Congenital anomalies (CAs) are the leading cause of infant mortality and one of the leading causes of death for young children in developed countries. As significant improvements have been seen world-wide in controlling childhood infectious disease and issues related to poor nutrition, CAs are now making a proportionally bigger impact on the health of the worlds children. In addition to the impact of CA status on the individual child and ones family, prevalence of CAs has a significant impact on the population, as children with birth defects can cost the system a great deal of money in the provision of specialized health and education services.<p>When conducting surveillance of five selected CAs between 1990 and 1999, Saskatchewan Health found significant regional differences in the prevalence of these CAs. The purpose of this study is to ascertain whether or not there is a regional difference in all types of CAs, to assess whether or not any regional disparities also exist in the use of health care services by children with and without CAs and to determine what factors influence childrens use of health care services in the study population.<p>This study follows a birth cohort of 17,414 children (9169 cases and 8245 controls) born between January 1, 1994 to December 31, 1998 until their 5th birthday, death or emigration out of Saskatchewan. Through graphical analysis, it was revealed that while an overall regional difference does not exist in the prevalence of CAs in Saskatchewan, there are regional differences in the prevalence of 13 of the 22 specific categories of conditions studied. One-way ANOVAs showed that children with CAs have higher numbers of physician visits (p<0.001) and hospitalizations (p<0.001), and longer lengths of stay in hospital (p<0.001) than children without CAs. Regional differences were found for all outcome variables for the total population, and for children with and without CAs. The outcome with the most substantial differences between children with and without CAs was length of stay, which may indicate differential access to outpatient services throughout the province. Finally, using Andersons theoretical framework of factors that influence the use of health care services (need characteristics, predisposing characteristics and enabling characteristics) three negative binomial models were built to examine childrens use of health care services using variables from each category. <p>This study found significant regional differences for all outcome measures studied, and found that region of residence was a significant predictor of childrens use of health care services even after accounting for a variety of other maternal and child factors.
| Identifer | oai:union.ndltd.org:USASK/oai:usask.ca:etd-08082007-094935 |
| Date | 25 August 2007 |
| Creators | Metcalfe, Amy Lynn |
| Contributors | Osei, William, Muhajarine, Nazeem, Blakley, Patricia, Abonyi, Sylvia |
| Publisher | University of Saskatchewan |
| Source Sets | University of Saskatchewan Library |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://library.usask.ca/theses/available/etd-08082007-094935/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Saskatchewan or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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