Understanding the Impact of Socioeconomic

Abstract:

Congenital disabilities have become a major health concern in modern era. Worldwide, high number of neonatal deaths of the new-born are registered due to congenital illness in poor families. Congenital disability is a birth defect in babies that occurs at the intrauterine stage and can be determined after birth or later in life. There are socioeconomic, racial or ethnic and gender disparities that pose adverse impacts on the survival experiences of infants with congenital illness. Generally, infants with a congenital illness, who were born in an ethnic minority or deprived or male-dominated family are more likely to have a lower survival rate. There are different types of congenital anomalies such as down syndrome, cystic fibrosis, pulmonary dysfunction, cerebral palsy and fragile X syndrome. In this context this study will present the current scenario of congenital disability in the society. This study will provide a new insight into how different kinds of disparities in society such as the socioeconomic, racial and ethnic disparity can influence the survival of infant with congenital illness. This study will contribute to provide a new insight on the factors that are associated with the disparities of survival rates of infants who suffer from congenital disorders. This study will also present an evidence-based discussion on how the mortality in infants with congenital illness can be prevented by managing the impacts of these disparities in the health and wellbeing of pregnant mothers and foetus.

Introduction:

This systematic review aims to discuss the disparities in the survival of infants due to congenital illness. Congenital disability can be defined as the disorder or anomaly that develops at birth and may become severe at the later life (Mody et al. 2021). The World Health Organisation defined congenital anomaly as the structural and functional disability that generally appears in the intrauterine life and is recognised at birth or after the birth or later life of children (Peterson et al. 2018). This systematic review will compare and evaluate the database of the selected literature thereby presenting relevant themes on the selected research topic. In discussion section, this systematic review will present a critical discussion in the information that are gathered from the selected literature.

Background:

Congenital disability is also termed as a congenital disorder or congenital anomaly (Davey et al. 2021). The World Health Organisational defines congenital disabilities as the functional or structural anomalies that develop during the intrauterine life and is identified in the prenatal stage, at birth or in the later life of the infant stage (Mody et al. 2021). Evidence suggests that different factors are associated with developing congenital disabilities in infants at their birth, these factors are genetic, socioeconomic, demographic, environmental; and biomedical factors. As mentioned by Peyvandi et al. (2020), pregnant mothers who are exposed to genetic mutation, unhealthy environment, poverty, poor access to health and social care resources due to poor social support are more likely to have a child with congenital disabilities. Although there are several critical regarding the causative factors of congenital disabilities in infants. As mentioned by Mody et al. (2021), rather than environmental and sociological factors, congenital abnormalities in infants in more connected with biomedical and genetic factors/. The evidence regarding this statement suggests that, as genes play important role in maintaining normal function and structure in different organ systems in the foetus, any type of mutation in genes in the foetus as well as in mothers can cause congenital disabilities in infants. On the contrary Peterson et al. (2018), argued that although genetic mutations are strongly associated with causing congenital disabilities in infants, environmental and socioeconomic factors are indirectly related to trigger this genetic mutation which thereby causing these congenital anomalies in infants.

Evidence suggests that there is a high disparity in the survival rates of infants with congenital disabilities. socioeconomic position and racial and ethnic disparity strongly impact the prevalence of mortality in infants with congenital malformation. as mentioned by Malherbe et al. (2018) survival rate of an infant with congenital disorders is lower in ethnic minority communities which be; long to lower socioeconomic class. as stated by Jones et al. (2018), infants mortality due to congenital disorders is higher in poor families because of the maternal risk behaviour, poor support to pregnant mothers, premature birth, lower gestation period, malnutrition, lack of intake of nutritious food during pregnancy and poor accessibility of pregnant mother to good health care facilities.

A report from the WHO shows that congenital disabilities have become a major health concern in newborns and infants who belong to poor and ethnic minority families (Harbert et al. 2020). Worldwide more than 295,000 neonatal deaths of the newborn have been registers due to congenital illness in poor families. As mentioned by Allsworth (2018), in the UK majority of infants death is due to congenital heart disorders and pulmonary dysfunction. There are different types of congenital anomalies such as down syndrome, cystic fibrosis, pulmonary dysfunction, cerebral palsy and fragile X syndrome. And cleft lip. The congenital disabilities in infants are associated with causing long term disabilities which would pose not only on their physical health but also; on their, social, psychological, economic and mental wellbeing in later life.

