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Maternal Infant and Child: Decreasing Infant Mortality

Maternal Infant and Child: Decreasing Infant Mortality. Brianna Rich, Sonja Wroblewski , Staci Mason, & Steve Rich. United States Statistics. 25, 000 infants die each year in the United States. The mortality rate in 2011 is 6/1000 infants.

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Maternal Infant and Child: Decreasing Infant Mortality

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  1. Maternal Infant and Child: Decreasing Infant Mortality Brianna Rich, Sonja Wroblewski, Staci Mason, & Steve Rich

  2. United States Statistics • 25, 000 infants die each year in the United States. • The mortality rate in 2011 is 6/1000 infants. • The death rate for African-American infants is 11.42 deaths per 1000. • African-American infants are 2.2 times more likely to die before their first year than white infants. • Nearly one million teenage pregnancies occur each year in the United States, and nearly 1 out 5 teen births ages 15-19 are repeat births. • Children born to mothers under age 15 have an increased risk of low birth weight and sudden infant death syndrome. (CDC, 2013) (CDC, 2014) (CDC, 2013) (Hoyert & Xu, 2012)

  3. Michigan State Statistics • In 2012, in Michigan alone, there were 41.1 out of 1000 females ages 15-19 that were pregnant. • The infant death rate (infant to one year old) in Michigan was 8.5 out of 1000 live births which is higher than the national average of 6 out of 1000 births. • The black infant death rate from 2004-2006 was 16.6/1000 while that of white infants was 5.4/1000. • SIDS death rate in Michigan in 2003 was 0.7 per 1000 births which is a lot higher than the benchmark made by Healthy People 2010 of only 0.25. (Kent County, Michigan, 2008) (Michigan.gov, 2012) (Michigan.gov, 2013) (Michigan Department of Community Health, 2011) (PRAMS report, 2008)

  4. Kent County Statistics • In Kent county, 44.4 out of 1000 females ages 15-19 were pregnant which was about 930 pregnancies. • Out of the 930 pregnancies, 137 abortions took place, and 144 miscarriages happened. • The infant death rate in Kent county in 2003 was 9.4 out of 1000 births which was higher than the benchmark of 4.5. • Kent county was in the top 5 counties with the highest abortion rate. They had 1,178 abortions in 2012. • The percentage of mothers receiving prenatal care was about 69.5% in 2000. This is a lot lower than Michigan's average of 80.4% and the United States at 83%. The benchmark was 90% for all areas. • 2008 FIMR report states, “in Kent County, black infants have death rates of 18/1,000 live births while white infants have death rates of 5.4/1,000 live births. A black infant is 3.3 times more likely to die before his first birthday than a white infant in Kent County” (Kent County, Michigan, 2008) (Michigan.gov,2012) (Michigan.gov, 2012)

  5. Community Problem Diagnosis Community Diagnosis: Risk of: high infant mortality rates from low birth weight, pre-term labor, birth defects, SIDS, accidents, poor health of the mother, physical abuse and neglect, and abortions Among: low income, minority, teen age or young adult, inner city mothers in Kent County Related to: conditions of the mother such as poor access to early prenatal care, not eating nutritious foods or inability to purchase them, living in communities with physical violence, poor educational opportunities or dropping out of school, sleeping with infants, poor community resources, a lack of family planning and birth spacing, and poor mental health. As evidenced by: FIMR annual report Statistics for 2008 (website: http://www.healthykent.org/infanthealth/fimr/FIMR%20Annual%20Report%20.pdf (Kent County, Michigan, 2008)

  6. Community characteristics associated with risks: Race Education and age Lack of family planning Income Inner City Lack of Transportation (Kent County, Michigan, 2008)

  7. Health indicators that verify risk: Infant Prematurity / Low birth weight /Birth defects/SIDS: Nutrition/Age/Health of the mother: Lack of early prenatal care: Physical abuse/Violence/ Accidents: Drug use and smoking of the mother: Mental Health /Stress: Abortion rate: (Kent County, Michigan, 2008) (Michigan.gov., 2012)

  8. Modifiable Factors/Indicators of Success Not using Condoms – if you used condoms you would not get pregnant • Having Sex before Marriage – if you waited until you were married, you would be older and more mature for an infant • Reckless Behavior – can harm the mother while pregnant, can cause preterm birth, and complications • Alcohol and Drug Use – these can cause premature birth and pregnancy complications • Smoking – this can cause preterm birth and complications • Not taking Pre-Natal Vitamins – this can cause deformities, pregnancy complications, and preterm birth (“What is Prenatal Care, 2013).

