State Infant Mortality SIM Collaborative State of Hawaii Department of Health

1
State Infant Mortality (SIM) CollaborativeState
of HawaiÿiDepartment of Health

• Loretta J. Fuddy, MPH, MSW
• Gigliola Baruffi, MD, MPH
• Mark Eshima, MA
• September 20, 2004
• Atlanta, Georgia

2
Current Activities to Address Infant Mortality

• Child Death Review Team
• Perinatal Periods of Risk (PPOR) Analysis Team
• Mälama A Hoÿopili Pono (Caring for Mothers and
  Children in the Right Way)

3
State of Hawaiÿi Resident Infant Mortality Rate
1980-2002
Source Hawaii. Department of Health. Office of
Health Status Monitoring.
4
Resident Infant Mortality Rate Confidence
Intervals
5
Unique Factors

• Ethnic Diversity Cultural Practices
• Geographic Isolation

6
Hawaiÿis Ethnic Diversity
Source Hawaii. Department of Health. Office of
Health Status Monitoring
7
Ethnic-Specific Infant Mortality Trends in
Hawaiÿi 1980-2000
Source Hawaii. Department of Health. Office of
Health Status Monitoring
8
Map World
9
Map Pacific Ocean
10
Map State of Hawaiÿi
11
PERINATAL PERIODS OF RISK METHODOLOGY
12
Map of Feto-Infant MortalityHawaiÿi, All
Races1996-2000
Maternal Health/ Prematurity 288
657 Feto-Infant Deaths
87,640 Fetal Deaths Live Births
Maternal Care 138
Newborn Care 106
Infant Health 125
13
Map of Feto-Infant Mortality Hawaiÿi, All
Races1996-2000
Feto-Infant Rate7.5
3.3
1.6
1.2
1.4
14
Excess Feto-Infant Mortality Hawaiÿi, 1996-2000
All Races
Reference
Excess
3.3
2.2
1.1
-

1.6
1.2
1.4
1.5
1.1
1.0
0.1
0.1
0.4
7.5
5.9
1.6
15
Excess Feto-Infant Mortality Hawaiÿi, 1996-2000
Teens
Reference
Excess
5.3
2.2
3.1
-

1.7
1.6
1.6
1.5
1.1
1.0
0.2
0.5
0.6
10.1
5.9
4.2
16
Kitagawa Analysis
Maternal Health/ Prematurity
Birthweight Distribution
Birthweight Specific-Mortality
17
CONCLUSIONS OF PPOR
?
Excess overall mortality was highest for teens
(4.2/1000).
?
Complete chart reviews needed for all future
infant deaths among teen mothers regardless of
cause.
?
Birthweight distribution NOT birthweight specific
mortality is responsible for excess VLBW deaths.
?
Review demographic and cause-of death information
on all (158) infant deaths gt2500 grams from
1996-2000.
18
Capacity to Address Infant Mortality

• Perinatal Summit
• March of Dimes Prematurity Summit
• State-wide Collaborative Activities
• Perinatal Consortium

19
Methodologies Strategies

• Additional Quantitative Analysis of Vital
  Statistics Data
• Qualitative Analysis
• Unique Cultural Practices