Maternal birthplace and experiences of perinatal healthcare in Belgium: Evidence from a cross-sectional survey.

Background: Patient experience is an important part of perinatal care quality. Migrant women in high-income countries often report more negative experiences than non-migrants, but evidence in Europe is patchy. In this study, we compared the experiences of two migrant populations with non-migrants, taking into account socioeconomic characteristics.

Associations between socioeconomic status and pregnancy outcomes: a greater magnitude of inequalities in perinatal health in Montreal than in Brussels.

Background: Comparing health inequalities between countries helps us to highlight some factors specific to each context that contribute to these inequalities, thus contributing to the identification of courses of action likely to reduce them. This paper compares the associations between socioeconomic status (SES) and 1) low birth weight (LBW) and 2) preterm birth, in Brussels and Montreal (in general population, natives-born mothers, and immigrant mothers).

Methods: A population-based study examining associations between SES and pregnancy outcomes was conducted in each city, using administrative databases from Belgian and Quebec birth records (N = 97,844 and 214,620 births in Brussels and Montreal, respectively).

Country of birth as a potential determinant of inadequate antenatal care use among women giving birth in Brussels. A cross-sectional study.

Background: One of the mechanisms explaining perinatal health inequalities could be inadequate antenatal care among some immigrant groups. Few European studies compared antenatal care use between different groups of immigrants taking into account individual characteristics. This research investigates the associations of three birth regions with the use of antenatal care, by also considering socioeconomic and migration-related determinants.

Measuring the invisible: perinatal health outcomes of unregistered women giving birth in Belgium, a population-based study.

Background: The unregistered population remains under-researched because of its "invisible" status in statistics. Studies on perinatal health outcomes of unregistered women remains particularly limited. Our objectives were 1) to describe the sociodemographic profiles of women who are not legally residing in Belgium and 2) to analyze the associations of registration status with pregnancy outcomes according to socioeconomic status and nationality.

Risk of Low Birth Weight According to Household Composition in Brussels and Montreal: Do Income Support Policies Variations Explain the Differences Observed between Both Regions?

Variations in social policy between countries provide opportunities to assess the impact of these policies on health inequities. This study compares the risk of low birth weight in Brussels and Montreal, according to household composition, and discusses the impact of income support policies. For each context, we estimated the impact of income support policies on the extent of poverty of welfare recipients, using the model family method.

[Study on the integration of mental health support into primary health care in Guinea].

Introduction: the low coverage of specialized mental health services and the shortage of human resources for mental health are enormous challenges for the health care system in Africa. The integration of mental health support into primary health care is a substantial and feasible complementary intervention to specialized services. We collected and analyzed data from 5 Health Care Centers (HCC) that had integrated this care package in Guinea.

Mothers' experiences of perinatal care in Belgian public hospitals: exploring the social inequalities. Protocol for a cross-sectional survey.

Introduction: In Europe, the social inequalities in perinatal health are usually found to be to the disadvantage of non-European immigrants and women with lower levels of education and income. Among the possible underlying mechanisms are inadequate access to healthcare services and suboptimal care. To explore this hypothesis in the Belgian context, our research will describe detailed maternal socioeconomic and migration characteristics, explore how these factors relate to each other, and how they relate to women's perinatal care trajectories and experiences of care.

Integration of mental health care in private not-for-profit health centres in Guinea, West Africa: a systemic entry point towards the delivery of more patient-centred care?

Background: Patient-centred care is an essential component of quality of health care. We hypothesize that integration of a mental health care package into versatile first-line health care services can strengthen patient participation, an important dimension of patient-centred care. The objective of this study is to analyse whether consultations conducted by providers in facilities that integrated mental health care score higher in terms of patient participation.

[Integrating mental health in community health centers in Guinea].

This study investigates effects of integrating mental health on staff attitudes in 5 community health centers in Guinea: more specifically, on destigmatizing mental health problems and on adopting patient-centered care approaches. It is based on semi-structured interviews with 27 health workers from health centers having integrated mental health care (Santé Mentale +, with acronym SM+); and, as a comparison group, with 11 health workers working in facilities that do not have integrated mental health (SM-). Attitudinal change among SM+ health workers contrasts sharply with the stigmatizing discourse of SM- health workers.

Is the socioeconomic status of immigrant mothers in Brussels relevant to predict their risk of adverse pregnancy outcomes?

Background: Understanding and tackling perinatal health inequities in industrialized countries requires analysing the socioeconomic determinants of adverse pregnancy outcomes among immigrant populations. Studies show that among certain migrant groups, education is not associated with adverse pregnancy outcomes. We aim to extend this analysis to further dimensions of socioeconomic status (SES) and to other settings.

Evaluating the effect of income support policies on social health inequalities (SHIs) at birth in Montreal and Brussels using a contextualised comparative approach and model family method: a study protocol.

