Maternal, Infant, Child Health Report: Exploring the health status of mothers living in the Cypress Health Region & their children EXECUTIVE SUMMARY Introduction The first six years of a child s life are vital to lifelong health. A child s early experiences and exposures will largely predict future health and success. These experiences are shaped by the many environments (economic, social, and physical) within which they live. High-functioning and supportive families, communities, daycares, schools, and health services make it more likely that children will grow into healthy, fulfilled teenagers and adults. Healthy children and families today will set the foundation for strong and vibrant communities tomorrow. Using a health lens, healthier children and families translate into: Reductions in newborn and infant morbidity Lower rates of preventable diseases in children Mothers and children who feel healthy Enhanced life expectancy Healthy body weights and fewer chronic diseases Fewer mental health concerns in childhood and beyond The early years matter over and above everything else that comes later The early years truly last a lifetime. -Dr. Clyde Hertzman Using a broader societal lens, healthier children and families will also mean: Improved school performance and achievement, including literacy and numeracy skills Lower crime rates Less strain on social programming Greater economic productivity
The Maternal, Infant, Child Health Report provides an important evidence base that will help the Cypress Health Region s leadership and teams to better-understand areas where we are strong, and areas where families and children must be further supported. This report examines trends and patterns in the health status of mothers, infants, and young children living within the Cypress Health Region boundaries between 2006 and 2013, and connects these findings to health service provision and utilization, and to the social and economic environment. Summary of Key Findings Chapter 1: Population Characteristics and Birth Trends 1. While the regional crude birth rate has been consistently lower than the provincial average in recent history, it rose by 40% from 2006-2011. Both rural communities and the city of Swift Current saw similar increases. 2. The teenage pregnancy rate increased by an average of 14.3% each year from 2006-2012. The Cypress Health Region rate was still considerably lower than the provincial rate and similar to peer health regions. 3. More than one in four CHR infants was born to a lone-parent family; a finding that highlights the importance of designing programs and delivering services with the needs and preferences of this population in mind. 4. The Caesarean section rate at the Cypress Regional Hospital has been significantly higher than provincial and national averages (2007-2013). In 2011-12, the age-adjusted rate was almost two times higher than the Saskatchewan rate (43.2 vs. 22.9 births per 100 deliveries, respectively). 5. Collectively, rural communities accounted for 60.5% of the total CHR population in 2013 and 46.4% of all births from 2008-2011. 6. More CHR mothers have been delivering their babies at the Cypress Regional Hospital (rather than delivering at a hospital in another health region) from 72.7% in 2008 to 80.5% in 2013. Chapter 2: Part I: Indicators of Infant Health Status 7. Regional stillbirth and infant mortality rates declined over time (2006-2012) and were lower than the Saskatchewan and Canadian averages. 8. Hospitalization rates for CHR children declined by an average of -8.2% each year in infants, -1.5% in the 1-3 year age group, and -2.5% in the 4-5 year age group (2006-2012). 9. All-cause hospitalization rates were slightly higher for children aged 1-5 years living in the Cypress Health Region (2010-12) compared to Saskatchewan (overall). The infant hospitalization rate was 28% lower. 10. When comparing rates of total hospitalizations per 100 infants living in the population, some interesting differences could be seen. CHR infants were half as likely (-55%) to have been hospitalized in 2010-2012 for a respiratory disease compared to the province overall. Infant rates of hospitalization for infectious or parasitic diseases were also considerably lower in CHR compared to the province overall (0.7 vs. 2.4 per 100 infants in the population), and declined (-46.2%) in the region over time (2007-09 and 2010-12).
