Juanita Graham MSN RNHealth Services Chief NurseMS State Dept of Health

% of infant deaths by birthweight, MS 2009

Retrospective cohort study using linked birth & death certificate files for MS infants, 1996-2003 (n=341,780). A population of (n=297,418) non-Hispanic white & black singleton live-born infants studied Assessing relationship between chronic conditions and IM, LBW, PTBFindings from Linked Data

Findings from Linked DataPoorest outcomes among:Black mothersBlack IM rates increased w/ maternal age< HS educationSingleNo prenatal care

Findings from Linked DataMaternal medical history:

Maternal Medical HistoryPTBLBWInfant DeathOR (95% CI)OR (95% CI)OR (95% CI)Previous infant

Problem: Many Mississippi babies die very small & very young despite prenatal care Hypothesis: Mississippi women are not healthy enough to achieve a full term, normal weight deliverySolution: Intervention PRIOR to conceptionMethod: IPC for small population with highest risk for poor delivery outcomes What to do? What to do?

Preconception / interconception care pilot programsRural vs. Urban communitiesDelta Infant Mortality EliminationMetro Infant Mortality EliminationMIME & DIME

Mississippi State Department of Health lead agencyUniversity of MS Medical Center principal recruitment site & service provider. Healthy Linkages referral service for identification of medical homes. Division of Medicaid data source. Partnering organizations

Federally qualified community health centers primary care medical homes. World Health Organization Collaborating Center for Reproductive Health technical assistance. Partnering organizations

Individualized interpregnancy care plan based on assessments of medical/ social risks for subsequent poor pregnancy outcomes Provision of primary health care & dental services in accordance with care plan for 24 months IPC intervention package

Assistance in achieving womans desire for subsequent pregnancies & need for optimum child spacing (ideally 18-20 months);Provision of appropriate social services & community outreach in each womans community. IPC intervention package

Expansive, rural geographical areaTransportationLimited resourcesLimited fundingProblems & lessons learned

On-going surveillance combined with comprehensive evaluation at the projects endHealth, reproductive and economic outcomes to be evaluatedCost-benefit analysis to compare cost savings to costs of program Project evaluation

Goal: Funding to support statewide expansion of programFormat: Medicaid waiver; other internal options include focusing on increased enrollment and participation in reimbursable programs that could sustain the programGoal

*Most recent MS IMR. CDC 2007 data list MS as having highest IMR. Nearly 2/3 of infant deaths occur within the first 28 days of life. **More than 70% of infant deaths occur among infants with less than normal birthweight. For more than a decade greater than half of infant deaths occur among very low birthweight infants. VLBW < 1500g. *High rate of teen births is often offered up as an explanation for high IMR. In reality, < 20% of infant deaths occur among mothers