Most child deaths occur in children aged under one year.
Still birth refers to babies born with no signs of life at or after 24 weeks of pregnancy. Nationally the rate has fallen by 18% since 1992 (Office for National Statistics (ONS), 2015: An overview of stillbirth numbers and rates in England and Wales and a European comparison, ). Perinatal mortality refers to stillbirths and deaths under the age of seven days. Nationally, the rate of perinatal mortality has fallen by more than a third since 1982 (ONS, 2014: Childhood, Infant and Perinatal Mortality in England and Wales, 2012 ).
Infant mortality (IM) refers to deaths of live born babies occurring less than one year from the time of birth, including pre-term infants. The infant mortality rate (IMR) is widely regarded to be one of the best single indicators of population health and progress towards reducing inequalities.
Infant and child death rates in the UK have declined substantially in recent years, and continue to fall (ONS, 2014: Childhood, Infant and Perinatal Mortality in England and Wales, 2012 ). The fall in infant mortality rate is similar across neonatal (under 28 days) and postnatal (between 28 days and 1 year) periods. However, still birth and infant mortality rates in the UK are higher than might be expected in high income countries, and many of these are preventable (Royal College of Paediatrics and Child Health (RCPCH), 2014), and stillbirth rates in England have changed little over the past two decades (Gardosi, 2013).
Nationally, most causes of infant deaths show a socio-economic gradient. Deprivation, births outside marriage, non-white ethnicity of the infant, maternal age under the age of 20 are independently associated with an increased risk of infant mortality.
Nationally, the most common cause of death in children after their first year of life is unintentional (accidental) injury. Other common causes include cancer, infections and congenital abnormality. Childhood deaths are most common in deprived populations and in children with a pre-existing medical condition or disability. Mortality rates are also higher in children of Pakistani or Black African origin (RCPCH, 2014: Why children die: death in infants, children and young people in the UK ).
It is important that we understand the causes of deaths in infancy and childhood in order that we can take appropriate action to reduce deaths with modifiable factors in the future.
The local picture
The stillbirth rate in Calderdale has followed a downward trajectory since 2007, and is now comparable to the England and Wales figure. Until 2007-11, the rate was consistently higher in Park ward than the Calderdale average, but latest figures reveal that the gap between Park and the district average has narrowed considerably, see Figure 1.
Figure 1: Still birth rate trends in Calderdale and Park ward
Until recently, infant mortality rates in Calderdale were significantly higher than both the Yorkshire and Humber and England and Wales averages, though are now similar to both Regional and National averages. In 2011-13, the infant mortality rate in Calderdale was 4.7 per 1000 live births. This rate is the lowest it has been since we started reporting the data. Though the rate has shown a downward trend since 1995 it is not decreasing as much as the national rate, resulting in an increased gap between the two (as shown by the linear trend in Figure 2, below). As always with infant mortality data, at a local level small changes in numbers of infant deaths can show a large impact on rates.
Figure 2: Infant mortality trends in Calderdale
The infant mortality rate has been consistently higher in deprived parts of Calderdale, and in areas with the greatest proportion of South Asian residents. Until recently, rates in Park ward have bucked the general downward trajectory seen elsewhere peaking at 14.2 per 1,000 in 2007-11. However, since this time, rates have fallen sharply and are now similar to those in other wards, and similar to the district average. In Calderdale, most infant deaths are caused by prematurity or congenital anomalies (61% in 2011-13).
Figure 3: Infant mortality trends by selected wards
The child mortality rate in Calderdale has remained static in recent years, and reflects both regional and national trends. In 2011-13, the rate of deaths in children aged 1-17 years was 1.58 per 10,000 compared to 1.36 in Yorkshire and the Humber and 1.19 in England, see Figure 4.
Figure 4: Child death trends in Calderdale (Directly Standardised Rate (DSR), rate per 10,000 aged 1-17 years)
In Calderdale, the child mortality rate was highest in the 0-4 age range. This is not reflective of regional or national trends, see Table 1.
Table 1: Child deaths (DSR, rate per 10,000 aged 1-17 years, 2011-2013)
|Aged 1 to 4||Aged 5 to 9||Aged 10 to 14||Aged 15 to 19|
|Yorkshire and Humberside||1.4||1.0||0.9||2.6|
In 2011-2013, diseases of the nervous system and external causes of mortality were the leading underlying causes of death among children aged 1-17 (23.8% each). Among the external causes of mortality the majority were transport accidents. The next most frequent causes of death were Malformations, Deformations and Chromosomal Abnormalities (14.28%) and Neoplasms (14.28%). Numbers attributable to other causes were very small.
The majority of both Infant and Child Mortalities in Calderdale (2011-2013) were to children living in the most deprived areas of Calderdale, with 43% in the most deprived quintile and 38% in the second most deprived.
Table 2: Child deaths (age 1-17 years) by deprivation quintile (Indices of Multiple Deprivation (IMD) 2010)
|IMD Quintile (1=Most Deprived, 5=Least Deprived)||3 year average morality rate per 10,000 - 2011/13 (children aged 1-17)|
Public Health England’s National Child and Maternal Health Intelligence Network (CHIMAT) Infant Mortality and Stillbirths Profiles and Service Snapshot provide more information on infant mortality, while the Calderdale and Kirklees Child Death Overview Panel Report provides information on all local child deaths in recent years (see References and further information).
