Academic literature on the topic 'Birth control Australia'

SummaryOfficial abortion statistics for South Australia for the years 1977–81 were examined and compared with those for 1970–76 reported earlier. The period 1970–81 represents the first 12 years' experience of legalized abortion in South Australia. A consistent increase in the incidence of abortion was noted, both in absolute numbers and in proportion to the number of live births. South Australia continued to experience lower fertility than other Australian states, although this would have been higher than in other states had it not been for the legalization of abortion. More of the younger and the unmarried women were obtaining abortions, indicating that they were increasingly using abortion as a form of birth control.

Objective: To provide information on live-birth prevalence and hospitalizations, including anxiety and depression, for cleft lip and/or palate (CL/P) in Western Australia (WA), using live-birth data 1980 to 2015. Design: Retrospective data linkage. Setting: Tertiary hospital. Patients: Cleft cohort consisted of people live-born with CL/P in WA between 1980 and 2015, and a gender and age-matched control group. Measures: Live-birth prevalence for CL/P by year. Hospital event counts, event ages, and length of stay (LOS) days by 18 diagnosis groups and 4 birth year categories between the cleft cohort and control group, and between cleft types. Count of events per alive persons per calendar year, and relative risk for proportions of persons in the cleft cohort and control group by diagnosis group. Results: Live-birth prevalence for CL/P was 19.7 per 10 000 (1 in 522). The cleft cohort had significantly higher event counts, lower event ages, and higher LOS days than the control group. Cleft lip and palate had significantly higher event counts, lower event ages, and higher LOS days than cleft lip or cleft palate only. There were 2 significant differences for anxiety or depression between the cleft cohort and control group, lower event ages, and higher LOS days in 1990s birth year category. Conclusions: This study provides a cleft data reference for WA. Live-birth prevalence for all clefts and by cleft type offers an appropriate method for estimating service utilization and provision. Patients with cleft accessed hospital services more frequently, at an earlier age, with higher LOS days than the control group.

ObjectiveEstimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.DesignCase–control study.SettingSites in Australia and New Zealand with at least 50 births per year.ParticipantsCases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.MethodsData were collected using the Australasian Maternity Outcomes Surveillance System.Primary and secondary outcome measuresIncidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).ResultsThe incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.

Background Most evidence for interpregnancy interval (IPI) and adverse birth outcomes come from studies that are prone to incomplete control for confounders that vary between women. Comparing pregnancies to the same women can address this issue. Methods We conducted an international longitudinal cohort study of 5,521,211 births to 3,849,193 women from Australia (1980–2016), Finland (1987–2017), Norway (1980–2016) and the United States (California) (1991–2012). IPI was calculated based on the time difference between two dates—the date of birth of the first pregnancy and the date of conception of the next (index) pregnancy. We estimated associations between IPI and preterm birth (PTB), spontaneous PTB, and small-for-gestational age births (SGA) using logistic regression (between-women analyses). We also used conditional logistic regression comparing IPIs and birth outcomes in the same women (within-women analyses). Random effects meta-analysis was used to calculate pooled adjusted odds ratios (aOR). Results Compared to an IPI of 18–23 months, there was insufficient evidence for an association between IPI <6 months and overall PTB (aOR 1.08, 95% CI 0.99–1.18) and SGA (aOR 0.99, 95% CI 0.81–1.19), but increased odds of spontaneous PTB (aOR 1.38, 95% CI 1.21–1.57) in the within-women analysis. We observed elevated odds of all birth outcomes associated with IPI ≥60 months. In comparison, between-women analyses showed elevated odds of adverse birth outcomes for <12 month and >24 month IPIs. Conclusions We found consistently elevated odds of adverse birth outcomes following long IPIs. IPI shorter than 6 months were associated with elevated risk of spontaneous PTB, but there was insufficient evidence for increased risk of other adverse birth outcomes. Current recommendations of waiting at least 24 months to conceive after a previous pregnancy, may be unnecessarily long in high-income countries.

