Abstract
Background
Perinatal health surveillance systems have lacked conceptual frameworks to translate data into information for policy and program planning. This paper demonstrates the application of a conceptual framework in the analysis of feto-infant mortality data in the province of Manitoba.
Methods
Fetal and infant deaths were categorized according to a two-dimensional framework of birthweight and age-at-death, and grouped into four broad categories of contributors to perinatal health: Maternal Health, Maternal Care, Newborn Care, and Infant Care. Birth Weight Proportionate Mortality Rates (BWPMR) were calculated for each of the four categories, and preventable “excess” feto-infant mortality was estimated through comparisons to a benchmark sub-population.
Results
Between 1985 and 1998, feto-infant mortality declined from 12.3 to 9.8 deaths per 1000 births in Manitoba. Much of this decline occurred in the Newborn Care category; there were only slight declines in deaths attributed to Maternal Health and Infant Care factors. Comparison of the feto-infant mortality rate to the benchmark rate revealed an excess of 3.46 deaths per 1000 births, an “opportunity gap” of 33%. Substantial regional variations in feto-infant mortality rates were observed.
Summary
Application of this conceptual framework provided useful information to aid in policy and program planning. As the greatest excess feto-infant mortality was observed in the Maternal Health and Infant Care categories, attention to the broader determinants of health which influence these categories will be required.
Résumé
Contexte
les systèmes de surveillance médicale périnatale n’ont pas encore les cadres conceptuels nécessaires pour que leurs données puissent étayer la planification des politiques et des programmes. On montre ici comment appliquer un cadre conceptuel à l’analyse des données sur la mortalité foeto-infantile au Manitoba.
Méthode
les cas de mortalité foetale et infantile ont été classés dans une matrice bidimensionnelle (poids à la naissance/âge au décès) et regroupés en quatre grandes catégories de facteurs contribuant à la santé périnatale: Santé maternelle, Soins aux mères, Soins aux nouveaunés et Soins aux nourrissons. On a calculé les taux de mortalité en proportion du poids à la naissance pour chaque catégorie et estimé la surmortalité foeto-infantile évitable par comparaison avec une sous-population de référence.
Résultats
Entre 1985 et 1998, la mortalité foeto-infantile a baissé au Manitoba, passant de 12,3 à 9,8 décès pour 1 000 naissances. La majeure partie de cette baisse a été enregistrée dans la catégorie des soins aux nouveau-nés; les décès attribuables à la santé maternelle et aux soins aux nourrissons ont très peu diminué. La comparaison du taux de mortalité foeto-infantile au taux de référence a mis en lumière une surmortalité de 3,46 décès pour 1 000 naissances, soit une possibilité d’amélioration de 33 %. On observe d’importants écarts régionaux dans les taux de mortalité foeto-infantile.
Résumé
l’application de ce cadre conceptuel fournit des renseignements utiles à la planification des politiques et des programmes. Comme la surmortalité foeto-infantile la plus importante a été observée dans les catégories Santé maternelle et Soins aux nourrissons, il faudra s’intéresser de plus près aux déterminants généraux de la santé qui influent sur ces catégories.
Footnotes
The full reports “Manitoba Perinatal Surveillance Report, 1985-1996” and “Manitoba Perinatal Health Surveillance Report, 1989-1998: Provincial and Winnipeg Geographic Breakdown” on which this article is based are available from the Manitoba Health Public Health Branch, 4th floor, 300 Carlton Street, Winnipeg, MB R3B 3M9, or online at: http://www.gov.mb.ca/health/publichealth/epiunit/reports.htm
Formerly of Standards Development Branch, Manitoba Health
Sources of support: This work was supported as part of preparation of two reports on perinatal health surveillance by the Epidemiology Unit of Manitoba Health. The results and conclusions are those of the authors and no official endorsement by Manitoba Health was intended or should be inferred.
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