Charlottesville and Albemarle Mobilizing for Action through Planning and Partnership Community Health Status Assessment

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Health and Wellness in Charlottesville At a
Crossroads Reducing African-American Infant
Mortality and Improving Pregnancy Outcomes
Lilian Peake, MD, MPH Charlottesville-Albemarle
Health Department October 22, 2008
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Infant MortalityAlbemarle, Charlottesville and
Virginia1995-2006
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Infant Mortality by RaceAlbemarle and
Charlottesville1995-2005
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Infant Mortality Among Black InfantsTJHD,
Virginia, U.S.1998-2004
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Top 5 Causes of Infant MortalityTJHD, 2002-2006
Source Division of Womens and Infants Health,
Virginia Department of Health
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Congenital Malformations (Birth Defects)
Source Division of Womens and Infants Health,
Virginia Department of Health
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What are the most common birth defects?

• Down Syndrome
• Heart defects
• Neural tube defects
• Metabolic disorders -
• e.g. Tay-Sachs disease
• Musculoskeletal defects
• Gastrointestinal defects

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What causes birth defects?

• Genetics
• Alcohol
• Certain drugs - e.g., Accutane, cocaine
• Certain Infections - e.g., syphilis
• Certain chemicals
• Insufficient amounts of folate
• Multifactorial
• Causes of 70 are unknown

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How can women reduce their risk of having a baby
with a birth defect?

• Have a preconception visit with healthcare
  provider
• Health history/genetic counseling
• Take folate vitamin (all women of child bearing
  age)
• Avoid drinking alcohol, smoking and using drugs
• Avoid medications without first checking with
  healthcare provider
• Avoid changing cats litter box and eating raw
  and undercooked meats (infection with
  toxoplasmosis)

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Low Birth Weight
Source Division of Womens and Infants Health,
Virginia Department of Health
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Percent of Low Weight (lt2500g) Births Albemarle,
Charlottesville, Virginia 1997-2004
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Percent of Low Weight Births for Black Infants
Charlottesville-Albemarle, Virginia, U.S.
1997-2004
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What causes low birth weight?

• Birth defects
• Mom has chronic health problems
• e.g., high blood pressure, diabetes
• Mom smokes while pregnant
• Mom drinks alcohol or uses illicit drugs while
  pregnant
• Infections in mom or fetus
• Rubella, chickenpox, toxoplasmosis
• Socioeconomic factors
• Income, moms education

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How can women reduce their risk of having a baby
that has a low birth weight?

• Have a preconception check-up
• Folate treat chronic medical conditions health
  history
• Receive early and regular prenatal care
• Get help to stop smoking
• Do not drink alcohol or use illegal drugs
• Learn about signs and symptoms of preterm labor
  and call healthcare provider if develop them

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of Infant Deaths by Number of Prenatal
VisitsTJHD, 2002-2006
Source Division of Womens and Infants Health,
Virginia Department of Health
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Percent of Births With gt10 Prenatal Visits
Albemarle and Charlottesville,1999-2004
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Local Barriers to Prenatal Care

• Study of Medicaid-eligible moms who delivered at
  UVA between Dec. 2007 and Feb. 2008
• Phone survey
• Only able to reach 32 of the 125 moms
• Mean age 25 (18-38)
• 50 graduated from high school
• 78 had not planned pregnancy
• 97 received some prenatal care (4-20 visits)
• 78 not married

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Local Barriers to Prenatal Care

• Difficulty making appointments
• Long lag time in getting first appointment
• Multiple steps
• Mailed appointment time (in English) rather than
  scheduling by phone
• Transportation problems
• Problems communicating with healthcare providers
• Feeling too sick to go to appointment

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No 1st Trimester Prenatal Care and Low Birth
Weight City of Charlottesville, 1990-2006
The Meadows
Greenbrier
Barracks Road
Barracks Rugby
Locust Grove
Venable
Lewis Mountain
Rose Hill
North Downtown
10th Page
Martha Jefferson
Starr Hill
Jefferson Park Ave.
Woolen Mills
Fifeville
Ridge St.
Johnson Village
Belmont
Frys Spring
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Births To Mothers With Less Than 12th Grade
Education, Albemarle, Charlottesville, and
Virginia 2002-2005
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(No Transcript)
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Black Mothers Education Less than 12 Years

• South Barracks/Rugby 54 (26)
• Ridge St./North area 51 (399)
• 10th and Page 44. 36 (266)
• Central Frys Spring 44 (25)
• Southwest Belmont 42 (19)
• Ridge St./South 42 (236)
• Southeast Venable 40 (75)

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Teen Pregnancy RateAlbemarle, Charlottesville,
and Virginia3-Year Rolling Averages, 1997-2005
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SIDS
Source Division of Womens and Infants Health,
Virginia Department of Health
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What is SIDS?

• Sudden, unexplained infant deaths
• Cause of death is unknown
• Not due to a chronic disease or illness
• After the cause of death has been determined,
  infant deaths that were initially classified as
  sudden, unexplained infant death can be referred
  to as sudden, unexpected infant deaths (SUID)

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Causes of SUID

• Accidental suffocation or strangulation
• Accidental poisoning
• Obstruction of respiratory tract
• Accidental falls
• Neglect, abandonment and other maltreatment
  syndromes
• Assault and homicide
• Other symptoms, signs and abnormal clinical and
  laboratory findings not elsewhere classified -
  unknown cause, or unexplained heart or breathing
  failure

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How can families reduce the risk of SIDS?

• Put your baby on her back to sleep
• Dont put baby on soft sleep surfaces and avoid
  loose bedding
• Waterbed, couch, sofa, or pillows, or sleeping
  with stuffed toys
• Dont let your baby become overheated while
  sleeping
• Dont smoke during pregnancy and dont let anyone
  smoke around your baby
• Dont let the baby sleep in your bed

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Questions?
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Neonatal Death Rate (lt28 Days)Albemarle,
Charlottesville and Virginia 1995-2005