Subcutaneous hormone implants are a useful method for managing overabundant marsupials in restricted enclosures in Australia. Levonorgestrel induces long-term infertility in the kangaroo, tammar wallaby and koala, although the contraceptive mechanism of levonorgestrel is unknown for any marsupial. In the present study, it was investigated if insertion of a single levonorgestrel or control implant at the time of reactivation of the diapausing blastocyst affected the subsequent post-partum oestrus or the preceding follicular development. Twenty levonorgestrel-treated and 16 control animals were autopsied the day before birth and the accompanying post-partum oestrus (Day 25), and 10 levonorgestrel-treated and five of the nine control animals were autopsied 3–4 days (Days 29–30) after the expected birth and oestrus. Peripartum behaviour was observed and birth and mating times were recorded. Levonorgestrel treatment did not prevent follicular growth because there was no significant difference between treatment and control animals in the size of the dominant follicle at Day 25. None of the levonorgestrel-treated females autopsied at Days 29–30 had ovulated (n = 10), in contrast to controls, where four of the five that were autopsied had ovulated. Mating occurred in eight of nine control animals but in only three of 10 levonorgestrel-treated females. Males showed a more sustained period of interest in the three that were mated than in the controls, and mating took place significantly later after birth (36 v. 10 h; P = 0.038). Follicular growth and development was not blocked in any female but only one-third of the animals mated and none ovulated after levonorgestrel treatment. These results suggest that levonorgestrel inhibits the preovulatory surge of luteinising hormone.

2010 sees the 50th anniversary of the introduction of the oral contraceptive pill in 1960. This development was made possible by the synthesis of the first orally active progestin some 9 years earlier. The contraceptive pill is the most popular means of family planning in developed countries, and arguably the most effective. It is the most common method of contraception in the USA (18%), Canada (14%), Australia (27%), New Zealand (20%) and most European countries, including the UK (26%)1. Reproductive health and success have in the past and continue today to be important contributors to our survival as a species. However, even from ancient times, there have been attempts to limit the effect of Eve's curse by reducing the number of children and spacing of successive pregnancies. However, it was only with advances in both scientific knowledge and understanding, together with social reforms, that information about birth control and the means to control fertility became widely available in the last century.

Although there is now substantial evidence linking low birthweight with impaired glucose tolerance and type 2 diabetes in adult life, the extent to which reduced fetal growth is associated with impaired insulin sensitivity, defective insulin secretion, or a combination of both factors is not clear. We have therefore examined the relationships between birth size and both insulin sensitivity and insulin secretion as assessed by an intravenous glucose tolerance test with minimal model analysis in 163 men and women, aged 20 yr, born at term in Adelaide, South Australia. Birth size did not correlate with body mass index or fat distribution in men or women. Men who were lighter or shorter as babies were less insulin sensitive ( P = 0.03 and P = 0.01, respectively), independently of their body mass index or body fat distribution. They also had higher insulin secretion ( P = 0.007 and P = 0.006) and increased glucose effectiveness ( P = 0.003 and P = 0.003). Overall glucose tolerance, however, did not correlate with birth size, suggesting that the reduced insulin sensitivity was being compensated for by an increase in insulin secretion and insulin-independent glucose disposal. There were no relationships between birth size and insulin sensitivity or insulin secretion in women. These results show that small size at birth is associated with increased insulin resistance and hyperinsulinemia in young adult life but that these relationships are restricted to the male gender in this age group.

