Infant Health in Missouri

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Infant Health in Missouri

• Ms. Paula Nickelson, Title V Director, Missouri
  Department of Health and Senior Services
• Dr. Pamela K. Xaverius, MCH Epidemiologist,
  Missouri Department of Health and Senior Services
  
• Ms. Pat Plumley, State Director of Program
  Services, March of Dimes, Missouri Chapter

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Infant Health Topics
 

• Assessments and Trends
• Current Activities with Dual Goals
• Reduce Infant Mortality Rate
• Increase Rates that indicate Infant Health
• Capacity to address Infant Health/Infant
  Mortality
• Future strategies

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Assessments Trends
 

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Infant Mortality Rate Mo vs. U.S., 1990-2001
Missouri
US
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Infant Mortality Racial Disparity
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Infant Health Indicators
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Perinatal Periods of Risk (White Excess Death
Missouri 1998-2001 Births)
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Perinatal Periods of Risk (African American
Excess Death Missouri 1998-2001 Births)
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Infant Mortality in Missouri
In an age of unprecedented health prosperity,
persistently high infant mortality rates and
associated racial disparities are both
unacceptable and under active evaluation in the
state of Missouri.
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Infant Health Activities
 

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Current Activities

• Fetal and Infant Mortality Review (FIMR)
• Prenatal Case Management
• Maternal and Child Health (MCH) System Contracts
• Healthy Start Programs
• Maternal-Child Health Coalitions
• Medicaid Coverage to Mothers and Children
• Reaching Out to Women Who Smoke
• SIDS Resources, Inc.
• Home Visiting Programs
• Safe Sleep Work Group
• Expansion of Newborn Screening Interventions
• Fetal Alcohol Syndrome Rural Awareness Prevention
  Program

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Capacity to Improve Infant Health
Human Resources A strong cadre of scientists
work within the state department, including two
full time MCH epidemiologists and a number of
research analysts support the MCH analytic
capacity. The three-member travel team includes
policy and research leadership, and a lead
external agency. The home team adds
representation from across the state, including
key service providers. Data Resources Rich
sources of data are also available, with vital
records data, priority MICA, BRFSS, PRAMS and an
assortment of programmatic data available to
assist in quantifying the effects of various
interventions on fetal/infant health. Financial
Resources Title V funds are used to support MCH
analysis with an important intent of ascertaining
the effect of interventions on fetal/infant
health. Partnerships Established working
relationships with Saint Louis University, School
of Public Health, the University of Missouri in
Columbia and Washington University, School of
Medicine.
 

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Future Strategies
 

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Approved Future Projects

• Expanded Perinatal Periods of Risk Analysis
• Epidemiologic Evaluation of Missouris
  Nurse-Family Partnership Program
• Sexually Transmitted Diseases During Pregnancy 
• Evaluating Responsible Reproductive Behavior
  Messages  

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Proposed Future Projects

• Evaluate interventions designed to increase
  proper infant sleep position, especially among
  the minority populations
• Identify strategies to prevent infant deaths due
  to injury
• Identify opportunities for improving infant care
  in minority populations
• Analyze sleep position and infant death
  connection through analysis of linked child death
  review and death certificate data
• Identifying states that have successfully
  decreased SIDS rates
• Conduct focus groups with African Americans to
  identify the key variables that influence infant
  care
• Evaluate the relation between oral health and
  birth outcomes

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Potential Barriers

• High health care costs or inadequate insurance
• Inaccessibility to health care
• Lack of transportation to healthcare providers
• Impersonal / culturally insensitive treatment
  received at health care facilities
• Socioeconomic status (e.g., marital status,
  education level, income level)
• Intentionality of pregnancy
• Lack of social support
• Perceptions about prenatal care

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• As a committed group of scientists, practitioners
  and policy makers, we buy into the notion of
  continual improvement and evaluation
• We are also resolved in our belief that
  evidence-based practice is necessary for public
  health initiatives
• We support comprehensive, broad-based, systemic
  approaches (i.e., those with the most robust
  impact on community behavior)