Presentation by Dr. David Paul Chair, Delaware Healthy Mother & Infant Consortium

Transcription

1 Presentation by Dr. David Paul Chair, Delaware Healthy Mother & Infant Consortium

2 Infant Mortality in Delaware BACKGROUND & KEY FACTS Delaware s infant mortality rate has continued to remain higher (8.5/1,000 in 03-07) than the U.S. average (6.8/1,000). Currently, Delaware is ranked the sixth highest state for infant mortality in the U.S. Among all infant deaths in Delaware, 60% occur at less than 28 weeks gestation. The leading cause of infant death among Caucasians and African Americans is prematurity.

3 Trends in Infant Mortality DELAWARE & U.S. Five-Year Average Infant Mortality Rates, Delaware & U.S. Deaths Per 1,000 Births Five-Year Intervals The Target of 4.50 was designated Healthy People 2010 U.S. Delaware Target (4.50)

4 Trends in Infant Mortality DELAWARE & U.S. Percentage by which Delaware's Infant Mortality Rate Exceeds that of the U.S., Five-Year Average Intervals 50.00% 45.00% Percentage Excess 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 18.01% 27.95% 31.05% 31.48% 35.23% 34.58% 28.45% 25.00% 10.00% 5.00% 0.00% Five-Year Intervals

5 Infant Mortality & Gestational Age THE CASES OF DELAWARE & RHODE ISLAND We know that: Prematurity is the leading contributor to infant mortality. We can significantly reduce infant deaths if we reduce the number of babies born too soon and too small. Illustration: Comparing Delaware and Rhode Island s Infant Mortality Rates by Gestational Age.

6 IMR Breakdown DELAWARE & RHODE ISLAND DELAWARE Weeks Deaths Births IMR Per 1000 Births By Age % % % % % Total RHODE ISLAND Weeks Deaths Births IMR Per 1000 Births By Age % % % % % Total

7 Comparing IMR Between Delaware & Rhode Island 8.0 Infant Mortality Rate for Delaware, Rhode Island, & Delaware with Rhode Island Gestational Age Distribution Applied, % Lower IMR Delaware, Rhode Island, Delaware, with Rhode Island Gestational Age Distribution

8 Infant Mortality Premature Birth Total Births 2006 Delaware 11, Alaska 10, Montana 12, South Dakota 11, Births <1500 grams 2006

9 Infant Mortality Premature Birth DE total infant deaths (n=503) % No info 0% <500 34% < % No info %

10 Costs of Premature Birth United States $26 Billion/year NICU costs $4,000/day Surviving 25 week gestation infant, length of stay 100 days

11 Infant Mortality WHAT WE KNOW: We know that MULTIPLE factors before, during and after pregnancy can contribute to poor birth outcomes such as premature birth and infant mortality Poor Nutrition, Obesity & Underweight Inadequate Provider Care Short Intervals between Pregnancy Infant Mortality & Poor Birth Outcomes Maternal Stress Genetic Predisposition Programs need to address more than the woman s preconception and prenatal care Infections & STIs Chronic Diseases Smoking, Alcohol & Drug Use

12 What We Know from PRAMS PREGNANCY PROFILE PRAMS (Pregnancy Risk Assessment Monitoring System), is a CDC-developed surveillance system which provides populationbased data on maternal attitudes and experiences before, during, and shortly after pregnancy. The 2007 Delaware findings include: 71% (N=480) did NOT take a daily multi-vitamin the month before pregnancy. 27% (N=167) of respondents had a pre-pregnancy BMI classified as obese. 60% (N=87) of smokers did not quit smoking during pregnancy 27% (N=178) received prenatal care late or not at all.

13 What We Know from FIMR FETAL INFANT MORTALITY REVIEW FIMR Case Review Teams: Intensively review medical/social records interview mothers whose infant has died. The information is used at the local level for assessing, planning, improving and monitoring the service systems and broad community resources that support and promote the health and well-being of women, infants and families. The top four issues identified from case reviews teams in were: Pre-existing medical conditions: 71% (N=96) had asthma, hypertension, diabetes/gestational diabetes, mental health issues or STDs. Medical and social services/community resources available but not used: 40% (N=55) had inadequate or a delay in referrals for home-based services. Obesity/nutrition: 36% (N=49), mothers were classified as obese. 24% (32 of 136) were classified as having inadequate nutrition and/or anemia in the first trimester.