In this context the selection of this topic is highly appropriate to the current scenario of congenital disability in the society which will provide new insight into how different kinds of disparities in society such as the socioeconomic, racial and ethnic disparity can influence the survival of infant with congenital illness. This study will contribute to provide a new insight on the factors that are associated with the disparities of survival rates of infants who suffer from congenital disorders. Also, this study is highly important in providing the evidence-based information to modern nurses and healthcare professionals regarding the strategies that can be used in clinical practices to reduce these disparities of survival rates in infants by reducing the prevalence of congenital disability in them. This research project will also present an evidence-based discussion on how the mortality in infants with congenital illness can be prevented by managing the impacts of these disparities in the health and wellbeing of pregnant mothers and foetus.

Research aims:

This research project aims to discuss the disparities in survival in infants who suffer from congenital disabilities.

Research objectives:

To analyse the factors that cause disparities in the survival of infants with a congenital illness

To recommend the effective initiatives and strategies that can be used to reduce the disparities in the survival of infants with congenital illness.

Research questions:

What are the factors that contribute to disparities in survival of infants due congenital illness?

How the socioeconomic disparities and health inequalities influence the survival and mortality of infants who suffer from congenital illness?

What are the facilitators that reduce the disparities in survival of infants suffering from congenital illness?

What strategies can be implemented to minimise the disparities in the survival on infants who suffer from congenital illness?

literature review:

A literature review can be defined as the survey of the different scholarly resources such as books, magazines and articles. This literature review section will compare the database that are collected and retrieved from the selected literature. This literature review will also discuss the theories and models related to the congenital illness in infants.

Concept of factors that contribute to inequalities in infant’ survival due to congenital illness in the UK:

Maternal health during pregnancy:

As opined by Green and Thorogood (2018), the prevalence of infant mortality due to congenital disability is triggered by socioeconomic, racial and ethnic disparities. Evidence suggests that there is a strong connection between maternal risk behaviour and the socioeconomic position (SEP) of a family. Pregnant mothers who belong to such a family which has a high SEP is able to afford a good, healthy and systematic gestation period. As mentioned by Gray (2018), the poor socio-economic condition of pregnant mothers is strongly connected with causing mutation or any infection to the foetus which ultimately led to congenital illness. On supporting this view Barbour (2014) mentioned that, mothers who belong to poor and minority ethnic communities have to live in the unhealthy and unhygienic environment and eat unhealthy and cheap foods which lead to lack of nutrition supply to the foetus.

Malnutrition or lack of proper nutritional supply to the foetus can cause premature birth and less gestation period which are considered as the potential risk factors for developing such congenital disabilities in infants that makes them highly vulnerable to death (Mason, 2018). Evidence suggests that the majority of the infants who are born prematurely due to the ill health of mothers are more like the key to having long term congenital health conditions such as heart condition or pulmonary illness which are highly fatal.

Ethnicity of mothers:

As mentioned by He et al. (2017), ethnicity has severe impacts on the prenatal and post-natal health of infants. The evidence-based report suggests that black infants with congenital illness are 1.3 times more vulnerable to mortality and morbidity than white infants. While discussing the connection between the survival of the infant with congenital illness Travers et al. (2020) mentioned that, ethnicity impacts the socioeconomic position, lifestyle, perspectives, living standard and culture of the family. As stated by Gidi et al. (2020), pregnant women who belong to the ethnic monitory community are more likely to be neglected bot socially, economically and culturally in the society which poses adverse impacts other gestation health thereby increasing the mortality risk of an infant by developing prevalence of lion term congenital illness.