Background Community lockdowns during the coronavirus disease 2019 (COVID-19) pandemic may influence preterm birth rates, but mechanisms are unclear. Methods We compared neonatal outcomes of preterm infants born to mothers exposed to community lockdowns in 2020 (exposed group) to those born in 2019 (control group). Main outcome studied was composite of significant neonatal morbidity or death. Results Median gestational age was 35 + 4 weeks (295 infants, exposed group) vs. 35 + 0 weeks (347 infants, control group) (p = 0.108). The main outcome occurred in 36/295 (12.2%) infants in exposed group vs. 46/347 (13.3%) in control group (p = 0.69). Continuous positive airway pressure (CPAP) use, jaundice requiring phototherapy, hypoglycaemia requiring treatment, early neonatal white cell and neutrophil counts were significantly reduced in the exposed group. Conclusions COVID-19 community lockdowns did not alter composite neonatal outcomes in preterm infants, but reduced rates of some common outcomes as well as early neonatal inflammatory markers.

AbstractThe aim of this study was to evaluate attention difficulties in a contemporary geographic cohort of adolescents born extremely preterm (EP, <28 weeks’ gestation) or extremely low birth weight (ELBW, birth weight <1000 g). The EP/ELBW group included 228 adolescents (mean age = 17.0 years) born in Victoria, Australia in 1991 and 1992. The control group were 166 adolescents (mean age = 17.4 years) born of normal birth weight (birth weight >2499 g) who were recruited in the newborn period and matched to the EP/ELBW group on date of birth, gender, language spoken and health insurance status. Participants were assessed on measures of selective, sustained, and executive (shift and divided) attention, and parents and participants completed behavioral reports. The EP/ELBW group performed more poorly across tests of selective and executive attention, had greater rates of clinically significant difficulties compared with the control group, and also had greater behavioral attention problems as reported by parents. Neonatal risk factors were weakly associated with attention outcomes. In conclusion, higher rates of attention impairments are observed in individuals born EP/ELBW well into adolescence and may have consequences for their transition to adulthood. (JINS, 2013,19, 1–12)

This dissertation traces how eugenics came to underpin discourses pertaining to free love, sex and reproduction in 1920s-1930s China. It shows the eugenic and evolutionist limits to radical or liberal intellectuals' understanding of the role of the individual in the pursuit of sex, free love and birth control. The study examines the scientific view of modernity embodied in eugenics, as well as the challenges to this vision based on humanism and sex aestheticism. Bertrand Russell's visit to China in 1920 with his lover Dora Black led to heated discussions surrounding free love and free divorce, where privacy, the eugenic idea of a "robust individual" and science were key. Meanwhile, translations and the reception of Ellen Key and Havelock Ellis's works on eugenics and love underpinned the reconciliation in Chinese liberal intellectuals' thought between individualism/evolutionary humanism and eugenics, particularly in their debates on sexual and emotional ethics in the 1920s. Margaret Sanger's visit to China in 1922 opened up a debate on the suitability of eugenic birth control to solve China's problems, such as overpopulation and venereal disease. By probing into her interactions with Chinese intellectuals in 1922, this study reveals how her eugenic ideas were received, as well as the political tensions regarding her birth control advocacy. The dissertation demonstrates that the sexual reproductive considerations that had been viewed in the 1920s as a problem of the relationship between the individual and nation/race/society, by the 1930s came to completely subordinate the role of the individual to national and racial regeneration concerns. Sanger's continued correspondence with Chinese medical professionals came to shape the birth control movement in the 1930s in more strictly eugenic terms. This research contends that eugenics was not only influential in discourse, but came to be implemented in practice in the fields of sex hygiene, birth control and VD regulation. The agency of pioneer female gynecologists in the 1930s is emphasized by examining how they brought eugenics in practice in their birth control clinics, how they localized global female experience and theories on birth control and hygiene, either through translation or through their attempts to reach working class women with contraceptive sex education. Lastly I argue that eugenics and social hygiene also functioned as a male oriented ideology in VD policies of various colonial powers: British, American, Japanese, and French as part of an economy of empire. By contrast Chinese Nationalist Hygiene Campaigns and female gynecologists' internalizing of eugenics focused on female health.

