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Children and Young People's Health (Public Health, State of the South West 2011)

8.7.1 Infant Mortality

8.7.1.1 Infant mortality is defined as death within the first year of life. Some deaths in infants are caused by congenital anomalies or extreme prematurity, and are probably unavoidable. However, factors which might increase infant mortality are smoking during pregnancy, and poor quality neonatal care.

8.7.1.2 Smoking during pregnancy has well known detrimental effects on the growth and development of a baby. In 2008/09, 14.8% of women in the South West were current smokers at the time of delivery, similar to the England average of 14.7%. In Torbay, which has the highest rate in the South West, more than one in five (22%) mothers were smokers at time of delivery (source: Health Profiles 2010).

8.7.1.3 Breast feeding has a number of health benefits for both baby and mother (source: NHS Breastfeeding). Breast milk helps protect babies against infections, as well as reducing the risk of developing asthma or eczema. For mothers, breastfeeding can help prevent developing certain diseases in later life, such as ovarian or breast cancer. Data for 2007/08 suggest that over 78% of babies were breastfed within 48 hours of birth in the South West, a rate which is higher than the England average of 72% (source: Health Profiles 2010).

8.7.1.4 Deaths under one year of age per 1,000 live births have been falling in England and in the South West. In 1981 there were 10.9 deaths per 1,000 live births in England and by 2008 this had dropped to 4.6 deaths per 1,000 live births. Similarly in the South West, the infant death rate dropped from 10.4 deaths per 1,000 live births in 1981 to 4.0 in 2009 (source: National Centre for Health Outcomes Development (NCHOD)). While the South West's infant mortality rate is lower than for England as a whole, there is variation by deprivation within the South West. Analysis conducted by the SWPHO shows that in 2007–09, there were 5.3 deaths per 1,000 live births in the most deprived areas of the South West, more than 30% higher than the rate for the South West as a whole.

8.7.2 Childhood Physical Activity, Diet and Obesity

8.7.2.1 The latest National Child Measurement Programme (NCMP) data for 2009/10 show that nearly one in ten children in Reception year in England were obese (9.8%), and nearly double this proportion of children in Year 6 were obese (18.7%). The South West had lower childhood obesity levels than England for both Reception year (9.2%) and Year 6 (16.1%). In contrast the percentage of children who were overweight in Reception year in the South West (14%) was higher than England (13.3%). The percentage of Year 6 children who were overweight was similar in the South West (14.3%) to England (14.6%).

8.7.2.2 Physical activity during childhood has a range of benefits including healthy growth and development, maintenance of energy balance, psychological well-being and social interaction. Through improved concentration and self-esteem, it can also improve school attendance, behaviour and attainment. A survey of state schools conducted in 2008/09 suggests that in the South West, 52.4% of children in state maintained schools take part in at least 3 hours of physical activity each week, a rate which is better than the England figure of 49.6 % (source:
Health Profiles 2010).

8.7.2.3 In England between 2001 (when monitoring started) and 2008, the mean portions of fruit and vegetables consumed by boys aged 5–15 years changed from 2.4 to 3.1 portions per day while the mean portions that girls consumed changed from 2.6 to 3.3 portions per day. In 2008 mean portions of fruit and vegetables consumed by boys aged 5–15 in the South West were the same as England (3.1 portions per day) but consumption by girls in the South West (3.1 portions per day) was lower (source: Health Survey for England 2008).

8.7.2.4 Data from the British Association for the Study of Community Dentistry shows that in 2007/08, the South West’s five-year-olds had an average of 1 tooth decayed, missing or filled, which is lower than the England average of 1.1 (source: Health Profiles 2010).

Figure 8.7.3.1 Under 18 conceptions data for local authorities (all LAs including county districts), South West, 2006-08

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Under 18 conceptions data for local authorities (all LAs including county districts), South West, 2006-08 (Fig 8.7.3.1). Source: Teenage Pregnancy Unit, ONS / Contains OS Data.

8.7.3.1 While the United Kingdom is experiencing its lowest rate of teenage pregnancy in 20 years, it is still far higher than comparable European countries (Teenage Pregnancy Strategy: Beyond 2010; A Snapshot of the Health of Young People in Europe, 2009). The overall South West rate is low compared to England. In 2006–08 there were, on average, 35 conceptions per 1,000 females aged 15–17 in the South West, which is lower than the England average of 41. However, a number of areas in the South West have significantly higher rates: Torbay and Bristol have the highest rates at 58 and 51 conceptions per 1,000 females aged 15-17 respectively.

