1. “How we did it?” Our PPOR Phase II story Sarojini Kanotra, PhD, MPH Louisville Department of Public Health & Wellness

2. Resources  Being part of Healthy Start program  Director- Dr Adewale Troutman  Division Director  Program Administrator  Continuous monitoring of Maternal and Child Health status in the community

3. Data Sources  Vital records  Birth  Death  Still Birth  Medical Examiner’s Database  Healthy Start database

4. Analytic Methods and Directions  Feto-infant mortality maps/graphs  Excess mortality rates and gaps  Kitagawa analysis  Logistic Regression  Use of GIS  Community health assessment  Fetal Infant Mortality Review

5. Fetal-Infant Mortality Rates, All 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

6. Trend in PPOR category specific mortality in Louisville in African Americans (per 1,000 births) 4.9 2.3 1.9 4.8 7.1 2.1 1.3 4.3 0.0 2.0 4.0 6.0 8.0 MHPMCNCIH 2000-20022001-2003

7. Perinatal Periods of risk category % attributable to low birthweight % attributable to birthweight specific mortality rate Total (%) MHP (Birth weight 500- 1499 grams) All Races 39-1029 Whites26-619 African American 52-1042 2 fold mortality excess in % attributable to VLBW in MHP category among African Americans compared to Whites Kitagawa analysis by race

8. Variable Unadjuste d Odds ratio Adjusted Odds ratio Lower CI Upper CI P-value Plurality- triplets 38.5145.8126.4879.25 < 0.0001 Plurality- twins 8.798.586.6811.01 < 0.0001 Medical risk 3.922.992.463.64 < 0.0001 Alcohol3.272.621.454.74 0.001 0.001 Race2.352.071.712.52 < 0.0001 Smoking1.481.331.061.67 0.013 0.013 Mother’s age<20 1.441.250.961.63 0.093 0.093 Why are VLBW babies born ?

10. Infant Heath (IH)- Cause specific mortality rates (CSMR) in Louisville Cause of Death Number of IH deaths IH death rate Referenc e IH Death rates Excess CSMR Congenital Anomaly 60.00020.000030.00017 Infection30.00010.000000.00010 SIDS140.00050.000140.00035 Injuries210.00070.000070.00066 Other / Undefined 230.00080.000140.00066 Total IH 670.00230.000380.00196

17. Community Involvement in Phase II Analysis  Use PPOR as part of practicum training of MPH students  Introduce PPOR in the MPH curriculum  Discussion in the Healthy Start Advocates meetings  Barriers-  Time, commitment, other competing issues

18. 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

19. Initiatives in Louisville  Mayor’s Healthy Hometown Movement  Center for Health Equity  MAPP process  Translation of Data into Policy Grant  Safe-Sleeping Campaign  Crib for Kids Campaign  State applying for the PRAMS grant

20. Some Policy Directions  Focus on Women’s health: Address preconceptional and interconceptional health  Implement FIMR  Prevent SIDS and deaths due to unsafe sleeping behavior  Sustain the programs such as Healthy Start  Center for Health equity-address disparities

21. E-mail: Sarojini.Kanotra@louisvilleky.gov Sarojini.Kanotra@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.”