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Health and Wellness in Charlottesville: At a Crossroads
Reducing African-American Infant Mortality and Improving Pregnancy Outcomes
Lilian Peake, MD, MPHCharlottesville-Albemarle Health Department
October 22, 2008
Infant MortalityAlbemarle, Charlottesville and Virginia
1995-2006
0
5
10
15
20
25
1995-1999 1996-2000 1997-2001 1998-2002 1999-2003 2000-2004 2001-2005 2002-2006
Infa
nt D
eath
s p
er 1
000
Liv
e B
irth
s
Albemarle Charlottesville Virginia United States
Healthy People 2010 Target
Source: Virginia Department of Health - Center for Health Statistics; CDC - National Center for Health Statistics
Infant Mortality by RaceAlbemarle and Charlottesville
1995-2005
0
5
10
15
20
25
95-99 96-00 97-01 98-02 99-03 00-04 00-05
Infa
nt D
eath
s p
er 1
000
Liv
e B
irth
s
Albemarle Black Albemarle White Charlottesville Black Charlottesville White
Healthy People 2010 Target
Source: Virginia Department of Health - Center for Health Statistics
Infant Mortality Among Black InfantsTJHD, Virginia, U.S.
1998-2004
0
5
10
15
20
25
1998-2001 1999-2002 2000-2003 2001-2004
Infa
nt D
eath
s p
er 1
000
Liv
e B
irth
s
TJHD Black Virginia Black US Black
Source: Virginia Department of Health - Center for Health Statistics
Healthy People 2010 Target
Top 5 Causes of Infant MortalityTJHD, 2002-2006
Source: Division of Women’s and Infant’s Health, Virginia Department of Health
Congenital Malformations (Birth Defects)
Source: Division of Women’s and Infant’s Health, Virginia Department of Health
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
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
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 cat’s litter box and eating raw and undercooked meats (infection with toxoplasmosis)
Low Birth Weight
Source: Division of Women’s and Infant’s Health, Virginia Department of Health
Percent of Low Weight (<2500g) Births Albemarle, Charlottesville, Virginia
1997-2004
0
4
8
12
16
20
1997-98 1998-99 1999-00 2000-01 2001-02 2002-03 2003-04
Per
cen
t of T
ota
l Bir
ths
Albemarle Charlottesville Virginia United States
Healthy People 2010 Target
Source: Virginia Department of Health - Center for Health Statistics; CDC - National Center for Health Statistics
Percent of Low Weight Births for Black Infants Charlottesville-Albemarle, Virginia, U.S.
1997-2004
0
4
8
12
16
20
1997-99 1998-00 1999-01 2000-02 2001-03 2002-04
Per
cen
t of T
ota
l Bir
ths
C'Ville-Alb Black Virginia Black US Black C'Ville-Alb White
Source: Virginia Department of Health - Center for Health Statistics; US Centers for Disease Control and Prevention
Healthy People 2010 Target
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, mom’s education
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
% of Infant Deaths by Number of Prenatal VisitsTJHD, 2002-2006
Source: Division of Women’s and Infant’s Health, Virginia Department of Health
Percent of Births With >10 Prenatal Visits Albemarle and Charlottesville,1999-2004
0
10
20
30
40
50
60
70
80
90
100
1999 2000 2001 2002 2003 2004
Per
cen
t of T
ota
l Bir
ths
Albemarle Charlottesville
Source: Virginia Department of Health - Center for Health Statistics
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
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
No 1No 1stst Trimester Prenatal Care and Low Birth Weight Trimester Prenatal Care and Low Birth WeightCity of Charlottesville, 1990-2006City of Charlottesville, 1990-2006
The Meadows
North Downtown
Rose Hill
10th & Page
Locust Grove
Greenbrier
Barracks Rugby
Barracks Road
Lewis Mountain
Venable
Belmont
Woolen Mills
Martha Jefferson
Ridge St.
Fifeville
Johnson Village
Fry’s Spring
Jefferson Park Ave.
Starr Hill
Births To Mothers With Less Than 12th Grade Education, Albemarle, Charlottesville, and
Virginia 2002-2005
0
5
10
15
20
25
2002 2003 2004 2005
Per
cen
t of T
ota
l Pre
gn
anci
es
Albemarle Charlottesville Virginia
Source: CLIKS (Community Level Information on Kids, Annie E Casey Foundation
Fry’s Spring
RidgeSt.
Belmont
Barracks/Rugby
Greenbrier
10th & Page
Venable
Locust Grove
Ridge St.
Belmont
10th & Page
Greenbrier
Barracks/Rugby
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 Fry’s Spring 44% (25) • Southwest Belmont 42% (19)• Ridge St./South 42% (236)• Southeast Venable 40% (75)
Teen Pregnancy RateAlbemarle, Charlottesville, and Virginia3-Year Rolling Averages, 1997-2005
0
10
20
30
40
50
60
70
80
1997-1999 1998-2000 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005
Pre
gn
an
cie
s p
er
10
00
Te
en
Ag
es
10
-19
Albemarle Charlottesville Virginia
Source: Virginia Department of Health - Center for Health Statistics, US Census Bureau
SIDS
Source: Division of Women’s and Infant’s Health, Virginia Department of Health
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)
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
How can families reduce the risk of SIDS?
• Put your baby on her back to sleep
• Don’t put baby on soft sleep surfaces and avoid loose bedding
– Waterbed, couch, sofa, or pillows, or sleeping with stuffed toys
• Don’t let your baby become overheated while sleeping
• Don’t smoke during pregnancy and don’t let anyone smoke around your baby
• Don’t let the baby sleep in your bed
Questions?