Infant Mortality in Mecosta County

1. Infant Mortality in Mecosta County Presented by: Kevin Doan, Katrina Lampman,Shelly Parker, Tina Palmer, and Carol Zinn

2. What factors contribute to infant mortality in Mecosta County?

3. 2011 Community Assessment

4. 2012 Community Assessment

5. Community Assessment 2011 2012

6. Indicator Definitions Infant mortality rate-numbers of deaths per 1,000 live births (less than 1 year of age) using a three year average Low birth weight-low weight births per 1,000 live births that are less than 2,500 grams (5 pounds, 8 ounces) using a three year average Smoking during pregnancy-smoking while pregnant are those who had a history of smoking and never quit and those who quit between conception and birth using a three year average

7. Analysis of Assessment Findings • What is causing infant mortality rate to increase in Mecosta County? • Low birth weight did not appear to be a factor • Mecosta County percentage of smoking during pregnancy is higher than Michigan and DHD#10 for both 2011 and 2012 • Infant mortality in Mecosta County increased in 2012 compared to 2011, but smoking has declined

8. Community Health Nursing Diagnosis • Risk of infant mortality • Among infants under the age of one born in Mecosta county. • Related to smoking during pregnancy • As demonstrated by a higher infant mortality rate in Mecosta county at 9.1 as compared to Michigan rate of 7.3. Mecosta county. In addition, the higher rate of pregnant women who smoked during pregnancy at 31.4% compared to the Michigan rate of 19.3%.

9. Smart Goal Reduce the percentage of pregnant women who smoke during pregnancy by 12% over for the next 3 years as evidenced by improved rates in Mecosta county as compared to the Michigan rate published in the District 10 community assessment reports.

10. Interventions (evidence based) Based on evidence, the following interventions improve maternal and infant health. • Increase health awareness in importance of nutrition, prenatal care, well-child visits, immunizations, infant and maternal screenings, smoking cessation, available resources, and information on infants sleeping safe. • Evaluate the community for resources • Health department, schools, health center, library, churches, local pharmacy, local college. • Collaborate with Ferris State University to recruit students for internships at the health department to help with home visits and screenings • Collaborate with the health department and local congressman to obtain grants and subsidies for public transportation as Mecosta County is a high needs area. Assess local resources to provide transportation to prenatal and well-child visits. • Collaborate with churches and workplaces to provide screenings and education. • Develop and implement community wellness teams, including members from schools, hospitals, health department, local health providers, and community members. • Identify those at risk in the hospital and providers offices for follow up care and education.

11. Interventions Cont. • Improve education in schools on the importance of health screenings, regular check ups, nutrition, and importance of prenatal care, alcohol, and smoking cessation pre conception and during pregnancy. • Increase local awareness by attending community meetings, collaborate with churches, schools, libraries and local representatives. • Go to health fairs, health screenings, clinics, and local events. Hand out brochures on community resources and education on importance of prenatal care and smoking cessation. • Collaborate with health clinics and Mecosta County hospital for free prenatal classes and education on smoking cessation. • Collaborate with Mecosta County Medical Center on making Spectrum Health community wellness booklets available in physicians’ offices, clinics, pharmacies, grocery stores, and health centers. • The Governor is working on legislation that would expand Medicaid coverage to low income parents • I compared Montcalm County to Mecosta County as the risks and problems are similar. Their infant mortality rate went down and the women receiving prenatal care got better. Mecosta County got worse. Both counties have implemented the Maternal Infant Health program that provides education, home visits, nutritional care and education. The program is made up of a team of nurses, social workers, dieticians, and lactation consultants. The service is free based on need.

12. Theoretical support Self-care Deficit • In order to increase the health of the children we need to increase the health of their mothers. The high rates of smoking while pregnant indicates a Self-care Deficit. • Theory was developed by Dorothea Orem in 1971, in which she states “Self-care and self-care of dependents are learned behaviors that individuals initiate and perform on their own behalf to maintain life, and well-being.”

13. Theoretical supportHealth Promotion • Interventions are directed towards individuals who are for the most part healthy. • Therefore they may have never had to actively make decisions to promote their health and well-being. • Would most likely define their health status by their absence of disease. • Nola Pender’s Health Promotion Model defines health as “as a positive dynamic state rather than simply the absence of disease.”

14. Theoretical supportHealth Promotion Cont. • Assumptions used from the Health Promotion Model • Health professionals constitute a part of the interpersonal environment that exerts influence on persons throughout their life span. • Self-initiated reconfiguration of person-environment interactive patters is essential to behavior change.

