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PubMedDate not supplied

Promoting infant health through home visiting by a nurse-managed community worker team.

This article describes the Resources, Education and Care in the Home program (REACH-Futures), an infant mortality reduction initiative in the inner city of Chicago built on the World Health Organization (WHO) primary health care model and over a decade of experience administering programs to reduce infant mortality through home visits. The program uses a nurse-managed team, which includes community residents selected, trained, and integrated as health advocates. Service participants were predominately African American families. All participants were low-income and resided in inner-city neighborhoods with high unemployment, high teen birth rates, violent crime, and deteriorated neighborhoods. Outcomes for the first 666 participants are compared to a previous home-visiting program that used only nurses. Participant retention rates were equivalent overall and significantly higher in the first months of the REACH-Futures program. There were two infant deaths during the course of the study, a lower death rate than the previous program or the city. Infant health problems and developmental levels were equivalent to the prior program and significantly more infants were fully immunized at 12 months. The authors conclude that the use of community workers as a part of the home-visiting team is as effective as the nurse-only team in meeting the needs of families at high risk of poor infant outcomes. This approach is of national interest because of its potential to achieve the desired outcomes in a cost-effective manner.

Adult↗
PubMed1999

Maternal substance abuse and infant health: policy options across the life course.

Maternal substance abuse is a significant contributor to infant morbidity and mortality. The setting of prenatal care has long been the focus of interventions and policies to prevent these adverse outcomes. However, substance abuse programs and policies that are designed for women who are not yet pregnant can have a significant impact upon this problem. Thus it is essential to view the female life course from a broader perspective in order to consider the full range of policy options for reducing the infant mortality and morbidity caused by maternal substance abuse. This framework also allows comparisons across and between substances and offers new directions for policy development.

Adolescent↗
PubMed1994

The perinatal and infant health status of Native Hawaiians.

Hawaii vital record data for 1979 through 1990 were analyzed to examine potentially differing relationships between maternal and infant risks and outcomes in native Hawaiian and White infants. Despite high rates of inadequate prenatal care and teenage and unmarried childbearing, the Hawaiian low-birth-weight rate was below the US average. Hawaiian infants experienced an elevated risk of mortality, particularly among those of normal birthweight during the postneonatal period. Public health initiatives to reduce infant mortality must go beyond preventing teenage pregnancy and low birthweight to address Hawaiian infants' unique pattern of risk factors and the social and economic environment in which such risks abound.

Adolescent↗
PubMed2002

Medicaid expansions and welfare contractions: offsetting effects on prenatal care and infant health?

Most states have adopted administrative measures to encourage the use of prenatal care among medicaid-eligible women. At the same time, declining welfare caseloads have caused many women to lose medicaid. We examine the effects of changes in income eligibility, administrative procedures, and welfare caseloads using data from all birth certificates for 1990-1996. Higher income cutoffs increased use of prenatal care, while decreases in welfare caseloads reduced it. Changes in income cutoffs also reduced fetal deaths. These results suggest that the administrative reforms have not broken the close link between welfare participation and access to medicaid.

Birth Weight↗
PubMed2000

Gestational age- and birthweight-specific declines in infant mortality in Canada, 1985-94. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.

We studied infant mortality rates in Canada within specific gestational age and birthweight categories after using probabilistic techniques to link information in Statistics Canada's live births data base (1985-94) with that in the death data base (1985-95). Gestational age- and birthweight-specific mortality rates in 1992-94 were contrasted with those in 1985-87 with changes expressed in terms of relative risks with 95% confidence intervals [CI]. Statistically significant reductions in infant mortality were observed beginning at 24-25 weeks of gestation and extended across the gestational age range to post-term births. Crude infant mortality rates, infant mortality rates among those > or = 500 g and among those > or = 1000 g decreased by 22%, 25% and 26%, respectively, from 1985-87 to 1992-94. The magnitude of the reductions in infant mortality rates ranged from 14% [95% CI 7, 21%] at 24-25 weeks of gestation to 40% [95% CI 31, 47%] at 28-31 weeks. Almost all reductions in gestational age- and birthweight-specific infant mortality between 1985-87 and 1992-94 were due to approximately equal reductions in neonatal and post-neonatal mortality. Live births > or = 42 weeks of gestation did not follow this rule; post-neonatal mortality rates among such live births decreased significantly by 51% [95% CI 26, 68%], although neonatal mortality rates showed no significant change. The mortality reductions observed across the gestational age and birthweight range are probably a consequence of specific clinical interventions complementing improvements in fetal growth. Temporal changes in the outcome of post-term pregnancies need to be carefully examined, especially in relation to recent changes in the obstetric management of such pregnancies.

Adult↗
PubMed2002

Maternal and infant health prepayment schemes in Shandong, China: a survey of demand and supply.

Maternal and infant prepayment schemes (MIPSs) appeared in China in the early 1980s, as a way of helping women to set aside adequate funds for childbirth. The responsibility for design was devolved to the county level, and many different approaches have been applied. For this and other reasons, there has been no consensus on important matters such as the level of prepayment, the range of covered services, and whether township health centres or family planning stations should operate the schemes. We aimed to clarify some of the uncertainty by conducting combined analyses of cost, willingness to pay, and willingness to supply. We used structured survey instruments to interview 4271 households with children aged under one year, and 18 township health institutions. Our analyses suggest that the ideal prepayment should be higher and the range of covered services should be wider than the current average, and that health centres rather family planning stations should operate the schemes.

Adult↗
PubMed2001

Ethnicity and infant health in Southern Brazil. A birth cohort study.

BACKGROUND: Black children present more health problems than white children, but little information is available from less developed countries. Ethnic inequalities may vary according to country, and studies from developing countries are needed to evaluate possible differentials and their magnitude, and identify social and health interventions. METHODS: Birth cohort study in Pelotas, Southern Brazil. Information collected during the perinatal period in hospitals, and at home at 1, 3, 6 and 12 months of age. In all, 5305 children were studied at birth, 96.8% of the sample of 1461 at 6 months, and 93.4% of this sample at 12 months of age. RESULTS: Of the children, 28% were African Brazilian. Socioeconomic position was lower among families of black children, and mothers presented a number of unfavourable characteristics. Black children presented higher prevalences of low birthweight (LBW), preterm and small-for-gestational age (SGA), were less often immunized, had more deficits of weight-for-age and height-for-age, and higher early neonatal and infant mortality. When a number of covariates, including antenatal care, were added to a multiple regression analysis the odds ratios were markedly reduced, but there was still a clear trend towards worse results for black children. Black mothers had some aspects of antenatal care of lower quality and were submitted less frequently to caesarean sections and episiotomies. CONCLUSIONS: Black infants experienced a much worse health status than white infants. Socioeconomic and other variables played a major role in determining inequalities between these ethnic groups. Antenatal care was especially important in explaining differentials in risk between black and white children.

Africa↗
PubMed1998

Optimal infant health through breastfeeding.

The American Academy of Pediatricians advocates that mothers breastfeed their infants for a full year. Home care providers can get involved by having skilled nurses visit soon after mothers and babies get home or by providing services such as lactation consultants or doulas.

Breast Feeding↗