Preventable Feto-Infant Mortality: Application of a Conceptual Framework for Perinatal Health Surveillance to Manitoba Perinatal Outcomes
Elliott, Lawrence J., Heaman, Maureen, Beaudoin, Carole, Baker, Lynn, Canadian Journal of Public Health
Application of a Conceptual Framework for Perinatal
Health Surveillance to Manitoba Perinatal Outcomes
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.
Public health surveillance has been defined as the ongoing systematic collection, analysis, and interpretation of outcome-specific health data for use in the planning, implementation, and evaluation of public health practice.1 Dr. Brian McCarthy of the Centers for Disease Control and Prevention (CDC), Atlanta, has defined perinatal health surveillance as a dynamic process which collects, analyzes, and responds to data on the occurrence and distribution of maternal and child health events in a defined population.2 Common to both of these definitions of surveillance are analysis and interpretation to turn raw data into useful "information". This information can be used for a variety of purposes, including: estimating the burden of ill health and poor outcomes, generating hypotheses as to the contributors to poor outcomes, setting research priorities, planning and evaluating preventive and treatment services, and monitoring trends in outcomes and practices over time.
Perinatal databases and information systems have heretofore lacked conceptual frameworks on which to base such analyses and assist in the translation of data into information useful for health policymaking. This paper demonstrates the application of a conceptual framework to perinatal surveillance data in the Canadian province of Manitoba, thereby providing useful information on perinatal outcomes and the potential for improving these outcomes. The particular outcome of focus in this paper is the feto-infant mortality rate, which includes fetal mortality after 28 weeks of gestation and infant mortality during the first year of life. Feto-infant mortality has been previously used as an indicator of overall maternal/infant wellbeing in populations, and has been observed to decrease dramatically over the last century in most countries.3-5
The perinatal health surveillance conceptual framework used in this study was developed by Dr. Brian McCarthy and colleagues at the World Health Organization (WHO) Collaborating Center in Perinatal Care, Centers for Disease Control and Prevention, Atlanta, Georgia.2,6-8 The conceptual framework analyzes feto-infant mortality by birthweight and age-at-death (Figure 1), and is used to determine the strategies having the greatest potential for reducing preventable feto-infant mortality through assessment of factors in four major categories: Maternal Health, Maternal Care, Newborn Care, and Infant Care. …