This thesis investigates Australian and Canadian legislation that regulated women's reproduction in the late nineteenth and early twentieth century and offers some explanation for their enactment. At the turn of the twentieth century, Australia and Canada enacted a series of laws that were aimed at limiting the control women could exercise over their reproductive functions. From the 1880s through to the first decade of the twentieth century, legislation that prohibited the advertisement of contraception, regulated maternity homes as well as criminal laws that proscribed abortion were promulgated by Australian and Canadian parliaments. This thesis investigates why such legislative activity occurred and proposes that the initiation of these measures targeting abortion, infanticide and birth control cannot be disassociated from the highly gendered and racialised rhetoric resonating throughout the British Empire. Concern about racial integrity, heightened by a fear generated by the declining birth rate, promoted a climate in which exercising control over women's fertility was seen as warranted. White women's reproductive capabilities were a vital ingredient in keeping the settler colonies of Australia and Canada white and British — white women were expected, quite literally, to give birth to the nation. As this thesis shows, when women did not adhere to these expectations of maternity, the law was used in an attempt to monitor and regulate their reproductive activities.

This thesis was written against the backdrop of Australia’s low fertility rate to investigate perceptions at the individual level, and within the social context, of influences on fertility and family size. The thesis aligns itself with cultural, ideational and institutional theories of fertility change. It seeks to augment contemporary debate and policy, which centre around work-family compatibility and the financial costs of children, by also investigating the influence of individuals’ expectations and experiences of conception, pregnancy, birth and early parenthood. For several decades the geographical, medical and sociological literature has shown these reproductive events to heavily impact on the physical and mental well-being of parents in developed societies, but it is only recently that some demographers have suggested that they warrant renewed investigation in low fertility research. These aspects are all the more salient as postmodern values associated with concern about personal well-being have risen to prominence and have become associated with the transition to below replacement fertility. The primary research in the thesis comprises 62 in-depth interviews with parents from across metropolitan South Australia, and a small survey of 45 individuals intending to start a family within two years. The thesis intentionally includes the views of men and of parents with larger families. Analysis of 1996 Census data establishes fertility patterns at the macro level as a basis for exploring the qualitative data. The thesis findings contribute new knowledge by showing that in South Australia cultural and family influences shape images of family life and family size despite the rhetoric of modern reproductive “choice”. They also demonstrate how lower fertility can result from individuals with postmodern preferences finding their experiences of parenthood clashing with their preferences for autonomy, rationality, personal achievement and quality of life. The thesis argues that such experiences can diffuse socially to negatively influence the images and anticipated impacts of parenthood, and hence the fertility desires, of others. In identifying gender differences in the impacts, the thesis concludes that low fertility theory and policy must diversify to better reflect the concerns of women as mothers, and to consider the embodied and social aspects of reproductive behaviour.
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Thesis (Ph.D.) -- University of Adelaide, School of Social Sciences, 2006