  9. Ecological Model: Used to explain why there is a problem • Personal factors • Relationships within the environment • Social structures • Values, beliefs, and culture (Harkness & DeMarco, 2012)

  10. What Does Kent County currently have in place to address the problem? • Kent County Infant Health Initatiative-Interconception Care • Life Skills • Teen Pregnancy Preventions • Women’s Health Network • WIC (Special Supplemental Food Programs for Women, Infants, & Children) • Vaccine for Children Program • Lead Screening/ Lead Poisoning Prevention • Sexually Transmitted Infection and HIV clinic • Public Health Clinics • Nurse Family Partnerships • NICU- Follow Up Visits –ensures a safe discharge • Child Care • Children’s Special Health Care Services • Maternal Infant Health Program (Kent County, 2012)

  11. Maternal Infant Health Program • Maternal Infant Health Program or the MIHP is in place to help mothers and their babies to remain healthy. • “MIHP is Michigan's largest home visiting program for Medicaid-eligible pregnant women and infants. • It provides home visitation support and care coordination for pregnant women and infants on Medicaid. • Services are intended to supplement regular prenatal/infant care and to assist healthcare providers in managing the beneficiary's health and wellbeing”. (Michigan.gov, 2014)

  12. Nurse Family Partnership Program • The Kent County Health Department acts as a strong resource in addressing the issue of teen pregnancy and poor infant health. Within the Health Department is the Nurse Family Partnership program. (Nurse Family Partnership, 2011) (Nurse Family Partnership, 2011)

  13. Role of nurses in addressing the problem • Public health nurses are key to the success of many community based health programs. • Nurse Partnership Program • Infant • Mother (Harkness & DeMarco, 2012) (Nurse Family Partnership, 2011)

  14. Strength of Community According to the FIMR (2008) “Infant deaths are a social problem that affects us all.” (Kent County, Michigan, 2008)

  15. Barriers of the Community • Economic funding • High crime, drug selling, violence • Cultural prejudice/racism • Poverty • Lack of available transportation • Lack of parental involvement • No sex education in schools or not enough • Lack of awareness of available programs (Kent County Health Department, 2005)

  16. Model for Change Interconception Care Program: Increase program attendance • The Interconception Care Program (ICP) aligns with Kent County data from the Perinatal Periods of Risk (PPOR) and targets all of the following outcome areas: • Fewer preterm births • Fewer low birth weight babies • More planned pregnancies • More pregnancies with a 12-18 month pregnancy interval. (ICP, 2010)

  17. Model For Change Continued.. The program is evidence-based. Early prenatal care is essential for our program goal. 1. Early prenatal care is necessary for the health of the baby. 2. Early prenatal care is the first step to figure out a mother’s baseline to monitor her health. 3. Prenatal vitamins, provided early during prenatal visits, are very important for the infant’s health. Vitamins such as folic acid reduce the risk of birth defects such as neural tube defects. 4. Clinicians identifying  high risk pregnancies and intervening early can reduce the rate of preterm births. Preterm births  have a greater risk of infant mortality. Examples of intervening include controlling  diabetes, hypertension, and obesity in the mother, and providing education on smoking cessation. 5. Early prenatal care is needed to screen mothers who abuse drugs because drugs can have damaging effects on the infants health. (Anthony, Austin, & Comier, 2010) (Picklesimer, Billings,Hale, Blackhurst, & Covington-Kolb, 2012) (Prenatal care fact sheet, 2012) (“What is prenatal care,” 2013)

  18. Interventions: WHAT What can we do to bring about change? • “The long-term goal of the ICP is to reduce infant mortality and reduce the disparity in survival between African American and White infants by assisting women in achieving full-term, normal-weight births and planned pregnancies with at least an 18 month pregnancy interval.” What factors are necessary for the program to be successful?    • “Working with non-traditional public health partners on health equity, social justice, racial equity, and organizations creating access to transit, healthy food, affordable housing, etc. has allowed the ICP to connect clients to needed services, and ultimately improve their health.” What will hinder our program? • “The total amount of ICP external grant funding was $130,000. Current funding to support ICP services is approximately $184,000 per year.” (ICP, 2010) (ICP, 2014)

