Nau mai, haere mai ki a Māori Health Review.
We aim to bring you top Māori and Indigenous health research from Aotearoa and internationally.
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Ko te manu e kai i te miro nōna te ngahere, Ko te manu kai i te mātauranga, nōna te ao.
Ngā mihi
Matire
Dr Matire Harwood
matire@maorihealthreview.co.nz
These authors undertook kaupapa Māori research with 223 kaumātua who participated in 17 focus groups across 7 study regions throughout Aotearoa New Zealand and 8 whānau from the Waikato region with an aim to determine Māori understandings of dementia, its causes, and ways to manage a whānau member with this condition. Five main themes emerged: Ngā Pūtake (causes); Ngā Rongoā (protective factors); Aroha and Manaakitanga (acceptance of illness and behaviour change); Kaitiakitanga (caregiving); and Ngā Ratonga (dementia services). It was identified that mate wareware (becoming forgetful and unwell, ‘dementia’) affects the wairua (spiritual dimension) of Māori. The study revealed Māori understandings of the causes of mate wareware and the role of aroha (love, compassion) and manaakitanga (hospitality, kindness, generosity, support, caring) involved in caregiving for whānau living with mate wareware. The study emphasised that whānau are crucial for the care of a kaumātua with mate wareware and that participants perceived that cultural activities were protective factors that optimised a person’s functioning within their whānau and community. There is an urgent need for culturally appropriate and comprehensive support to assist whānau with their knowledge building and empowerment to meet the needs of those with mate wareware. A collaborative healthcare practice with practitioners accessing the necessary mātauranga Māori (Māori knowledge) is paramount.
This study compared clinical characteristics and in-hospital and post-discharge outcomes of 62 consecutive patients (8 females; median age 41 years) with methamphetamineassociated cardiomyopathy (MAC) at Middlemore Hospital from 2006 to 2018 and compared them to an age-range matched cohort with non-ischaemic cardiomyopathy (NCM). The majority of MAC patients were of indigenous Māori ethnicity. MAC patients were younger than the NCM cohort, had higher peak N-terminal pro-B-type natriuretic peptide and lower left ventricular ejection fraction at presentation, and a higher incidence of cardiogenic shock at presentation (10 vs 2, p = 0.030). During follow-up, 15 deaths occurred in the MAC cohort compared with 7 deaths in the NCM cohort. Compared with NCM patients, MAC patients had an increased mortality risk (HR 2.7; 95% CI 1.1-6.2, p = 0.029) and a trend to more heart failure re-admissions (HR 1.6; 95% CI 1.0-2.8, p = 0.075). Independent predictors of mortality during follow-up were baseline left ventricular end diastolic diameter and failure of improvement in right ventricular systolic function, while heart failure readmission in MAC patients was predicted by failure of improvement in left ventricular ejection fraction.
This study examined the incidence of stroke and traumatic brain injury (TBI) by age and ethnicity in 2 New Zealand population-based epidemiological studies (Brain Injury Outcomes New Zealand In the Community [BIONIC] and Auckland Regional Outcomes of Stroke Studies [ARCOS-IV]). A similar stroke risk was seen for men and women, but men had a 2-fold higher relative risk of mild TBI and a 3-fold relative risk of moderate/severe TBI compared with females. The incidence of TBI was over 5-fold that of stroke. Māori had the highest incidence of TBI after 5 years of age, while New Zealand European/Pākehā had the highest TBI incidence in those aged <5 years. Higher incidences of stroke were observed for Pacific people and Māori until 75-84 years, after which Europeans had a higher incidence. The observed differences with ethnicity suggest the need for different prevention strategies for the 2 groups.
The regional and ethnic differences in rates of publicly funded osteoarthritis (OA)-associated hip and knee replacement surgeries and mortality after surgery were explored in this New Zealand populationbased, retrospective, cross-sectional study. A total of 53,439 publicly funded primary hip replacements and 50,072 publicly funded primary knee replacements with a diagnosis of OA were identified between 2005 and 2017 in patients aged 14-99 years. Increases in the number and age-standardised rates of hip and knee replacements were seen over the time period, with Māori having the highest age-standardised rate of hip replacements, followed by European/others and Pacific peoples; Asians had the lowest rate. Pacific peoples had the highest age-standardised rate of knee replacements, followed by Māori and European/others, while Asians again had the lowest rate. The lowest rates of hip and knee surgeries were seen in the Northern Health Network and the Southern Health Network, respectively. Standardised mortality ratios decreased over the time period and were lower than in the general population: 0.92 (95% CI 0.89-0.95) for hip and 0.79 (95% CI 0.76-0.82) for knee surgery recipients. 30-day, 90-day and 1-year mortality patterns were similar to the standardised mortality ratios.
These New Zealand authors evaluated the relationship between perceived discrimination, as measured in pregnancy, with birth weight and gestation length among 1653 Māori, Pacific, and Asian women. Some type of unfair treatment that they attributed to their ethnicity was reported by 30% of the sample. Among Māori women, unfair treatment at work and in acquiring housing were associated with lower birth weight when compared to Māori women not experiencing these types of discrimination (β – 243 and – 146 g, respectively), while significantly shorter gestation was found in those experiencing an ethnically motivated physical attack and unfair treatment in the workplace, in the criminal justice system, or in banking ( β – 1.06 , – 0.95 , – 0.55 and – 0.73 weeks, respectively).
