Canadian Perinatal Health Report 2000

Canadian Perinatal Health Report 2000 (2,004 KB) in PDF Format

Introduction
Contributors
Canadian Perinatal Surveillance System Steering Committee Members (2000)
The State of Perinatal Health in Canada - An Overview
Section A Determinants of Maternal, Fetal and Infant Health
	1.	Behaviours and Practices Prevalence of Prenatal Smoking Prevalence of Prenatal Alcohol Consumption Prevalence of       Breastfeeding Rate of Live Births to Teenage Mothers Rate of Live Births to Older Mothers
	2.	Health Services Labour Induction Rate Cesarean Section Rate Rate of Operative Vaginal Deliveries Rate of Trauma to the Perineum Rate of Early Maternal Discharge from Hospital after Childbirth Rate of Early Neonatal Discharge from Hospital after Birth
Section B Maternal, Fetal and Infant Health Outcomes
	3.	Maternal Health Outcomes Maternal Mortality Ratio Induced Abortion Ratio Ectopic Pregnancy Rate Severe Maternal Morbidity Ratio Rate of Maternal Readmission after Discharge following       Childbirth
	4.	Fetal and Infant Health Outcomes Preterm Birth Rate Postterm Birth Rate Fetal Growth: Small-for-Gestational-Age Rate, Large-for-       Gestational-Age Rate Fetal and Infant Mortality Rates Severe Neonatal Morbidity Rate Multiple Birth Rate Prevalence of Congenital Anomalies Rate of Neonatal Hospital Readmission after Discharge at Birth
	Bibliography
Section C Appendices
		Appendix A: Data Sources and Methods Appendix B: List of Perinatal Health Indicators Appendix C: List of Acronyms Appendix D: Components of Fetal-Infant Mortality Appendix E: Data Tables Appendix F: Canadian Perinatal Surveillance System       Publications (as of September 2000) Appendix G: Evaluation Form

The Canadian Perinatal Health Report, 2000 is the first national surveillance report from the Canadian Perinatal Surveillance System (CPSS), and was produced by Health Canada's Bureau of Reproductive and Child Health and the CPSS Steering Committee. Together, the Bureau and the Steering Committee have developed the conceptual framework for the CPSS, identified appropriate perinatal health indicators and their data sources, and undertaken analysis and interpretation of the data. This report and subsequent national surveillance reports (to be released at regular intervals) will be complemented by the ongoing publication of fact sheets and peer-reviewed scientific papers.

The CPSS has prepared a companion document to this and future surveillance reports: Perinatal Health Indicators for Canada: A Resource Manual^1. This manual, which provides information on the indicators being monitored by the CPSS, is intended as a reference guide for readers of this national surveillance report and for those undertaking perinatal health data collection, analysis, interpretation and response at provincial, territorial or regional levels.

Background
The Bureau of Reproductive and Child Health began the development of the CPSS in 1995, as part of Health Canada's initiative to fill gaps in national public health surveillance. The work of the Canadian Perinatal Regionalization Coalition (now the Canadian Perinatal Programs Coalition) on the development of a national perinatal database was an important foundation for the CPSS. The CPSS collaborates with Statistics Canada, the Canadian Institute for Health Information (CIHI), provincial and territorial governments, health professional organizations, advocacy groups and university-based researchers. Representatives of these groups and several international experts serve on the CPSS Steering Committee and its study groups. The mission, principles and objectives of the CPSS are described elsewhere.^2,3

CPSS Conceptual Framework
The CPSS considers a health surveillance system to be a core system of ongoing data collection, analysis and interpretation on vital public health issues. The result is information that is used to develop and evaluate interventions, with the aim of reducing health disparities and promoting health.² Figure I depicts the cycle of surveillance, adapted from a conceptual framework described by Dr. Brian McCarthy, Centers for Disease Control and Prevention, Atlanta, Georgia.⁴

Overlying this concept of health surveillance is the concept of the determinants of health: that health status is influenced by a range of factors including, but not limited to, health care.⁵ Therefore, it is important to monitor not only health outcomes, but also factors - such as behaviours, physical and social environments, and health services - that may affect those outcomes. Health surveillance aims to contribute to improved health outcomes - that is the end point. However, information on trends and patterns in various risk and protective factors helps to explain patterns of morbidity and mortality, and may point the way to effective interventions and allocation of health resources that will improve outcomes. Monitoring of health determinants and monitoring of health outcomes go hand in hand in health surveillance systems.