All child deaths in Calderdale are reviewed by the Child Death Overview Panel (CDOP). This statutory multi-agency panel collects and reviews information about all child deaths in order to identify public health concerns and make recommendations for future practice. Some deaths are subject to further investigation, including unexpected deaths and those where abuse or neglect is suspected.
It is not considered appropriate to collect user views on this topic.
The Child Death Overview Panel has highlighted priority issues in Calderdale, and has made a number of recommendations in relation to these.
From 2012 onwards an ethnicity indicator has not been available on the mortality datasets, meaning that analysis cannot be carried out on trends by ethnic group. With higher stillbirth, infant mortality and child death rates in some ethnic minority groups – particularly the South Asian group, which is relatively highly populous in Calderdale (Grey et al., 2009: Towards an understanding of variations in infant mortality rates between different ethnic groups in England and Wales ), this presents an area of concern.
A number of risk factors are linked to stillbirth, infant mortality and child death, as considered in detail in RCPH (2014) ( Why children die: death in infants, children and young people in the UK ) and the CHIMAT Infant Mortality and Stillbirth profiles . Importantly in Calderdale, smoking during pregnancy, which has well-evidenced detrimental effects for growth and development in utero, has increased year-on-year since 2011/12, bucking the national downward trend. Rates in Calderdale are now significantly higher than the national average (Public Health England Outcome Framework (PHE PHOF) 2.03: Smoking status at time of delivery ).
Projected future need
The child population in Calderdale is expected to increase (ONS, 2015b: Population projections ). The young age structure of the South Asian population mean that there are likely to be more South Asian children in future years. In Calderdale, this group is particularly concentrated in the most deprived wards, and particularly in Park ward, which has consistently had a birth rate significantly higher than the district average for a number of years. Nationally, Pakistani babies are more than twice as likely to die in infancy as White British babies, due in part to the prevalence of congenital anomalies in this group (Grey et al., 2009: Towards an understanding of variations in infant mortality rates between different ethnic groups in England and Wales ).
Key considerations linked to the known evidence base (what works?)
Though infant and child mortality rates in Calderdale are broadly similar to the national average, it has been suggested that in the UK, not enough is being done to ensure that children survive and thrive, with stark inequalities by socio-economic classification and ethnicity, and a high proportion of preventable deaths (RCPCH, 2014: Why children die: death in infants, children and young people in the UK ).
Recent estimates suggest that in the UK, 24% of child deaths involved “modifiable factors” (REF). In Calderdale, this figure is 38% (Calderdale Council, 2015).
A 2014 RCPCH report outlines a number of areas of suggested focus which may reduce infant and child mortality rates. These are summarised below:
- Reduce the risk of preterm birth and low birth weight;
- Promote maternal health;
- Improve recognition and management of acute illness;
- Enforcement of existing legislation to reduce deaths from injuries and poisoning, though a “concerted and sustained” policy response to reduce deaths from violence and self-harm is needed;
- A focus on prevention and care for children with long-term conditions, to include a focus on mental ill-health, nutrition, alcohol and tobacco, the environment and transport.
Finally, highlighting the socio-economic inequalities in infant and child mortality rates, the report notes that: “children’s lives can be protected through supportive social policy and redistributive fiscal measures” (RCPCH, 2014: Why children die: death in infants, children and young people in the UK ).
References and further information
- Gardosi, J., Madurasingher, V. et al. (2013): Maternal and fetal risk factors for stillbirth: population based study. BMJ. 2013 Jan 24;346:f108;
- Grey, R., Headley, J. et al. (2009): Towards an understanding of variations in infant mortality rates between different ethnic groups in England and Wales , Inequalities in Infant Mortality Project Briefing Paper 3: Oxford: National Perinatal Epidemiology Unit;
- ONS (2014): Childhood, Infant and Perinatal Mortality in England and Wales, 2012 ;
- ONS (2015a): An overview of stillbirth numbers and rates in England and Wales and a European comparison, ;
- ONS (2015b): Population projections ;
- PHE National Child and Maternal Health Intelligence Network (CHIMAT): Infant Mortality and Stillbirths Snapshot ;
- PHE National Child and Maternal Health Intelligence Network (CHIMAT ): CHIMAT Infant Mortality and Stillbirth profiles – local authorities;
- RCPCH (2014) Confidential Enquiry into Maternal and Child Health (CEMACH): Why children die: death in infants, children and young people in the UK .
More information about children and young people can be found in the Further resources , including a presentation on Infant and perinatal mortality in Yorkshire and the Humber [PDF 1255KB] .
The Public Health England (PHE) National Child and Maternal Health Intelligence Network (CHIMAT) Infant Mortality and Stillbirths Snapshot contains information about:
- Local prevalence of key risk factors for Infant mortality and stillbirth;
- Recent trends in Still birth, neo-natal, post-neonatal and infant mortality rates;
- Unexplained deaths in infancy rate;
- Further resources.
Please contact: PH.Intelligence@calderdale.gov.uk for further information about:
- neonatal mortality (from 1995 onwards);
- post neonatal mortality (from 1995 onwards);
- infant mortality (from 1995 onwards);
- stillbirth(from 1995 onwards);
- causes of death for infant mortality and child deaths;
- the annual Child Death Overview Panel report.
- Department for Education (2013): Child death reviews: improving the use of evidence ;
- Department of Education (2015): Child death reviews: year ending 31 March 2015 ;
- ONS (2015): Unexplained Deaths in Infancy: England and Wales, 2013 ;
- PHE (2015): Reducing infant mortality in London .
Naomi Marquis, Public Health Intelligence Officer, Public Health, Calderdale Council.