Nunavut government finds new way to guard infant health
Surveillance system aimed at better health policies
Nunavut health providers will soon collect information from thousands of Nunavummiut on prenatal and early childhood health as they visit their nursing stations or hospitals.
The “pregnancy outcome child health surveillance system” is a series of standardized forms for health workers to fill out when women visit health centres while pregnant or with young children.
The forms will finally provide raw data to compile statistics that have never been assembled for Nunavut.
These include the frequency of birth defects, fetal alcohol spectrum disorder, sudden infant death syndrome, household smoking practices, nutrition and many others.
“It’s a very important project,” Nunavut pediatrician Radaj Jetty said.
“This territory really needs this type of surveillance system. This will help us gather very important information and decide on public health strategies for the territory.”
Much of this information is already collected at medical appointments, but it’s never been assembled into a territory-wide database before.
Most usefully, the data will help researchers to figure out the relationship between things like parental smoking and respiratory infections among children, and whether mothers have cut down or quit smoking during pregnancy.
Studies based on this data will be useful in helping the department of health and social services in developing more effective policies on child health in Nunavut, Jetty said.
“We have a high suspected incidence of behavioral problems and developmental problems among children in Nunavut,” Jetty said.
One of the system’s investigators, Dr. Laura Arbor, said Nunavut suffers a high occurrence of birth defects and anemia, but it’s not clear why. The new system could help answer such questions.
The department will collect the forms from health centre visits at set times: the first prenatal visit, at 28 weeks of pregnancy, at 36 weeks of pregnancy, at birth, at six months of age, at 12 months, between two and three years, and between four and five years .
They will gather information on the child’s weight, blood samples, and any infections, and also record social indicators such as smoking, food security, language, education, parental work history and so on.
Arbor wanted to assure people that the data will be kept confidential and would be used only to assemble statistics for developing policy, and would not be given directly to doctors, nurses or social workers.
News of the surveillance system emerged on the heels of a Canadian Medical Journal report on Inuit health outcomes published in January.
The study, which covered the years 1990 to 2000, showed that almost one Inuk baby in 40 died before their first birthday during that period.
Nunavut’s chief medical officer of health, Dr. Isaac Sobol, said the trend of infant mortality, at least in Nunavut, is improving, but still far above the Canadian average.
However, when shown Statistics Canada numbers as far back as the territory’s inception in 1999, Sobol backed away from that statement and admitted there was no clear trend on infant mortality.
StatsCan’s data shows the infant mortality rate in Nunavut has bounced around from 10 to 19.8 per 1,000 live births from 1999 to 2006, the last year such data is available.
Nunavut’s small population means a few cases can significantly alter what the data says, so the rate tends to fluctuate.
In Nunavut’s worst recorded year, 2003, 15 babies died in their first year of life. In Nunavut’s best year, 2005, there were seven infant deaths.
As for the study, it found that infant mortality rate between 1990 and 2000 in the four Inuit regions was 16.1 per 1,000 births.
Ninety per cent of births in Nunavut, Nunavik, Nunatsiavut and the Inuvialuit region of the Northwest Territories during that period were from Inuit mothers.
The study broke down birth outcomes and infant deaths according to birth weight, preterm births, and the age of the baby at the time of death.
According to the numbers, the Inuit regions’ worst infant mortality is during the first year of life.
From 1990-2000, 10.8 babies out of every 1,000 died “postneonatal deaths”, between 28 days and the first year of life. That’s more than five times the national average.
The study pointed to preventable causes including maternal smoking, infection and sudden infant death syndrome.
Its conclusions recommended education campaigns to inform mothers of the risks of second-hand smoke, and telling people to lie their babies on their backs, not on their bellies, to sleep.
Sobol agreed with the report’s assessments, especially its assessment of “socio-economic conditions” contributing to infant death.
“Studies show poverty is bad for health,” he stated. “It doesn’t matter if you’re Inuit, or in inner cities.”
The “macroeconomic” conditions of Nunavut such as poverty and overcrowding lead to the symptoms that contribute to high infant mortality, Sobol said.
These include the use of tobacco and alcohol, overcrowding and poor attention to parenting skills.
Nunavut’s Department of Health and Social Services has been struggling to address the problem of high infant mortality for years.
There was one silver lining presented in the report: Inuit babies are more likely to be large for their gestational age, even if they are born premature.