11. In 2010-12, the total hospitalization rate was 20.0% higher in CHR children aged 4-5 years compared to Saskatchewan overall a difference that was largely due to the higher number of admissions for respiratory system diseases (eg. chronic tonsillitis, pneumonia, acute bronchiolitis, croup, asthma). 12. The overall rate of congenital anomalies in CHR infants (2008-2012) was 545.4 cases per 10,000 total births; a figure similar to the provincial rate of 557.0 during the same period. Chapter 2: Part II: Factors Influencing Infant Health Status 13. Approximately three-quarters (74%) of mothers reported taking folic acid supplements before conception a practice that has been shown to prevent some serious cases of birth defects (ie. spina bifida, anencephaly, congenital heart defects). This figure is higher than the national rate of 60%, perhaps due to a greater number of planned pregnancies in the local population. 14. Although most (89.1% in 2011) mothers breastfed their babies shortly after birth in the hospital, just 3.2% were breastfeeding exclusively at six months. Together Health Canada, the Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada recommend breast milk only for the first 6 months. The World Health Organization has put forth 50% as the population target, to be achieved by 2022. Chapter 3: Public Health Nursing Services for Maternal and Infant Health 15. A 2010-11 survey found that most (89%) CHR mothers that breastfed reported giving their infant Vitamin D supplements. While the regional figure was higher than the national rate of 79% (2011-12), care providers should continue to promote vitamin D supplementation to mothers with nursing infants and toddlers. 16. The percentage of women giving birth at the Cypress Regional Hospital who reported never having attended a prenatal course increased from 31.6% in 2010 to 40.2% in 2013. 17. In 2013, 53% of CHR mothers received an in-home visit by a Public Health Nurse. It took an average of 5 days to be phoned to schedule this visit. This finding is considerably longer than regions like Saskatoon with home visiting programs designed to see mothers and their newborns within 1-2 days of discharge. 18. Two-year old child immunization rates in the Cypress Health Region in 2012/13 were similar to the overall Saskatchewan rates, but were slightly lower than rates in Heartland and Sun Country (peer health regions). Important differences were identified across the different geographic zones within the Region. Two-year old full immunization coverage rates were lowest in the southern portion of our region (eg. Shaunavon, Eastend, Mankota, Val Marie) and rates were highest in the city of Swift Current and communities to the east (eg. Herbert, Hodgeville, Ponteix). 19. Access to Community Water Fluoridation was lower in Cypress Health Region communities compared to the rest of Saskatchewan, potentially contributing to increased rates of early childhood dental caries observed locally.
Chapter 4: Early Childhood Development 20. Through use of the Early Development Instrument (EDI), it was found that 21.6% of kindergarten children attending schools in southwest Saskatchewan were not ready for school - an indicator of vulnerability. While this result was better than the Saskatchewan rate (30.2%), it is still a cause for concern given that early vulnerability has been correlated with lifelong health, learning and behaviour. More children living in the City of Swift Current, or in the North or South zones were school ready compared to those living in the West (eg. Leader, Maple Creek, Richmound) and East (eg. Herbert, Hodgeville, Ponteix, Vanguard) zones. Recommendations The following recommendations will help to ensure that the Cypress Health Region and its partners support mothers and their children to the best extent possible. By doing so, it is more likely that infants and children in our communities will enjoy good health today and will have the building blocks they need to enjoy lifelong health. 1. That the Cypress Health Region s Senior Leadership Team assigns a specific department and person(s) to lead the development of a regional action plan to address the findings and recommendations contained within this report. 2. Improved data collection and indicator monitoring is imperative for perinatal surveillance and quality improvement. While new information systems such as Panorama are planned for implementation, where possible, steps should be taken immediately to improve capture of pertinent information in local databases. 3. Permanent epidemiological support must be secured to ensure that Working with our partners and engaging local communities will be integral to continuing southwest Saskatchewan s tradition of vibrant and healthy children and families. Public Health s information needs are met and that the Cypress Health Region has adequate intelligence to inform decision making and planning. 4. Further analysis of geographic differences and application of strategies thereafter to help ensure equitable access to services for health region residents and to bring attention to differences in population health outcomes. 5. A more focused strategy to improve breastfeeding and postnatal support for mothers is needed. The region should make the hiring of a full-time community lactation consultant a priority, as it is currently staffed at 0.2 FTE for the entire region. Community resources such as the La Leche League of Saskatchewan should be promoted in the interim. In addition, the Cypress Health Region should support and enable the implementation of requirements to meet Baby Friendly Accreditation.
