Infant Mortality Lessons Learned from a Fetal and Infant Mortality Review Program

Objective To review fetal and infant deaths from women enrolled in Indianapolis Healthy Start using the National Fetal and Infant Mortality Review (FIMR) methods to provide strategies for prevention. Methods: Marion County Public Health Department (MCPHD) FIMR staff identified and reviewed 22 fetal and infant deaths to Indianapolis Healthy Start program participants between 2005 and 2012. Trained FIMR nurses completed 13 of 20 maternal interviews and compiled case summaries of all deaths from the MCPHD FIMR database.. Results Case review teams identified a total of 349 family strengths, 219 contributing factors, and made 220 recommendations for future pregnancies. FIMR deliberation values for Healthy Start program participant deaths were similar to other infant deaths in Marion County during the same time period. Common themes that emerged from the reviews included lack of social support, absence of paternal involvement, substance abuse, non-compliance, and poor health behaviors leading to chronic health conditions that complicated many pregnancies. Conclusions A number of the infant deaths in this review could have been prevented with preconception and inter-conception education and by improving the quality and content of prenatal care.     

Infant Mortality in Albania

During the post-war period in Albania, the infant mortalityrate (IMR) was reduced substantially from 121 in 1950 to about30 in the mid-1980s. The IMR is now increasing. In 1991, theestimated IMR was 34. Several factors account for the increase:a worsening economic situation; a high prevalence of malnutrition;the former pronatalist policies prohibiting family planning;and the breakdown of the system of maternal and child care.These problems are manifest in the leading causes of infantdeath in Albania: respiratory infections; congenital anomalies;and diarrhoeal diseases. There is an urgent need for short-term,emergency programmes aimed at (1) improving nutritional status;and (2) preventing and treating respiratory infections and diarrhoea1disease in infants. Medium and long-range programmes are alsoneeded to strengthen the already existing infrastructure forprimary maternal and child health care and family planning.     

State Infant Mortality: An Ecologic Study to Determine Modifiable Risks and Adjusted Infant Mortality Rates

Objective To determine factors contributing to state infant mortality rates (IMR) and develop an adjusted IMR in the United States for 2001 and 2002. Design/Methods Ecologic study of factors contributing to state IMR. State IMR for 2001 and 2002 were obtained from the United States linked death and birth certificate data from the National Center for Health Statistics. Factors investigated using multivariable linear regression included state racial demographics, ethnicity, state population, median income, education, teen birth rate, proportion of obesity, smoking during pregnancy, diabetes, hypertension, cesarean delivery, prenatal care, health insurance, self-report of mental illness, and number of in-vitro fertilization procedures. Final risk adjusted IMR’s were standardized and states were compared with the United States adjusted rates. Results Models for IMR in individual states in 2001 (r ² = 0.66, P < 0.01) and 2002 (r ² = 0.81, P < 0.01) were tested. African-American race, teen birth rate, and smoking during pregnancy remained independently associated with state infant mortality rates for 2001 and 2002. Ninety five percent confidence intervals (CI) were calculated around the regression lines to model the expected IMR. After adjustment, some states maintained a consistent IMR; for instance, Vermont and New Hampshire remained low, while Delaware and Louisiana remained high. However, other states such as Mississippi, which have traditionally high infant mortality rates, remained within the expected 95% CI for IMR after adjustment indicating confounding affected the initial unadjusted rates. Conclusions Non-modifiable demographic variables, including the percentage of non-Hispanic African-American and Hispanic populations of the state are major factors contributing to individual variation in state IMR. Race and ethnicity may confound or modify the IMR in states that shifted inside or outside the 95% CI following adjustment. Other factors including smoking during pregnancy and teen birth rate, which are potentially modifiable, significantly contributed to differences in state IMR. State risk adjusted IMR indicate that other factors impact infant mortality after adjustment by race/ethnicity and other risk factors.     

Perspectives of African-American Women on Infant Mortality

ABSTRACT

Twice as many African-American infants die each year when compared to White infants. This study explores the lived experiences of African-American women to identify factors related to this racial gap in infant mortality. Thirteen African-American women from two Virginia towns participated in either a focus group or in-depth interviews. Content and interpretive analysis revealed several themes. Participants indicated that the experiences of stress and racism are constant factors in African-American women's lives and are inseparable from their pregnancy experiences. Participants noted the importance of social support and the health care provider–client relationship for positive pregnancy outcomes.     

The Influence of Infant Feeding Practices on Infant Mortality in Southern Africa

Objective To examine the adjusted and unadjusted effects of infant feeding practices on infant mortality in Southern Africa. Methods A merged dataset from the most recent Demographic and Health Surveys for Lesotho, Swaziland, Zambia and Zimbabwe was analysed using the Cox Proportional Hazard Model. A total number of 13,218 infants born in 5 years preceding all the surveys with information on infant feeding practices constituted the study population. Infant mortality was the outcome variable and infant feeding practices categorised into; no breastfeeding, partial breastfeeding and exclusive breastfeeding were the main explanatory variables. Maternal demographic and socio-economic characteristics and infants’ bio-demographic characteristics were also studied. Results Although, exclusive breastfeeding was quite low (12 %), exclusively breastfed infants exhibited a 97 % lower risk of dying during infancy compared to infants not breastfed in the region. Variations existed by country in the levels and patterns of both infant mortality and infant feeding practices. Mother’s country, highest level of education and marital status; child’s sex, birth weight and preceding birth interval were the significant predictors of infant mortality in Southern Africa. Conclusions Any form of breastfeeding whether exclusive or partial breastfeeding greatly reduces the risk of infant mortality with the greatest mortality reduction effect observed among exclusively breastfed infants in Southern Africa. To reduce the upsurge of infant mortality, there is the need to step up the effectiveness of child nutrition programmes that promote breastfeeding and put emphasis on exclusive breastfeeding of infants in the region.