Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.6 Infant Health
A.6 Infant Health
Pages 276-299
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From page 276... ...
, and low birth weight infants -- those weighing less than 2,500 grams (5 pounds, 8 ounces) -- are at greatest risk (McCormick, 1985; Paneth, 1995)
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From page 277... ...
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)
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From page 278... ...
These domains can be used to organize a field set of potential performance indicators for community efforts to protect and improve infant health. Although some of the proposed indicators address concerns that are not easily operationalized as quantitative measures, they help illustrate issues that might benefit from additional effort to develop suitable measures or data sources.
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From page 279... ...
Effective therapies are available to treat many other infections such as otitis media, pneumonia, and gastroenteritis. Infants in group day care have a higher incidence of common respiratory and gastrointestinal infections compared with babies not in day care settings.
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From page 280... ...
Low birth weight is a marker for high risk of death or serious morbidity in the near and longer term. Communities might also use these very low weight births as the basis for a review of factors in maternal health that could be contributing to preterm birth or slow fetal growth.
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From page 281... ...
Once pregnancy occurs, early use of prenatal care services and having at least half of the recommended number of prenatal visits are associated with lower rates of low birth weight (Kotelchuck, 1994) and may serve as a marker for other healthful practices (Alexander and Korenbrot, 1995)
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From page 282... ...
Early prenatal care gives women access to care and advice that can promote better birth outcomes, including detecting highrisk conditions that may require special attention. Individual decision making may have a greater influence on when prenatal care is started than on how many visits are made, which may reflect special health risks (many visits)
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From page 283... ...
Preconceptional counseling for couples with known genetic risks can guide decisions regarding pregnancy. Prenatal screening for conditions such as Down syndrome and neural tube defects can inform families that a serious disorder is likely, giving them an opportunity to prepare for the care that the child will need or to decide not to continue the pregnancy.
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From page 284... ...
Particular attention should be focused on those birth defects that might be prevented through prenatal care or through control of toxic exposures. For example, instances of neural tube defects might suggest the need to improve folic acid supplementation before and during pregnancy.
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From page 285... ...
3. Percentage of families with preterm or low birth weight infants or with infants with chronic illness or disabilities served by home visiting programs.
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From page 286... ...
8. Percentage of employees with health insurance that covers at least 80 percent of the costs of prenatal care, delivery, and well child care.
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From page 287... ...
Day care services are provided in many forms, some of which include care by family members, in-home care by a paid but unlicensed care giver, and care in large group settings. Infants enrolled in large-group day care suffer more frequent respiratory and gastrointestinal infections than infants who are cared for without exposure to large numbers of other children, but such settings may offer benefits that must be weighed against this particular health risk.
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From page 288... ...
Environmental tobacco smoke has been shown to be associated with low birth weight and increased rates of respiratory and ear infections, and it may increase the risk of SIDS. Information on smokers living with pregnant women or infants would suggest both the extent of infant exposure to tobacco smoke in the home and whether the need for a smoking cessation program emphasizing the health risks to infants is widespread.
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From page 289... ...
Mothers at high risk for delivering very low birth weight babies can be transferred to facilities with neonatal intensive care nursery services. The appropriate application of neonatal intensive care can improve survival for those babies born prematurely or with serious health problems.
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From page 290... ...
Women of reproductive age who do not have a regular source of health care may fail to receive preconceptional care that could promote a successful pregnancy and birth outcome. These women may also be more likely to delay the start of prenatal care or may have difficulty obtaining appropriate care during the course of their pregnancy.
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From page 291... ...
Reducing infant deaths is likely to be a priority for every community, but they will be rare enough that the infant mortality rate will not be a reliable measure in most communities unless data are aggregated
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From page 292... ...
Low birth weight is a marker for increased risk of morbidity and mortality. It reflects the combined effect of a variety of factors including the mother's health and lifestyle, the infant's genetic endowment, socioeconomic circumstances, and the quality of prenatal health care services.
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From page 293... ...
Exposure to environmental tobacco smoke is an avoidable health risk for infants, even prenatally. Information on whether smokers live with pregnant women and small children can help a community formulate smoking cessation programs appropriate for that audience.
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From page 294... ...
The indicators selected to provide an overall tool for assessing efforts in a community to improve infant health are a small segment of what might be a very large collection. These indicators bring together measures of health risk (birth weight, environmental tobacco smoke, and immunization)
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From page 295... ...
1995. The Role of Prenatal Care in Prevent ing Low Birth Weight.
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From page 296... ...
1994. Relation of the Content of Prenatal Care to the Risk of Low Birth Weight: Maternal Re ports of Health Behavior Advice and Initial Prenatal Care Procedures.
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From page 297... ...
A Report of the Public Health Service Expert Panel on the Content of Prenatal Care. Washington, D.C.: U.S.
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From page 298... ...
298 TABLE A.6-1 Field Model Mapping for Sample Indicator Set: Infant Health Field Model Domain Construct Sample Indicators Data Sources Stakeholders Disease Reduce low birth Percentage of babies born Birth certificates, Health care providers weight and its weighing <1,500 grams vital statistics Health care plans adverse effects State health agencies Percentage of babies born Local health agencies weighing <1,000 grams Community organizations Special health risk groups General public Social Reduce the health Percentage of eligible women Program records; State health agencies Environment impact of economic and and infants enrolled in AFDC, community survey Local health agencies nutritional deprivation WIC, or related programs Social service agencies Local government Special health risk groups Encourage better Percentage of mothers less Community survey; Local government education for than 18 years of age who program records Education agencies, adolescent mothers are enrolled in school institutions Community organizations General public Reduce workplace Percentage of employees who Community survey; Local government barriers to use of report that they can use paid employer survey Business, industry health care services leave for prenatal, well child, and insurance General public and sick child care licensing authority IMPROVING HEALTH IN THE COMMUNITY
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From page 299... ...
Reduce financial barriers Percentage of employees with Community survey; Health care plans to health care services health insurance that covers employer survey Local government at least 80 percent of costs of Business, industry prenatal care, delivery, and General public well child care Physical Reduce exposure to Percentage of smokers living Community survey General public Environment environmental tobacco in homes with pregnant A.6 INFANT HEALTH smoke women or children <1 year of age Health Care Ensure access to Percentage of infants weighing Health plan Health care providers specialty care for high- <1,500 grams at birth born records; hospital Health care plans risk births in facilities designated level II discharge records State health agencies or III perinatal care centers Local health agencies Special health risk groups General public Ensure timely Percentage of 1-year-olds who Immunization Health care providers preventive care have received all recommended registry or Health care plans immunizations medical charts State health agencies Local health agencies General public NOTE: AFDC, Aid to Families with Dependent Children; WIC, Special Supplemental Food Program for Women, Infants, and Children.
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