6. Improve outreach to young mothers to reduce prenatal exposure to alcohol and smoking, increase folic acid supplementation, and to connect them to appropriate income support and education programs. Social media should be explored as a means of connecting to mothers and supporting them with evidence-based health information and to help link them to our services. Physicians, midwives, and nurse practitioners practicing within our communities are vital partners in this effort and should be consulted on new strategies. 7. Mothers living within our communities should be consulted on topics relating to the quality of maternity care and public health services in order to better-understand the needs and preferences of pregnant women and new mothers, and to tailor our services accordingly. Topics covered may include: prenatal care; breastfeeding support; prenatal education; postnatal visits; hospital care; and midwifery services. 8. Efforts should be made to reduce Caesarean section rates at the Cypress Regional Hospital using evidence-proven interventions including but not limited to: multidisciplinary review of scheduled Caesarean births; increasing rates of vaginal birth after a previous Caesarean birth via mother and physician education; and improved management. 9. A multi-pronged approach to improve childhood immunization rates should be implemented, including the use of reminders and scheduling of clinics after-hours and weekends. Surveying mothers that choose not to immunize or delay immunization may also provide insights for improved service provision. 10. Community water fluoridation should be advocated in all rural municipalities in order to improve oral health. 11. Opportunities for engaging Hutterian communities should be explored further in order to ensure the health needs of all pregnant women and children are being met through culturally safe care. Attention should be paid to participation in prenatal education, immunization clinics, postnatal visits, data collection initiatives, and other health programming. Prairie communities take pride in their ability to grow high-yield, quality crops, recognizing their importance to our families and to the future of our communities. The same can be said about our children. Growing healthy families ultimately requires that we work together to maintain and improve the health of our children and their families. Working with our partners and engaging local communities will be integral to continuing our tradition of vibrant and healthy children in southwest Saskatchewan. All of society benefits when we invest in our children.
Improving Maternal and Child Health This report is intended to bring together evidence from the broader literature and combine it with local findings to equip decision-makers and public health professionals with the information necessary to plan, respond, and improve local services. While there is a breadth of information contained within these pages, the voices of mothers, families, educators, and community-based organizations are missing. If Cypress Health Region is to base its practice on the preferences, values and needs of families, the next step will be engaging this important population. Improving population health services in Cypress Health Region will require multi-directional actions that focus on: o public health leadership, o front-line public health providers, and o intersectoral and multi-organizational partnerships. Public health leadership needs to remain committed to the ideals of a healthy society, with an ever-evolving understanding of the needs of our communities and clients. Partnership has been recognized as a veritable way of improving the population s health. These partnerships may take different forms, and the leadership in Cypress Health Region is encouraged to explore potential within its jurisdiction. The Growing Healthy Families coalition, a broad-based child and youth wellness strategy aimed at promoting healthy living in southwest Saskatchewan, is an excellent example of a new intersectoral partnership working to improve the health and wellness of local children and youth. This report has revealed important details about the local maternal, infant, child population. In many respects, Cypress Health Region appears to be doing very well. But there are some important and unimpressive trends, such as the elevated Caesarean section rates, pockets of low immunization coverage, low exclusive breastfeeding rates, and delays in connecting with new mothers after discharge. Strong public health commitment is required to sustain the progress made by the health region and to ensure the tradition of good health will be passed down from previous generations. Authors Winquist B, Torr D, Sauder K, Eguzo K. Maternal, Infant, and Child Health: Exploring the overall health status of mothers living in the Cypress Health Region and their children. Cypress Health Region, Swift Current: 2014. For more information please contact: Dr. Brandy Winquist, Decision Support Consultant and Epidemiologist Cypress Health Region Telephone: (306)778-5422 Email: brandy.winquist@cypressrha.ca Dr. David Torr, Consulting Medical Health Officer Cypress and Heartland Health Regions Telephone: (306)831-7631 Email: dr.david.torr@cypressrha.ca For a full copy of the report, please visit our website: http://www.cypresshealth.ca/