““How we did it?” How we did it?” Our PPOR Phase II Our PPOR Phase II storystory

Sarojini Kanotra, PhD, MPHSarojini Kanotra, PhD, MPH

Louisville Department of Public Louisville Department of Public Health & WellnessHealth & Wellness

ResourcesResources

Being part of Healthy Start programBeing part of Healthy Start program Director- Dr Adewale TroutmanDirector- Dr Adewale Troutman Division DirectorDivision Director Program AdministratorProgram Administrator Continuous monitoring of Maternal and Continuous monitoring of Maternal and

Child Health status in the communityChild Health status in the community

Data SourcesData Sources

Vital recordsVital records BirthBirth DeathDeath Still BirthStill Birth

Medical Examiner’s DatabaseMedical Examiner’s Database Healthy Start databaseHealthy Start database

Analytic Methods and Analytic Methods and DirectionsDirections

Feto-infant mortality maps/graphsFeto-infant mortality maps/graphs Excess mortality rates and gapsExcess mortality rates and gaps Kitagawa analysisKitagawa analysis Logistic RegressionLogistic Regression Use of GISUse of GIS Community health assessmentCommunity health assessment Fetal Infant Mortality ReviewFetal Infant Mortality Review

Fetal-Infant Mortality Rates, Fetal-Infant Mortality Rates, All RacesAll Races

MH/P

136/4.6

MC

71/2.4

NC

36/1.2

IH

67/2.3

2001-2003

310 total deaths

29,357total live births

MH/P

89/3.00

MC

68/2.25

NC

37/1.25

IH

61/2.05

2000-2002

255 total deaths

29,707 total births

Highest mortality was attributable to MHP followed by MC

Trend in PPOR category specific mortality

in Louisville in African Americans (per 1,000 births)

4.9

2.31.9

4.8

7.1

2.1

1.3

4.3

0.0

2.0

4.0

6.0

8.0

MHP MC NC IH

2000-2002 2001-2003

Perinatal Periods of risk Perinatal Periods of risk categorycategory

% attributable to % attributable to low birthweightlow birthweight

% attributable to % attributable to birthweight specific birthweight specific

mortality ratemortality rate

Total Total (%)(%)

MHP (Birth weight 500-MHP (Birth weight 500-1499 grams)1499 grams)

All RacesAll Races 3939 -10-10 2929

WhitesWhites 2626 -6-6 1919

African AmericanAfrican American 5252 -10-10 4242

2 fold mortality excess in % attributable to VLBW in MHP category among African Americans compared to Whites

Kitagawa analysis by race

VariableVariable UnadjusteUnadjusted Odds d Odds ratioratio

Adjusted Adjusted Odds Odds ratioratio

Lower Lower CICI

Upper Upper CICI

P-P-valuevalue

Plurality-Plurality-tripletstriplets

38.5138.51 45.8145.81 26.4826.48 79.2579.25 < < 0.00010.0001

Plurality-Plurality-twinstwins

8.798.79 8.588.58 6.686.68 11.0111.01 < < 0.00010.0001

Medical riskMedical risk 3.923.92 2.992.99 2.462.46 3.643.64 < < 0.00010.0001

AlcoholAlcohol 3.273.27 2.622.62 1.451.45 4.744.74 0.0010.001

RaceRace 2.352.35 2.072.07 1.711.71 2.522.52 < < 0.00010.0001

SmokingSmoking 1.481.48 1.331.33 1.061.06 1.671.67 0.0130.013

Mother’s Mother’s age<20age<20

1.441.44 1.251.25 0.960.96 1.631.63 0.0930.093

Why are VLBW babies born ?

Cause specific mortality rates in I H

category in Louisville, 2001-2003

0.00.10.20.30.40.50.60.70.80.9

Congenital

Anomaly

Infection SIDS Injuries Other /

Undefined

Rat

e pe

r 1000

Reference Louisville

Infant Heath (IH)- Cause specific mortality rates (CSMR) in Infant Heath (IH)- Cause specific mortality rates (CSMR) in Louisville Louisville

Cause of Cause of DeathDeath

Number Number of IH of IH deathsdeaths

IH death IH death raterate

ReferencReference IH e IH Death Death ratesrates

Excess Excess CSMRCSMR

CongenitaCongenital Anomalyl Anomaly 66 0.00020.0002 0.000030.00003 0.000170.00017