Introduction: Assessing the effects of social policies on social health inequalities (SHIs) is a complex issue. Variations in social policy between countries or regions provide natural experiments in policy implementation to perform comparative research. Comparisons are most enlightening when: the object of the evaluation is well defined (types of policies, population groups); the context of policy is analysed (history, implementation); the impact of policy on household poverty is outlined in detail; the influence of various factors (other than poverty) on SHI is taken into consideration.

[Stigmatisation of mental illness by medical students in Conakry, Guinea].

Introduction: Stigmatisation of mental illness constitutes a major problem in the development of mental healthcare programs, especially when it originates from health professionals themselves. The aim of this research is to investigate possible attitudes of stigmatisation among first and final year medical students registered at the University of Conakry faculty of medicine in Guinea-Conakry (West Africa).

Methods: Focus group discussions identified students' attitudes and perceptions in relation to mental illness, their explanatory models, their opinions concerning traditional and modern therapeutic practices with regard to mental illness, and their interest to possibly incorporate psychiatry in their future medical practice.

Exploration of the functions of health impact assessment in real-world policymaking in the field of social health inequality: towards a conception of conceptual learning.

With the implementation of health impact assessment (HIA)'s conceptual model into real-world policymaking, a number of fundamental issues arise concerning its decision-support function. Rooted in a rational vision of the decision-making process, focus regarding both conceptualisation and evaluation has been mainly on the function of instrumental policy-learning. However, in the field of social health inequalities, this function is strongly limited by the intrinsic 'wickedness' of the policy issue.

Are all immigrant mothers really at risk of low birth weight and perinatal mortality? The crucial role of socio-economic status.

Background: Increasing studies show that immigrants have different perinatal health outcomes compared to native women. Nevertheless, we lack a systematic examination of the combined effects of immigrant status and socioeconomic factors on perinatal outcomes. Our objectives were to analyse national Belgian data to determine 1) whether socioeconomic status (SES) modifies the association between maternal nationality and perinatal outcomes (low birth weight and perinatal mortality); 2) the effect of adopting the Belgian nationality on the association between maternal foreign nationality and perinatal outcomes.

Neonatal outcomes in obese mothers: a population-based analysis.

Background: If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, then few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the present study after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis.

Methods: This study used 2009 data from the Belgian birth register data pertaining to the regions of Brussels and Wallonia and included 38,675 consecutive births.

Effect of adopting host-country nationality on perinatal mortality rates and causes among immigrants in Brussels.

Objectives: Perinatal mortality rates vary between ethnic groups but the relation with immigrant status is unclear. Previous research suggested that birth outcomes may either improve or deteriorate with duration of residence, depending on the migrant group. The objectives of this study are to describe and measure inequalities in pregnancy outcomes, perinatal mortality and causes of perinatal deaths according to current citizenship versus national origin of the mother, in Brussels.

Missing information in birth certificates in Brussels after reinforcement of data collection, and variation according to immigration status. A population-based study.

Background: A problem repeatedly reported in birth certificate data is the presence of missing data. In 2008, a Centre for Perinatal Epidemiology was created inter alia to assist the Health Departments of Brussels-Capital City Region to check birth certificates. The purpose of this study is to assess the changes brought by the Centre in terms of completeness of data registration for the entire population and according to immigration status.

Classification of cesarean sections among immigrants in Belgium.

Objective: To provide insight into the differential effect of immigration on cesarean section (CS) rates, using the Robson classification.

Design: A population-based study using birth certificates from the birth registry of 2009.

Setting: All births in two of the three Belgian regions excluding Flanders.

The associations between nationality, fertility history and diabetes-related mortality: a retrospective cohort study in the Brussels-Capital Region (2001-2005).

Background: The relationship between women's parity and diabetes mortality has been investigated in several studies, with mixed results. This study aims to establish if parity and age at first birth are associated with diabetes-related mortality and if these factors contribute to variations in diabetes-related mortality among women with different nationalities.

Methods: Data of the 2001 census are linked to registration records of all deaths and emigrations (period 2001-2005).

Ethnic differences in diabetes-related mortality in the Brussels-Capital Region (2001-05): the role of socioeconomic position.

Objectives: To examine if and to what extent ethnic differences in diabetes-related mortality are associated with differences in education and housing status.

Methods: The data consist of a cohort study linking the 2001 census to emigration and mortality data for the period 2001-05. The study population comprises all Belgian and North African inhabitants of the Brussels-Capital Region (BCR) aged 25-74.

High perinatal mortality rate among immigrants in Brussels.

Background: The relation between immigration status and perinatal mortality is unclear. The objective of this study is to describe and measure inequalities in perinatal mortality and causes of perinatal deaths according to maternal nationality and socioeconomic status.

Methods: A population-based cohort study related to all babies born during the period of 1998-2006 whose mothers were living in Brussels, irrespective of the place of delivery.

[Health and living conditions: reflections around an attempt for a multiple and sectoral approach].

There is consensus amongst community members, local practitioners and policy and decision makers on the need for an inter-sectoral approach to health, environment and living conditions. The author analyses the processes of linking various sectors involved in six health and environment projects developed at the local or regional level in Brussels-Capital. The question of inter-sectoral collaboration is addressed differently at the regional and local levels.