As mentioned by Gidi et al. (2020), there is strong relation between the gestational health of pregnant women and their ethnicity. Maternal ethnicity decides whether there will be any risk of developing a congenital illness in later life of infants (Mody et al. 2021). Evidence suggests that, in most of the cases of women who belong to minority ethnic community, have poor family support, lack of proper healthcare advise from NHS staffs, lack of respect in the society, poor mental and physical health and lack of healthy eating during their pregnancy. Women who belong to the minority ethnic community in UK and USA, such as South Asian or Africa community, are most of the times suffer from poor gestational health which leads to pre-mature delivery of babies. As stated by Malherbe et al. (2018), premature delivery can contribute to develop congenital disabilities babies in later life. As argued by to Peyvandi et al. (2020), as compared to the pregnant mothers who belong to white communities, the pregnant mothers who live in ethnic minority communities are more likely to face a lack of family support, poor nutritional support lack of partner’s support, lack of psychological and spiritual support and proper health education, which makes the foetus to suffer from the different genetic defect of poor heath which then reduces their survival rate after birth. General disparities in society are also a potential factor that poses adverse impacts on the survival rate of infants suffer from congenital illness.

On the contrary Gidi et al. (2020) argued that, although ethnicity can be potential causes of mortality in infants suffering from congenital illness, there are many other factors that influence disparities in survival rate in infants who suffer from congenital illness such as, socio economic disparities, gender bias, the quality-of-care delivery to pregnant women and their regular lifestyle. Many cases have been registered in NHS hospitals, in which pregnant mothers despite belonging to well-educated and high-profile family background face premature delivery or infant death at post-natal period due to their irregular and unhealthy lifestyle during pregnancy. Moreover, the unavailability of doctors at right time during the end of gestation period, lack of experiences and skill of midwives to support the pregnant mothers and skill of paediatricians who check the health condition of the new born are also the important factors that contribute to widening the disparities of survival rates in infant suffering from congenital illness. (Malherbe et al. 2018).

As argued by Harbert et al. (2020), gender disparity in many ethnic minority and deprived communities makes the family members do not support the needs of the pregnant women which leads to mortality of babies due to premature birth or if babies are born at full gestational week, then there are high chances of developing different congenital abnormalities which reduce the survival probability of infants. On the contrary Malherbe et al. (2018) argue that social, racial and ethnic disparities, are not only associated with poor support and care to pregnant women but also associated with creating severe disparities in knowledge which influence the survival rate of an infant with congenital illness.

On the contrary Mody et al. (2021) argued that, the preference of male children in backdated and deprived communities leads to a poor family support, pack of economic and nutritional support to the mothers at post-partum period, which makes motes have reduces the production of breast milk and have an ill-health which can cause infant death due to developing the congenital illness.

Poor education and knowledge gaps in pregnant mothers:

As stated by Malherbe et al. (2018), knowledge gaps become wider in the people belonging to the poor, ethnic minority community in which pregnant mothers hardly have any knowledge regarding maintaining a healthy pregnancy and good infant health after birth. The survival rate of an infant with congenital disabilities is 3 times more in families who belong to high socio-economic and majority communities as compared to their peers who belong to poor and ethnic minority communities. Jones et al. (2018) justify this statement by stating that. Pregnant mothers belonging to rich and high societies are well educated and is exposed to regular up to date health care information regarding effective management in pregnancy, who improve their knowledge and activities in leading a healthy life (O'Driscoll et al. 2018). Therefore, in the case of infants belonging to rich and well-educated families, by performing the different medical tests, parents and health professionals can make an earlier determination of any genetic defects or anomalies in the foetus.

Literature gaps:

During carrying out this literature review, different limitations or drawbacks are also identified. The first drawback of the selected literature is that it fails to discuss the impacts that the disparities in survival of infants with congenital illness on the health and wellbeing on wider society. Moreover this literature review mainly emphasizes on factors contributing to the inequality in survival rate in infants, but the selected literature fails to point out the strategies that can be implemented to reduce the wider disparities in the infant survival due to congenital illness. Also there are limited clinical interventions that are described in the selected literature which is not sufficient to provide an evidence-based information to modern clinicians regarding how to reduce the disparities in the survival rate in the infants suffering from congenital illness.

