Nunatsiaq News
NEWS: Nunavut September 11, 2018 - 11:25 am

Nunavut still leads in infant mortality in Canada

Chief medical officer says less smoking would help

JANE GEORGE
The GN’s baby boxes, introduced in 2016, include a selection of children’s books, clothing, baby and maternal care products and education material. The box itself is approved by Health Canada as a safe sleeping space for infants, too—but the baby boxes haven't yet lowered the infant mortality rate in Nunavut. (FILE PHOTO)
The GN’s baby boxes, introduced in 2016, include a selection of children’s books, clothing, baby and maternal care products and education material. The box itself is approved by Health Canada as a safe sleeping space for infants, too—but the baby boxes haven't yet lowered the infant mortality rate in Nunavut. (FILE PHOTO)

(Updated,2:30 p.m.)

Nunavut’s infant mortality rate remains Canada’s highest, and it continues to rise.

That’s due to factors such as bed sharing, infections, smoking by parents, genetic tendencies to develop dangerous low blood-sugar levels and some potentially life-threatening birth defects that are more common in Nunavut.

Nunavut’s Health Department is trying to address infant mortality through such measures as its Nunavut-wide “baby bed” program, said the territory’s chief medical officer, Kim Barker.

But curbing tobacco use, something Barker said “we can all do,” would be the number one action that would help keep babies from dying.

Maternal smoking before a baby’s birth can lead to a lower birth weight and prematurity, among other things, putting babies more at risk of infections. Smoking around infants can also increase the likelihood of them contracting infections.

Since 2015, the territory’s infant mortality rate—that is, the number of babies who die before their first birthday—has increased.

While acknowledging that this is true, Barker said it doesn’t take a large number of deaths to make Nunavut’s rate rise or vary from year to year. That’s due to the small population and the way that statistics are calculated, per 1,000 births, which is more than the number the territory sees in a single year.

Barker said she’s hopeful the infant mortality rate this year will be lower, as some of the public health messages given out to parents start to kick in.

Nunavut’s infant mortality rate is now roughly four times the national rate and more than five times higher than in British Columbia.

Meanwhile, Canada’s infant mortality rate has remained stable at approximately 4.5 deaths per 1,000 live births since 2006, notes a recent report from the University of Calgary’s O’Brien Institute of Public Health.

In 2016, the infant mortality rate in Nunavut rose to 17.7 deaths per 1,000 births, up from 12.8 deaths per 1,000 births in 2015—an increase underscored by the recent report, which also considered issues like mental health and food insecurity.

If you look at Statistics Canada data for infant mortality in Nunavut, you can see that for baby boys, the death rate is higher than that for baby girls.

Overall, the rate at which babies die is often used as a general indicator of the level of health in a country, and Nunavut’s infant mortality rate are now closer to what you would find countries such as Bulgaria, Mexico or Thailand.

The reasons for this increase in Nunavut’s infant mortality rate is likely linked to the serious problems that surfaced in research published more than five years ago in the BMC Pediatric Journal.

In 2012, to determine the causes of and potential risk factors for infant mortality in Nunavut, a group of researchers, including Nunavut’s former chief coroner, Padma Suramala, reviewed all infant deaths documented by the Nunavut chief coroner’s office and the Nunavut Bureau of Statistics between 1999 and 2011.

Their research pointed to a serious risk factor for infant deaths: bed-sharing, especially where babies may have infections or a tendency for low blood-sugar levels, or their parents smoke or have “impaired arousal.”

Many Inuit mothers prefer to share their bed with infants, the research noted.

The research paper’s authors acknowledged that “advising against bed-sharing under all circumstances may not be easily accepted,” although when combined with risk factors such as sleep position, it may play a role in these deaths.

They stated there is a need for “improved safe sleep messaging in Nunavut.”

Results from surveys of Nunavut mothers suggested then that only about four in 10 mothers placed their infants to sleep on their backs, compared to nearly eight in 10 in the rest of Canada.

Placing infants to sleep on their backs has substantially reduced sudden infant death syndrome, or SIDS, those unexplained deaths of babies worldwide, “apparently over-riding inherent risk factors and reducing risk of asphyxia,” the 2012 research said.

In Nunavut, this research was followed two years later by an advisory suggesting Nunavut parents make sure their babies sleep on their backs.

Then four years later, in 2016, the Nunavut government rolled out its plan to send baby box care packages to all newborns to cut infant mortality rate as has been done in Finland.

Now Nunavut calls these “baby beds.” Barker said. These boxes can be used until babies are about six months old.

Barker said health workers in the communities also talk a lot to young parents about the “ABCs” of putting babies to sleep: alone, on their back, and in a crib.

The 2012 research also suggested an association between a gene variant and unexpected infant deaths in Nunavut, which could represent “a complex interaction of the variant with environmental risk factors including sleep position, bed-sharing, prenatal and postnatal tobacco smoke exposure and food security.”

As discussed again last month in Copenhagen at the International Congress on Circumpolar Health, seven in 10 infants in the Kitikmeot and Kivalliq regions of Nunavut and about half of the babies from the Baffin region are born with a variant of the CPT1A gene that instructs the body to produce an enzyme that helps the body process fats for energy.