  19. Interventions: WHY • To DECREASEinfant mortality. • To PROTECTthe infants. • To HELPbuild a HEALTHIERfuture. • To STRENGHTENperinatal care. (ICP, 2010)

  20. Intervention – WHYdo we NEED/WANT the Interconception Program • For teen mom education • To increase birth spacing • To decrease NICU admissions, stillbirths, and miscarriages • For the Wellness Program, Brush Up for Baby Program (BUFB), and the Family Planning Program • To provide teen moms emotional support (ICP, 2010)

  21. Interventions: WHO • Who is the target population- low income, minority, teen age or young adult, inner city mothers in Kent county • Who do we need permission from to run- Michigan Department of Community Health (MDCH). • Who is the support people to run the program- 1. The funders (Grants from MDCH and the CDC) 2. Members of the Kent County Health Department (Community Health Nurses, nutritionist, social workers, physicians, health administrators/directors) 3. Various Community organizations/groups (local hospitals, Healthy Kent 2020 (HK 2020) Infant Health Implementation Team (IHIT), Kent County Working Together for a Healthy Tomorrow Coalition's Community Health Improvement Plan (CHIP) 4. The Media advertisements/coverage such as Fox News 5. Parents/family/friends of the target mothers 6. Compliance and attendance by the target mothers Fox 17 News, 2013 Kent county,2012

  22. Interventions: HOW • Advertisement/Commercials/Fliers • Education • High School/Alternative Education Locations • School nurses • Hospitals (ICP, 2010)

  23. Interventions: WHEN • When is the program going to take place- It will be available before, throughout, and after the selected population is pregnant. • “The focus is to provide enhanced case management services for high-risk women to ensure their optimal preconception health” starting before they get pregnant to ensure good health so that the pregnancy starts healthy. This helps with “alleviating social factors and life stressors that impact maternal and pregnancy health”. • Working with these women throughout the entire pregnancy helps to reduce the amount of women that have infants with low birth weights and other maternal and infant problems. (ICP, 2014)

  24. Interventions: WHERE • Where will the program be located-The program will take place in Kent county, specifically the Grand Rapids, MI area. • This is where themajorityof the selected population resides. • “KCHD (Kent County Health Department) provides services to a population of 606,622 in 2010. KCHD is located in Grand Rapids, MI.” (ICP, 2014)

  25. Desired Outcomes • “One of the main goals of the Interconception Program is to increase birth spacing” • “Prevent Infant deaths” • “More planned pregnancies” • “Increase quality of life” (ICP, 2010)

  26. Health Belief Model (Health belief model, 2014) (ICP, 2010)

  27. Method of Evaluation of Interventions • Fetal Infant Mortality Report (FIMR) on infant mortality and morbidity will show decreases in infant mortality rates overall and for our target population (teen, urban, minority mothers). • Effectiveness can be measured by marked increases in the amount of mothers, especially minority teen mothers, that attend or are enrolled in theICP program. • Decreases in the amount of teen pregnancies and greater spacing between births by at least a year will show effectiveness. • Success is measured by increases in enhanced health of the mothers (decreasing obesity, avoiding drug use, avoiding smoking, using condoms, adhering to taking prenatal vitamins, and controlling blood glucose levels). (ICP, 2010)

  28. Indicators of Success • Women with increased birth spacing • Decrease in stillbirths and miscarriages • Increase in planned pregnancies • Increase in quality of life for both mother and infant • Infants with increase birth weights • Increase in gestational age • Increase in women receiving prenatal care (ICP, 2010) (ICP, 2014)