Data search strategy and source:

Research methodology is the crucial aspect in any research project which outlines the entire systematic pathways which the researcher is going to follow to accomplish the research study (Barbour, 2014). For conducting this systematic review here the researcher used the PRISMA tool for screening, retrieving and extracting data from relevant published articles. This systematic review is carried out by using 5 online database systems such as CINAHL, MEDLINE, PubMed, Psych Info and British National Index however after searching the research articles through using BNI it was seen that the majority of the research papers are repeated. Different relevant key terms are used to select and retrieve the appropriate research articles. These key terms are congenital disability, infant mortality, prenatal, post natal and gestational. This systematic review also used Boolean operators for narrow or extend the literature search thereby selecting thte highly relevant research articles. Boolean operators such as AND, OR and NOT are used to expand or narrow the literature search. following keywords are used for this literature search:

 Keywords /search terms:

Study selection criteria:

Inclusion and exclusion criteria:

Inclusion and exclusion criteria are the crucial aspects of any secondary research study or systematic research which enable the researcher to narrow the literature search thereby retrieving only relevant research articles (Green and Thorogood, 2018). Inclusion and exclusion criteria can be defined as the predefined characteristics of any research study that are used to select the objectives that can be applied to search for the appropriate research particles on the research topic.

First a total of 468 articles were searched by using online database. After this first search it was seen that majority of articles are not valid as they were older more than five years. Therefore, a second search was generated by using 5-year time frame (2016-2021 years) to select only the research papers that are published in 5 years-timeframe. In this search a total of 85 research papers were selected. Then a third screening of the research articles was conducted to select such research papers that contain highly valid and authentic research elements such as valid research design research methodology, data collection and data analysis process. Then a fourth search was conducted as the search result gained after conducting the third search was not able to provide the authentic and valid research articles. In this fourth search the validity of the abstract and the literature review of each research articles are screened and analysed. Then 70 research papers were obtained. Then a fifth and sixth search were conducted which resulted into 32 and 22 research articles respectively. Finally, a sixth literature search had been conducted to check the online accessibility of the selected research papers. Finally, 8 research papers were selected. [Refers to Appendix: PRISMA tool]

Data extraction:

A data extraction has been initially carried out by the researcher by using the standardised data collection form. Then the researcher checked the quality of the extracted research data. The data extracted from the selected literature are tabulated in the PARISH table in Appendix. The extracted data include different characteristics such as year of publication, authors, country, sample size, study design, research methods, usefulness and limitations. The data extraction assisted the researcher of this study to carry out an effective quality assessment of the selected research article. [Refers to Appendix 2: PARISH table]/p>

Risk of bias assessment:

Risk of bias has been assessed by the researcher to analyse different criteria of the selected research papers set transparency in the selection method, retrieval of the data, performance, attrition, detection, reporting and detections. Here researcher categorise the risk of bias as low, moderate, critical, serious and unclear. The research paper that have serious risk of bias are generally excluded from the literature search. Articles with low or moderate risk of bias are included based on the importance of their database regarding meeting the research objectives.

Assessment of the quality evidence:

Here researcher has used The Grading of Recommendations Assessment, Development and Evaluation (GRADE) in terms of assessing the quality of ah research evidence. The quality of the selected evidence are assessed in the five domains such as: 1. the validity of the study design, 2. the validity of the research method, 3. Credibility of athirst, 4. Unexplained inconsistency or heterogeneity of research results, 5. Publication bias, and 6. Indirectness to the research evidence. All these domains are used by the research to analyse the validity authenticity and credibility of the research articles.

Chapter 4: Data analysis and synthesis: (Thematic analysis)

Following themes are formulated by analysing the findings from the selected research articles.

Theme 1: Disparities in the survival rate of infants with congenital disabilities due to racial and ethnic disparity:

The racial or ethnic disparity is strongly associated with the health outcomes for the infant who suffer from congenital disabilities. As mentioned by Peyvandi et al. (2020) ethnicity mediates lifestyle, food habits, culture, perspective, food preference and regular habits of families. Evidence suggests that health inequalities in an infant with congenital illness are stringily collected with their ethnic background or racial trend (Peterson et al. 2018). This statement is supported by Harbert et al. (2020) by stating that, in the majority of the ethnic minority community there is a higher rate of infant mortality due to congenital heart failure or pulmonary illness. Evidence suggests that there is a strong association between congenital cardiac disease in infants and their ethnicity or racial background. As opined by Allsworth (2018), women from the ethnic minority group suffer from a lack of better health education, proper healthcare guidelines, and lack of regular health check-ups during the pregnancy and devoid of proper gestational healthcare tests which makes it difficult for them to maintain the safety measures and healthy lifestyle that are needed for a healthy pregnancy

As argued by Malherbe et al. (2018), race and ethnicity play major roles in determining the access of women to proper healthcare facilities, better education, good social support and proper family care during their pregnancy. In this context, Jones et al. (2018) stated that evidence suggests that, survival rates in infants suffering from congenital health condition is lower if they born in an ethnic minority family. This is because, in most cases, the pregnant women which belong to ethnic minority communities do not get proper healthcare support family care, positive emotional and psychological support, financial support and nutritional support, which creates difficulties in forming an organ system in the foetus.