14 Infant Mortality WHAT WE DON T KNOW: RACIAL DISPARITIES IM Rate By Race and County African American Caucasian In Delaware, there is a significantly higher Infant Mortality Rate among African American infants as much as two to nearly three times that of Caucasian infants The IMR for African Americans is consistently higher than Caucasians in all three counties Contributing factors to disparities? New Castle Kent Sussex

15 Trends in Infant Mortality DELAWARE & RACIAL DISPARITIES All Races White Black Disparity

16 Addressing Delaware Infant Mortality INFANT MORTALITY TASK FORCE REPORT In May 2005, the Governor's Infant Mortality Task Force (IMTF) issued a report on Delaware's high infant mortality rate. The report included twenty recommendations to reduce the infant mortality rate and eliminate the racial disparity in the rate at which these babies die. The Delaware Healthy Mother and Infant Consortium (DHMIC) was established as a successor to the IMTF to advocate for, and oversee, the implementation of the recommendations of the Task Force.

17 Delaware Healthy Mother and Infant Consortium PROGRESS DHMIC mandates include reviewing and analyzing evaluations and reports and making appropriate recommendations. DHMIC has made great progress in addressing the recommendations: Six of the twenty are done Eleven of the twenty are in-progress However, three of the twenty have not been addressed due to lack of resources 1. Reproductive health coverage for those up to 650% FPL 2. Oral health promotion 3. Evaluation of the impact of environmental risk factors

18 DHMIC s Approach HOW WE HAVE ACHIEVED SUCCESS Using a science-based model to address the health of women across their life span. This Life Course Perspective looks at the health of the mother from the day of her birth to the birth of her child. Programs and initiatives designed to intervene at many levels: woman, family, provider, community. Evidence shows that multiple programs and initiatives in a combined effort to tackle the various preconception and prenatal issues will have the greatest effect on reducing infant mortality. We've made important inroads towards improving women's health and reducing infant morality.

19 Healthy Women/Healthy Babies AN EXAMPLE OF COMPREHENSIVE CARE Reimburses 8 statewide medical vendors for preconception, prenatal, mental health and nutrition services. Adheres to CDC recommendations on preconception and interconception care. Bases program eligibility on target population and risk factors. Individual-level reporting. Includes an evaluation component examining proximal and distal outcomes. During fiscal year 2009, the program served 11,382 women across the state. Of those women served who were pregnant, 95 % did not have a pregnancy complication.

20 Achieving Optimal Health BEFORE Pregnancy REPRODUCTIVE LIFE PLAN A Life Plan helps women plan their future. This may or may not include having children. Helps women create life goals that may or may not include having children. Helps plan the spacing of pregnancies. Helps prevent unplanned pregnancies. Helps women understand the importance of folic acid intake. Helps determine family health history and genetic risk for birth defects. Helps reinforce the importance of healthy relationships and mental health. Provides resources for improving health.

21 Delaware Healthy Mother and Infant Consortium PROGRESS The prematurity prevention program prevented 30 premature deliveries in fiscal year The DHMIC developed a reproductive health education tool that will reach over 100,000 in the first year. Genetic counseling is available for free to all men and women at risk for having an infant born with a birth defect. To better serve the diverse population, Spanish-language interpretation services is provided for over 500 patients per year. Immunizations, folic acid supplements, health screening for stress, intimate partner violence, exposure to toxins, STD s, and drug/alcohol use is standard for all women served through the program.

22 Delaware Healthy Mother and Infant Consortium NEXT STEPS & SUSTAINABILITY We will continue to collect and analyze data on the health of pregnant women, fetal deaths, infant deaths and birth defects. We expect the programs to show results in prematurity, low birth weight and infant mortality over time. The infant mortality rate in Delaware dropped from 9.2/1,000 births ( ) to 8.5/1,000 births ( ). Although there has been a long term trend of increasing low birth weight babies, Delaware has had decreasing IM since DHMIC s steps for reducing infant mortality include: Enrolling more high-risk women in the Health Women/Healthy Babies Program Promoting the Reproductive Life Plan Preventing prematurity through targeted intervention Creating a state-wide perinatal health collaborative to improve the way care is delivered to women. BOTTOM LINE: Continuing momentum is imperative for success and sustainability!

23 Infant Mortality in Delaware Historical Perspective Increase began 9.2 IMR U.S. Delaw are

24 QUESTIONS? CONTACT US! Dr. David Paul: For more information, visit our website at: Thank you!