Briefing Paper 2015/04
Women’s and Children’s Health
RESEARCH AND INFORMATION
Research and Information
Briefing Paper 2015/04 (Published July 2015)
Women’s and children’s health
This is one in a series of briefing papers that has been produced by the Research and Information
team. It is intended that these papers will be used by Council services and, where appropriate, our
Community Planning partners to assist policy development and wider service delivery. Some papers,
including this one, may be of interest to a wider audience.
This is the second of three related briefing papers which explore topics relating to the Health and
Wellbeing of Aberdeen’s population:1. Health and Health Outcomes (health issues relating to Aberdeen’s adult population)
2. Women’s and Children’s Health (health issues relating specifically to women and children)
3. Health Behaviours (behaviours which may have a direct impact on health e.g. smoking)
This paper uses available data to present a brief overview of some of the health issues which relate
specifically to women and children in Aberdeen City and Grampian. There is considerable variation
in the level and type of information available on different topics. In general, information is given for
Aberdeen City and comparator local authorities (highest and lowest), or for Scotland, to allow
comparison. Additionally, where data is available on a small-scale neighbourhood level, this is also
presented. In some cases this has not been possible as information is not available at local authority
level (e.g. where information is only available at Health Board level). An introductory section gives
an overview of Aberdeen’s population structure to provide context for the reader.
For more information on these issues, please contact:
Anne McAteer
Research and Information Team
Office of Chief Executive
Aberdeen City Council
1st Floor, Old Town House
Broad Street
Aberdeen AB10 1FY
 01224 522182
 [email protected]
Other briefing papers in this series have included the following topics:
 Population Report, Aberdeen City and Shire
 Population of Older People in Aberdeen
 Migrant Workers in Aberdeen City and Shire
These papers, and other statistical reports, can be found in the ‘Stats and Facts’ section of the
Aberdeen City Council website: www.aberdeencity.gov.uk/statsandfacts
We value your comments/feedback and would appreciate if you could provide your comments on
this paper by clicking the following link:
https://www.surveymonkey.com/s/research-feedback-form
WOMEN’S AND CHILDREN’S HEALTH IN ABERDEEN CITY - SUMMARY

Women aged 20-24 years are more commonly diagnosed with genital herpes simplex than
any other age/sex group. In Grampian rates of diagnoses of genital herpes simplex have
increased substantially over the past 10 years, with 256 female diagnoses in 2013 – a rate of
132 per 100,000 population (women aged 15-64 years). This is higher than the Scottish
average rate (116 per 100,000 population) and one of the highest rates among all Scottish
Health Boards.

In 2013 there were 1,109 female diagnoses of genital chlamydia in Grampian – 77% of which
were in women aged 15-24 years – equivalent to a rate of 571 per 100,000 population
(women aged 15-64 years) which is lower than the rate for Scotland (598 per 100,000
population). Rates of genital chlamydia have fluctuated markedly in the past 10 years, rising
steeply between 2010 and 2012, before falling sharply in 2013.

In 2014 there were 1,290 notifications of terminations in the Grampian Health Board area;
equivalent to a rate of 11.1 per 1,000 population (women aged 15-44 years) and similar to
the Scottish rate of 11.0. In Grampian most terminations (58.9%) were in women aged 2029 years. Rates of terminations were higher in more deprived areas - 19.1 per 1,000
population in SIMD 1 compared to 8.5 per 1,000 population in SIMD 5.

Rates of teenage pregnancy in Aberdeen City were slightly higher than equivalent Scottish
rates. In 2012, there were 287 teenage pregnancies; a rate of 44.3 per 1,000 population
(females aged 15-19 years) compared to 41.5 per 1,000 population for Scotland. Overall
rates of teenage pregnancies in Grampian have fallen in the past 10 years.

Within Aberdeen City, the proportion of first-time mothers under 20 years varied, with some
areas (based on Intermediate Zones) having no teenage births whereas in others areas
teenagers accounted for over 20% of all first-time mothers. In general rates of teenage
pregnancy were higher in the more deprived areas of the city.

Almost 15% of pregnant women in Aberdeen were classified as ‘current smokers’ in 20112013 (3 year combined total). This was lower than the Scottish average of 19.0%. Rates of
smoking during pregnancy are higher in more deprived areas of the city (Intermediate
Zones) and range from a low of 2.2% to a high of 35.9%. Overall, the rates of smoking during
pregnancy have fallen over the past 10 years.

In Aberdeen CHP there were 164 maternities recording drug misuse in 2010/11-2012/13 (3year aggregate). Rates of drug misuse in pregnancy have been consistently higher in
Aberdeen than in either Grampian or Scotland, but have been falling over the past 3 years.

In Grampian, 2.3% of full-term births and 59.7% of premature births were categorised as
either low or very low birth weight. The proportion of low-weight full-term births is
generally higher in more deprived areas of the city.

In 2013/14, 37.9% of 6-8 week-old children in Aberdeen were exclusively breast-fed. This is
considerably higher than the Scottish rate of 27.1%. Within Aberdeen, rates varied between
a low of 13.7% in Torry East to a high of 62.5% in Cults, Bieldside and Milltimber West.
i

Rates for up-take of immunisation at 24 months were slightly lower in Aberdeen City than in
Scotland, with 95% targets not being met for both Men C Vaccine (90.6%) and Pneumococcal
Conjugate Vaccine (93.5%).

In 2014, 85.5% of children in Grampian were registered with an NHS Dentist – the secondlowest rate of all NHS boards in Scotland. Following inspection as part of the National
Dental Inspection Programme, 8% of Primary 1 children and 1.9% of Primary 7 children were
advised to seek immediate dental care, and 21% of P1 children and 53% of P7 children were
advised to seek dental care in the near future.

In 2013/14, height and weight measurements were recorded for 1,922 P1 children in
Aberdeen. Of these, over a quarter were classified as being at risk of overweight (13.9%) or
obesity (11.3%). This is slightly higher than the respective Scottish figures of 12.4% and
10.1%.

In 2014 in Grampian, there were a total of 2,816 referrals to the Child and Adolescent
Mental Health services, most of which were on an out-patient or community-based basis.
Rates of referral were slightly lower in Grampian than in Scotland.
ii
Background Information
Population: In June 2014, Aberdeen had an estimated population of 228,990. Overall the proportion
of males and females is fairly even, however there are some differences within specific age ranges;
in particular women make up more than 60% of those in the 75+ age group.
Compared to Scotland as a whole, Aberdeen has a relatively high proportion of young adults – those
in the 16-29 year age group make up over a quarter (25.1%) of Aberdeen’s total population. The
comparable figure for Scotland is 18.3%. In contrast, Aberdeen has a smaller proportion of older
people. Those aged 60 years and over make up only 20.1% of Aberdeen’s population compared to
24% for Scotland. Children (<16 years) make up approximately 15% of Aberdeen’s population –
slightly lower than the Scottish average. Table 1 presents a breakdown of the age and sex structure
of Aberdeen City’s population.
Table 1: Aberdeen City population by age and sex, 2013
Age Group
Male
Female
Total
Percentage of
all ages
Years
n (%)
n (%)
n
%
Scotland
Percentage of
all ages
%
0-15
17,175 (51.2)
16,431 (48.9)
33,566
14.7%
17.0%
16-29
28,413 (49.5)
29,009 (50.5)
57,422
25.1%
18.3%
30-44
25,473 (52.0)
23,494 (48.0)
48,967
21.4%
19.1%
45-59
21,664 (50.1)
21,544 (49.9)
43,208
18.9%
21.6%
60-74
14,547 (49.0)
15,119 (51.0)
29,666
13.0%
15.9%
75+
6,242 (38.6)
9,919 (61.4)
16,161
7.1%
8.1%
113,474 (49.6)
115,516 (50.4)
228,990
100.0%
100.0%
All ages
Source: National Records of Scotland, Available at: http://www.nrscotland.gov.uk/
N.B Due to rounding sums may not add up.
