title: Preventable feto-infant mortality: application of a conceptual framework for perinatal health surveillance to Manitoba perinatal outcomes.
abstract: BACKGROUND
  Perinatal health surveillance systems have lacked conceptual frameworks to translate data into information for policy and program planning. This paper demonstrates the application of a conceptual framework in the analysis of feto-infant mortality data in the province of Manitoba.
  
  
  METHODS
  Fetal and infant deaths were categorized according to a two-dimensional framework of birthweight and age-at-death, and grouped into four broad categories of contributors to perinatal health: Maternal Health, Maternal Care, Newborn Care, and Infant Care. Birth Weight Proportionate Mortality Rates (BWPMR) were calculated for each of the four categories, and preventable "excess" feto-infant mortality was estimated through comparisons to a benchmark sub-population.
  
  
  RESULTS
  Between 1985 and 1998, feto-infant mortality declined from 12.3 to 9.8 deaths per 1000 births in Manitoba. Much of this decline occurred in the Newborn Care category; there were only slight declines in deaths attributed to Maternal Health and Infant Care factors. Comparison of the feto-infant mortality rate to the benchmark rate revealed an excess of 3.46 deaths per 1000 births, an "opportunity gap" of 33%. Substantial regional variations in feto-infant mortality rates were observed.
  
  
  CONCLUSIONS
  Application of this conceptual framework provided useful information to aid in policy and program planning. As the greatest excess feto-infant mortality was observed in the Maternal Health and Infant Care categories, attention to the broader determinants of health which influence these categories will be required.
authors.affiliation: Faculty of Nursing, Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, MB. maureen_heaman@umanitoba.ca
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Elliott
authors.forename: Carole
authors.initials: C
authors.lastname: Beaudoin
authors.forename: Lynn
authors.initials: L
authors.lastname: Baker
authors.forename: James F
authors.initials: JF
authors.lastname: Blanchard
mesh_terms: D000328:Adult; D019985:Benchmarking; D001724:Birth Weight; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D006291:Health Policy; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007234:Infant, Premature; D008350:Manitoba / Q000453:epidemiology; D008427:Maternal Health Services / Q000592:standards*; D008429:Maternal Welfare; D018743:Perinatal Care / Q000592:standards*; D011159:Population Surveillance; D040442:Public Health Informatics; D012040:Regional Health Planning; D012959:Socioeconomic Factors