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Improving Health in the Community: A Role for Performance Monitoring
2000 is for a low-birth weight rate of no more than 5 percent of live births (USDHHS, 1991).
In the United States, 7.3 percent of babies born in 1994 weighed less than 2,500 grams, and about 1.3 percent weighed less than 1,500 grams (Ventura et al., 1996). The incidence of low birth weight varies by race and ethnicity. Among African Americans, 13.2 percent of infants born in 1994 weighed less than 2,500 grams. In addition, factors such as poverty, lower levels of maternal education, unintended pregnancy, and delayed prenatal care are associated with increased rates of low birth weight (Hughes and Simpson, 1995). Many low birth weight infants require costly medical care. An estimate for 1988 (which does not capture the impact of new technologies) suggests added medical care costs of $15,000 per low birth weight infant during the first year of life (Lewit et al., 1995).
Low birth weight can occur because of an early, preterm birth or slow growth during a normal period of gestation (Paneth, 1995). Steps such as cessation of maternal smoking and adequate maternal nutrition have been shown to reduce the risk of slow fetal growth (USDHEW, 1973; IOM, 1990). The risk of mortality is higher for preterm births, but evidence for interventions that can reduce their occurrence is mixed (Paneth, 1995). Some evidence suggests that vaginal or intrauterine infections may be contributing to preterm births (Fiscella, 1996; Goldenberg and Andrews, 1996). Early and continuing prenatal care can help identify risks for low birth weight and may help ensure that both mothers and infants receive care that can improve survival even if low birth weight cannot be averted (Alexander and Korenbrot, 1995). Prenatal care can also provide benefits to mothers and infants that do not translate into changes in birth weight.
After the neonatal period, infant health is influenced strongly by family resources. A loving and caring home with educated parents makes an important contribution to healthy infant development and, therefore, future capacity to become a well-functioning adult (Carnegie Task Force on Meeting the Needs of Young Children, 1994). Among factors affecting physical health, injury is a leading preventable cause of mortality and morbidity. Parental knowledge of and attention to injury prevention have documented benefits for children (Bass et al., 1993; Gielen et al., 1995). Immunization also is a well-recognized means of protecting health and is a marker for adequate use of well child care (Rodewald et al., 1995). Promoting healthy psychosocial development is also important. For example, factors influencing the home environ-