Figure 1 gives a more detailed breakdown of the age/sex structure of Aberdeen’s population,
highlighting the large number of young adults and the gender disparity in the older age ranges.
Figure 1: Aberdeen City Population by age and sex, 2014
Source: National Records of Scotland, Available at: http://www.nrscotland.gov.uk/
iii
Women’s and children’s health
1.
Female Sexual Health – Sexually Transmitted Infections
Young people, particularly women under the age of 25, are the group most at risk of being
diagnosed with a Sexually Transmitted Infection (STI). This section presents data for the two
STIs which most commonly affect women: genital herpes simplex and genital chlamydia.
Information on STIs is collected in the Electronic Communication of Surveillance in Scotland
System (ECOSS), a Health Protection Scotland (HPS) surveillance system which is updated
every day with positive test results from all Scottish diagnostic and reference laboratories.
Data is available at Health Board level only. (Information on male sexual health and other STIs
can be found on the HPS website at: http://www.hps.scot.nhs.uk/.)
1.1.
Genital Herpes Simplex Virus
In 2013, more than twice as many women were diagnosed with genital herpes simplex than
men (ratio 2.3:1 for Scotland and 2.1:1 for Grampian). This rate has been consistent over the
past 10 years. In Scotland, over 60% of infections were diagnosed in people under the age of
30, with the largest number of diagnoses being in women and men aged 20-24 years.
In Grampian in 2013, there were 256 female diagnoses of genital herpes simplex, a rate of 132
per 100,000 population (female population aged 15-64). This is considerably higher than the
Scottish rate of 116 per 100,000 population, and one of the highest rates among all Scottish
Health Boards. Table 1.1 presents numbers and rates of female diagnoses for all Scottish
Health Boards to allow comparison (note: data for Orkney, Shetland and the Western Isles has
not been disclosed to ensure patient confidentiality).
Table 1.1: Genital herpes simplex virus, laboratory diagnoses for females 2013: number and
rate by NHS board
NHS Health Board
1
Number of diagnoses
Rate of diagnoses
Ayrshire and Arran
125
102
Borders
34
95
Dumfries and Galloway
72
152
Fife
110
90
Forth Valley
80
80
Grampian
256
132
Greater Glasgow and Clyde
572
145
Highland
86
84
Lanarkshire
121
55
Lothian
353
120
Tayside
253
187
Scotland
2,062
116
Source: ECOSS/Health Protection Scotland, Available at: http://www.hps.scot.nhs.uk/
1
Rate per 100,000 female population aged 15-64, based on 2013 poulation estimates
1
Trends: In Grampian, as in Scotland as a whole, the number of genital herpes simplex
diagnoses has approximately doubled over the past 10 years, rising from 192 in 2004 and
peaking at 412 in 2012. Figure 1.1 shows number of diagnoses in Grampian and Scotland
(both sexes) for the 10 years since 2004 (the scale for Grampian is on the right).
As can be seen, for the most part, trends in diagnoses in Grampian follow a similar pattern to
Scotland. However, in Grampian numbers rise steeply between 2010 and 2012, going from
272 to 412 – an increase of over 50% on 2010 figures - before dropping to 378 in 2013. In
Scotland the number of diagnoses has increased year-on-year since 2011.
Figure 1.1: Genital herpes simplex virus, number of laboratory diagnoses (both sexes),
Grampian Health Board, 2004 to 2013
3500
500
3000
Scotland
2000
300
1500
200
1000
Grampian
400
2500
100
500
0
0
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Scotland
Grampian
Source: ECOSS/Health Protection Scotland, Available at: http://www.hps.scot.nhs.uk/
1.2.
Genital Chlamydia
Genital Chlamydia is more common that genital herpes simplex, however the demographic
patterning is similar. As with genital herpes, most diagnoses of genital chlamydia in Scotland
over the past 10 years were in women, who, in 2013 accounted for 62% of all diagnoses.
Diagnoses of genital chlamydia were highest in younger adults, with 71% of all diagnoses and
77% of diagnoses in women, being in those under the age of 25. Most diagnoses were made
in women and men aged 20-24.
In Grampian in 2013, there were a total of 1,109 diagnoses of genital chlamydia in women – a
rate of 571 per 100,000 population (women aged 15-64 years). This is lower than the Scottish
rate of 598 per 100,000 population. Of the 1,109 diagnoses in Grampian, 855 (77%) were in
women aged 15-24 years. This is equivalent to a rate of 2,282 per 100,000 women aged 15-24
years – almost 4 times higher than the overall rate for women aged 15-64 years. Table 1.2
presents numbers and rates of female diagnoses for all Scottish Health Boards for women
aged 15-64 years and women aged 15-24 years to allow comparison.
2
Table 1.2: Genital Chlamydia infection diagnoses for women aged 15-64 years and women
aged 15-24 years 2013: number and rate 2013, by NHS Board
Women aged 15-64 years
1
Women age 15-24 years
2
Number of
diagnoses
Rate of
diagnoses
Number of
diagnoses
Rate of
diagnoses
Ayrshire and Arran
784
640
608
2,824
Borders
167
466
126
2,171
Dumfries and Galloway
325
685
257
3,212
Fife
628
516
482
2,053
Forth Valley
554
553
438
2,334
Grampian
1109
571
855
2,282
Greater Glasgow and Clyde
2464
623
1,792
2,274
Highland
487
477
376
2,325
Lanarkshire
979
444
753
1,953
Lothian
2222
752
1,728
2,903
Orkney
25
368
22
1,932
Shetland
40
546
23
1,773
Tayside
928
686
741
2,710
Western Isles
14
167
12
916
10,726
598
8,213
2,422
NHS Health Board
Scotland
Source: ECOSS/Health Protection Scotland, Available at: http://www.hps.scot.nhs.uk/
1
Rate per 100,000 female population aged 15-64, based on 2013 poulation estimates
2
Rate per 100,000 female population aged 15-24, based on 2013 poulation estimates
Trends: Figure 1.2 shows the trends in the number of diagnoses of genital chlamydia (both
sexes) for Grampian and Scotland for the past 10 years (the scale on the right is for
Grampian). As can be seen, there has been no consistent pattern in Grampian, with
fluctuations in the number of cases of chlamydia diagnosed each year. In particular, there
was a steep rise between 2010 and 2012 (similar to that seen in the same period for genital
herpes simplex), where numbers diagnosed rose from 1,838 in 2010 to 1,969 in 2012, before
dropping sharply to 1,752 in 2013. In Scotland as a whole, the numbers being diagnosed with
chlamydia rose more consistently in the first half of the period, peaking in 2008 at 19,054
diagnoses. Since 2011 the numbers have dropped each year.
3
20000
2000
1950
1900
1850
1800
1750
1700
1650
1600
Scotland
19000
18000
17000
16000
15000
Scotland
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
14000
Grampian
Figure 1.2: Genital chlamydia infection, number of laboratory diagnoses, Grampian and
Scotland, 2004-2013
Grampian
Source: ECOSS/Health Protection Scotland, Available at: http://www.hps.scot.nhs.uk/
2.
Abortions
In Scotland there is a requirement to notify the Chief Medical Officer of all terminations
carried out. This Information is collated by Information Services Division (ISD) Scotland who
have released provisional data on terminations carried out in Scotland in 2014. Information is
available at Health Board level with limited data available at local authority level.
