Maternal and Child Health
The Maternal and Child Health Research Theme is focused on co-designing and evaluating health promoting innovations in the early years to support health across the lifecourse.
Our interdisciplinary team lead research in the three interconnected stages of early years research: sexual and reproductive health and rights, maternity care, and interventions to support infants and children with complex health needs.
Together we achieve transformative research by:
- Working closely with the World Health Organisation to advance their research agendas on: male engagement in sexual and reproductive health and rights; midwifery-led care; and supporting children to thrive in the early years. Our appointment of Fran McConville, Lead Midwifery Advisor to the WHO as an Honorary Professor of Practice enhances this sustained partnership between our team and WHO
- Contributing to National Institute for Health Research standards for patient and public involvement
- Our team’s management of two national population health registers, ‘the Northern Ireland Cerebral Palsy Register’ and ‘Neonatal Intensive Care: Outcomes Research and Evaluation’ underpin early years interventions nationally and with international partners
EXAMPLE RESEARCH PROJECTS
The COVID-19 pandemic has had a significant impact on all our lives. However, for carers of loved ones who have severe disabilities the removal of services and reduction in support has resulted in an increase in mental ill health.
This project, led by Dr Mark Linden and funded by UK Research and Innovation Economic and Social Research Council (UKRI- ESRC), seeks to capture the experiences of family carers for loved ones with severe disabilities. Using PMLD as an exemplar condition, the team will speak to carers and voluntary sector workers across the UK and Republic of Ireland about their experiences of the COVID-19 pandemic. The ultimate aim of this research is to co-design a support programme based on the new learning gained through our discussions with carers.
Dr Fiona Lynn is leading on the cost-effectiveness analysis of breastfeeding support interventions relevant for the United Kingdom.
Dr Lynn is part of a team, led by Prof Alison McFadden at the University of Dundee, who have been awarded funding from the National Institute for Health Research (NIHR) for an evidence synthesis and stakeholder engagement study on breastfeeding, Action4Breastfeeding.
The study involves updating the highly-cited Cochrane systematic review ‘Support for healthy breastfeeding mothers with healthy term babies’, conducting a mixed-methods review of process evaluations and engaging with stakeholders to develop National Health Service (NHS) guidance for breastfeeding support.
The aim of the research is to improve health outcomes and reduce health inequalities for women and children in the United Kingdom by increasing breastfeeding rates. Further details for Action4Breastfeeding can be found here.
Professor Mark Tomlinson (Professor of Maternal and Child Health) was one of the co-ordinating writers of the World Health Organization (WHO) document – “Nurturing Care for Early Childhood Development: A framework for helping children survive and thrive to transform health and human potential”.
Professor Tomlinson is also part of the writing team for the Nurturing Care Handbook which will be published in 2021. (https://nurturing-care.org/handbook/).
Mark is currently a member of the WHO Strategic and Technical Advisory Group of Experts (STAGE) for Maternal, Newborn, Child, Adolescent Health & Nutrition. STAGE provides high level strategic and technical advice to WHO on matters relating to maternal, newborn, child and adolescent health. STAGE reports to the Director General of the WHO.
Mark is one of the Commissioners and co-authors of the WHO-Lancet commission ‘A Future for the World’s Children?’ A future for the world’s children? A WHO-UNICEF-Lancet Commission (thelancet.com). He is also part of Children In All Policies (CAP-2030) that will implement the recommendations of the Commission by promoting children’s rights and protecting their health through science, advocacy and coalition-building (https://cap-2030.org/).
A model of Group Antenatal Care and Education known as ‘Getting Ready for Baby’ was developed and implemented across maternity care in Northern Ireland.
Dr Jenny McNeill led this research with Dr Fiona Lynn and Dr Lorna Lawther which was funded by Northern Ireland Health and Social Care Research and Development Division.
The study examined the impact of this transformation to the provision of maternity services with the implementation of this model of care in the antenatal period. Group antenatal care models were associated with increased satisfaction with care, improved health outcomes for mothers and newborns and facilitated enhanced access to continuity of midwifery carer for women during pregnancy.
This research has led to a collaboration with a global team evaluating group antenatal care implementation strategies (United Kingdom Lead Prof C McCourt, City University London) and two further studies led by Dr Jenny McNeill evaluating continuity of midwifery carer models for women with universal and additional care needs in Northern Ireland, in partnership with the Department of Health and Social Care.
Research Expertise of Maternal and Child Health Staff
- Sexual and reproductive health and rights
- Maternity and Neonatal care
- Child and adolescent health especially in relation to brain injury, cerebral palsy and early years nurturing care
- Evidence and gap maps and systematic reviews of the literature
- Intervention co-design and co-production through patient and public involvement
- Mixed methods evaluation including randomised controlled trials with embedded process evaluations
- Health economics
- Policy design and evaluation to address sustainable development goals
Research by Dr Carmel Kelly and Professor Maria Lohan contributed to transformations of sexual healthcare provision resulting in an accessible early-detection service for the general population in Northern Ireland and for all prisoners in Northern Ireland (NI).
Further, their research is shaping the World Health Organisation’s (WHO) global agenda for the improvement of sexual and reproductive healthcare by effective engagement with males.