8.7.3.2 Teenage pregnancy is associated with health and wellbeing risks for mothers and new babies. Teenage mothers are prone to poor antenatal health, lower birth weight babies and a higher risk of infant mortality. Their long-term health and that of their children is worse than average. They are also less likely to finish their education, less likely to find a good job, and more likely to become single parents and raise their children in poverty (source: Teenage Pregnancy Research – Briefing1).

8.7.3.3 Young people and teenagers are also particularly vulnerable when it comes to repeat abortions. The rate of women undergoing a second or subsequent abortion can be viewed as an indicator of inadequacy in relation to contraception, whether insufficient service access, sub-optimal service provision or ineffective individual use of contraceptive method. A quarter (25%) of abortions in females aged under 25 years in England in 2009 were repeat abortions, and over a tenth (11%) of abortions in females aged under 19 years were repeat abortions (source: SWPHO, Sexual Health Balanced Scorecard).

8.7.3.4 In the South West, a fifth (20%) of all abortions in females under 25 are repeat abortions. While this percentage is lower than England as a whole, Torbay and Swindon have percentages similar to the England average (26% and 24% respectively).

8.7.4 Immunisation

This section has been provided by the HPA South West.

8.7.4.1 The measles-mumps-rubella vaccine (MMR) is a safe and highly effective vaccine that was introduced in 1988 with a coverage of over 90% between the early 1990s and 1998. However, a fall in uptake was observed from 1997 (down to 81% in 2003/04) as a result of adverse publicity about the vaccine. More recently in 2009/10, the uptake has increased significantly, reaching 89.1%. Within the South West there is wide variation in MMR uptake by
Primary Care Trust (PCT) (Figure 8.7.4.1).

Figure 8.7.4.1 Uptake of MMR vaccination by second birthday by Primary Care Trust in the South West, 2009/10

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Uptake of MMR vaccination by second birthday by Primary Care Trust in the South West, 2009/10 (Fig 8.7.4.1). Source: HPA.

8.7.4.2 The incidence of mumps has fallen dramatically since the introduction of the MMR vaccine, but in recent years outbreaks of mumps have occurred in the cohort of children born inthe few years before 1984. These children were too old to be offered the MMR vaccine (introduced in 1988) but were susceptible as they had no previous exposure to the virus and therefore did not have natural immunity.

8.7.4.3 More recently, the HPA has observed cases of measles in traveller communities in England. Whilst it is encouraging that coverage of MMR vaccination is increasing, there is still a need for uptake rates to increase further to be confident of avoiding outbreaks.

8.7.4.4 Actions taken and planned to raise uptake include: work with practices with particularly low uptake MMR conferences and training days targeted to health visitors, practice nurses and GPs improvements in information systems in some areas.

8.7.4.5 Strong and urgent efforts are needed to improve uptake of MMR vaccination and exploit all opportunities to vaccinate children of any age who have not received two doses of MMR. In August 2008, the Chief Medical Officer announced the MMR catch up programme to reduce the risk of a measles epidemic in the UK. Research and analysis conducted by the HPA indicated that around 1.9 million school children and 300,000 pre-school children were not completely vaccinated against measles in England. This suggested that the number of susceptible children had now reached a level where measles transmission could be sustained, leading to the potential for an outbreak of between 30,000 and 100,000 cases.

8.7.4.6 The National Human Papilloma Virus (HPV) Vaccination Programme started at the beginning of September 2008. Certain HPV infections can cause cervical cancer, other cancers and genital warts. The national immunisation programme uses the bivalent HPV vaccine (Cervarix TM, GlaxoSmithKline) and will protect girls against infection with HPV 16 and 18 which are associated with 70% of cervical cancers. Annual HPV vaccine uptake data for 2009/10 are presented by PCT in the South West for Year 8 girls aged 12–13 (Cohort 7) in Figure
8.7.4.2.

Figure 8.7.4.2 Uptake of the HPV vaccine in girls 12 - 13 in Primary Care Trusts in the South
West September 2009 - August 2010

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Uptake of the HPV vaccine in girls 12 - 13 in Primary Care Trusts in the South West September 2009 - August 2010 (Fig 8.7.4.2). Department for Health.