As mentioned by O'Driscoll et al. (2018), as compared to white women, black women are more likely to give premature birth to their babies in which most of the babies are diagnosed with congenital diseases. PHE (2019), mentioned that in England and Wales many cases of premature birth and post-natal death of infants of South Asian and black mothers have been registered (Gidi et al. 2020). Clinical intervention shows that the potential reason behind disparities in the survival rates in white and black ethnic infants is the gestational health complications, malnutrition to the foetus and lack of systematic and proper eat care support due to pregnancy.

As mentioned by Travers et al. (2020), maternal ethnicity race strongly influences the survival experience of infants. Evidence-based studies show that the mortality rate in infants of non-Hispanic black mothers is higher as compared to infants of white mothers. The survival rate of infants of non-Hispanic black mothers is reduced by 50% due to hog prevalence of hypoplastic left cardiac syndrome in them. The recent WHO report also shows that worldwide, the survival rates of children and infants of mothers who belong to ethnic minority communities reduce at a faster rate due to the prevalence of down syndrome, and cerebral pulse in infants. As stated by He et al. (2017), many cases of infant deaths are registered worldwide due to cerebral palsy in ethnic minority families. Although there are many criticisms regarding the connection between congenital illness in infants that are genetic and maternal ethnicity, many studies suggest that the gene mutation that causes down syndrome is triggered by different socioeconomic, environmental and racial factors (Chou et al. 2019). In the case of others belonging to the ethnic minority community generally do not receive the proper physical, psychological and emotional support that they need during their pregnancy which can contribute to making hormonal and biological changes in the body thereby increasing the risk of developing genetic congenital disabilities infants.

Theme 2: Impacts of health inequalities on survival of infant with congenital disability due to socioeconomic disparity:

The survival experiences of infants suffering from congenital disabilities are triggered by the socioeconomic condition of their families. The socioeconomic standard of a family meditates and determines the ability of mothers to afford good nutrition, a healthy environment, positive thoughts, proper psychological and emotional assistant and good living standards throughout the gestational period (Davey et al. 2021). As opined by Peyvandi et al. (2020), poverty plays a crucial role in reducing the survival rates in infants by developing fatal congenital disabilities in them such as cerebra palsy, down syndrome, and chronic pulmonary illness. As argued by Mody et al. (2021), although the maternal socioeconomic conditions are connected with survival disparities in infants with a congenital illness, there are many cases of infants’ death in rich and high society families due to lethal congenital health conditions. Evidence suggests that unemployment lack of education lack of proper housing and low standard food intake leads to an unhealthy pregnancy which reduces the survival experiences of infants born in these underprivileged families. As mentioned by Peterson et al. (2018), in case of pregnant mothers who reside in the deprived community have other options but to unhealthy and unhygienic housing conditions with lack of light and air which pose adverse impacts on their gestational health. As mentioned by Jones et al. (2018), there are many cases in the UK, in which pregnant mothers belonging to a lower socioeconomic class are diagnosed with diet chronic health condition such as gestational diabetes, cardiac problem and pulmonary diseases which also transfer to the foetus through amniotic fluid thereby developing fatal congenital illness in babies after birth.

As stated by Harbert et al. (2020), disparities in the survival of infants who suffer from congenital illness are strongly associated with the disparities in family income, social support and accessibility to good health and social care. Mothers belonging to poor familiarities generally do not get any supportive community environment and proper family support which pose adverse impacts on the health and wellbeing of their foetus at the intrauterine stage. As mentioned by Allsworth (2018), pregnant mothers need full support from their society to access inclusive services and all the healthcare facilities. Pregnant mothers need proper support in meeting all their personalised needs such as a clean and hygienic environment in their surroundings, lack of stress, good and healthy dietary advice, regular health check-up and consistent motivation. Maternal socioeconomic condition is strongly connected with how the foetus will get all the nutrition and will develop all the organ systems in proper form.

