Infant mortality in Missouri: Where we are and where do we go from here

1
Infant mortality in Missouri Where we are and
where do we go from here?

• Venkata Garikapaty, MSc,MS,PhD,MPH
• Maternal and Child Health Epidemiologist
• Missouri Department of Health and Senior
  Services
  
• December 8, 2006

2
Background

• Population of women in child bearing age (15-44
  years) increased by 4.4 between 1991 and 2005
  
• 80, 15 and 5 of annual Missouri births are to
  white, AA and Hispanic women respectively
  
• Medicaid births increased from 35.2 in 1991 to
  46.8 in 2005

3
Infant mortality in Missouri

• Missouri 34th in the nation for high infant
  mortality rate (IMR)
  
• 39 decline in overall IMR since 1980, 43 and
  40 decline in white and African-American (AA)
  IMR respectively
  
• Declines in Missouris IMR coincided with an
  increase in preterm and low birth weight (LBW)
  babies

4
Infant mortality in Missouri, 1980-2005
5
IMR, LBW and PTB in Missouri, 1991-2004
6
Cause specific infant mortality by race, 2001-04
7
Economic Indicators
8
Missouri births by health insurance status
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of Medicaid births by race
10
Economic indicators
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Racial issues in health care

• Racial residential segregation A fundamental
  cause of racial disparities in health Williams
  et al
  
• 25 of AA births in MO are in St. Louis City,
  MO
  
• St. Louis City, MO A classic case High IMR,
  High teen pregnancy rates, 1 in US for Gonorrhea
  and 2 for Chlamydia, high school dropout rates
  are high,voted most dangerous city in the US?
• St. Louis City indicators from Kids Count on
  children were very poor, ranking the city115 out
  of 115 counties in the state

12
Life style associated risk factors
13
Smoking during pregnancy in Missouri
14
Missouri
15
Education and Economics

• The Silent Epidemic Perspectives of High School
  Dropouts, Bill Melinda Gates Foundation
  
• More than 20,300 students didn't graduate from
  Missouri's high schools in 2004 costing almost 5
  billion in lost wages over their lifetime
  
• The unemployment rate for Missouri high school
  dropouts is 20.1 percent compared to only 4.4
  percent for high school graduates

16
Programs in Missouri to mitigate IM / risk
factors a public health view point
17
Home Visiting Programs

• Home Visiting Programs
• Missouri Community Based Home Visiting Program
• Building Blocks of Missouri (Olds Model)
• Both programs serve pregnant and parenting
  mothers and their children through age two of the
  targeted child
  
• Outcomes analysis is in progress

18
Home Visiting Programs -Locations
Building Blocks of Missouri
Missouri Community Based Home Visiting Program


Both Programs
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Programs to reduce IM / risk factors in MO

• HRSA Grant, 2004 MO Health Care Insurance and
  Access Survey most comprehensive survey on
  health insurance ever taken up in MO
  http//www.dhss.mo.gov/DataAndStatisticalReports/M
  issouri_Final_Report.pdf
• Healthy Start Programs
• Maternal and Child Health Coalition Kansas City
• Maternal, Child and Family Health Coalition of
  Metropolitan St. Louis
  
• Missouri Bootheel Regional Consortium, Sikeston
• Fetal Infant Mortality Review (FIMR)- 8 cases in
  Kansas City, 32 cases in St. Louis, MO
  
• St. Louis and Kansas City Maternal and Child
  Health Coalitions

20
Programs to reduce IM /risk factors in MO
21
Programs to reduce IM /risk factors in MO
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March of Dimes programs in MO

• Education through media and high schools
  theimportance of the increase of Newborn
  Screening
  
• Continuing education to health care professionals
  through grand rounds and nursing modules
  
• Awareness of Warning signs of Preterm birth
  during high stress situations
  
• Publicity campaign to increase knowledge of risk
  factors of Premature birth

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MOD programs in MO (contd)

• Promote good choices for women to have healthy
  babies
  
• Education on healthy pregnancy and folic acid in
  teen clinics and schools
  
• Provide resources and materials to
  Missouriorganizations
  
• Funding of Chapter grants throughout the state
• Offer high school education classes on FAS

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Partners
Coalition / partner building has been a key
success of the SIMC project

• Healthy Start Programs (3)
• St. Louis and Kansas City Maternal Child and
  Family Health Coalitions
  
• March of Dimes
• SIDS Resources Inc.
• Section of Healthy Families and Youth,MO DHSS
• Office of Epidemiology MO DHSS
• Local Public Health Agencies

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Summary

• Significant declines in MO IMR over the past two
  decades, disparities persist
  
• Enhanced prenatal care and support services for
  pregnant women
  
• AA Infant deaths due to prematurity conditions
  warrants further investigation
  
• Lifestyle associated risk factors continue to
  remain a serious concern

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Where do we go from here?

• Evidence based community and culture driven
  public health programs to reduce IM and
  associated racial disparities
  
• Continue working with existing partners and
  provide support to new members
  
• Programs to improve preconception health
• Education and Economic reform are key to reducing
  racial disparities in health care

27
Acknowledgements

• AMCHP
• Pat Plumley - March of Dimes
• Pam Bryant Springfield - Greene County Health
  Dept.
  
• Kendra Copanas MCFHC, St. Louis
• Susan McLoughlin- MCHFC, Kansas City
• Cynthia Dean
• Bootheel Consortium

• Glenda Miller- Director
• Division of Community Public Health, MO DHSS
• Melinda Sanders - Section of Healthy Families and
  Youth, MO DHSS
  
• Bureau of Health Informatics MO DHSS
• ACOG