Catalyst for a regional register for congenital anomalies:
There has been longstanding concern about the high levels of childhood disability in Bradford, yet little evidence about the prevalence despite national recommendations for regional registers. The Maternal and Child Health Collaboration for Leadership in Applied Health Research and Care (CLARHC) was able to review the evidence about the benefits and methods for setting up a congenital anomalies register. Working with our network of paediatricians we established a bespoke reporting system and a Bradford congenital anomalies register. The benefits of this work led to a successful proposal to Directors of Public Health across Yorkshire to establish a regional congenital anomalies register (YCAR) to help monitor patterns of anomalies and inform public health planning.
Setting up the first UK universal testing for gestational diabetes:
The Maternal and Child Health CLAHRC team worked with the Born in Bradford team and our network of obstetricians to review the risk factors for gestational diabetes for women in pregnancy and establish universal screening in Bradford Teaching Hospitals NHS Foundation Trust. The team has evaluated the universal testing which demonstrated an increased detection rate from 2% to 7% of pregnant women, allowing clinicians to target effective treatment to reduce adverse pregnancy outcomes. Since universal screening began, 2.3 times more women (around 2730 women) have been treated for gestational diabetes. One of the team has now been invited onto the NICE guideline committee for diabetes in pregnancy, providing the opportunity to feed our results into national practice. A HTA application has been successful and work is underway to provide definitive evidence of the cost-effectiveness of different approaches to screening.
Introduction of routine vitamin D supplementation in pregnancy:
The Maternal and Child Health CLAHRC team were able to investigate concerns from midwives and paediatricians about low levels of Vitamin D supplementation in a high risk population. Using BiB data we demonstrated less than 10% of eligible women were taking supplements. Qualitative interviews found that lack of awareness of the recommendations for vitamin D supplementation in pregnancy, English being a second language and fear of side effects were amongst the barriers to these women taking the recommended vitamin D supplements during pregnancy. We used this quantitative and qualitative evidence to work with clinicians to establish provision of vitamin D during attendance at ultrasound visits. A re-audit (n=123 women) demonstrated 97% of women recalled being offered supplements and 87% took up the offer.
Identifying and supporting children with difficulties:
The Healthy Children Healthy Families (HCHF) CLARHC theme have been working with 77 primary schools in Bradford to assess children and provide feedback to teachers on literacy, motor control and social, emotional and behavioural health. This has enabled teachers to target support to children more effectively. Our team has also developed a web-based resource for school leaders, Evidence 4 Impact (E4I) http://www.evidence4impact.org.uk/, to find proven approaches for helping children succeed. The CLAHRC is now supporting the dissemination of this tool to local authorities in West Yorkshire.
Improving air quality:
Our CLAHRC programme has worked with the European Escape study to use results which show a clear link between exposure to pollutants in pregnancy and low birth weight to convince Bradford Metropolitan District Council to tackle air pollution in the city. £400,000 will be spent on retro-fitting 25 buses which travel the most polluted routes in the city, with selective catalytic reduction systems which reduce emissions by 80%.
Changing midwifery and health visitor practice:
The Maternal and Child Health CLAHRC team established two communities of practice (CoPs), one with local midwives (MW) and one with local health visitors (HV). These CoPs have investigated how data on maternal smoking habits and breast feeding are collected. From the findings, a number of recommendations to improve data collection processes and clinical practice have been made. For example, the development of a high risk care pathway for smoking mothers was recommended by the CoP and has now been implemented. Changes were also made to the processes of collecting and recording a wide variety of data via the Child Health Informatics Service, thus improving the quality of local data available to inform local clinical practice.
Identifying children with high levels of adiposity:
There is increasing evidence that for a given BMI South Asian children have greater total and central adiposity than White British children and are potentially more metabolically sensitive to body fat. These differences are not identified by BMI. The HCHF theme is working in partnership with school nurses in Bradford to improve the identification of South Asian children who are overweight and obese by using more appropriate measures of adiposity. We have raised the local authority and school nurses awareness of ethnic differences in childhood adiposity and have contributed to a review of the future role of school nurses, encouraging the addition of skinfold measurements into the National Child Measurement Programme in Bradford.
Redesigning classrooms to reduce sedentary behaviour:
Adverse associations between sedentary behaviour and cardiometabolic health risk markers (obesity, blood pressure, cholesterol, insulin) have been reported in children. In a feasibility study, researchers from the HCHF theme installed height adjustable desks in two primary school classrooms and we were able to reduce children’s sitting time. The study is the first of its kind in Europe and found promising results with children’s sitting time reduced by 81 minutes per day.
Changing practice across professions:
A major aim for both CoPs has been to improve communications between MWs and HVs in the antenatal and postnatal periods. Significant progress has been achieved in this since the CoPs secured the necessary agreements to change the time of distribution for the Personal Child Health Record (the ‘Red Book’). The PCHR was being given to parents after delivery by their HV; it is now be distributed during pregnancy by the MW and be used to improve the two-way transfer of information between professionals throughout the antenatal and postnatal periods.
Developing a national public health tool for monitoring child health:
Our CLAHRC programme has been working closely with ChiMat and the Department of Health to develop a population based tool to help with mapping the potential future outcomes for children aged five years, based on indicators of the family around birth and up to nine months of age. The outcomes are based on learning and development, behaviour and health. The indicators used and the weightings given within the tool are based on academically rigorous research carried out by the University of York. The PREview tool is now available for national use: http://www.chimat.org.uk/preview
Determining the cost effectiveness of healthy start vitamins:
The Healthy Start vitamin scheme is UK wide for pregnant women, new mothers and children under the age of 4 years old, who are in receipt of income-related benefits or tax credits. The HCHF theme has contributed to the National Institute for Clinical Excellence special report on the cost-effectiveness of relaxing the eligibility criteria of the scheme. The BiB study collected information about pregnant mothers’ use of vitamin supplements, and this information was used in a key scenario analysis as part of the economic modelling for the NICE report. Based on this modelling, NICE makes recommendations on the cost-effectiveness of different universal offerings of the Healthy Start scheme.