Download - “How we did it?” Our PPOR Phase II story
““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: [email protected]@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.”