The aim of this doctoral thesis was to study the incidence, risk factors and outcomes of type 1 diabetes for children in South Australia, born from 1999-2013. The incidence of type 1 diabetes has doubled in the last four decades in many countries including Australia, and has substantial individual and economic consequences. Evidence from studies on type 1 diabetes aetiology and its implications is mixed. In this thesis, the linkage of multiple population-wide administrative data over 15 years, and use of rigorous epidemiological approaches has resulted in a better understanding of the risk factors and implications of type 1 diabetes. There are four studies in this doctoral thesis. In the first descriptive study, the incidence of type 1 diabetes was estimated by individual and area-level socioeconomic characteristics among children (aged ≤11 years) in South Australia, born from 2002-2013. Findings of the study showed that type 1 diabetes incidence rates differed depending on the measures of socioeconomic characteristics. Individual-level indicators showed higher type 1 diabetes incidence among more advantaged children, however, there was no clear area-level socioeconomic patterning of type 1 diabetes. Area-level measures of socioeconomic position are likely to have a greater risk of misclassification from true socioeconomic position, which suggests that the use of area-level measures may be misleading. Socioeconomic position is a major determinant of health and can modify the risk factors of type 1 diabetes. For example, as per hygiene hypothesis, the socioeconomically dis-advantaged children are less likely to have type 1 diabetes, which is supported by the findings of individual-level socioeconomic patterning of type1 diabetes in the first study. In addition, socioeconomically disadvantaged women are less likely to have a caesarean birth and more likely to smoke in pregnancy. I chose to study these two risk factors of type 1 diabetes because the evidence was inconsistent, and some studies had methodical limitations. Evidence about the effect of caesarean section on childhood type 1 diabetes is mixed; ranging from very small or no risk to 20-30% increased risk. A prevailing theory is that exposure to the gut and vaginal microbiota during a vaginal birth protects against type 1 diabetes. Therefore, in the second study, the impact of caesarean birth on childhood type 1 diabetes (aged ≤15 years) was estimated. This involved linking multiple administrative datasets of children in South Australia, born from 1999-2013. The question was extended to whether type 1 diabetes risk differed for children born by prelabour or intrapartum caesarean to further test the idea of microbiota exposure on type 1 diabetes. That is because children born by prelabour caesarean do not get exposure to maternal vaginal microbiota, and intrapartum caesarean births may have some exposure. Findings of the study obtained from Cox proportional hazard regression analysis showed a negligible 5% higher incidence (HR = 1.05, 95% CI 0.86-1.28) for caesarean births compared with normal vaginal delivery, with wide confidence intervals including the null. Contrary to the hypothesis of a higher type 1 diabetes risk for prelabor caesarean (because of non-exposure to maternal vaginal microbiota) type 1 diabetes risk for intrapartum caesarean was slightly higher (HR = 1.08, 95% CI 0.82-1.41) than prelabor caesarean (HR = 1.02, 95% CI 0.79-1.32). This negligible risk of type 1 diabetes for children who had caesarean birth, either prelabor or intrapartum, and the potential for unmeasured confounding suggested that birth method induced variation in neonatal microbiota might not be involved in modifying type 1 diabetes risk. Like caesarean section, maternal smoking in pregnancy is also a debated risk factor for childhood type 1 diabetes. Evidence about maternal smoking on childhood type 1 diabetes is inconsistent; studies have been small, and many did not adjust for important confounders or address missing data. In the third study of this doctoral thesis, the effect of maternal smoking in pregnancy on childhood type 1 diabetes was estimated using Cox proportional hazard regression analysis, once again by linking multiple administrative datasets of children in South Australia, born from 1999-2013. The analytical approach for this study ranged; from Cox proportional hazard analysis with adjustment for wide range of confounders using the SA ECDP linked data, involving multiple imputation for missing data; to conducting meta-analysis in order to get more precise estimate. But smoking is notoriously residually confounded, therefore, I made special efforts to investigate the possibility of residual confounding by using a negative control and E-value. The findings demonstrated that maternal smoking in pregnancy was associated with a 16% (HR 0.84, 95% CI 0.67, 1.08) lower childhood type 1 diabetes incidence, compared with unexposed children, which was also supported by the meta-analytic estimates of population-based cohort studies (HR 0.72, 95% CI 0.62, 0.82) and case-control studies (OR 0.71, 95% CI 0.55, 0.86). The negative control outcome and E-value analyses indicated the potential for residual confounding in the effect of maternal smoking on childhood type 1 diabetes. Triangulation of evidence from this study along with the results of similar population-based studies, suggested a small reduced risk of childhood type 1 diabetes for children exposed to maternal smoking in pregnancy. However, the mechanisms linking maternal smoking in pregnancy with childhood type 1 diabetes require further investigation. In the fourth study of this thesis, the impact of childhood type 1 diabetes on children’s educational outcomes in year/grade 5 at age ~10 were estimated, linking population-wide data of children in South Australia, born from 1999-2005. In this study, a doubly-robust analytical method called augmented inverse probability weighting (AIPW) was used to compute the average treatment effect of type 1 diabetes on children’s educational outcomes. AIPW gives an unbiased estimate if either the outcome model or the treatment model is correctly specified. The findings of this study demonstrated that children with type 1 diabetes are not disadvantaged in terms of educational outcomes in year 5, potentially reflecting improvement in type 1 diabetes management in Australia. In summary, the work in this doctoral thesis has demonstrated that type 1 diabetes incidence differed depending on the measure of socioeconomic position. The hygiene hypothesis was only supported by the individual-level socioeconomic pattering of type 1 diabetes incidence in South Australia. The involvement of birth method induced variation in neonatal microbiota in type 1 diabetes was not supported by the caesarean and childhood type 1 diabetes study. Despite the evidence of residual confounding in the estimate of maternal smoking in pregnancy on childhood type 1 diabetes, triangulation of the evidence suggested small reduced risk for children exposed to maternal smoking in pregnancy, but further research will be needed to understand the mechanism. The findings of similar educational outcomes for children with and without type 1 diabetes, highlighted the importance of improvements in diabetes management.
Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2020

