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In partnership with Birmingham East and North Primary Care Trust and Health Launchpad at the Young Foundation, we have been working closely with health practitioners, local community organizations, pregnant women, mothers and many more to produce this unique resource with the aim of combating perinatal mortality.

Perinatal
Describes the period surrounding birth, and traditionally includes the time from fetal viability from about 24 weeks of pregnancy up to either 7 or 28 days of life.

Perinatal mortality
Fetal deaths after 24 completed weeks of gestation and death before 7 completed days.

BEN PCT has the second highest perinatal mortality rate in the country.  During our initial scoping exercise, we pinpointed some key issues from conversations with doctors, midwives, family support workers, pregnancy outreach workers, and mothers:

• Problems around the degree to which families and patients connect  with services  - little understanding of the process/timescale, intimidated by hospitals and doctors, lack of awareness of how to expect to be treated
• A failure to engage with services early enough
• Understanding of the importance of a healthy lifestyle before/during pregnancy – food and diet, folic acid, exercise etc
• Existing conditions e.g. diabetes
• Major concerns around breastfeeding and a failure to persevere which has been influenced by misconceptions e.g. that it’s better to change to baby formula because baby will appear bigger/healthier
• Cultural and wider perceptions of pregnancy
• Mental health, including stress and depression
• A lack of awareness of the availability of support and groups

In order to help tackle some of these issues, Maslaha has embarked on a unique series of films specifically aimed at pregnant Muslim women which will increase understanding and direct towards local available services. 

Some more statistics for BEN PCT:

• Approximately 100,000 individuals in NHS BEN are living with a limiting long term condition (approximately 70% are of working age)
• Second highest perinatal mortality rate in the country
• Over 1 in 3 children in BEN live in poverty
• Washwood Heath is ranked 10th across the UK for high child poverty levels
• Men die an average 6 years earlier that the national rate
• Cardio-Vascular Disease for men in BEN is the major driver for premature mortality
• There is a greater than 6 year difference in average life expectancy in the six miles from Washwood Heath to Sutton town centre, one of the most significant divisions in the region
• 2007 Index of Multiple Deprivation ranked this area as the most 14th deprived local authority in Britain
• Half of the city’s ten priority wards fall within BEN
• The rank of income scale places Birmingham as the most deprived in Britain in terms of income and employment. Worklessness in BEN is particularly concentrated in its most deprived wards: Kingstanding, Washwood Heath and Shard End

Tips on how to look after yourself and your baby during pregnancy

This work has been funded by Birmingham East and North PCT and Health Launchpad.

Type 2 diabetes is up to six times more common in people of South Asian descent, and up to three times more common in those of African and African-Caribbean descent, as demonstrated by the figures below :

• General population – 4.3% in men and 3.4% in women
• Black Caribbean origin – 10% in men and 8.4% in women
• Indian origin – 10% in men and 5.9% in women
• Pakistani origin – 7.3% in men and 8.6% in women
• Bangladeshi origin – 8.2% in men and 5.2% in women

In addition, according to the PBS model, the prevalence of diagnosed diabetes is lower than the expected prevalence, which suggests that there could be a number of people with diabetes who have not yet been identified in practice .

This work has been funded by Westminster Primary Care Trust.

Special thanks also to:

• Our religious advisor, Dr Usama Hasan.
• Effusion
• BEMDA
• Westminster Diabetes Centre
• Dr. Ahmed from Queens Park Health Centre

• The Young Foundation

• Na'eem Ahmed and Imad Ahmed from Selfless
• Ziaur Rahman and Abul Kalam from the Queens Park Bangladeshi Association

Why Diabetes in Tower Hamlets?
Tower Hamlets has a large Muslim community (36%) and understanding how religious beliefs and cultural values shape behaviour and attitudes to healthcare is essential if their needs and health problems are to be addressed. The PCT identified diabetes as a priority, as there are an estimated 13-14,000 people with diabetes in the borough, largely occurring within the Asian community – a prevalence rate of three times the national average.  

Outcomes
Feedback from patients and service providers has been extremely positive.  Many patients were very appreciative of an approach which incorporates faith and information in their first language, and expressed a desire for more resources covering other illnesses prevalent in the community, such as asthma, gastric problems, heart conditions and depression. Consultants and nurses were particularly pleased to have been directly consulted, allowing them to inform the development of a useful resource.  Their engagement with the pilot was instrumental in ensuring its relevance to everyday practice, and their feedback following the pilot will inform further improvements to this approach.

“There was a young, intelligent man who came to me with Type 1 diabetes who told me he was going to fast during Ramadan and I said ‘please don’t, you will die’.  I gave him the DVD and said, ‘maybe you will find something in here to help’.  He got through Ramadan, though I don’t know how or what he did, so if that stopped him from being admitted to hospital, if you save one person, then that’s brilliant.”  

Nurse, Diabetes Clinic, Mile End Hospital

“My dad has diabetes, and I think it’s really useful that it’s in Sylheti.  It would be really good if you could do another project for depression in different languages, especially in Bengali, but also other minority languages as well, because that’s a real problem here in the community.”

Patient, Female, 22, Shah Jalal clinic

“My wife suffers from diabetes, and this DVD is good, it’s very good.  I speak English, but it’s nice to have it in my mother tongue as well.  Also, it would be good to know more about asthma, how to take medicine, gastric diseases”    

Patient, Male, 63, Mile End Hospital

“The Islamic point of view is very good; it’s more inclusive and reaches more people.  Other resources we have been given before have been useless; the patients cannot understand the advice.  This is particularly good for people who have just been diagnosed, but also good as a reminder for long-term sufferers.”

Diabetes Nurse, Varma Surgery

Watch our films and visit our website to learn more about how to look after your health if you have diabetes.

This resource was commissioned by Tower Hamlets PCT.

Maslaha focused on the Washwood Heath and Bordesley Green area of Birmingham, with an 80 per cent BME community – the majority of which are Pakistani (80%).  The PCT has identified significant problems in these areas, including:

• Poor quality infrastructure, with many surgeries occupying converted houses poorly suited to their purpose
• Little change in services since the 1970s
• Some GPs seeing as many as 50 patients in three hours, despite long waiting hours
• High unnecessary prescription of antibiotics
• A vast proportion of patients do not need to see a GP, but visit because of reasons such as psycho-social problems, free prescriptions, worry, and little knowledge of how to manage own health

According to practitioners, the highest risk group is men in their 40s, however women also play a pivotal role as they tend to be more motivated than men and are often in charge of diet.  The typical vicious circle leads to a combination of poor diet, high salt intake, smoking and a lack of exercise contributing towards weight gain leading to abdominal obesity, which South Asians are particularly prone to.

The website and DVD is actively being used by Amaanah Surgery, two schools in the local area and through a local youth organisation called Comm:Pact.

Dr Khalid, who is a partner in Amaanah surgery, said: "This has been the most useful health intervention we have used as it reaches patients directly. There has been a real demand for the DVDs and when we have marketed the website, I know there has been a real surge in use."

Follow our progress and thoughts...

This work has been funded by Birmingham East and North PCT and Health Launchpad.