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?