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Health and Wellness in Charlottesville: At a Crossroads Reducing African-American Infant Mortality and Improving Pregnancy Outcomes PowerPoint PPT Presentation


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Health and Wellness in Charlottesville: At a Crossroads Reducing African-American Infant Mortality and Improving Pregnancy Outcomes . Lilian Peake, MD, MPH Charlottesville-Albemarle Health Department October 22, 2008. Infant Mortality Albemarle, Charlottesville and Virginia 1995-2006.

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Health and Wellness in Charlottesville: At a Crossroads Reducing African-American Infant Mortality and Improving Pregnancy Outcomes

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Health and Wellness in Charlottesville: At a Crossroads

Reducing African-American Infant Mortality

and Improving Pregnancy Outcomes

Lilian Peake, MD, MPH

Charlottesville-Albemarle Health Department

October 22, 2008


Infant MortalityAlbemarle, Charlottesville and Virginia1995-2006


Infant Mortality by RaceAlbemarle and Charlottesville1995-2005


Infant Mortality Among Black InfantsTJHD, Virginia, U.S.1998-2004


Top 5 Causes of Infant MortalityTJHD, 2002-2006

Source: Division of Women’s and Infant’s Health, Virginia Department of Health


Congenital Malformations (Birth Defects)

Source: Division of Women’s and Infant’s Health, Virginia Department of Health


What are the most common birth defects?

  • Down Syndrome

  • Heart defects

  • Neural tube defects

  • Metabolic disorders -

    • e.g. Tay-Sachs disease

  • Musculoskeletal defects

  • Gastrointestinal defects


What causes birth defects?

  • Genetics

  • Alcohol

  • Certain drugs - e.g., Accutane, cocaine

  • Certain Infections - e.g., syphilis

  • Certain chemicals

  • Insufficient amounts of folate

  • Multifactorial

  • Causes of 70% are unknown


How can women reduce their risk of having a baby with a birth defect?

  • Have a preconception visit with healthcare provider

    • Health history/genetic counseling

  • Take folate vitamin (all women of child bearing age)

  • Avoid drinking alcohol, smoking and using drugs

  • Avoid medications without first checking with healthcare provider

  • Avoid changing cat’s litter box and eating raw and undercooked meats (infection with toxoplasmosis)


Low Birth Weight

Source: Division of Women’s and Infant’s Health, Virginia Department of Health


Percent of Low Weight (<2500g) Births Albemarle, Charlottesville, Virginia 1997-2004


Percent of Low Weight Births for Black Infants Charlottesville-Albemarle, Virginia, U.S. 1997-2004


What causes low birth weight?

  • Birth defects

  • Mom has chronic health problems

    • e.g., high blood pressure, diabetes

  • Mom smokes while pregnant

  • Mom drinks alcohol or uses illicit drugs while pregnant

  • Infections in mom or fetus

    • Rubella, chickenpox, toxoplasmosis

  • Socioeconomic factors

    • Income, mom’s education


How can women reduce their risk of having a baby that has a low birth weight?

  • Have a preconception check-up

    • Folate; treat chronic medical conditions; health history

  • Receive early and regular prenatal care

  • Get help to stop smoking

  • Do not drink alcohol or use illegal drugs

  • Learn about signs and symptoms of preterm labor and call healthcare provider if develop them


% of Infant Deaths by Number of Prenatal VisitsTJHD, 2002-2006

Source: Division of Women’s and Infant’s Health, Virginia Department of Health


Percent of Births With >10 Prenatal Visits Albemarle and Charlottesville,1999-2004


Study of Medicaid-eligible moms who delivered at UVA between Dec. 2007 and Feb. 2008

Phone survey

Only able to reach 32 of the 125 moms

Mean age = 25 (18-38)

50% graduated from high school

78% had not planned pregnancy

97% received some prenatal care (4-20 visits)

78% not married

Local Barriers to Prenatal Care


Local Barriers to Prenatal Care

Difficulty making appointments

Long lag time in getting first appointment

Multiple steps

Mailed appointment time (in English) rather than scheduling by phone

Transportation problems

Problems communicating with healthcare providers

Feeling too sick to go to appointment


No 1st Trimester Prenatal Care and Low Birth Weight

City of Charlottesville, 1990-2006

The Meadows

Greenbrier

Barracks Road

Barracks Rugby

Venable

Locust Grove

Lewis Mountain

Rose Hill

North Downtown

10th &Page

Starr Hill

Martha Jefferson

Jefferson Park Ave.

Fifeville

Woolen Mills

Ridge St.

Johnson Village

Belmont

Fry’s Spring


Births To Mothers With Less Than 12th Grade Education, Albemarle, Charlottesville, and Virginia 2002-2005


Barracks/

Rugby

Greenbrier

Greenbrier

Barracks/

Rugby

Venable

10th & Page

10th & Page

Locust

Grove

Belmont

Belmont

Ridge St.

Ridge

St.

Fry’s

Spring


Black Mothers’ Education Less than 12 Years

  • South Barracks/Rugby 54% (26)

  • Ridge St./North area 51% (399)

  • 10th and Page 44.36% (266)

  • Central Fry’s Spring 44% (25)

  • Southwest Belmont 42% (19)

  • Ridge St./South 42% (236)

  • Southeast Venable 40% (75)


Teen Pregnancy RateAlbemarle, Charlottesville, and Virginia3-Year Rolling Averages, 1997-2005


SIDS

Source: Division of Women’s and Infant’s Health, Virginia Department of Health


What is SIDS?

  • Sudden, unexplained infant deaths

    • Cause of death is unknown

    • Not due to a chronic disease or illness

  • After the cause of death has been determined, infant deaths that were initially classified as sudden, unexplained infant death can be referred to as sudden, unexpected infant deaths (SUID)


Causes of SUID

  • Accidental suffocation or strangulation

  • Accidental poisoning

  • Obstruction of respiratory tract

  • Accidental falls

  • Neglect, abandonment and other maltreatment syndromes

  • Assault and homicide

  • Other symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified - unknown cause, or unexplained heart or breathing failure


How can families reduce the risk of SIDS?

  • Put your baby on her back to sleep

  • Don’t put baby on soft sleep surfaces and avoid loose bedding

    • Waterbed, couch, sofa, or pillows, or sleeping with stuffed toys

  • Don’t let your baby become overheated while sleeping

  • Don’t smoke during pregnancy and don’t let anyone smoke around your baby

  • Don’t let the baby sleep in your bed


Questions?


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