CPSS Indicators
A health indicator is "a measurement that, when compared to either a standard or desired level of achievement, provides information regarding a health outcome or important health determinant."² The Bureau of Reproductive and Child Health and the CPSS Steering Committee undertook a process to identify the perinatal health indicators that should be monitored by a national perinatal surveillance system.¹ The group considered the importance of the health outcome or determinant, the scientific properties of the indicator, such as its validity in measuring that outcome or determinant, and the feasibility of collecting the data required to construct it. Appendix B contains the set of indicators that resulted from this process. The first 43 indicators listed are ranked according to the Steering Committee's assessment of health importance. Nine additional indicators were added to the list after subsequent consultations.

The principal data sources currently available for national perinatal health surveillance are described in Appendix A and in more detail in Perinatal Health Indicators for Canada. Using these available data sources (vital statistics, hospitalization data and national health surveys), the CPSS can report on only a subset of the indicators in Appendix B. The program is supporting efforts to improve existing databases and fill data gaps. This work, accompanied by ongoing developments in information technology and health information systems, will provide more perinatal health data at the national level, so that the number of indicators on which the CPSS can report will increase, as will our ability to understand and explain temporal trends and geographic and other disparities in the indicators.

Outline of the Report
This report contains information on 24 perinatal health indicators, grouped as indicators of health determinants (behaviours and practices and health services) and indicators of outcomes (maternal, fetal and infant health). For each indicator, surveillance results are presented, data limitations discussed and key references listed. Statistics for each indicator consist mainly of temporal trends at the national level and interprovincial/territorial comparisons for the most recent year for which data are available.

Summary
Perinatal health surveillance is a necessary component of managing the health system to improve the health status of pregnant women, mothers and infants in Canada. It is far more than a static database for perinatal health. Rather, it comprises a dynamic, integrated system of data collection, linkage, validation, analysis, interpretation and reporting that permits timely identification of "red flags," tracking of temporal trends and geographic and other disparities, as well as assessment of the effect of changes in clinical practice and public health policy. Perinatal health surveillance provides both a measurement tool (where we have been in the past, where we are at present) and a stimulus to action (where we need to be in the future).

Michael S. Kramer, MD Professor of Epidemiology and Biostatistics and Pediatrics McGill University Chairperson, CPSS Steering Committee

Catherine McCourt, MD, MHA, FRCPC Director, Bureau of Reproductive and Child Health Centre for Healthy Human Development Public Health Agency of Canada Health Canada

References

1. Health Canada. Perinatal Health Indicators for Canada: A Resource Manual. Ottawa: Minister of Public Works and Government Services Canada, 2000 (Catalogue No. H49- 135/2000E).
   
2. Health Canada. Canadian Perinatal Surveillance System Progress Report. Ottawa: Minister of Supply and Services Canada, 1995.
   
3. Health Canada. Canadian Perinatal Surveillance System Progress Report 1997-1998. Ottawa: Minister of Public Works and Government Services Canada, 1999.
   
4. McCarthy B. The risk approach revisited: A critical review of developing country experience and its use in health planning. In: Liljestrand J, Povey WG (Eds.), Maternal Health Care in an International Perspective. Proceedings of the XXII Berzelius Symposium, 1991 May 27-29, Stockholm, Sweden. Sweden: Uppsala University, 1992: 107-24.
   
5. Federal, Provincial and Territorial Advisory Committee on Population Health. Strategies for Population Health: Investing in the Health of Canadians. Ottawa: Minister of Supply and Services Canada, 1994.

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Canadian Perinatal Health Report 2000
(2,004 KB) in PDF Format