1 / 33

Perinatal Periods of Risk Approach: The U.S. Urban Experience

Perinatal Periods of Risk Approach: The U.S. Urban Experience. A New Community Approach to Fetal & Infant Mortality. Perinatal Periods of Risk Work Group. Boston Public Health Commission. City M at CH / CDC. William Sappenfield Magda Peck Vera Haynatzka Jennifer Skala.

bockj
Download Presentation

Perinatal Periods of Risk Approach: The U.S. Urban Experience

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Perinatal Periods of Risk Approach: The U.S. Urban Experience A New Community Approach to Fetal & Infant Mortality

  2. Perinatal Periods of Risk Work Group Boston Public Health Commission CityMatCH / CDC William Sappenfield Magda Peck Vera Haynatzka Jennifer Skala Barbara Ferrer Mary Ostrem Hawaii State Department of Health Public Health Seattle- King County Cheryl Prince Florentina Salvail Loretta Fuddy Charlene Gaspar Hafsatou Diop Kathy Carson Christie Spice

  3. Perinatal Periods of Risk Approach • Developed by Dr. McCarthy & W.H.O. • Simple approach • Strong conceptual basis • Mobilizes communities • Prioritizes prevention efforts • Establishes ongoing surveillance • Used in developing countries

  4. Why a New Approach to Infant Mortality? • A simple approach that can be easily used by communities nationwide. • An approach that can identify gaps in the community. • An approach that can target resources for prevention activities. • An approach that can mobilize the community to action.

  5. Perinatal Periods of Risk Approach:5 Major Steps 1) Engage community partners early to gain consensus and support. 2) Map feto-infant mortality by birthweight & age at death. 3) Focus on reducing the overall feto-infant mortality rate. 4) Examine potential opportunity gaps between population groups. 5) Target further investigations and prevention efforts on the gaps.

  6. 1. Engage Community Partners Early • Improving feto-infant mortality requires mobilization and change in many sectors and by many individuals in the community. • Consensus about and ownership of the problem is essential in developing community support for solutions. • Monitoring the problem and the solutions and necessary strategy adjustments require effort by many partners.

  7. 2. Map Feto-Infant Mortality Age at Death Birthweight

  8. Age at Death Conception 1 Year Birth Fetal Infancy 20 wks 28 wks 4 wks Growth Intervention Spontaneous Abortion Early Fetal Late Fetal Neonatal Postneonatal Infant Feto-Infant I Perinatal II III

  9. Feto-Infant Mortality Birthweight Distribution Mortality by Birthweight Socio-Economic Smoking Race Medical Conditions Risk Factors Gender Gestational age Race Medical Conditions Prenatal Care Smoking Cessation Tocolytics Interventions Perinatal Care Quality Care Referrals Access Health Insurance Primary Care Content Availability Referral Systems Transport Systems Expertise

  10. Map Feto-Infant Mortality Age at Death Fetal (24+ wks) Neonatal Postneonatal Birthweight 1 2 3 500-1499 g 4 5 6 1500+ g

  11. Map Feto-Infant MortalityWhat Is Missing in the 6 Cells? • Fetal deaths <24 wks • Live births <500 g • Spontaneous abortions • Induced abortions

  12. Map Feto-Infant Mortality Age at Death Post neonatal Fetal Neonatal Birthweight 500- 1499 g 1 2 3 1500+ g 4 5 6

  13. Map Feto-Infant Mortality Post neonatal Fetal Neonatal Maternal Health/ Prematurity 500-1499 g Maternal Care Newborn Care Infant Health 1500+ g

  14. Map Connections to Action Maternal Health/ Prematurity Preconceptional Health Health Behaviors Perinatal Care Prenatal Care Referral System High Risk OB Care Maternal Care Perinatal Management Perinatal System Pediatric Surgery Newborn Care Sleep Position Breast-Feeding Injury Prevention Infant Health

  15. Map Feto-Infant MortalityPhoenix, Arizona, All Races1995-97 Maternal Health/ Prematurity 252 710 Feto-Infant Deaths 68,275 Fetal Deaths & Live Births Maternal Care 157 Newborn Care 124 Infant Health 177

  16. 3. Focus on Reducing the Overall Feto-Infant Mortality Rate • The overall rate includes fetal deaths which are often excluded. • Cell or group specific mortality rates are calculated such that they add up to the total feto-infant mortality rate. • Excess mortality rates and numbers are also calculated such that they relate to the total feto-infant rate.

