Vol. 494 No. 6
7 Mrs. Barnes asked the Minister for Health and Children the number of peri-natal deaths in Tralee General Hospital, County Kerry, for each of the years from 1995 to date; and the investigation, if any, undertaken into the weight of the babies concerned, the age of the mother, social status and pregnancy history in each instance. [18865/98]
16 Mr. L. Burke asked the Minister for Health and Children the number of peri-natal deaths in hospitals in Cork city for each of the years from 1994 to date; and the investigation, if any, undertaken into the weight of the babies concerned, the age of the mother, social status and pregnancy history in each instance. [18869/98]
30 Mr. Bradford asked the Minister for Health and Children if he will have arrangements made for an investigation to be conducted into the reason a rate of 13.9 babies per one thousand born to women living within the Cork city boundary died in the first year of life in 1994 as compared with an average of 5.7 babies per thousand nationally; and if consideration will be given to the reason Cork city had the highest infant mortality rate in the country in 1992 and 1993 according to statistics released by the Central Statistics Office. [18867/98]
55 Ms Clune asked the Minister for Health and Children if he will have arrangements made for an investigation to be conducted into the reason a rate of 13.9 babies per one thousand born to women living within the Cork city boundary died in the first year of life in 1994 as compared with an average of 5.7 babies per thousand nationally; and if consideration will be given to the reason Cork city had the highest infant mortality rate in the country in 1992 and 1993 according to statistics released by the Central Statistics Office. [18866/98]
69 Mr. Creed asked the Minister for Health and Children the number of peri-natal deaths in hospitals in Cork city for each of the years from 1994 to date; and the investigation, if any, undertaken into the weight of the babies concerned, the age of the mother, social status and pregnancy history in each instance. [18870/98]
96 Mr. Shatter asked the Minister for Health and Children the number of peri-natal deaths in Tralee General Hospital, County Kerry, in each of the years from 1995 to date; and the investigation, if any, undertaken into the weight of the babies, the age of the mother, social status and pregnancy history in each case. [18985/98]
97 Mr. Shatter asked the Minister for Health and Children if he will have investigations made into the reason, in 1994, a rate of 13.9 babies per one thousand born to women living within the Cork city boundary died in the first year of life as compared with an average of 5.7 babies per thousand nationally; and if consideration will be given to the reason Cork city has the highest infant mortality rate in the country in 1992 and 1993 according to statistics released by the Central Statistics Office. [18986/98]
99 Mr. Shatter asked the Minister for Health and Children the number of peri-natal deaths in hospitals in Cork city for each of the years from 1994 to date; and the investigation, if any, undertaken into the weight of the babies, the age of the mother, social status and pregnancy history in each instance. [18988/98]
I propose to take Questions Nos. 7, 16, 30, 55, 69, 96, 97 and 99 together.
By way of explanation I would like to inform the House that infant mortality relates to deaths in the first year of life. The infant mortality rate is the number of infant deaths in the first year of life per 1,000 live births. Peri-natal mortality relates to late foetal death and death in the early neo-natal stage. The early neo-natal stage refers to the first week of life.
The principal causes of infant mortality include prematurity, low birth weight, infections, congenital abnormalities i.e. defects present at birth and sudden infant death syndrome or cot death. Infant mortality is affected by complex and multiple factors. It is recognised internationally that one of the major determinants of infant mortality is social and economic circumstances. Peri-natal deaths are, in the main, due to prematurity and also to congenital abnormalities and infections. The number of peri-natal deaths in Tralee General Hospital for the year 1994 to date in 1998 is:
|
1994 |
13 |
|
1995 |
15 |
|
1996 |
12 |
|
1997 |
11 |
|
1998 to date |
7 |
The number of peri-natal deaths in public hospitals in Cork City for each of the years 1994 to date in 1998 is:
|
St. Finbarr's Hospital |
Erinville Hospital |
South Infirmary/Victoria Hospital |
|
|
1994 |
21 |
34 |
2 |
|
1995 |
15 |
27 |
2 |
|
1996 |
19 |
25 |
2 |
|
1997 |
14 |
23 |
|
|
1998 to date |
12 |
16 |
The South Infirmary/Victoria Hospital's maternity unit closed in February 1997. The total number of peri-natal deaths from 1994 to date in 1998 in respect of the relevant Cork hospitals is 212. The total for Tralee General Hospital for the period 1994 to date is 58. The infant mortality rates per 1,000 live births in respect of Cork County Borough — Cork city — County Cork, County Kerry and nationally are:
|
Cork County Borough (Cork City) |
Cork County |
Kerry |
Nationally |
|
|
1994 |
13.9 |
5.7 |
4.6 |
5.7 |
|
1995 |
8.3(provisional) |
8.1(provisional) |
4.9(provisional) |
6.3(provisional) |
|
1996 |
11.9(provisional) |
4.9(provisional) |
3.2(provisional) |
5.5(provisional) |
|
1997 |
4.6(provisional) |
3.9(provisional) |
3.8(provisional) |
6.2(provisional) |
The figures for infant mortality for the Southern Health Board areas of Cork County Borough, County Cork and County Kerry have been examined by the SHB going back to 1987. From this examination the Cork city area appears to have higher infant mortality rates than County Cork or County Kerry. However, in 1997 the infant mortality rate for Cork city had dropped to 4.6 per 1,000 which is below the national average of 6.2 per 1,000. The Cork city area also has higher levels of low birth weight babies — a risk factor in itself for infant mortality.