The extraordinary lives of lizards remain largely hidden from human eyes. Lizards feed, mate, lay eggs or give live birth, and carefully manage their temperatures. They struggle to survive in a complex world of predators and competitors. The nearly 700 named Australian species are divided into seven families: the dragons, monitors, skinks, flap-footed lizards and three families of geckos. Using a vast array of artful strategies, lizards have managed to find a home in virtually all terrestrial habitats. Australian Lizards: A Natural History takes the reader on a journey through the remarkable life of lizards. It explores the places in which they live and what they eat, shows how they make use of their senses and how they control their temperatures, how they reproduce and how they defend themselves. Lavishly illustrated with more than 400 colour photographs, this book reveals behavioural aspects never before published, offering a fascinating glimpse into the unseen lives of these reptiles. It will appeal to a diverse readership, from those with a general interest in natural history to the seasoned herpetologist.

Background An estimated 292 million people are living with chronic hepatitis B virus (HBV) infection globally, including 223,000 people in Australia. HBV diagnosis and linkage of people living with HBV to clinical care is suboptimal in Australia, with 27% of people living with HBV undiagnosed and 77% not receiving regular HBV clinical care. This systematic review aimed to characterize population-level interventions implemented to enhance all components of HBV care cascade and analyse the effectiveness of interventions. Review questions Question 1: What population-level interventions, programs or policy approaches have been shown to be effective in reducing the incidence of hepatitis B; and that may not yet be fully rolled out or evaluated in Australia demonstrate early effectiveness, or promise, in reducing the incidence of hepatitis B? Question 2: What population-level interventions and/or programs are effective at reducing disease burden for people in the community with hepatitis B? Methods Four bibliographic databases and 21 grey literature sources were searched. Studies were eligible for inclusion if the study population included people with or at risk of chronic HBV, and the study conducted a population-level interventions to decrease HBV incidence or disease burden or to enhance any components of HBV care cascade (i.e., diagnosis, linkage to care, treatment initiation, adherence to clinical care), or HBV vaccination coverage. Studies published in the past 10 years (since January 2012), with or without comparison groups were eligible for inclusion. Studies conducting an HBV screening intervention were eligible if they reported proportion of people participating in screening, proportion of newly diagnosed HBV (participant was unaware of their HBV status), proportion of people received HBV vaccination following screening, or proportion of participants diagnosed with chronic HBV infection who were linked to HBV clinical care. Studies were excluded if study population was less than 20 participants, intervention included a pharmaceutical intervention or a hospital-based intervention, or study was implemented in limited clinical services. The records were initially screened by title and abstract. The full texts of potentially eligible records were reviewed, and eligible studies were selected for inclusion. For each study included in analysis, the study outcome and corresponding 95% confidence intervals (95%CIs) were calculated. For studies including a comparison group, odds ratio (OR) and corresponding 95%CIs were calculated. Random effect meta-analysis models were used to calculate the pooled study outcome estimates. Stratified analyses were conducted by study setting, study population, and intervention-specific characteristics. Key findings A total of 61 studies were included in the analysis. A large majority of studies (study n=48, 79%) included single-arm studies with no concurrent control, with seven (12%) randomised controlled trials, and six (10%) non-randomised controlled studies. A total of 109 interventions were evaluated in 61 included studies. On-site or outreach HBV screening and linkage to