  17. Focus on Overall Mortality Cell- or Group-Specific Mortality Rates Number of deaths in cell 4 3 Number of live births & fetal deaths Maternal Health/ Prematurity Number of deaths in a group Number of live births & fetal deaths

  18. Map Feto-Infant MortalityPhoenix, Arizona, All Races1995-97 Maternal Health/ Prematurity 252 710 Feto-Infant Deaths 68,275 Fetal Deaths & Live Births Maternal Care 157 Newborn Care 124 Infant Health 177

  19. Focus on Overall Mortality Phoenix, Arizona, All Races1995-97 Maternal Health/ Prematurity 3.7 Feto-Infant Mortality Rate 710 x 1,000 = 10.4 68,275 Maternal Care 2.3 Newborn Care 1.8 Infant Health 2.6

  20. Focus on Overall MortalityLearn by Comparisons • Compare within feto-infant mortality rates by examining the 4 group rates. • Compare overall and group rates over time. • Compare overall and group rates between different population groups.

  21. Focus on Overall MortalityComparison of Socio-Demographic Groups • Maternal Race and Ethnicity • white, black & other • Hispanic & non-Hispanic • Maternal Age and Education • <20 years of age • 20+ years and <13 years of education • 20+ years and 13+ years of education • Geography • Health Care Payment Source

  22. Where in the US Is Carmen Sandiego? 4.7 3.4 1.7 2.7 5.2 12.5 3.0 1.9 2.0 5.0 12.0 2.2 2.2 3.5 Source: NCHS 1995-97 12.8

  23. Where in the US Is Carmen Sandiego? 4.7 Tulsa 3.4 1.7 2.7 5.2 12.5 Omaha 3.0 1.9 2.0 5.0 12.0 New Orleans 2.2 2.2 3.5 Source: NCHS 1995-97 12.8

  24. 4. Examine the “Opportunity Gap” Between Population Groups • Identify the potential for reduction in the community. • Decide on internal reference groups for comparison. • Consider external reference groups for comparison. • Calculate excess mortality rates by components.

  25. Examine the “Opportunity Gap” Reference Groups Attempt to choose a simple optimal group; at least 15% of the population U.S. studies: • 20 or more years of age • 13 or more years of education • Non-Hispanic white women

  26. Excess Feto-Infant MortalityPhoenix, Arizona, 1995-97 All Races Reference Excess 3.7 1.6 2.1 2.3 1.8 2.6 1.6 1.2 1.6 0.7 0.6 1.0 - = 10.4 6.0 4.4

  27. Examine the “Opportunity Gap” • Examine excess overall mortality, both rate and number. • Examine excess mortality across the four groups. • Calculate the percentage of excess mortality by racial and socio-economic groups.

  28. Excess Feto-Infant MortalityPhoenix, Arizona, 1995-97 All Races Reference Excess 3.7 1.6 2.1 2.3 1.8 2.6 1.6 1.2 1.6 0.7 0.6 1.0 - = 10.4 6.0 4.4

  29. 5. Target Investigations & Prevention Efforts on the Gap • Shift effort and attention to the group(s) that contributes most to the gap. • Conduct further studies or mortality reviews on the group(s) that contributes to the gap (Phase 2 studies). • Examine current prevention efforts on the group(s) that contributes to the gap (Phase 2 policy/program reviews).

  30. Phase 2 Studies Maternal Health/ Prematurity Infant Health SIDS Birthweight Distribution Injury Birthweight- Specific Mortality Infection Anomalies

  31. Fetal & Infant Mortality Reviews • Focus FIMR activities on the group contributing to the gap. • Describe in greater depth the risk factors, events or services that may contribute to the gap. • Validate the quality of vital records and other information. “Paint the faces behind the numbers”

  32. Perinatal Periods of Risk ApproachLessons Learned • Make sure the community is on board to understand the results. • Obtain direct access to the data. • Have at least 60 feto-infant deaths to make sense of the 4 mortality groups. • Investigate the unlinked infant deaths. • Look out for the unknowns. • Be prepared to go further.

  33. Perinatal Periods of Risk Approach:5 Major Steps • Engage community partners early to gain consensus and support. • Map feto-infant mortality by birthweight & age at death. • Focus on reducing the overall feto-infant mortality rate. • Examine potential opportunity gaps between population groups. • Target further investigations and prevention efforts on the gaps.

More Related