Using Perinatal Periods of Risk (PPOR) and Geographic Information System (GIS) to assess feto-infant mortality rates and to identify strategic areas for community-based intervention in Louisville Sarojini Kanotra, PhD, MPH, CHES Troutman, Adewale, MD, MA, MPH Sheila Andersen, JD, MA, BSN Nazenin Assef, MS

About Louisville 16 th largest city in the United States

Objectives Assess feto-infant mortality rates in Louisville Metro using Perinatal Periods of Risk approach Identify the strategic areas in perinatal health for community-based intervention using GIS mapping Translate data into information for policy and program planning

Demographics of Louisville Metro Population by Race

Infant Mortality Rate, 2002 HP2010 Goal=4.5

Infant Mortality Rate In Louisville Metro by Race, 2002

Fetal-Infant Mortality Rates, All Races MH/P 89/3.00 MC 68/2.25 NC 37/1.25 IH 61/ total deaths 29707total live births MH/P 85/2.93 MC 75/2.58 NC 45/1.55 IH 59/ total deaths 29,049 total births Excluded from the analysis: fetal deaths under 24 weeks and live births under 500 grams

Fetal-Infant Mortality Rates, Whites MH/P 42/1.95 MC 50/2.32 NC 23/1.07 IH 25/ total deaths 21,523 total live births MH/P 49/2.28 MC 47/2.19 NC 30/1.40 IH 33/ total deaths 21,452 total live births

Fetal-Infant Mortality Rates, African Americans MH/P 36/4.93 MC 17/2.330 NC 14/1.92 IH 35/ total deaths 7303 total live births MH/P 35/4.96 MC 26/3.680 NC 15/2.13 IH 24/ total deaths 7055 total live births

Excess Mortality (Rates) as Compared to an Internal Reference, All Races, Internal reference included women 20 years or older, non-Hispanic White, had 13 or more years of education

Feto-Infant Mortality Rates by Race, MH/P 42/1.95 MC 50/ NC 23/1.07 IH 25/1.16 MH/P 36/4.93 MC 17/ NC 14/1.92 IH 35/4.79 White African American

Maternal Health/ Prematurity Excess

Dissemination of the Results New Health Department Director Health Status Assessment Committee Healthy Start Advocates Meetings attended by the Medical Examiner and State Representative March of Dimes Prematurity Summit Child Fatality Review Meetings(State & Local) Community Partnership for Protection of Children Local Birthing Hospital Special meeting organized for State Legislators serving the Healthy Start area

Outcomes of Data Dissemination Development of a PPOR Team Reduction of persisting disparities in infant mortality is part of the strategic plan of the department Received local monies to start a Center for Elimination of Racial Disparities Collaboration with the State in starting Fetal Infant Mortality Review (FIMR) in Louisville Women’s Health Task Force Committee

Other Initiatives Mayor’s Healthy Hometown Movement MAPP process Translation of Data into Policy Grant Safe-Sleeping Campaign Crib for Kids Campaign State applying for the PRAMS grant

Accomplishments of Healthy Start Program Reduction in poor pregnancy outcomes such as low birth weight births Increase in the number of women initiating prenatal care in the first trimester Increase in the number of women receiving preventive care services after delivery Zero infant mortality to Healthy Start participants

Where are we now?…… Assess feto-infant mortality rates in Louisville Metro using Perinatal Periods of Risk approach Identify the strategic areas in perinatal health for community-based intervention using GIS mapping ۩Translate data into information for policy and program planning

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