Medical researchers believe this enzyme’s variant probably offered an advantage to people who first migrated to North America from Siberia, when their high-fat diet would have favoured a different kind of metabolism that used fats, rather than sugars, for energy.

But today, about one in 300 people with this enzyme variant develop severely low blood-sugar, or hypoglycemia, when they are sick or not eating properly.

And that form of CPT1A—also found in Alaska, Nunavik and Greenland—can lead to severe complications. These may become worse during illness, with effects that range from seizures to sudden unexpected death.

Researchers believe the CPT1A variant could also be associated with the overall high mortality of infants from one month to one year old in Nunavut. Infants with this variant face a mortality rate in the territory that’s nine times higher than the national average.

In B.C., medical guidelines and information have been already developed to provide more First Nations parents with the information they need about this variant, which many of them also carry.

B.C. guidelines for health workers say parents should be given an emergency letter to present to emergency personnel, because infants and children with the CPT1A variant who are unable to eat may need an intravenous dextrose solution to prevent dangerously low blood-sugar levels from developing.

The guidelines also suggest health workers provide information to families about healthy feeding practices to prevent hypoglycemia, especially during illness or periods of prolonged fasting.

But you don’t see these handouts in Nunavut.

Barker said since so many carry the gene variant the Health Department offers the advice to everyone.

As for the prevalence of birth defects, these include a high number of heart defects that are nearly four times more frequent than expected in Canadian populations.

A 2004 study suggested that genetic predisposition to specific heart defects, and a diet low in folic acid and vitamin A in conjunction with alcohol intake, could be linked to these heart defects.

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(7) Comments:

#1. Posted by Paul Murphy on September 11, 2018

Go over to Tammaativvik Boarding home at any time during the day.  Count how many pregnant women in from the communities for prenatal care are smoking. Count how many women carrying babies in their amautis are smoking while the toxic smoke blows back into the baby’s face. 

Then we blame the health care providers for the deaths of these very same babies. Sorry mothers it’s YOUR fault these children are sick. It’s YOUR fault these babies are dying from health related causes.

Now go to the bars and see how many of these pregnant women are drinking.  Then we blame the health care providers for children born with defects and FASD.  No women it’s YOUR fault. No one else is at fault but YOU!!

YOU know what you are doing is wrong but you continue to do it!  Nothing less than child abuse and murder of babies.

#2. Posted by who cares-Thanks Jane- Padma on September 11, 2018

Thanks Jane for brining up such an important issue, I have supported the research from 1999 to 2011 to review all infant deaths to determine the cause and risk factors associated in each infant death to prevent similar deaths in Nunavut. As you mentioned very correctly a group of people after the review put in their best efforts along with the Chief Coroner brought the recommendations for safe sleeping practices and the baby boxes rolled in.

In addition, I have collected and ordered tests to compile data for CPT1A variant genes from all sudden infant deaths that occurred in all regions but Kitikmeot and Kivalliq region show positive results more in these two regions and extended my discussions with CHEO and was about to participate with NTI research study in 2018. My passion is to prevent these infant deaths and establishing Pediatric death review committee in Nunavut.
However, my passion and dreams were taken away from me. BUT WHO CARES, no one does?????.

#3. Posted by David on September 11, 2018

Paul Murphy will likely get flamed, but here is a headline just a few articles down from this one.

“For FASD Awareness Day, Nunavut health officials urge alcohol-free pregnancies”

From the article:A 2004 Justice Canada document suggested the rate in Nunavut, based on figures from Alaska, could be as much as 50 times higher than the national average.

#4. Posted by ??????????????????????????? on September 11, 2018

#1: What responsibility do men bear?  You know, the fathers, the ones who participate in women getting pregnant. None? Women bear all the responsibility? Your comments sound very misogynist, simplistic, and they are unhelpful. It is a shared responsibility, and a responsibility to work together in Nunavut for people, including mothers, to have safe homes, mental health care, and get educated about how to provide a safe environment for their babies.

#5. Posted by Paul Murphy on September 12, 2018

Men are responsible for women smoking and drinking while pregnant???  Another left wing feminist comment. In all other aspects of child care I agree that men have a responsibility but let’s not be ignorant about who puts the cigarette or drink in a woman’s mouth.  Your comment just gives women another excuse for continuing their life threatening habit.

#6. Posted by olaf on September 13, 2018

Smokers, now here this - smoking harms your babies that you say you love so much.
4,9999 chemicals in a cigarette get on your breath, hair, skin and clothes   - then you pick up a newborn!  Yuk!
Poor babies with such small lungs too.
If you love your kids you wouldn’t be puffing away like a chimney.
Or standing outside, wearing an amouti smoking while the chemical smoke blows back in your child’s face.
How dangerous is that? 
Very dangerous!  Do you love your babies or not????
For God’s sake QUIT!!!!

#7. Posted by Rankin on September 13, 2018

As a female, I totally agree with you Paul Murphy. It is the sole responsibility of the mother not to drink and smoke while pregnant. Blaming anyone else is nonsense. The men need to smoke outside and not in the house as 2nd hand smoke is very bad for a developing baby but otherwise, ladies cut that crap out for 9 plus months!

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