In 2014 there were 1,290 notifications of terminations in the Grampian Health Board area; a
rate of 11.1 per 1,000 women aged 15-44 years – similar to the rate for Scotland which was
11.0 per 1,000 women aged 15-44 years, and equivalent to a rate of 203.7 terminations per
1,000 live births. For the most part, abortion rates are broadly similar across different Health
Board areas, with most falling between 10 and 12 per 1,000 women aged 15-44 years.
However, rates in the Islands (4.6), Borders (8.5) and the Highlands (9.1) were lower and the
rate in Tayside (13.0) higher.
In Aberdeen City there were 746 terminations in 2014; of which 103 (13.8%) were in females
under 20 years of age, 439 (58.9%) were in women aged 20-29 years and 204 (27.3%) were in
women aged 30 years and over. Comparison with Scottish figures (Table 2.1) shows that
proportions of terminations in Aberdeen were lower in the youngest and oldest age groups,
but higher in the 20-29 year age group.
Table 2.1: Abortions by age group, Aberdeen and Scotland, 2014P
Under 20 years
Aberdeen City
Scotland
20-29 years
30+ years
Total
n
%
n
%
n
%
n
%
103
13.8
439
58.9
204
27.3
746
100
1,966
17.1
6,178
53.8
3,331
29.0
11,475
100
Source: ISD Scotland, Available at : https://isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2015-05-26/201505-26-Terminations-2014-Report.pdf?67461794615
P
Provisional data
4
Deprivation: In Grampian, as in Scotland as a whole, the rate of abortions was higher in more
deprived areas than in less deprived areas. In Grampian the abortion rate in the most
deprived 20% (based on SIMD 2012 quintiles) was 19.1 per 1,000 women aged 15-44 years.
This was considerably higher than the equivalent rate for Scotland which was 14.2. Across all
Scottish Health Boards, only Tayside had a higher rate of abortions (19.7) in SIMD 1. Figure
2.1 highlights the strong deprivation gradient in rates of abortion for Grampian and Scotland.
Figure 2.1: Abortion rates1 for Grampian and Scotland by SIMD 2012 quintiles, 2014P
25.0
19.1
20.0
16.2
15.0
14.2
12.4
10.411.0
9.1 9.4
10.0
Scotland
8.2 8.5
Grampian
5.0
0.0
1 - Most
deprived
2
3
4
5 - Least
deprived
Source: ISD Scotland, Available at: https://isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2015-05-26/201505-26-Terminations-2014-Report.pdf?67461794615
1
Rate per 1,000 women aged 15-44 years
P
Provisional data
Trends: Figure 2.2 shows the trends in abortion rates for Grampian Health Board and
Scotland from 1991 to 2014. As can be seen, for most of the period the abortion rate has
been higher in Grampian than Scotland as a whole. In Grampian rates fell between 1997 and
2000 from 12.7 to 10.9 (per 1,000 women aged 15-44 years), before rising to a peak of 13.8 in
2007. Since then, with the exception of 2012, rates have fallen each year.
Figure 2.2: Trends in abortion rates1 for Grampian and Scotland, 1991-2014P
16.0
14.0
12.0
Scotland
10.0
Grampian
8.0
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
4.0
1991
6.0
Source: ISD Scotland, Available at: https://isdscotland.scot.nhs.uk/Health-Topics/Sexual-Health/Publications/2015-05-26/201505-26-Terminations-2014-Report.pdf?67461794615
1
Rate per 1,000 women aged 15-44 years
P
Provisional data
5
3.
Teenage pregnancies
Scotland has a higher rate of teenage pregnancy than most other Northern and Western
European countries and reducing unintended teenage pregnancy is a priority for the Scottish
Government. Information on teenage pregnancy is derived from registrations to National
Records Scotland (NRS) and available on ISD Scotland. The teenage pregnancy rate is counted
as the number of deliveries combined with the number of abortions. It does not include
miscarriages. Available information is used to estimate the woman’s age at the likely time of
conception.
In Aberdeen City Community Health Partnership (CHP) area in 2012, there were 287 teenage
pregnancies (aged <20 years), equivalent to a rate of 44.3 per 1,000 population (based on
female population aged 15-19 years). This was slightly higher than the Scottish rate of 41.5
for the same period. Teenage pregnancy rates in Scotland ranged from a low of 20.7 in East
Renfrewshire CHP to a high of 75.6 in Kirkcaldy and Levenmouth CHP.
Pregnancy rates for under 16’s and under 18’s are given as 3-year rolling aggregates. For
2010/12 the pregnancy rate for <16 years in Aberdeen was 8.7 per 1,000 population (based on
female population aged 13-15 years), and for <18 years it was 36.7 per 1,000 population
(based on female population aged 15-17 years). Again these rates are slightly higher than
respective Scottish rates of 6.1 and 31.3. Table 3.1 shows the numbers and rates of teenage
pregnancies for Aberdeen and Scotland.
Table 3.1: Teenage pregnancies, Aberdeen City CHP and Scotland, 2010/12
Under 16 years:
2010/12
Aberdeen City CHP
Scotland
Number
Rate
73
1,602
Under 18 years:
2010/12
1
Number
Rate
8.7
338
6.1
8,495
Under 20 years: 2012
2
3
Number
Rate
36.7
287
44.3
31.3
6,497
41.5
st
Source: National Records Scotland/ISD Publication Report, Teenage Pregnancy, Year of Conception ending 31 December 2012,
Available at: http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Teenage-Pregnancy/
1
Rate per 1,000 population, based on female population aged 13-15 years, 3 year rolling aggregate
2
Rate per 1,000 population, based on female population aged 15-17 years, 3 year rolling aggregate
3
Rate per 1,000 population, based on female population aged 15-19 years
Information on numbers of teenage pregnancies in different areas of Aberdeen is available
from the Scottish Neighbourhood Statistics (SNS) website. This is based on data from the
Scottish Morbidity Record 02 (SMR02) and relates to hospital births. The most recent figures
are for Intermediate Zones for 2009-2011 (3-year aggregate).
Within Aberdeen City, the proportion of first-time mothers under the age of 20 years varied
considerably – with some areas having no teenage births (Cults, Bieldside and Milltimber
West; Braeside, Mannofield, Broomhill and Seafield South; Ferryhill South; Braeside,
Mannofield, Broomhill and Seafield East), whereas in other areas teenagers accounted for
over 20% of all first-time mothers. Table 3.2 lists the Intermediate Zones in Aberdeen with
the highest proportion of first-time mothers under 20 years old. The Zones with the highest
proportion of teenage first-time mothers are mainly in the more deprived areas of the city.
6
Table 3.2: First-time mothers, 19 years and under, Aberdeen City, 2009-20111
number
Percentage of first-time
mothers 19 years and
under
%
Cummings Park
17
28.8
Northfield
27
27.3
Heathryfold and Middlefield
26
24.8
Kincorth, Leggart and Nigg North
17
20.7
Mastrick
15
20.5
Summerhill
11
20.4
Garthdee
16
18.6
Tillydrone
24
17.9
Torry East
16
15.5
First time mothers 19
years and under
Intermediate Zone
Source: SMR02/ISD/SNS, Available on http://www.sns.gov.uk/
1
3-year aggregate for financial year ending 31st March
Trends: Figure 3.1 shows the rates of teenage pregnancies (<20 years) for Aberdeen City and
Scotland from 2001-2012. Overall, rates of teenage pregnancies in Aberdeen have fallen
considerably in the past 10 years – a broadly similar pattern to Scotland as a whole. In
Aberdeen the rates dropped sharply between 2008 and 2009 (from 58.1 to 52.3) and again
between 2010 and 2011 (from 51.8 to 41.1). However there was a slight increase between
2011 and 2012.