Theme 3: Prevalence of morality of infant with congenital disability and gender disparities:

Gender disparity is also associated with a reduced survival rate of nutrients with congenital illness. As mentioned by O'Driscoll et al. (2018), in a male-dominated society, the personalised needs of women are always neglected. The survival experiences of infants are dependent on whether pregnant or nursing mothers get proper healthcare support good nutrition healthy environment, proper physical and psychological assistance and family support throughout the gestation. As mentioned by Gidi et al. (2020), gender bias in society makes severe negligence to the personalised needs of pregnant mothers which not only impact the health and wellbeing of mothers but also impact adversely the prenatal health of babies. Many cases of brain malfunction, poor heart function and improper formation o organs of prenatal babies are registered due to the fact that they do not get the support and care from their family members as well as the partners during their pregnancy.

As opined by Peyvandi et al. (2020) there are many south Asian communities residing in the rural and suburban region in England and Wales, in which pregnant women suffer from brutal behaviour, harsh attitude and severe neglect from their partners and in-laws which impact their physical and mental health. Evidence suggests that in male-dominated families, pregnant women are mots of the times are not allowed to express the issues that they experience during pregnancy, the health needs and mental and physical needs which adversely impacts the development and growth of the foetus (Peterson et al. 2018). There is high mortality of infants due to congenital cystic fibrosis, in male-dominated ethnic minority communities, due to mothers do not follow proper medicate regimen ad healthy diet during pregnancy. As opined by Mody et al. (2021), survival experiences in an infant with congenital illness are poor in which mothers suffer from gestational health complications, physical and mental health problems and poor family guidance. Even in many cases, women cannot get assistance from their partners to take them to the gynaecologist for receiving regular advice. In many communities, gender bias is so apparent that it impacts adversely on the girl child, in which if the girl child born with a congenital illness, they are neglected from getting proper healthcare facilities and family support which makes them highly vibrance to death. On the other had. In the post-partum period, which is crucial for nursing mothers to get proper family and healthcare support, there are many families who pose stress, overburden of household words and mental torture on nursing mothers which cause a reduction in breast milk production thereby hampering the nutrition to the new-born. As stated by Jones et al. (2018), in male-dominated families, nursing mothers often can not get proper nutrition, physical rest, positive vibes and care, which makes it difficult for new-born to get proper nutrients through breast milk. Malnutrition, due to lack of proper nutrition to an infant with congenital illness leads to the infant's death.

Theme 4: effective initiative in reducing health inequality in infants suffering from congenital illness:

Under the health and social care act (2015), health and social care providers will support all the personalised and healthcare needs of pregnant and new mothers (Jones et al. 2018). Though providing proper health education to pregnant mothers in the ethnic minority community, it is possible to improve the knowledge of pregnant women regarding what strategies they can use to have a healthy and risk-free vergency (Harbert et al. 2020). Though conducting a health promotion campaign against health inequalities for the infant with a congenital illness, health and social care providers must promote awareness of would-be or new parents regarding what is a congenital illness, how it develops in the prenatal period and how its risk can be prevented. As argued by Allsworth (2018), in the case of removing health inequalities in societies to reduces the disparity in the survival of infants with a congenital illness, it is important to improve the socio-economic condition of families. UK government have already taken initiatives in increasing employment opportunities in backward and minority communities by providing skill development training and professional career cared knowledge which will contribute to improving the socio-economic condition of these families by providing them employment opportunities (O'Driscoll et al. 2018). Through improving the income level of families, providing them with proper housing facilities and improving the social environment, the government can contribute to the positive development of mental and physical health of mothers which will reduce the mortality risk in babies with congenital illness.

By conducting the health awareness campaign for women, health and social care providers can approach all pregnant women, new mothers and unmarried women, to improves their knowledge regarding how to reduce the risk of congenital illnesses in the newborn. As mentioned by O'Driscoll et al. (2018), community care nurses must play a crucial role in guiding women during their pregnancy to get proper healthcare facilities from GP clinics and undertake all the healthcare examinations to determines the health status of both mother and foetus.