15. Theoretical SupportGoal-Attainment • The goal of improving the health of Mecosta county by decreasing the infant mortality rate. • Imogene King’s theory “highlights the importance of the participation of all individuals in decision making and deals with the choices, alternatives, and outcomes of nursing care.”

16. Policies & Programs “Right Start” program in Michigan • Ranking of maternal/infant well-being • Expand health care coverage to low income parents • Expand Medicaid eligibility Maternal Health and Wellness Plan • Provides prenatal care and care after delivery up to a year for Medicaid eligible mothers • The Patient Protection and Affordable Care Act • Provides screenings and well-baby visits, and immunizations free of deductibles and co-pays Safe motherhood Initiative • Conducted by The World Health Organization The Maternal and Infant Health Program • Conducted through the CDC • PRAMS The Maternal, Infant and Early Childhood Home Visiting Program • Through The U.S. Department of Health and Human Services Mecosta County Medical Center • Assesses community needs and implements interventions based on need. This is updated every three years.

17. Plan • Michigan ranks thirty seven out of the fifty states for infant mortality • We plan to decrease that rate based on the following factors: • Women in Mecosta County are not getting enough prenatal care especially in the first trimester of pregnancy. • Women in Mecosta County continue to smoke while pregnant • These factors can result in low-birth rate, birth defects, preterm births, and complications during pregnancy • Issues that may hinder access to health care are: • Under insurance or no insurance, lack of transportation, single parenting, education level, socio-economic status, and high costs of co-pays and deductibles • Other factors that cause infant mortality: • Underlying health issues of the mother, poor maternal nutrition, lack of adequate folic acid, sudden infant death syndrome, and accidents or injuries. • Plan • Assess community needs based on strengths and weaknesses. • Increase public awareness • Improve awareness of resources • Identify those most at risk • Educate community • Implement wellness teams • Assess resources of the community

18. Evaluation Short Term Long Term • Students to do quarterly surveys with pregnant women who smoke during prenatal visits • Survey mothers following birth at their well baby follow up • Anticipate seeing an improvement within 2 years when comparing stats from the District Health Department • Hope to see percentages drop when compared to Healthy People 2020

19. Questions?

20. References • Centers for Disease Control and Prevention. Reproductive Health. Maternal and infant health. Retrieved from: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/i ndex.htm • Department of Health and Human Services. National partnership for action to end health disparities toolkit for community action. Retrieved from: http://minorityhealth.hhs.gov/npa/files/Plans/Toolkit/NPA_Tool kit.pdf • District Health Department #10 (2013). Mecosta county chartbook. Retrieved from http://dhd10.org/index.php/dhd10-community- statistics • HealthyPeople.gov. (2013). Maternal, infant, and child health. Retrieved from: http://www.healthypeople.gov/2020/LHI/micHealth.aspx

21. References • Michigan Department of Community Health. Mecosta-Osceola ranking of maternal/infant well-being: ”Right Start” in michigan’sgreat start collaboratives. Retrieved from: http://www.mlpp.org/wp- content/uploads/2013/04/MecostaOsceola-RS-GSC.pdf • Michigan League for Public Policy, (2013). Infant mortality in michigan2013. Retrieved from: http://www.mlpp.org/kids- count/michigan-2/10191-2 • Michigan League for Public Policy, (2012). Kids count in michigandata book 2012. Retrieved from: http://www.mlpp.org/wp- content/uploads/2012/11/KCDB12Mecosta.p • MDCH Department of Community Health. Women, infants & children. Retrieved from: http://michigan.gov/mdch/0,4612,7-132-2942---,00.html

22. References • Muecke, M. A. (1984). Community health diagnosis in nursing. Public Health Nursing, 1(1), 23-35. • Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2006) Health promotion in nursing practice (5th ed.). Upper Saddle River, NJ: Pearson Education. • Pender, N., & Pender, A. R. (2001). Health promotion in nursing practice (4th ed.). Englewood Cliffs, NJ: Prentice Hall. • Theoretical Foundations of Professional Nursing. (2011). In K. K. Blais, & J. S. Hayes (Eds.), Professional nursing practice concepts and perspectives (6 ed., p. 102). Upper Saddle River, New Jersey: Pearson

23. References • U. S. Department of Health and Human Services. (2010, July). Community health status report mecosta county michigan. Retrieved from http://www.keepingkidsalive.org/Counties/county_da ta/Mecosta.pdf • U. S. Department of Health and Human Services. Health resources and services administration maternal and child health. Maternal, infant and early childhood home visiting program. Retrieved from: http://mchb.hrsa.gov/programs/homevisiting/