Figure 3.1: Trends in rates1 of teenage pregnancies, Aberdeen City CHP and Scotland, 20012012
65.0
60.0
55.0
50.0
45.0
40.0
35.0
30.0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Scotland
Aberdeen City
Source: National Records Scotland/ISD Publication Report, Teenage Pregnancy, Year of Conception ending 31st December 2012,
Available at: http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Teenage-Pregnancy/
1
Rate per 1,000 population (calculated using female population aged 15-19)
7
4.
Mothers smoking during pregnancy
Smoking during pregnancy can influence the health of a woman and increase the risk of
having a low birth-weight baby. Information on smoking during pregnancy is obtained from
the Scottish Morbidity Record 02 (SMR02) which is submitted by maternity hospitals to ISD.
Information at Health Board level is available from ISD and information at local authority level
is available on SNS as a 3-year combined total (2011-2013).
In Grampian in 2013, 919 (15%) of the women with a known smoking status at their first
antenatal booking were classified as ‘current smokers’ – this is lower than the rate for
Scotland which was 18.4%. The most recent rate for Aberdeen City (based on a 3-year
combined total for 2011-2013) was very similar to the 2013 rate for Grampian at 14.8% - again
this was lower than the comparable rate for Scotland for the same period which was 19%.
Across Scotland, the proportion of ‘current smokers’ at first antenatal booking ranged from a
low of 11.1% in Shetland Islands to a high of 28.0% in North Ayrshire. Table 4.1 presents the
proportion of ‘current smokers’ for Aberdeen City as well as top and bottom ranking local
authorities. Comparison with other local authority areas shows Aberdeen to have one of the
lowest rates of ‘current smokers’ across Scotland.
Table 4.1: Prevalence of women smoking during pregnancy by Local Authority Areas in
Scotland, 2011-2013
Local Authority
Rank1
‘Current Smoker’ at first antenatal appointment 2011-2013
n
%
Shetland Islands
1
85
11.1
East Renfrewshire
2
275
11.5
East Dunbartonshire
3
323
11.9
Aberdeen City
7
1,228
14.8
Dundee City
30
987
25.1
Dundee City
31
1,328
26.0
North Ayrshire
32
1,174
28.0
32,152
19.0
SCOTLAND
Source: ISD Scotland (SMR02), Available at: http://www.sns.gov.uk/
1
Rank out of 32 local authorities (low to high)
2
Percentage (from a 3 year combined total) of all women with a known smoking status at first antenatal booking appointment
who are recorded as ‘current smoker’
Deprivation: There is a strong association between level of deprivation and smoking during
pregnancy. In Scotland in 2012/13, over 29% of women in SIMD 1 (most deprived 20%) were
‘current smokers’ compared to only 6% of those in SIMD 5 (least deprived 20%). The
association between deprivation and smoking during pregnancy can be seen in Aberdeen.
Data from Aberdeen’s Intermediate Zones for 2011-2013 (3-year aggregate) shows the
highest rates of smoking during pregnancy were found in the more deprived areas, with the
proportion of ‘current smokers’ at first antenatal booking ranging from a low of 2.2% in
Braeside, Mannofield, Broomhill and Seafield East to a high of 35.9% in Torry East. Table 4.2
8
shows the Intermediate Zones in Aberdeen with the lowest and highest rates of women
smoking during pregnancy.
Table 4.2: Smoking status at first antenatal visit, Aberdeen Intermediate Zones, 2011-2013
Smoking during pregnancy: 2011-20131
Number of
women
booked
n
Percentage
smoking
Percentage
not known
if smoking
Percentage
of former
smokers
Percentage
of never
smokers
%
%
%
%
181
2.2
2.8
5.5
89.5
132
2.3
0.0
13.6
84.1
106
2.8
0.0
1.9
95.3
155
3.2
1.9
7.1
87.7
Midstocket
150
3.3
0.7
4.7
91.3
Woodside
223
25.1
2.2
10.8
61.9
Mastrick
211
26.5
0.9
12.3
60.2
Northfield
255
26.7
1.2
9.4
62.7
Heathryfold and Middlefield
248
31.0
0.0
11.3
57.7
Torry East
231
35.9
1.3
11.7
51.1
Intermediate Zone
Braeside, Mannofield,
Broomhill and Seafield East
Cults, Bieldside and Milltimber
East
Braeside, Mannofield,
Broomhill and Seafield South
Braeside, Mannofield,
Broomhill and Seafield North
Source: ISD Scotland (SMR02), Available at: http://www.sns.gov.uk/
1
3 year aggregate data for year ending 31st March
Trend: Figure 4.1 shows the proportions of ‘current smokers’ for Aberdeen and Scotland from
2000-2002 to 2011-2013 (3 year aggregates). Over the last 10 years, the prevalence of
women smoking during pregnancy in Aberdeen has fallen by over 10%, from a high of 26.6%
for 2002-2004 (3-year aggregate), to the current (2011-2013) level of 14.8%. As can be seen,
for much of this period rates of smoking during pregnancy have been slightly higher in
Aberdeen than in Scotland. However, while the downward trend has continued in Aberdeen,
in Scotland there has been a slight upward trend in smoking rates among pregnant women.
Figure 4.1: Trends in percentage of women smoking during pregnancy, Aberdeen and
Scotland, 2000-2002 to 2011-2013
Percentage %
30
25
20
15
10
5
Aberdeen City
Scotland
Source: ISD Scotland (SMR02), Available at: http://www.sns.gov.uk/
1
3-year aggregate data for financial year ending 3st March
9
5.
Drug misuse in pregnancy
As with smoking, drug misuse during pregnancy can affect the health of the mother and also
influence the risk of having a low birth-weight baby. Information on drug misuse during
pregnancy is obtained from the Scottish Morbidity Record 02 (SMR02) which is submitted by
maternity hospitals to ISD. Maternities recording drug misuse are presented as a 3 year
aggregates (financial year ending 31st March). Information is available at Health Board and
Community Heath Partnership (CHP) level.
In the period 2010/11-2012/13, in NHS Grampian there were 253 maternities recording drug
misuse – a rate of 13.8 per 1,000 maternities. This was lower than the Scottish rate of 19.7
per 1,000 maternities. In Aberdeen City CHP area there were 164 maternities recording drug
misuse. This equates to a rate of 19.7 per 1,000 maternities – considerably higher than the
rate for Grampian and matching the rate for Scotland.
There was substantial variation in rates of drug misuse in pregnancy across the different CHP
areas – ranging from a low of 5.5 in East Dunbartonshire to a high of 73.8 in Midlothian CHP.
Table 5.1 presents CHPs with highest and lowest rates of drug misuse in pregnancy. As can be
seen, Aberdeen City is among the poorer ranking CHPs - 25th out of 32 CHP areas - for rates of
recorded drug misuse.
