Title: Closing the Gap in Infant Mortality in Mississippi
Author:
Section/SPIG: Maternal and Child Health
Issue Date:
Considerable disparity exists between white and black infant mortality in Mississippi and greatly affects the health of the state. The Closing the Gap on Infant Mortality: African American-Focused Risk Reduction (CTG) program is designed to accelerate the rate of change among black populations and reduce significant disparity in infant mortality related to low birthweight, preterm birth and Sudden Infant Death Syndrome. A combination of medicinal, behavioral, educational, and service system enhancement risk reduction interventions are being implemented in two target areas of the state. Interventions are primarily geared toward eliminating disparities by maximizing access to pregnancy and inter-pregnancy care and examining trends in fetal, infant, and maternal mortality. Implementation activities are under way and preliminary findings will be disseminated as appropriate. Obstacles and barriers to access for Mississippi mothers and infants are being considered.
The CTG grant has enabled the Mississippi Department of Health to move to a higher level of intervention involving many partners working together. The grant activities are geared towards identifying and addressing gaps in provisions of care, access to services, and professional education regarding evidence-based practice and protocols. Grant staff convene groups, create appropriate data collection tools, compile and synthesize disparate information, systematically share information with the group, and write up plans of action, including any necessary protocols. In conjunction with the MDH OB/GYN Consultant, grant staff has developed a standardized checklist of evidence-based interventions which influence birth outcomes.
To promote growth and expansion of services and access, the program plans to identify the most promising and feasible activities and support the implementation of those activities in the communities with greatest need. An example of this would be the fetal fibronectin (fFn) test, a laboratory test proven highly predictive of non-imminent preterm birth. A negative test result confirms that 99.9 percent of the time, the mother will not deliver for at least 14 days. Since only a small percentage of women who present with signs of preterm labor actually deliver prematurely, it is important to be able to identify those who do not need expensive hospitalization and treatments to prevent preterm labor, to save hospital costs, prevent waste of Medicaid funds, and eliminate unnecessary use of scarce resources. Triage also provides mothers who are in need of imminent services with better access and more focused and higher quality care. The program has provided this reasonably inexpensive equipment to three hospitals in the Delta, making this service easily accessible to mothers in all five of the Delta pilot counties. Other aspects of the program include the following:
- Service expansion plans include training radiological and obstetrical healthcare professionals in the pilot regions to perform cervical length measurements via ultrasonography.
- Grant staff are also responsible for developing and overseeing a community health worker program. The CHWs canvass high risk neighborhoods going door to door and into community settings to locate mothers and infants in need of access to the health care system.
- Perinatal regionalization activities include preparation of a written perinatal regionalization plan, currently being written by partners from a recent study of perinatal regionalization in Mississippi.
The Maternal Infant Mortality Surveillance System process brings together a local team of professionals and laypersons to examine de-identified cases of infant and maternal deaths. The purpose of these reviews will be to understand how a wide array of local, social, economic, public health, educational, environmental, and safety issues relate to these losses. This mechanism will help to build relationships among providers, offer educational opportunities, and identify system and infrastructure issues that need to be addressed. MDH systematically offers services to families who experience perinatal loss through the interview that is carried out by social workers.
Research activities include conducting focus groups in six of the eight pilot counties to determine culturally appropriate messages for Sudden Infant Death Syndrome (SIDS) risk reduction activities. A proposed phenomenological qualitative study seeks to “hear the voice” of the African American mother who has experienced a SIDS loss. Other SIDS risk reduction activities include contracting with a forensic nurse to expand SIDS diagnosis capacity among county coroners and promote completion of infant death scene investigations.
Finally, dissemination of information is a key component for achieving a lasting effect within the state. In years two and three of the grant, MDH will sponsor educational conferences related to grant activities and research findings focused on reducing infant mortality among African American populations. The purpose of these conferences will be to maintain a statewide focus on infant mortality and its prevention. The health of mothers and infants is of critical importance, both as a reflection of the current health status of the state and as a predictor of health for future Mississippi generations.
For more information on the CGT project, contact Juanita Graham, MSN, RN, Mississippi Department of Health, <Juanita.Graham@msdh.state.ms.us>.