Addressing the challenge in Northern Ireland
To transform sexual healthcare into an accessible early-detection service, Dr Kelly worked with colleagues in the South Eastern Trust to generate and evaluate a cost-effective community-based model for sexual healthcare, that normalised sexual healthcare in GP practices while bolstering links to specialist practice. The model facilitated upskilling of over 250 health primary care professionals and improved access to sexually transmitted infection (STI) testing – across the whole Trust serving 20% of Northern Ireland population. This new model of care has resulted in earlier treatment of STIs and preventing onward transmission and long-term sequelae. The Chief Medical Officer has recommended its roll-out for the whole of Northern Ireland.
Addressing the challenge in prison healthcare
Dr Kelly, Professor Lohan and research fellow, Dr Michelle Templeton contextualised and adapted the community model of sexual healthcare for all prisoners in NI (over 2000), with particular focus on male prisoners (97% of prison population is male), thereby addressing the particular sexual healthcare needs of one of society’s most under-served vulnerable groups. Before their research, there was an ad-hoc consultant led-service in prisons, primarily responding to symptomatic cases. Following their research, there is now a continuous, early-detection nurse-led sexual health service in all prisons in Northern Ireland. The team (in combination with partners at University of Glasgow and University of Sterling and research fellow Dr Martin Robinson) also co-produced an innovative relationship and sexuality education programme with, and for, male prisoners “If I Were a Dad”, now delivered by Barnardo’s in national youth offender institutes of Northern Ireland and Scotland.
Addressing the challenge globally
The QUB team’s long-standing specialist research expertise in the engagement of males in sexual and reproductive health led to a commission by the WHO to scientifically synthesize the global evidence to shape the WHO’s global policy agenda on engaging men and boys in sexual and reproductive health and rights. http://dx.doi.org/10.1136/bmjgh-2019-001634; http://dx.doi.org/10.1136/bmjgh-2020-002997 “Drawing from our collaboration with Professor Lohan and her team, WHO and HRP will be able to offer global leadership and guidance on masculinities and sexual and reproductive health and rights (SRHR)” Director of Sexual and reproductive Health and research, WHO.
Research undertaken as part of the Northern Ireland Cerebral Palsy Register (NICPR), led by Drs Claire Kerr and Oliver Perra and formerly by Dr Jackie Parkes at the School of Nursing and Midwifery at Queen’s University Belfast has:
1. Enabled development of new services, providing specialist care and targeted rehabilitation to all children with cerebral palsy (CP) in Northern Ireland (NI).
For example, data provided by NICPR underpinned the business case for a tertiary paediatric neurodisability service, serving all of NI, that provides specialised management of movement disorders to 500-600 children annually.
2. Developed cost-effective tools to describe CP that have been adopted across NI and internationally, that improve communication between healthcare professionals and families and reduce clinical assessment burden.
For example, as a partner in a European research consortium (Surveillance of Cerebral Palsy in Europe (SCPE) the team contributed to development of decision and classification tools for CP. In 2018, this European Consortium (SCPE) reported that over 21,000 European children with CP are routinely assessed using these tools including over 2,000 children from NI. The impact has been not only a harmonisation between health professional tools but improved communication between health professionals and patients and families.
3. Informed UK and international standards of care, including, National Institute for Clinical Excellence (NICE) guidelines and a UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD).
For example, nine publications by the QUB team are cited in the 2017 NICE guideline on assessment and management of CP in under 25s. The team’s research contributions informed recommendations for recognising and discussing speech issues, assessment of mental health problems, and assessment and management of comorbidities in CP.
The joint United Nations Population Fund, International Confederation of Midwives and World Health Organisation State of the World Midwifery Report (2021) recently emphasised the need for investment in midwife-led care provision. Dr Maria Healey and team have been working for some time to develop a robust clinical framework to make midwifery-led units (MLUs) a safe and satisfactory place for women and their partners to give birth.
Research Undertaken: Findings from EU COST Action STSM2 by Healy (2013) uncovered a variation in application and content of eligibility criteria in the assessment of women, influencing their access to give birth in MLUs in Northern Ireland. Subsequently, a programme of work led by Dr Maria Healy with Dr Patricia Gillen (Southern Health and Social Care Trust & Ulster University) commenced leading to a co-production, involving maternity care stakeholders and service users, of an evidenced-based ‘Guideline for Admission to Midwife-led Units in Northern Ireland & Northern Ireland Normal Labour and Birth Care Pathway’, with Supporting evidence. The pathway was designed for implementation for all women with a straightforward pregnancy in any birth setting.
Impact: The evidenced-based guideline and pathway have been implemented across the five Health and Social Care Trusts in Northern Ireland, other parts of the United Kingdom and internationally. The guideline is cited in Standard 8 of the European Midwifery Unit Standards (2018), which has been endorsed by United Kingdom National Institute of Clinical Excellence and the European Midwives Association. The guideline and pathway were presented by Dr Healy to maternity care leads at the World Health Organisation in Geneva (2018), translated following WHO, Process of translation into six different languages (Catalan, Galician, German, Portuguese, Italian, Spanish & Swedish) and published in Spainish and Portuguese (2021).