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