Table 5.1: Maternities recording drug use, number and rate by Community Health
Partnership area, 2010/11 – 2012/13
2010/11 – 2012/13
Community Health
Partnership
Rank
East Dunbartonshire
2
Number of maternities
recording drug misuse
Rate of maternities
recording drug misuse
1
15
5.5
Islands (Orkney, Shetland,
Western Isles)
2
12
5.9
East Renfrewshire
3
15
6.3
Aberdeen City
25
164
19.7
East Lothian
30
133
54.3
West Lothian
31
305
55.9
Midlothian
32
177
73.8
3,338
19.7
1
SCOTLAND
Source: SMR02/ISD, Available at http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/index.asp
1
Rank out of 32 Community Health Partnership areas (low to high)
2
Rate per 1,000 maternities
Trends: Figure 5.1 presents the trends in rates of recorded drug misuse in pregnancy for
Aberdeen City CHP, NHS Grampian and Scotland. As can be seen, the rates have consistently
been higher in Aberdeen City than in either Grampian or Scotland. However, in Aberdeen
City, the rates of recorded drug misuse in pregnancy have dropped for each of the last 3 years
(based on rolling 3-year aggregate figures) – from 24.9 per 1,000 maternities in 2008/092010/11 to the most recent figure of 19.7. This contrasts with rates for Scotland as a whole
10
which show a continuing upward trend. In Grampian, there is also a slight upward trend in
rates.
Figure 5.1: Trends in rates1 of recorded drug misuse in pregnancy, Aberdeen City, Grampian
and Scotland: 2006/07-2008/09 to 2010/11-2012/13
30.0
25.0
Rate
20.0
15.0
10.0
5.0
0.0
2006/07-2008/09
2007/08-2009/10
Aberdeen City CHP
2008/09-2010/11
2009/10-2011/12
NHS Grampian
2010/11-2012/13
Scotland
Source: SMR02/ISD, Available at: http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/index.asp
1
Rate per 1,000 maternities
Deprivation: No information is available on rates of recorded drug misuse in pregnancy by
deprivation within Aberdeen, however it is likely that rates will be higher in the more deprived
areas of the city. In Scotland in 2012/13, the rate of maternities recording drug use was 4
times higher in the most deprived areas (28.8 per 1,000 maternities) than in the least deprived
(7.1 per 1,000 maternities). Figure 5.2 clearly highlights the deprivation gradient in recorded
drug misuse during pregnancy.
Figure 5.2: Rate of recorded drug misuse in pregnancy by level of deprivation (SIMD 2012
quintiles), Scotland, 2012/13
Scotland
35.0
30.0
25.0
20.0
15.0
2012/13
10.0
5.0
0.0
1 (most
deprived)
2
3
4
5 (least
deprived)
Source: SMR02/ISD, Available at: http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/index.asp
1
Rate per 1,000 maternities
11
6.
Low weight live births
Low birth weight is a major determinant of infant mortality and morbidity. As it is associated
with a range of social and environmental factors (e.g. maternal smoking, maternal age,
deprivation, previous obstetric history, drug/alcohol use) it is often used as a health status
indicator. Low birth weight is categorised as between 1500-2499g and very low birth weight
is under 1500g. Information on low birth weight is obtained from SMR02 and available on ISD
Scotland.
Provisional figures for 2013 for the Grampian Health Board area show that 6.6% of live births
were either low birth weight or very low birth weight. This is in line with the equivalent rate
for Scotland which was 6.4%. As could be expected, a much higher proportion of premature
births were low birth weight compared to full-term births. Only 2.3% of all full-term births
(born at or after 37 weeks gestation) were categorised as low birth weight, while for
premature births (born before 37 weeks gestation) this figure rises to 46.3%. An additional
13.4% of premature births were categorised as very low birth weight (under 1500g). The
proportions within each of the birth-weight categories for premature births in Grampian are
very similar to equivalent figures for Scotland (see Table 6.1).
Table 6.1: Premature births by birthweight for Grampian Health Board and Scotland, year
ending 31 March 2013
Premature (born before 37 weeks gestation)
Grampian Health Board
Scotland
Total
<1500g
1500-2499g
2500g+
n
%
%
%
499
13.4
46.3
40.3
4,132
13.9
45.3
40.5
Source: SMR02/ISD, Available at: https://isdscotland.scot.nhs.uk/Health-Topics/Maternity-and-Births/Publications/2014-0826/2014-08-26-Births-Report.pdf?77877444029
Full-term live births: Information on low birth weight live full-term singleton births for
Aberdeen City (based on SMR02 data) is available on SNS as a 3-year rolling aggregate. Out of
the 7,682 live singleton full-term births in the 3-year period ending 31st March 2013, 155
(2.0%) were classified as low weight. The proportion of low birth weight live births varied
across Aberdeen, the highest being 4.4% in Balgownie and Donmouth East, while several of
the Intermediate Zones had no reported low birth weight live births. Table 6.2 shows
Aberdeen’s intermediate zones with the highest proportions (3.0% or more) of low birth
weight live births.
12
Table 6.2: Low birth weight live full-term singleton births, Aberdeen City Intermediate
Zones, 3-year aggregate, 2011-2013
Live singleton
births
Low weight live
singleton births
Low weight as a
percentage of live
singleton births
n
n
%
Balgownie and Donmouth East
68
3
4.4
Northfield
233
9
3.9
Froghall, Powis and Sunnybank
189
7
3.7
City Centre
252
9
3.6
Stockethill
196
7
3.6
Seaton
175
6
3.4
Cummings Park
121
4
3.3
Summerhill
154
5
3.3
Sheddocksley
126
4
3.2
Garthdee
192
6
3.1
Heathryfold and Middlefield
227
7
3.1
Intermediate Zone
Source: SMR02/ISD, Available at: http://www.sns.gov.uk/
1
3-year aggregate for financial year ending 31st March
Trend: While the actual number of low birth weight live singleton births has increased slightly
over the past 10 years (137 in the 2000-2002 period to its current level of 155 in the 20112013 period), since 2004-2006 the proportion of low birth weight births per live singleton
births has decreased slightly – although the difference is very small (less than 1%). Figure 6.1
presents numbers (right hand-side of scale) and proportions of low birth weight live singleton
births in Aberdeen from 2000-2002 to 2011-2013.
3
180
160
140
120
100
80
60
40
20
0
Percentage %
2.5
2
1.5
1
0.5
0
Number
Percent
Source: SMR02/ISD, Available at: http://www.sns.gov.uk/
1
3-year aggregate for financial year ending 31st March
13
Number
Figure 6.1: Trend for numbers and proportions of low birth weight live singleton births,
Aberdeen 2000-2002 to 2011-20131
7.
Babies exclusively breastfed at 6-8 weeks
Encouraging and supporting breastfeeding is recognised as an important public health activity
and the Scottish Government has adopted as policy World Health Organisation guidance in
recommending exclusive breastfeeding for the first six months of a child’s life. Information on
breastfeeding is collected at routine child health reviews and recorded on the Child Health
Systems Programme Pre-school system (CHSP Pre-School) and available on ISD.
In 2013/2014, out of the 2,222 reviews conducted, 37.9% of 6-8 week-old children in
Aberdeen City were exclusively breastfed and 53.6% were breastfed (includes mixed breastfed
and formula). This is considerably higher than the respective Scottish rates of 27.1% and
37.9%. The proportion of children who are exclusively breastfed at 6-8 weeks has increased in
the past few years from 33.0% in 2010/11 to its current level of 37.9%.
Local area statistics (Intermediate Zones) on breastfeeding are available on SNS. There was
substantial variation in rates of breastfeeding across different areas of Aberdeen. Rates of
children exclusively breastfed at 6-8 weeks ranged from a low of 13.7% in Torry East to a high
of 62.5% in Cults, Bieldside and Milltimber West. Table 7.1 shows Intermediate Zones with
the lowest and highest rates of breastfeeding.
