Reducing Infant Mortality Demonstration Site Model - Beeston Hill & Holbeck & Chapeltown Joanne Davis – Health Improvement Specialist Sahera Ramzan – Health Improvement Practitioner Neighbourhoods Team, Public Health, NHS Leeds

TARGET Definition: Infant Mortality: the numbers of deaths of children aged under one year per 1000 live births. Starting with children under one year, by 2010 to reduce by at least 10% the gap in mortality between the routine and manual group and the population as a whole. The baseline is We have set a local target to reduce the IM rate in “deprived Leeds” to 7 per 1000 live births by 2013.

INFANT MORTALITY RATES FOR LEEDS, YORKSHIRE & HUMBER, AND ENGLAND & WALES Source: NCHOD Rate per 1000 live births LCIUCI ENGLAND & WALES YORKSHIRE AND THE HUMBER LEEDS PCT Leeds rate is higher than the England rate, but is lower than the Yorkshire & Humber rate

TRENDS: LEEDS, Y&H, ENGLAND

WHAT THIS MEANS IN LEEDS In Leeds, around 50 babies under one year old die each year. Leeds rate = 5.2 per 1000 live births (2005-7). The IM rate for deprived Leeds (10 % SOA’s) is higher than the Leeds average. The single year rate was 4.7 per 1000 for 2008, a marked fall from 5.8 in In 2008, 46 Leeds babies died, of whom a high proportion died within the first 28 days.

WHAT ARE THE CAUSES OF INFANT DEATH? Most deaths occur in the “neonatal period” (first 28 days) from: Extreme prematurity Congenital anomalies Other problems related to pregnancy and delivery Deaths after the neonatal period include: Congenital & chromosomal abnormalities Infection Sudden infant death Accidents and intentional injuries

Risk Factors For IM? We know the risk factors for infant mortality are: Poverty and deprivation Ethnicity (Pakistani and Caribbean) Teenage mothers Consanguinity

“DEPRIVED LEEDS” 5 YEAR AGGREGATED INFANT MORTALITY RATES We have set a local target to reduce IM rate in “deprived Leeds” to 7 per 1000 live births by 2013

Part of the Leeds Response: Reducing IM Demonstration Site Model The aims of the RIMDS model: Through local partnership work provide a range of complementary interventions to improve perinatal health and in particular to reduce the infant mortality rate in Beeston Hill/ Holbeck and Chapeltown. (Both areas are made up of 10 % SOA’s and have higher than the Leeds average ethnic minority population and higher than the Leeds average teenage pregnancy rates)

Identifiable Actions to Reduce the Gap in Infant Mortality What would work Impact on the gap What would work (percentage points) Reducing conceptions in under 18s in the R&M group by 44% to meet the target Targeted interventions to prevent SUDI by 10% in the R&M group Reducing the prevalence of obesity in the R&M group to 23% Increasing the rate of breastfeeding initiation in the R&M group to those of the non-R&M group from 67% to 83% Immediate actions Optimising preconception care Early booking Access to culturally sensitive healthcare Reducing maternal and infant infections Reducing overcrowding in the R&M group, through its effect on SUDI Reducing the rate of smoking in pregnancy by two percentage points by 2010 Meeting the child poverty strategy Long-term actions Improving maternal educational attainment

Practical examples of work carried out in the RIMDS’s - Breathing Space. - Making Every Penny Count. - Local Healthy Start Promotion. - Holistic Baby Clinic. - Mosses Basket Loan Scheme - Antenatal / Postnatal Physical Activity Programme. - Local Midwife teams Malvern team & Leopold team. - Risk & Resilience Programme.

Making Every Penny Count Local multi-agency events Training front line staff ‘Lets Talk Money’ courses Local financial information leaflets Financial Inclusion audit FI briefings for front line staff (CAB, Credit Union, Loan Sharks)

Healthy Start Conducted local research Involving partners Increasing awareness & knowledge – general promotion Implementation of local vitamin scheme Evaluation Replicate working in other areas of the city

Risk and resilience We know that… Teenage mothers experience 60% higher rates of infant mortality and are at increased risk of low birth-weight which impacts on the child's long-term health. Teenage mothers are 3 times more likely to suffer from post-natal depression and experience poor mental health for up to 3 years after the birth. Teenage mothers are at far greater risk of living in poverty. Beeston Hill lies within a Teenage Pregnancy Hotspot Ward (City & Hunslet) The 2 High Schools within the area are Priority 1 in terms of teenage conception rates

4 Projects under 1 umbrella o Young Peoples Sexual Health Research Project o Speakeasy Training programme with local workers and parents o Sex & Relationship project within 2 High Schools o Sex & Relationship project with young people in the community

Speakeasy has worked well because…. 9 local workers were trained a facilitators….. Who then went on to train 32 parents and carers in the local area…… Who all achieved level 1, 2 or 3 OCN awards

Evaluation of RIMDS Model, What’s made it work: Opportunity to share knowledge and skills with partners, has enabled relationships to be established with other professionals working locally. Group decision making process, e.g. coining the phrase Making Every Penny Counts The infrastructure is there which enables you to get projects up and running quickly. Didn’t realise IM was such an issue in Chapeltown and the factors that could be done to address that. Knowing what is available in the local area for women and families I work with The midwifes and other professionals work in a more holistic way now. There are more local projects.

Evaluation of RIMDS benefits to local community The community are getting a more effective service provision. Raised awareness around key SUDI messages in the local community. Individual families have benefited from accessing a mosses basket through the loan scheme. Grandparents, families and the next generation are more informed. On home visits families have benefited from accurate information. Been able to attend a Making Every Penny Count event at school and go to a local Let’s Talk Money Course Access to local exercise session and activities with baby. Having the same midwife through out.

Evaluation of RIMDS Model, Barriers: Steering group difficult to get everyone involved in the work. Not always possible to demonstrate the immediate benefit and impact in a short timeframes. Felt that much of the community and residents would not be directly aware of the work going on Unable to attend all the meetings due to other commitments. Further funding would have helped