Limitations of the research:

The potential limitations of this research study are that due to time and fund insufficiency more research papers could not be analysed and included in this research that may create some gaps regarding presenting the evidence-based information on the topic. Many of the good and highly authentic research papers cannot be accessed just because they are paid articles. Dur to time limitations only three factors associated with disparities of survival rates of infants with congenital illness can be considered and discussed rather than covering other important factors such as the availability of healthcare, environmental factors, biological factors, psychological factors.

Chapter 5: Conclusion:

From the above-mentioned discussion, it can be concluded that congenital disability is a birth defect in babies that occurs at the intrauterine stage and can be determined after birth or later in life. There are socioeconomic, racial or ethnic and gender disparities that pose adverse impacts on the survival experiences of infants with congenital illness. Generally, infants with a congenital illness, who were born in an ethnic minority or deprived or male-dominated family are more likely to have a lower survival rate. This is due to the gestational health complication of mothers belonging to deprived and ethnic minority communities due to negligence to their basic needs. Through proper health education, healthcare support, developing self-management skills and meting the personalised needs of mothers it is possible to reduce the health inequalities for infants with congenital illness thereby reducing their mortality rate.

Reference list:

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Chou, F.S., Chakradhar, R. and Ghimire, L.V., 2019. Socioeconomic and racial disparities in the prevalence of congenital heart disease in infants of diabetic mothers. The Journal of Maternal-Fetal & Neonatal Medicine, pp.1-4.

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Davey, B., Sinha, R., Lee, J.H., Gauthier, M. and Flores, G., 2021. Social determinants of health and outcomes for children and adults with congenital heart disease: A systematic review. Pediatric Research, 89(2), pp.275-294.

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He, H., Xiao, L., Torrie, J.E., Auger, N., McHugh, N.G.L., Zoungrana, H. and Luo, Z.C., 2017. Disparities in infant hospitalizations in Indigenous and non-Indigenous populations in Quebec, Canada. CMAJ, 189(21), pp.E739-E746.

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Malherbe, H.L., Christianson, A.I., Woods, D. and Aldous, C., 2018. Contribution congenital disorders to neonatal mortality in South Africa. South African Medical Journal, 108(7).

Mason, J. (2018) Qualitative Researching. 3rd edition. Sage. London.

Mody, K.S., Henstenburg, J. and Herman, M.J., 2021. The Health & Economic Disparities of Congenital Musculoskeletal Disease Worldwide: An Analysis of 25 Years (1992-2017). Global Pediatric Health, 8, p.2333794X21994998.

O'Driscoll, D.N., McGovern, M., Greene, C.M. and Molloy, E.J., 2018. Gender disparities in preterm neonatal outcomes. Acta Paediatrica, 107(9), pp.1494-1499.

Peterson, J.K., Catton, K.G. and Setty, S.P., 2018. Healthcare disparities in outcomes of a metropolitan congenital heart surgery center: the effect of clinical and socioeconomic factors. Journal of racial and ethnic health disparities, 5(2), pp.410-421.

Peyvandi, S., Baer, R.J., Chambers, C.D., Norton, M.E., Rajagopal, S., Ryckman, K.K., Moon‐Grady, A., Jelliffe‐Pawlowski, L.L. and Steurer, M.A., 2020. Environmental and Socioeconomic Factors Influence the Live‐Born Incidence of Congenital Heart Disease: A Population‐Based Study in California. Journal of the American Heart Association, 9(8), p.e015255.

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Seale, C. editor. (2018) Researching Society and Culture. Fourth edition. London. Sage.

Travers, C.P., Carlo, W.A., McDonald, S.A., Das, A., Ambalavanan, N., Bell, E.F., Sánchez, P.J., Stoll, B.J., Wyckoff, M.H., Laptook, A.R. and Van Meurs, K.P., 2020. Racial/ethnic disparities among extremely preterm infants in the United States from 2002 to 2016. JAMA network open, 3(6), pp.e206757-e206757.

PRISMA tool

PRISMA tool

Appendix 2: PARISH table:

PARISH table: PARISH table: PARISH table: PARISH table: PARISH table: PARISH table: PARISH table:
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