Table 7.1: Intermediate Zones in Aberdeen City with the lowest and highest rates of
breastfeeding at 6-8 weeks, 2013/14
Number receiving a
6-8 week review:
2013/14
Percentage
breastfed at 6-8
week review:
2013/14
n
%
Percentage
exclusively
breastfed at 6-8
week review:
2013/14
%
Torry East
51
21.6
13.7
Cummings Park
38
28.9
21.1
Northfield
72
38.9
22.2
Kincorth, Leggart and Nigg South
54
40.7
22.2
Mastrick
58
31.0
22.4
Heathryfold and Middlefield
52
30.8
23.1
Hanover
69
66.7
55.1
Braeside, Mannofield, Broomhill
and Seafield North
49
75.5
57.1
West End North
31
83.9
58.1
West End South
63
82.5
61.9
Ferryhill North
58
77.6
62.1
Cults, Bieldside and Milltimber
West
16
81.3
62.5
Source: Child Health Systems Programme (Pre-school)/Scottish Neighbourhood Statistics, Available at: http://www.sns.gov.uk/
As can be seen from the above table, level of breastfeeding tends to be lower in areas with
higher levels of deprivation. This is consistent with figures for Scotland as a whole which show
that only 15.1% of children in the most deprived areas (based on SIMD 2012 quintiles) are
14
breastfed exclusively at 6-8 weeks, compared to 42.6% in the least deprived areas. Scottish
data also shows that maternal age is associated with breastfeeding. A smaller proportion of
younger mothers (12.4% of 20-24 year olds and 24.5% of 25-29 year olds) breastfeed
exclusively at 6-8 weeks compared to older mothers (34.6% of 30-34 year olds, 36.7% of 35-39
year olds and 36.3% of 40+ year olds). Additionally, within those age-bands, there is a clear
gradient in level of breastfeeding by level of deprivation, with those in the most deprived
areas being less likely to breastfeed than those in the least deprived areas (CHSP Preschool/ISD Scotland).
8.
Immunisation uptake at 24 months
Children are protected through immunisation against many serious infectious diseases.
Vaccination programmes aim to both protect the individual and to prevent the spread of
these illnesses through the population. In Scotland there is a national target for 95% of
children to complete courses of routine childhood immunisations (Diphtheria, Tetanus,
Pertussis, Polio, Hib (DTP/Pol/Hib), Men C and Pneumococcal Conjugate Vaccine (PCV)) by 24
months of age. An additional target of 95% uptake of one dose of Measles, Mumps and
Rubella (MMR) vaccine by 5 years old was introduced in 2006. Information on immunisations
is collected on the Scottish Immunisation and Recall System (SIRS) and is available on ISD
Scotland.
Table 8.1 shows the percentage of children who completed the primary course of
immunisations by 24 months of age for Aberdeen City CHP and for Scotland in 2014. As can
be seen, completion of primary courses for Men C (90.6%) and PVC (93.5%) vaccines did not
reach the 95% targets and were lower than the completion rates for Scotland as a whole. The
completion rate for DTP/Pol/Hib did meet the target (96.9%), but was still lower than the
equivalent Scottish figure of 98.1%. At 93.5%, the completion rate at 24 months for MMR1
was also lower than the Scottish rate, however the target of 95% completed by 5 year-olds
was achieved (96.8%).
Table 8.1: Primary Immunisation uptake rates, Aberdeen City CHP and Scotland, 2014
Percentage completed primary course by 24 months
Number in
1
cohort
DTP/Pol/Hib
Men C
PVC
MMR1
MMR1
uptake by 5
2
year olds
%
%
%
%
(n) %
Aberdeen
City CHP
2,753
96.9
90.6
93.5
93.5
(2,575) 96.8
Scotland
58,636
98.1
95.0
97.1
95.6
(59,719) 97.3
Source: SIRS, Available at: http://www.isdscotland.org/Health-Topics/Child-Health/Immunisation/
1
Children reaching 24 months of age during the evaluation period 1 January to 31 December 2014 (i.e. born 1 January to 31
December 2012)
2
Children reaching 5 years of age during the evaluation period 1 January to 31 December 2014 (i.e. born 1 January to 31
December 2009)
Local area information (based on Intermediate Zones) for 2013 on the uptake of DTP/Pol/Hib
immunisations at 24 months is available on SNS. Out of Aberdeen’s 47 intermediate zones, 10
15
did not meet the 95% target uptake of DTP/Pol/Hib by 24 months. These are shown in Table
8.2.
Table 8.2: Intermediate Zones not meeting 95% target uptake of DTP/Pol/Hib at 24 months,
Aberdeen, 2013
Number in 24
month cohort:
2013
Number
vaccinated
against
DTP/Pol/Hib at
24 months: 2013
Percentage
vaccinated
against
DTP/Pol/Hib at
24 months: 2013
Cults, Bieldside and Milltimber West
40
34
85%
Cults, Bieldside and Milltimber East
64
56
87.5%
Midstocket
40
36
90%
City Centre
53
48
90.6%
Hilton
69
64
92.8%
Ferryhill North
30
28
93.3%
Culter
49
46
93.9%
Summerhill
52
49
94.2%
Sheddocksley
56
53
94.6%
Hanover
59
56
94.9%
Source: SIRS/Scottish Neighbourhood Statistics, Available at: http://www.sns.gov.uk/
Information on the uptake of the MMR1 vaccine at 5 years old is also available at a local level.
The 95% uptake target was not met in 19 of Aberdeen’s Intermediate Zones. Table 8.3 shows
the Intermediate Zones that did not meet the target.
16
Table 8.3: Intermediate Zones not meeting 95% target uptake of MMR1 at 5 years,
Aberdeen, 2013
Number in 5 year
cohort: 2013
Number
vaccinated
against MMR at 5
years: 2013
Percentage
vaccinated
against MMR at 5
years: 2013
City Centre
24
19
79.2%
Cults, Bieldside and Milltimber East
71
59
83.1%
Old Aberdeen
28
24
85.7%
West End North
37
32
86.5%
George Street
47
42
89.4%
Braeside, Mannofield, Broomhill and
Seafield South
42
38
90.5%
Rosemount
35
32
91.4%
Torry West
62
57
91.9%
West End South
51
47
92.2%
Ferryhill South
39
36
92.3%
Stockethill
54
50
92.6%
Cults, Bieldside and Milltimber East
41
38
92.7%
Braeside, Mannofield, Broomhill and
Seafield East
42
39
92.9%
Sheddocksley
57
53
93.0%
Seaton
47
44
93.6%
Balgownie and Donmouth East
32
30
93.8%
Hazelhead
50
47
94.0%
Garthdee
51
48
94.1%
Culter
57
54
94.7%
Source: SIRS/Scottish Neighbourhood Statistics, Available at: http://www.sns.gov.uk
Deprivation: In Scotland as a whole, uptake of vaccinations is good (above 95%) across all
levels of deprivation. Interestingly, and in contrast with most health related issues, in
Aberdeen, some of the areas with the lowest uptake of vaccinations are those which are in
the least deprived areas – possibly a continuing reaction following the adverse publicity
around some vaccinations which resulted in parents in higher socio-economic groups being
more likely to decline vaccines (although caution is required in this interpretation as the
numbers involved are very small).
9.
Child dental health
The NHS General Dental Service is usually the first point of contact that patients have with a
dentist. Patients register with an NHS Dentist to receive NHS dental treatment. Information
on the General Dental Services is published by ISD.
17
Provisional figures for 2014 show that 85.5% of children (<18 years) in the Grampian Health
Board area were registered with an NHS Dentist. Figure 9.1 shows registrations by Health
Board area for Scotland for 2010, 2012 and 2014. Although the proportion of registrations
has increased (from 69.5% in 2010), Grampian currently has the second-lowest level of child
NHS dental registrations in Scotland – only Western Isles is lower at 84.3%.