While well developed health services are important, of even greater significance is to address the associated social and economic factors such as poverty, nutrition and smoking all of which contribute to poorer health status and consequently higher infant mortality.
The Southern Health Board has examined the trends in infant mortality rates and are currently re-investigating the deaths in greater detail. In particular, the board is examining the cause of each infant death. The figures produced in the recently published Central Statistics Office Report on Vital Statistics (1994) relate to county and city borough areas. The health board is currently endeavouring to break down the deaths on a small area basis. It is also undertaking a study of the factors which influence the peri-natal death rate in its area and is examining the causes of peri-natal deaths in each hospital since 1988.
Is the Minister aware of the concern that the level of peri-natal deaths in Kerry, in the context of births in Tralee General Hospital, was almost double the national average for some years for which statistics are available? Can he confirm that is the position and will he indicate what steps his Department intends taking to look into the reason for this and to ensure any steps which are required in the health area will be taken to address this problem?
As I said in my reply, the health board is pro-actively investigating all these deaths on an individual basis and working on a smaller area matrix to determine what issues are involved. There are a number of issues and it is not primarily down to health facilities, it concerns the health status of mothers and foetuses in peri-natal deaths and that of young infants in infant deaths. It is being taken seriously by the Southern Health Board and an investigation is ongoing.
Does the Minister accept there is no reason the position as regards births in Kerry should be different to that in any other part of the country? Will he confirm that, if additional facilities or consultants are required in Tralee General Hospital, he will make the necessary financial allocations available and give the necessary sanctions? Is he asking the health board to report back to him on this issue and on the high level of infant mortality in the Cork city area which, for reasons which are not understood at present, substantially exceeded the national average until 1997?
Registration of birth may have taken place where a baby was born and that could distort the figures as regards the residence of the mother. One would have to go into the statistics in greater detail but on the face of it this would justify a pro-active inquiry and that is ongoing. Issues like that may be distorting factors and could explain the position, rather than other factors being involved. We will have to get to the bottom of that. There is no suggestion in the information available to me from the Southern Health Board that an inadequacy of facility or expertise at the time of birth is the cause of this problem — wider public health issues may be involved, as well as where the registration took place and the catchment areas for the birth mother in relation to each hospital, which could be outside the county.
Will the Minister acknowledge that there is substantial concern about this in Cork and that it is of great importance that the results of the inquiry being conducted by the Southern Health Board are not only made available to him but are published? Will he confirm that they will be published, that the urgent need for new maternity services in Cork is being and will be met and that any other action necessary will be taken on foot of the results of the investigation now taking place?
When the report becomes available, the public should know the reasons. There is no problem with that. The reasons for the trends upwards and downwards in the Southern Health Board area are being investigated by the board. As regards infant mortality, the board has gone back to 1987 in its exercise and is trying to break down the deaths to the smallest possible area to enable it to establish the specific cause of death in each case.
In this context, about 50 per cent of the deaths are due to prematurity. The board is attempting to identify the deaths associated with the various complex causes and factors, such as social and economic circumstances, as well as the normal ill-health factors. Towards this end, the small area research unit in Trinity College, Dublin, has developed a deprivation index and the Southern Health Board will use it to try to establish if there is a link between social and economic circumstances and infant mortality rates.
In relation to peri-natal mortality, the board is also undertaking a study of all the factors which influence the peri-natal death rate and is examining each peri-natal death going back to 1988 to find its cause.
