evidence-based public health initiatives to reduce avoidable deaths. The impact of colonization and subsequent government initiatives has been commonly observed among the Indigenous peoples of Australia, Canada, New Zealand, and the United States. The quality of Indigenous data that informs mortality statistics are similarly connected to these distal processes, which began with colonization. We discuss the methodological and technical challenges in measuring mortality for Indigenous populations within a historical and political context, and identify strategies for the accurate ascertainment and inclusion of Indigenous people in mortality statistics.

Liver function of hepatitis B carriers in childhood

This study followed 314 children who were carriers of hepatitis B virus for 2 to 4 years and compared them with noncarriers, matched for age and sex, from the same community. No confirmed carrier lost hepatitis B surface antigen. Hepatitis B e antigen (HBeAg) was lost at a rate of 10.6% per year; the rate of decay was not affected by age or gender. Liver enzymes were higher in HBeAg-positive than in HBeAg-negative carriers and loss of HBeAg was usually followed by return to values in the normal range. There was evidence, however, of persistent mild liver dysfunction in carriers even after development of antibody to HBeAg. Serum alanine aminotransferase concentrations above twice the upper limit of normal were observed in 7% of carriers on at least one occasion but persisted for more than 1 year in less than 1% and clinical manifestations were rare. The hepatitis B carrier state was uncomplicated during the course of this study. However, risks of subsequent serious disease in adult life may be significant and continued surveillance of carriers is important for individual protection and to determine adverse prognostic features.

New Zealanders’ attitudes towards access to their electronic health records: Preliminary results from a national study using vignettes

This project investigates public attitudes towards sharing confidential personal health information held in electronic health records (EHRs). The project uses computer assisted telephone interviewing (CATI) to conduct a quantitative national survey of the attitudes of New Zealanders towards access to their personal health information using vignettes. Respondents are presented with vignettes which describe ways in which their health information might be used, and asked about their attitude to and consent for each type of access. The project outcome will be a specification of requirements for an e-consent model meeting the needs of most New Zealanders, thus enabling the potential benefits of electronically sharing confidential health information from EHRs. This article presents preliminary results from the first 1828 respondents. Respondents were most willing to share their information for the purpose of providing care. However, removing their name and address greatly increased the acceptability of sharing information for other purposes.

Barriers to Best Outcomes in Breastfeeding for Māori: Mothers' Perceptions, Whānau Perceptions, and Services

This research explores the perceptions of New Zealand Māori women and their whānau (customary Māori extended family) toward barriers to achieving best outcomes in infant feeding: exclusively breastfed infants at 6 months. Interviews are undertaken with 59 Māori women who have given birth in the previous 3 years and 27 whānau members. Although mothers and whānau members feel positively toward breastfeeding and generally expect to breastfeed exclusively, these expectations are unmet in many cases because of lack of support when establishing breastfeeding; lack of support when life circumstances change; lack of timely, culturally relevant, and comprehensible information; confusion about smoking while breastfeeding; uncertainty about the safety of bed-sharing, and perceived lack of acceptability of breastfeeding in public. The relatively high rates of tobacco use by Māori create a tension for breastfeeding mothers, cited by some as a reason for ending breastfeeding prematurely. J Hum Lact. 25(3):307-316.

THE ROLE OF WHĀNAU IN MĀORI WOMEN’S DECISIONS ABOUT BREAST FEEDING

Objective This project investigated Māori womens decision making around breastfeeding within the context of whānau attitudes towards breastfeeding in order to describe the dynamic role played by the whānau whānui (extended family) in a womans decision to breastfeed or not. Methods During late 2004 and early 2005, 30 women who had cared for a newborn within the previous three years and 11 family members were recruited from within Auckland (a major urban area) and small towns and rural areas in and around the Bay of Plenty. Purposive sampling was used to recruit a diverse demographic of Māori women and whānau members. Given the exploratory nature of the study, detailed qualitative data was collected during semi-structured face-to-face interviews with women alone or together with whānau. All participants self-identified as Māori and were over 16 years of age. Ethical approval for the study was obtained from the University of Auckland Human Participants Ethics Committee. Results A diverse range of women were interviewed in terms of age, socio-economic status, gravida, parity, pregnancy wantedness, birthing experience, babys age and breastfeeding experience. Women who did not want to breastfeed and women who formula-fed their babies from early on were under-represented in this research. The womens partners, mothers, sisters and aunties were cited most often as having a role in the decision to breastfeed and in supporting breastfeeding. Most of the women and whānau thought it was the feeding mothers place to decide if she would breastfeed or not and for how long. Infant feeding usually came up for discussion around ordinary home life and meetings during one-on-one conversations. Sometimes infant feeding was not discussed with whānau until the mother encountered problems. Conclusion This research supports the assertion that whānau are central and that whānau could be mobilised to support healthy choices. Further research is needed to investigate fathers’ experience of maternity services to inform the development of health education materials to prepare partners for their role in supporting breastfeeding. Research should also seek to identify which healthcare policies undermine and minimise the role of the father and other whānau in pregnancy, birthing and infant care. Public health policies that encourage the delivery of health services to whānau in a culturally appropriate, accessible and effective way are important for promoting whānau ora (family health and well-being) and supporting Māori development.