Figure 9.1: Percentage of children registered with an NHS Dentist in Scotland, by NHS BoardP
Source: ISD/ MIDAS, Available at: https://isdscotland.scot.nhs.uk/Health-Topics/Dental-Care/Publications/2015-01-27/2015-0127-Dental-Report.pdf , PFigures for 2014 are provisional
Deprivation: In Scotland as a whole, differences in registration by deprivation have decreased
over the years and in September 2014, for the first time, similar registration rates for children
were seen across all SIMD quintiles. While this was not fully consistent in all NHS Board
areas, registration rates in Grampian were broadly similar in all SIMD quintiles although the
rates in each quintile were lower than those for Scotland. Table 9.1 shows the percentage of
children registered with an NHS dentist by deprivation (SIMD quintile) for Grampian and
Scotland at 30th September 2014.
Table 9.1: Percentage of children registered with an NHS dentist by deprivation, Grampian
and Scotland at 30th September 2014P
NHS Board
SIMD 1
(most
deprived)
%
SIMD 2
SIMD 3
SIMD 4
%
%
%
SIMD 5
(least
deprived)
%
Grampian
86.6
85.9
84.4
85.2
86.2
Scotland
88.7
89.1
88.8
89.1
89.9
Source: ISD/ MIDAS, Available at: https://isdscotland.scot.nhs.uk/Health-Topics/Dental-Care/Publications/2015-01-27/2015-0127-Dental-Report.pdf
P
Figures for 2014 are provisional
18
National Dental Inspection Programme: The National Dental Inspection Programme (NDIP) is
carried out annually – two school year groups are involved; Primary 1 (P1) children and
Primary 7 (P7) children. Both groups of children are given a basic inspection and the dental
status of each child is categorised into three groups depending on the level of dental health
and treatment need observed. Parents and carers are then advised by letter. The letter types
are as follows:

Letter A – should seek immediate dental care on account of severe decay or abscess
Letter B – should seek dental care in the near future due to one or more of the
following: history of tooth decay, a broken or damaged front tooth, tooth wear, poor
oral hygiene or may require orthodontics
 Letter C – no obvious decay experience but should continue to see the family dentist
on a regular basis
Tables 9.2 and 9.3 show the results of the basic inspection in P1 and P7 children for NHS
Health Boards for 2014. In Grampian, 8% of P1 children inspected were advised to seek
immediate dental care (Letter A); slightly lower than the Scottish figure of 9.3%. The
proportion of Letter A’s issued was lower in P7 children (1.9%), but over half (52.8%) of P7
children inspected were advised to seek dental care in the near future (Letter B). This was
slightly higher than the Scottish average figure of 50.3%.
Table 9.2: Primary 1 children inspected, NHS Health Boards and Scotland, 2013/14
NHS Board
Estimated
number of
P1 children
in Local
Authority
schools
n
Number
of
children
inspected
Proportion
of children
inspected
Proportion
of letter
A’s issued
Proportion
of letter
B’s issued
Proportion
of letter
C’s issued
n
%
%
%
%
Ayrshire & Arran
3978
3611
90.8
5.4
26.8
67.8
Borders
1177
1059
90.0
5.9
20.3
73.7
Dumfries &
Galloway
1577
1277
81.0
10.6
21.1
68.3
Fife
3979
3916
98.4
9.2
22.4
68.4
Forth Valley
3380
3101
91.7
10.8
22.0
67.1
Grampian
6132
5546
90.4
8.0
21.3
70.6
Greater Glasgow
& Clyde
12724
11805
92.8
12.0
26.9
61.1
Highland
3342
3004
89.9
7.3
27.3
65.4
Lanarkshire
6672
6064
90.9
10.7
21.7
67.6
Lothian
9111
8411
92.3
8.3
23.5
68.3
Orkney
242
212
87.6
1.9
25.0
73.1
Shetland
291
245
84.2
2.0
17.1
80.8
Tayside
4118
3960
96.2
8.6
24.5
66.8
Western Isles
298
228
76.5
7.9
22.4
69.7
57021
52439
92
9.3
24
66.7
Scotland
Source: ISD NDIP Database, Available at: http://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2014-1028/2014-10-28-NDIP-Report.pdf
19
Table 9.3: Primary 7 children inspected, Grampian Health Board and Scotland, 2013/14
NHS Board
Estimated
number of
P7 children
in Local
Authority
schools
n
Number
of
children
inspected
Proportion
of children
inspected
Proportion
of letter
A’s issued
Proportion
of letter
B’s issued
Proportion
of letter
C’s issued
n
%
%
%
%
Ayrshire & Arran
4017
3179
79.1
1.4
54.5
44.1
Borders
1281
1002
78.2
0.9
47.5
51.6
Dumfries &
Galloway
1518
1241
81.8
2.9
52.8
44.3
Fife
3785
3252
85.9
2.3
43.9
53.8
Forth Valley
3364
2668
79.3
2.1
49.5
48.4
Grampian
5934
4617
77.8
1.9
52.8
45.3
Greater Glasgow
& Clyde
12678
10294
81.2
2.8
52.7
44.5
Highland
3393
2705
79.7
2.0
54.5
43.5
Lanarkshire
6597
5425
82.2
1.7
44.2
54.1
Lothian
8401
6373
75.9
1.6
51.9
46.6
Orkney
215
163
75.8
-
47.2
52.8
Shetland
301
224
74.4
0.4
27.7
71.9
Tayside
4397
3313
75.3
1.1
47.5
51.4
Western Isles
290
242
83.4
2.5
52.5
45.0
56171
44698
79.6
2
50.3
47.7
Scotland
Source: ISD NDIP Database, Available at: http://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2014-1028/2014-10-28-NDIP-Report.pdf
While a full breakdown of results is not available for Aberdeen City, ScotPHO publishes
information on the number of children who received a Letter C – the most recent data relates
to 2012/13. In Aberdeen, of the 1,223 children in P1 who were given a basic inspection,
67.8% were issued a Letter C. Of the 578 P7 children inspected, 44.5% were issued a Letter C.
See Table 5.3.
Table 5.3: Primary 1 and Primary 7 children issued a Letter C at basic dental inspection,
Aberdeen City and Scotland, 2012/2013
Total no. of P1
children
inspected
n
Proportion of
C letters
issued
%
Total no. of P7
children
inspected
%
Proportion of
C letters
issued
%
Aberdeen City
1,223
67.8
578
44.5
Scotland
57,021
66.4
56,171
45.2
Local Authority
Source: NDIP Database/ScotPHO, Available at: https://scotpho.nhsnss.scot.nhs.uk/scotpho/
Detailed inspection: In addition to the basic inspection, some Primary 1 children were also
given a more detailed inspection. In 2014 in Grampian 2,768 P1 children (45.1% of the
estimated total number of P1 children) were involved in this further inspection. Of these,
20
73% had no obvious decay, but 22% were found to have untreated decay. Equivalent Scottish
figures are 68% and 26% respectively.
Deprivation: Across Scotland the detailed inspection of P1 children also showed a continuing
link between level of deprivation (SIMD 2012 quintiles) and poor oral health. Although in
Scotland oral health continues to improve across all deprivation quintiles, the difference
between those in the most deprived areas (SIMD 1) and those in the least deprived areas
(SIMD 5) is still apparent, with only 53% of P1 children in SIMD 1 showing no obvious decay
experience compared to 83% of P1 children in SIMD 5 (Figure 9.2). Although, no specific
information for Grampian Health Board is available, it is likely that the pattern here will be
similar.