Current maternal mental health screening practices and supports amongst Māori and Pacific peoples in New Zealand were explored in this qualitative research involving interviews and focus groups with maternity carers and mothers of Māori and Pacific descent. Mothers and carers both reported that maternal mental health screening is ad hoc in this country and discussed multilevel barriers that hamper screening and access to supports. Gaps in maternal mental health services were identified, with a need for service improvements to be targeted at patient, provider, and systems levels.
This study explored the motivation of 29 Māori women requesting bariatric surgery for obesity through semi-structured interpersonal interviews informed by kaupapa Māori research methodologies. A majority of respondents reported that obesity-related disease and a better quality of life were the greatest sources of motivation. Whānau were key to achievement of preoperative milestones required for acceptance for bariatric surgery. Experiences of fat-shaming and yo-yo dieting were also factors in choosing to have surgery.
The prevalence of obesity in children presenting to secondary care in southern New Zealand and their clinical management were investigated in this study. A review of data contained in the electronic anthropometry database in the region for the period 19 July 2010 to 16 July 2015 identified obesity prevalence. Clinical records were examined using a standard data extraction form for 333 obese children. In this region, the prevalence of overweight and obesity was stable over the 5-year period, but it was higher than the average national rates. There was an over-representation in terms of obesity by children of Māori and Pacific Island ethnicity, males, and those most deprived. Among 333 obese children investigated in the study, only 45.0% received a diagnosis of obesity and 24.7% of those children had further investigations related to possible obesity complications (72.7% were given management plans). Māori and Pacific Island children were less likely to receive clinical intervention for their obesity, while older females were more likely to receive such treatment.
This study used 19 focus groups (including Māori, Pacific, Indian, and New Zealand European caregivers) to examine factors contributing to body weight in children. Across all groups, cost of healthy foods was the highest ranked factor. Ease of access to takeaways and lack of food preparation time were similarly ranked. Cultural factors and screen time were identified as inducing sedentary behaviours in children and a lack of time to ensure children exercised was the next ranked factor. Lack of familial, social, and health promotion support, and others’ behaviour and attitudes were identified by participants as negatively impacting what children ate. All groups rejected cultural stereotypes for higher obesity rates. Compared to Māori and New Zealand Europeans, Pacific Island and Indian participants noted loss of culture and extended family support, and not having culturally appropriate nutrition education or social support and services as additional factors.
This analysis of data from the Older People’s Oral Health Survey examined the residual dentition of 987 people living in residential aged care facilities. The most prevalent (24.7%; 95% CI 20.4, 29.7) dentate configuration was maxillary tooth-bounded saddles against a partially dentate lower. Younger people generally had less tooth loss and a higher prevalence of Kennedy classes II, III and IV. More females than males had a fully dentate arch. Māori were 8-fold more likely to have only mandibular anterior teeth. Upper dentures were worn more frequently than lower dentures. Various degrees of tooth loss were common with upper tooth-bounded saddles against partially dentate lower combination. Edentulous maxilla opposed by some standing teeth occurred in ≥25%, and was most common among those who were older and in Māori. Maxillary prostheses were more common than mandibular prostheses.
The population-based, prospective, cross-sectional, Wellington Keratoconus Study aimed to determine the prevalence of keratoconus (progressive thinning of the cornea) in 1916 Wellington high school students (mean age 14.6 years). Overall, keratoconus occurred in 1/191 (0.52%) participants and among Māori in 1/45 (2.25%) participants. Participants with keratoconus had a mean Kmax of 48.7 diopters (D), at the thinnest point they had mean pachymetry of 494.05 μm and mean posterior elevation of 23.4 μm, and they had a Belin/ Ambrosio enhanced ectasia display overall D value of 4.30. In those with keratoconus, 80% had visual impairment of ≥0.2 Logarithm of the Minimum Angle of Resolution (LogMAR) in the better eye; 70% did not use visual aids, 70% had atopy, and 60% were from a low school decile.
This systematic review of 54 qualitative studies of Māori consumer experiences of health services and programmes was conducted to assess Māori experiences and characterise how recommendations inform strategies to address inequities. Experiences mapped to social determinants of health inequities mostly related to direct interactions, in particular patient-clinician communication and relationships, and clinician and systemic cultural competency. Key recommendations mapped to potential strategies at all levels of the political, social and health system ranging from individual interactions, community change, to broader public and system-level strategies. Recommendations focused on actions that reduce risks of exposure to health-damaging factors including health literacy interventions, increased cultural competency resources and increased Māori health service development and workforce capacity.
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Tēnā koutou katoa Nau mai, haere mai ki a Arotake Hauora Māori. We aim to
Tēnā koutou katoa Nau mai, haere mai ki a Arotake Hauora Māori. We aim to
Tēnā koutou katoa Nau mai, haere mai ki a Arotake Hauora Māori. We aim to
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