  29. References Anthony, E.K., Austin, M. J. , & Comier, D.R. (2010). Early detection of prenatal substance exposure and the role of child welfare. Children and Youth Services Review,32(1), 6-12. doi:10.1016/j.childyouth.2009.06.006 Centers for Disease Control and Prevention. (2013). Infant Mortality. Retrieved from: http://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm Centers for Disease Control and Prevention. (2014). About teen pregnancy: Teen pregnancy in the United States. Retrieved from: http://www.cdc.gov/teenpregnancy/aboutteenpreg.htm Centers for Disease Control Vital Signs.(2013). Preventing repeat teen births. Retrieved from http://www.cdc.gov/VitalSigns/TeenPregnancy/index.html Fox 17 News. (2013). Decline in infant mortality in kent county. Retrieved from http://fox17online.com/2013/06/07/decline-in-infant-mortality-in-kent-county/#axzz36PDAlWZD Harkness, G. A., & DeMarco, R. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. Health belief model (2014). In University of twente. Retrieved from http://www.utwente.nl/cw/theorieenoverzicht/theory%20clusters/health%20communication/health_belief_model/ Hoyert, D. & Xu, J. (2012) Deaths: Preliminary data for 2011. National Vital Statistics Reports, 61(6), 1-52. Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf Interconception Care Program. (2010). Retrieved from http://www.accesskent.com/Health/Publications/pdfs/KCIHI_2010_AnnualReport.pdf Interconception Care Program. (2014). In Network of care. Retrieved from http://wicomico.md.networkofcare.org/ph/model-practice-detail.aspx?pid=792 Kent County, Michigan. (2008). Fetal infant mortality report. Retrieved from http://www.healthykent.org/infanthealth/fimr/FIMR%20Annual%20Report%20.pdf Kent County Health Department. (2005). Kent county infant health initiative: Community action plan. 3-66.Retrieved from http://www.healthykent.org/infanthealth/cap/communityactinonplan.pdf Kent County, Michigan. (2008). Fetal infant mortality report. Retrieved from http://www.healthykent.org/infanthealth/fimr/FIMR%20Annual%20Report%20.pdf

  30. References Kent County, Michigan. (2012). Health department, 2012 annual report. Retrieved from https://www.accesskent.com/Health/Publications/pdfs/2012_annual_report.pdf Michigan Department of Community Health. (2011). Michigan infant death statistics: January 1 through December 31, 2009. 1-53. Retrieved from http://www.mdch.state.mi.us/PHA/OSR/annuals/Infant%20Deaths%202009.pdf Michigan.gov. (2012). Number of reported induced abortions. Retrieved from http://www.mdch.state.mi.us/pha/osr/abortion/Tab_1.asp Michigan.gov. (2012). Pregnancies by Outcome and Fertility, Abortion and Pregnancy Rates by County. Retrieved from http://www.mdch.state.mi.us/pha/osr/abortion/pregbycoteen.asp Michigan.gov. (2013). Michigan infant mortality. Retrieved from http://michigan.gov/mdch/0,4612,7-132-2944_4669_4694---,00.html Michigan.gov. (2014). About MIHP. In Maternal infant health program. Retrieved from http://www.michigan.gov/mihp Nurse Family Partnership. (2011). Providing help during pregnancy for first-time moms. In Nurse family partnership. Retrieved from http://www.nursefamilypartnership.org Nurse Family Partnership. (2011). Transforming the lives of first-time moms and their babies. In Nurse family partnership. Retrieved from http://www.nursefamilypartnership.org/about/what-we-do Picklesimer, A., Billings,D., Hale, N. Blackhurst, D., & Covington-Kolb, S. ( 2012). The effect of centering pregnancy group prenatal care on preterm birth in a low-income population. American Journal of Obstetrics and Gynecology, 206 (5), 415.e1-415.e7. Planned Parenthood. (n.d.). Planned Parenthood Federation of America : Planned Parenthood. Retrieved July 18, 2014, from http://www.plannedparenthood.org PRAMS report (2008) Retrieved from http://michigan.govdocumentsmdchMI_PRAMS_2008_Annual_Repot_9_28_2010_340775_7.pdf Prenatal care fact sheet. (2012). In Womenshealth.gov. Retrieved June 23, 2014, from http://womenshealth.gov/publications/our-publications/fact-sheet/prenatal-care.html#b What is prenatal care and why is it important? (2013). In Eunice Kennedy Shriver national institute of child health and human development. Retrieved from http://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/Pages/prenatal-care.aspx

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