Figure 9.2: Change between 2008 and 2014 in the proportion of P1 children in Scotland with
no obvious decay experience by SIMD1 quintile
2008
100
2010
2012
2014
80
- - National target for P1 children by 2010
70
60
83
81
79
73
77
74
68
70
68
65
59
61
62
59
52
47
20
50
30
53
40
75
50
42
% with no obvious decay experience
90
10
0
1
Most deprived
2
3
SIMD quintile
4
5
Least deprived
Source: ISD NDIP database, Available at: http://www.isdscotland.org/Health-Topics/Dental-Care/Publications/2014-10-28/201410-28-NDIP-Report.pdf
1
SIMD used has been subject to availability, as follows: 2008- SIMD 2006; 2010 & 2012- SIMD 2009; 2014- SIMD 2012.
10.
Child obesity in primary 1
Children’s weight and growth is an important marker of their general nutrition and physical
health. Child growth references are widely used as a tool for detecting children who are not
growing properly or who are under- or over-weight. As part of the child health programme
provided by all Scottish Health Boards, height and weight measurements are collected in
Primary 1 children and recorded on the child health school system (CHSP school).
In 2013/14, height and weight measurements were recorded for 1,922 Primary 1 children
(86.2% of the estimated population of 5 year-olds) in the Aberdeen City CHP area. Over a
quarter (25.2%) of these were classified as being at risk of overweight (13.9%) or obesity
(11.3%). This is higher than the Scottish average of 22.6% (12.4% overweight and 10.1%
21
obesity). Figure 10.1 shows figures for all CHPs for Primary 1 children at risk of overweight
and obesity combined.
Figure 10.1: Percentage of Primary 1 school children at risk of overweight or obesity
combined by CHP, Scotland, school year 2013/2014
Note - Epidemiological categories are used: At risk of overweight (BMI greater than or equal to 85th
centile and less than 95th centile); At risk of obesity (BMI greater than or equal to 95th centile)
Gender: While there is no local data available, figures for Scotland as a whole suggest few
differences by gender in the proportion of Primary 1 children at risk of overweight (12.5% for
boys and 12.4% for girls), although a slightly higher proportion of boys were at risk of obesity
(10.5% for boys and 9.7% for girls).
Deprivation: Figures for Scotland show a clear progression in the increased risk of overweight
or obesity by increased level of deprivation. Across all NHS Boards, 25.9% of Primary 1
children in SIMD Quintile 1 (most deprived) were at risk of overweight or obesity compared to
17.8% of those in SIMD Quintile 5 (least deprived). Figure 10.2 shows the progression across
SIMD Quintiles.
22
Figure 10.2: Percentage of Primary 1 children in Scotland at risk of overweight or obesity
combined, by SIMD 2012 Quintile, school year 2013/14
11.
Child and Adolescent Mental Health (CAMH) Services
The NHS in Scotland provides mental health services for children and young people with a
wide range of mental health conditions including Attention Deficit Hyperactivity Disorder
(ADHD), anxiety, behaviour problems, depression and early onset psychosis. The treatment is
provided through Child and Adolescent Mental Health (CAMH) services, mainly on an outpatient or community-based basis. Information on how many children and young adults (<18
years) are referred to CAMH services is collected to help manage waiting times. It is available
on a quarterly basis and is published on ISD.
In the period January to March 2015, a total of 818 children and young people in the
Grampian Health Board area were referred to CAMH services. This is equivalent to a rate of
7.4 per 1,000 people under the age of 18, which was slightly higher than the rate for Scotland
as a whole (6.6 per 1,000 people under 18 years). Rates of referral for this period varied from
a low of 4.4 in NHS Shetland, to a high of 11.2 in Dumfries and Galloway – however as service
provision varies slightly across NHS Boards (some areas provide services for all those under 18
years while other provide services for those over 16 years only if they are in full-time
education) direct comparison is not possible. In Grampian children and young people are
eligible for service provision until their 18th birthday.
Table 11.1 shows referral numbers and rates for NHS Grampian and Scotland for each quarter
of 2014, including the total number of referrals for the year.
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Table 11.1: Number and rate1 of referrals received to Child Adolescent Mental Health
services, NHS Grampian and Scotland, 2014
January to March
2014
All
referrals
Referral
rate
n
April to June 2014
All
referrals
Referral
rate
n
July to September
2014
All
referrals
Referral
rate
n
October to December
2014
All
referrals
January to
December
2014
Referral
rate
Total
referrals
n
n
NHS
Grampian
759
6.9
681
6.2
602
5.5
774
7.0
2,816
Scotland
7660
7.4
6,284
6.4
5,579
5.7
7,640
7.4
27,163
Source: ISD CAMHs Waiting Times Database, Available at: http://www.isdscotland.org/Health-Topics/WaitingTimes/Publications/data-tables.asp?id=1366#1366
1
Referral rates are per 1,000 people under age 18
As can be seen in the above table, the rates for the NHS Grampian area are slightly lower than
the rates for Scotland as a whole in each quarter of 2014. No local level information on
referrals was available.
Conclusion
This paper uses available routine data to present a brief overview of some of the health issues which
relate specifically to women and children in Aberdeen City and Grampian. As with more general
health issues (see Health and Health Outcomes Briefing Paper), the picture is a mixed one. There are
some positive aspects with, for example, rates of teenage pregnancies, terminations, smoking during
pregnancy and drug misuse during pregnancy all falling in the past few years. Similarly, Aberdeen
has relatively high rates for breastfeeding and low rates for smoking during pregnancy compared to
Scottish averages. Additionally, rates for referrals to Child and Adolescent Mental Health Services
were slightly lower than average rates for Scotland.
However, there were also some less positive aspects. Although on a downward trend, rates of
teenage pregnancy and drug misuse during pregnancy were still worse than Scottish averages; as
were the proportions of Primary 1 children at risk of overweight or obesity and the take-up of
immunisations. Also, despite increases in the past few years, Grampian still has one of the lowest
rates in Scotland of children registered with an NHS dentist. Additionally, and in contrast with other
women’s health issues where overall rates are falling, sexual health in Grampian is a potential cause
for concern; numbers of diagnoses of genital herpes simplex have risen substantially and rates of
diagnoses are considerably higher than Scottish averages and, despite the recent fall in numbers,
diagnoses of genital chlamydia also show an upward trend.
Underlying the broad picture presented above, within Aberdeen there were also differences
depending on where you live. Where local area information was available (Intermediate Zone), it
showed that most cases areas with high deprivation had worse outcomes than those with low
deprivation. For example, rates of teenage pregnancies, smoking during pregnancy and low birth
weight live births were substantially higher in more deprived areas and rates of breastfeeding were
lower. The only exception was immunisation take-up, where was the picture more mixed with
lowest take-up being in some of the least deprived areas of the city.
24
Unfortunately, local area information is not available for all of the topics we have examined. In
some cases this is to preserve patient anonymity, and in others it may be a consequence of the
rationale for collecting the data (e.g. to monitor waiting times). The end result is that it is difficult to
say with certainty whether this pattern is similar across all issues, although Scottish data shows a
continuing link between high deprivation and worse health outcomes. One of the main benefits of
local area information is that it identifies specifically where to target potential interventions. Unlike
many of the broader health issues examined in the Health and Health Outcomes briefing paper (e.g.
cancer, heart disease, life-expectancy) which are not easily addressable through local, small-scale
intervention strategies, some of the issues examined in this paper may be more open to this type of
initiative. Targeted interventions in specific locations or with specific age/social groups, aimed at,
for example, increasing breastfeeding rates or promoting safe-sex could potentially have an
important impact in improving women’s health in some of the more deprived areas of the City.
25
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