InfectionInfection 33 0.00010.0001 0.000000.00000 0.000100.00010

SIDSSIDS 1414 0.00050.0005 0.000140.00014 0.000350.00035

InjuriesInjuries 2121 0.00070.0007 0.000070.00007 0.000660.00066

Other / Other / UndefinedUndefined 2323 0.00080.0008 0.000140.00014 0.000660.00066

Total IHTotal IH 6767 0.00230.0023 0.000380.00038 0.001960.00196

Northwest

Ujima

Cane Run

South Jefferson

South Central

First at Jefferson

Barret InsideWatterson

Barret Northeast

Barret Southeast

BOH

Key

Very LowLowMeanHighHigherVery High

Infant Mortality Rate by Neighborhood Place2002

1 0 1 2 Miles

Percent of Children in PovertyJefferson County, 2000 Census

Copyright (c) 2004, LOUISVILLE AND JEFFERSON COUNTY METROPOLITAN SEWER DISTRICT (MSD), LOUISVILLE WATER COMPANY (LWC) and LOUISVILLE METRO GOVERNMENT All Rights Reserved.

N

3 0 3 6 9 Miles

0 - 10%

11 - 20%

21 - 40%

41 - 60%

61 - 80%

81% and higher

KEY

Healthy Start Area

Key

0 - 20%20-40%40-50%60-80%80-100%

Percent Minority Population in Neighborhood Place Area

2002 Low Birth Weight BirthsAs a Percentage of All BirthsBy Louisville Metro Neighborhood Place

Percent LBW5 - 8 %8 - 11 %11 - 14 %14 - 17%

2002 Very Low Birth Weight BirthsAs a Percentage of All BirthsBy Louisville Metro Neighborhood Place

Percent VLBW1 - 2 %2 - 3 %3 - 4 %4 - 5 %

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KEY

Healthy Start Area

Perinatal Care System

Community Involvement in Community Involvement in Phase II AnalysisPhase II Analysis

Use PPOR as part of practicum training Use PPOR as part of practicum training of MPH studentsof MPH students

Introduce PPOR in the MPH curriculumIntroduce PPOR in the MPH curriculum Discussion in the Healthy Start Discussion in the Healthy Start

Advocates meetingsAdvocates meetings Barriers-Barriers-

Time, commitment, other competing issuesTime, commitment, other competing issues

Dissemination of the ResultsDissemination of the Results New Health Department DirectorNew Health Department Director Health Status Assessment CommitteeHealth Status Assessment Committee Healthy Start Advocates Meetings attended by Healthy Start Advocates Meetings attended by

the Medical Examiner and State Representativethe Medical Examiner and State Representative March of Dimes Prematurity SummitMarch of Dimes Prematurity Summit Child Fatality Review Meetings(State & Local)Child Fatality Review Meetings(State & Local) Community Partnership for Protection of Community Partnership for Protection of

ChildrenChildren Local Birthing HospitalLocal Birthing Hospital Special meeting organized for State Legislators Special meeting organized for State Legislators

serving the Healthy Start areaserving the Healthy Start area

Initiatives in LouisvilleInitiatives in Louisville

Mayor’s Healthy Hometown MovementMayor’s Healthy Hometown Movement Center for Health EquityCenter for Health Equity MAPP process MAPP process Translation of Data into Policy GrantTranslation of Data into Policy Grant Safe-Sleeping CampaignSafe-Sleeping Campaign Crib for Kids CampaignCrib for Kids Campaign State applying for the PRAMS grantState applying for the PRAMS grant

Some Policy DirectionsSome Policy Directions

Focus on Women’s health: Address Focus on Women’s health: Address preconceptional and interconceptional healthpreconceptional and interconceptional health

Implement FIMRImplement FIMR Prevent SIDS and deaths due to unsafe Prevent SIDS and deaths due to unsafe

sleeping behaviorsleeping behavior Sustain the programs such as Healthy StartSustain the programs such as Healthy Start Center for Health equity-address disparitiesCenter for Health equity-address disparities

E-mail: E-mail: Sarojini.Kanotra@louisvilleky.govSarojini.Kanotra@louisvilleky.gov

Acknowledgements“Supported in part by project(H49 MC 00152) from Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health

and Human Services.”