Grant: Partnerships for Health System Improvement (PHSI)

Nunavut leads the country for adverse early child health outcomes, in particular, rates of infant hospitalisations (>300/1000) for respiratory infections and infant mortality rates three times greater than the rest of the country. In our 1999-2008 review of IM cases the leading causes were sudden unexpected death and respiratory infection. We also showed in preliminary studies that Nunavut infants with a gene variant important in the way fat is used for energy (CPT1A P479L) had a fivefold greater risk of sudden death or death due to infection. Paradoxically, we also showed this gene variant is common in Nunavut infants (>60%) suggesting protection historically, perhaps with a diet high in fat but low in sugars. In the context of other contributors to infant mortality, we will explore the effect of the CPT1A variant and whether there are broader effects on early Inuit health. In addition to respiratory infection being a leading cause of IM, many more infants are hospitalized for this reason. As with IM, assessing the broad underlying determinants is crucial to provide insights into prevention strategies. We aim to develop a profile of infants most likely to present with lung infection and determine which infants are at greatest risk for severe decompensation. Based on evidence we will optimize the vaccination protocols locally for a sometimes detrimental virus, RSV, and assess effectiveness of the program. Our partnership with Health and Social Services, Nunavut Tunngavik Inc, Qaujigiartiit Health Research Centre, in conjunction with the newly implemented Nutaqqavut "Our Children" Health Information System (NHIS), provides unique tools and local input to address these priorities. The over-arching goal is to obtain evidence to determine which modifiable risk factors affect infant health in the most detrimental way. Policy decisions on RSV vaccine, newborn screening and public health prevention strategies are urgently needed and will be informed with these results.