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BackgroundBaltimore City: Highest rate of infant death in Maryland In 2009 4th worst infant mortality rate in the
U.S. Infant mortality rate 10.5 per 1000 live births
(2nd year decline from 13.5 in 2009) 93 infants died in 2010 (from 128 in 2009) Average of over 7 babies per month African American: 14.5 per 1,000 White: 3.6 per 1,000
Infant Mortality in Baltimore City
Leading Causes of Infant MortalityUnited States (2005)
% of all Infant Deaths
Rate per 1,000 Live Births
1. Congenital Abnormalities 20% 1.3 2. Low Birth Weight / Preterm Birth 17% 1.1 3. Sudden Infant Death Syndrome (SIDS) 8% 0.5
Baltimore City (2006) 1. Low Birth Weight / Preterm Birth 26% 3.2 2. Sudden Infant Death Syndrome (SIDS) 17% 2.0 3. Congenital Abnormalities 10% 1.2
Data Source: Baltimore City Health Department analysis of data from the Maryland Vital Statistics Administration; U.S. Data from the NCHS Infant Mortality Statistics, 2005 Period Linked Birth-Death Data
Set report
Causes of Death: Baltimore and US
Intended Outcomes
Reductions in the following:• Rate of pre-term births by at least 10% (283
fewer preterm babies)
• Rate of low birth weight infants by at least 10% (259 fewer low birth weight babies)
• Number of deaths from unsafe sleep by at least 30% (12 infants)
Factors Affecting Birth Outcomes
• Health of the mother and father before conception
• Medical and social support during pregnancy
• Access to critical knowledge and services after birth
Stage Pre-Pregnancy Pregnancy Post-Pregnancy
Care Preconception Prenatal & Obstetric Postpartum & Neonatal
Modifiable Determinants of Adverse Outcomes
SmokingSubstance abuse
Poor nutrition/obesityPsychosocial stressDomestic violence
Infection/ Sexually Transmitted InfectionsUnderlying Chronic Illness
Lack of Health Insurance CoverageUnderlying Determinants of Poor Reproductive Health
Poverty Environmental exposures
Poor housingRacism
Genetic factors
Interventions Specific to Stages
Planned pregnancies: - Wanted & timed - Spaced Good nutrition - Adequate folate High quality primary care STD treatment
High quality prenatal care
Access to high-risk obstetrics
Home visiting for high-risk pregnancies
Breastfeeding Safe sleep Adequate nutrition Immunizations
Project Conceptual Model
Policies and tools
improved
Community Mobilization
Mass media
Improved Triage
Increased Co-
ordination
Exposure to
Messages
Increased identification of women at
risk
Improved Referral
Ideational factors
Increased Use of Quality High
Impact Services
Improved Behaviors
Improved Birth
Outcomes
Service Provider Outreach
Project Outputs Short-term Outcomes Intermediate Outcomes
Long-term Outcomes
BHB’s Organization Structure
Implementation
Timeline: 10+ years 4 years of initial funding
Intervention: Families/Individuals, Communities, Services,Policy/Systems
Entry Points: Postpartum/Pregnancy/Preconception Phases of Communication: Healthy Parenting,
Healthy Pregnancies, Healthy Baltimore12 Communities – 2 selected through RFP process
Upton/Druid Hts
Patterson ParkNorth and East
Families and Individuals
Families and individuals at risk use available services and practice behaviors that improve birth outcomes
• Using voices/opinions/stories from community members and professional stakeholders for branding and to develop each of the phase of implementation
Communities
Communities know their role in supporting improved birth outcomes and buy into strategy• Mobilization at City Level
– Remembrance Ceremonies– Mass media – Targeted community
education at Jury duty,DSS waiting rooms, detention centers
– Rattle and Roll Day– Tree planting
Communities
Mobilization at Funded Community level –Youth employment and outreach–Social Marketing: Text4Baby–Group-based: Baby Basics
Services
Agencies and partners providing services adhere to policies and guidelines for risk assessment and referral with goal of increasing access
• Cadre of trainers trained as change agents and disseminators of messages
• Provision of safe sleep service provider toolkit• Development of safe sleep checklist for home visiting programs• Provision of cribs
Policy and Systems
Policy for coordinating risk assessment and referral is in place– Mayoral safe sleep and stop smoking
proclamations– Hospital postpartum discharge policy for
infant safe sleep– Child Fatality Review Team/Fetal and Infant
Mortality Review Team – Community Action Team – Neighborhood Action Teams
12-Year Average—19.2
Baltimore City Child Fatality ReviewUpdate on Sleep-Related Infant Deaths
(SRIDs)—October 2012
Number of infant and sleep-related deaths per year, Baltimore City, 2009-2011
Correlation between change in IMR and change in number of sleep-related deaths = 0.74
Data
• Surveys of mothers of infants <1 year of age attending pediatric health care services– Highlandtown Healthy Living Center (n=96)– Pediatrics at the Harbor (n=133)
• Data collected between Summer 2011 and Spring 2012
Safe sleep behaviors among mothers of infants <1 year of age
In which one position did you most often lay your baby down to
sleep?
How often did your baby sleep in the same bed with you or anyone
else?
Sources of Information about Safe Sleep
*Difference between English and Spanish; p<0.05
Percent of mothers reporting that they never co-sleep with their infant, by exposure to safe sleep information
Controlling for Age, Education, Age of child, Receipt of cash assistance, Has Health Insurance*Different from No Exposure; p<0.05
* *
Percent of mothers reporting that they put their infant on their back, by exposure to safe sleep information
Controlling for Age, Education, Age of child, Receipt of cash assistance, Has Health Insurance*Different from No Exposure; p<0.05
B’more Fit Data
• Weekly weigh-in data from Weight Watchers
• Participant surveys every 12 weeks
• Comparison data collected at 2 WIC sites– Not yet started; IRB approval delayed due to HIPAA
issues
B’more Fit: Average weekly weekly weight change (in pounds), by site and duration of attendance
Average weekly weight change among
SiteAll participants
with 2 visitsAll participants with a
duration of at least 10 weeks
Park Heights -0.38 -0.62
Druid Hill -0.19 -0.20
Patterson Park -0.36 -0.50
Data through end of September, 2012
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