HBV clinical care coordination were the most frequent interventions, conducted in 27 and 26 studies, respectively. Question 1 We found no studies reporting HBV incidence as the study outcome. One study conducted in remote area demonstrated that an intervention including education of pregnant women and training village health volunteers enhanced coverage of HBV birth dose vaccination (93% post-intervention, vs. 81% pre-intervention), but no data of HBV incidence among infants were reported. Question 2 Study outcomes most relevant to the HBV burden for people in the community with HBV included, HBV diagnosis, linkage to HBV care, and HBV vaccination coverage. Among randomised controlled trials aimed at enhancing HBV screening, a meta-analysis was conducted including three studies which implemented an intervention including community face-to-face education focused on HBV and/or liver cancer among migrants from high HBV prevalence areas. This analysis demonstrated a significantly higher HBV testing uptake in intervention groups with the likelihood of HBV testing 3.6 times higher among those participating in education programs compared to the control groups (OR: 3.62, 95% CI 2.72, 4.88). In another analysis, including 25 studies evaluating an intervention to enhance HBV screening, a pooled estimate of 66% of participants received HBV testing following the study intervention (95%CI: 58-75%), with high heterogeneity across studies (range: 17-98%; I-square: 99.9%). A stratified analysis by HBV screening strategy demonstrated that in the studies providing participants with on-site HBV testing, the proportion receiving HBV testing (80%, 95%CI: 72-87%) was significantly higher compared to the studies referring participants to an external site for HBV testing (54%, 95%CI: 37-71%). In the studies implementing an intervention to enhance linkage of people diagnosed with HBV infection to clinical care, the interventions included different components and varied across studies. The most common component was post-test counselling followed by assistance with scheduling clinical appointments, conducted in 52% and 38% of the studies, respectively. In meta-analysis, a pooled estimate of 73% of people with HBV infection were linked to HBV clinical care (95%CI: 64-81%), with high heterogeneity across studies (range: 28-100%; I-square: 99.2%). A stratified analysis by study population demonstrated that in the studies among general population in high prevalence countries, 94% of people (95%CI: 88-100%) who received the study intervention were linked to care, significantly higher than 72% (95%CI: 61-83%) in studies among migrants from high prevalence area living in a country with low prevalence. In 19 studies, HBV vaccination uptake was assessed after an intervention, among which one study assessed birth dose vaccination among infants, one study assessed vaccination in elementary school children and 17 studies assessed vaccination in adults. Among studies assessing adult vaccination, a pooled estimate of 38% (95%CI: 21-56%) of people initiated vaccination, with high heterogeneity across studies (range: 0.5-93%; I square: 99.9%). A stratified analysis by HBV vaccination strategy demonstrated that in the studies providing on-site vaccination, the uptake was 78% (95%CI: 62-94%), significantly higher compared to 27% (95%CI: 13-42%) in studies referring participants to an external site for vaccination. Conclusion This systematic review identified a wide variety of interventions, mostly multi-component interventions, to enhance HBV screening, linkage to HBV clinical care, and HBV vaccination coverage. High heterogeneity was observed in effectiveness of interventions in all three domains of screening, linkage to care, and vaccination. Strategies identified to boost the effectiveness of interventions included providing on-site HBV testing and vaccination (versus referral for testing and vaccination) and including community education focussed on HBV or liver cancer in an HBV screening program. Further studies are needed to evaluate the effectiveness of more novel interventions (e.g., point of care testing) and interventions specifically including Indigenous populations, people who inject drugs, men who have sex with men, and people incarcerated.