A Clinical Study of Post Perinatal Deaths in Southern Derbyshire

Newlands, Mary (1993) A Clinical Study of Post Perinatal Deaths in Southern Derbyshire. MD thesis, University of Glasgow.

Abstract

This study was undertaken to investigate why in Southern Derbyshire, a district apparently representative of much of England and Wales, the Infant Mortality Rate since 1975 has been generally higher than the national rate. Between 1981 and 1983 the use of national and small area statistics identified that rates varied significantly above the national averages (Relative Risk = 1.18 [95% C.I. 1.01 -1.34] X2= 7.01 df = 1 p <0.01) and that the problem lay in both the perinatal and post perinatal period. This study is based upon a hypothesis that:- Elucidation of the determinants of infant mortality requires more than the collection of routine clinical and statistical data. The study is presented therefore as a thesis constructed from a series of clinical and epidemiological investigations with the following objectives. 1. To establish the geographical location of all post perinatal deaths and to relate them to the demographic and socio-economic features of the District. 2. To define criteria for differentiating possibly avoidable and preventable from probably not preventable deaths. 3. To identify defects in clinical and community health services which could have contributed to avoidable and preventable deaths. 4. To investigate each death in detail to identify features which might have been contributory to the death and which, if avoided, could have influenced the outcome. 5. To investigate differences in causes and patterns of deaths between the north and the south of the County of Derbyshire. 6. To identify factors which may explain why, in the decade since 1981, death rates in Southern Derbyshire were higher, and those in North Derbyshire lower than the national averages. As a background to the study, the history, geography and demography of Derbyshire was reviewed: The Registrar General's censuses of populations 1971 and 1981 indicated that Southern Derbyshire was unremarkable to the national demographic status. The main differences between Southern Derbyshire and England and Wales were the proportions of ethnic minorities, migration of families and home ownership. Local demographic and socio-economic features showed areas of deprivation within Derby City and areas of economic decline to the east and south of the District due to closure of coal mines and decline in the heavy engineering industries. Historically, Derbyshire appears to have reached its zenith in early Georgian times when Darwin and Wedgwood made their mark. Derbyshire was a leader in the industrial revolution and enjoyed the notoriety of the group of intellectuals known as the Lunatic Society. Derbyshire has never been a leader in the field of medical progress yet in 1908 Sidney Barwise, the then County Medical Officer of Health, made the observation that infant deaths should be divided into two groups - preventable and not preventable. He was locally the first person to make this observation, which is again tested in the present thesis. Two mortality studies had previously been undertaken in Southern Derbyshire. These were:- 1. A Derbyshire Area Working Party which was set up in 1978 following a request from the Secretary of State to the chairman of the Regional Health Authority in 1977. 2. The 1983/84 Trent Regional Confidential Enquiry into Child Deaths - 28 weeks gestation to one year after birth. This was a case control study and provided more detail. My own studies which form the basis of this thesis were based on the following observations. A similar scale of preventability rating was applied to trends in death registrations over a 15 year period in relation to changes in registered causes. In 1979 the group of diagnoses ascribed to trauma transferred into the Sudden infant death syndrome diagnosis, as did 25% of those deaths ascribed to infection. A data base of post perinatal mortality over a five year period confirmed that the local post perinatal death rates were high and that the profile of deaths was the same as elsewhere in the country. Two further studies were undertaken using routine data collection. These comprised an evaluation of the effects of notifiable childhood infections on post perinatal mortality rates and evidence of workload and performance in the Primary Health Care Teams, measured by standard indicators. These studies were limited in their contribution to the investigation of post perinatal mortality, but proved useful as management tools. Concepts of preventability of death after birth were examined in the light of Barwise's principles and the findings from the 1983/84 study. The approach of grouping diagnoses by scale of preventability was the most pragmatic way of looking at the problems of post perinatal mortality. The study was concerned with the possible preventability of factors mitigating against the child after birth which were contributory to the child's death. (Abstract shortened by ProQuest.).

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Additional Information: Adviser: J L Emery
• Keywords: Epidemiology, Biostatistics
• Date of Award: 1993
• Depositing User: Enlighten Team
• Unique ID: glathesis:1993-74779
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 13 Nov 2019 15:58
• Last Modified: 13 Nov 2019 15:58
• URI: https://theses.gla.ac.uk/id/eprint/74779