Perinatal Periods of Risk Approach: Tarrant County Experience

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Perinatal Periods of Risk ApproachTarrant
County Experience

• Anita K. Kurian, MBBS, DrPH
• Division Manager Chief Epidemiologist
• Tarrant County Public Health
• February 27, 2009

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Infant Mortality RatesU.S., Texas, Tarrant
County 1994-2004
9.0
8.5
8.0
7.5
7.0
Deaths per 1,000 live births
6.5
6.0
5.5
5.0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
U.S.
Texas
Tarrant County
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Infant Mortality RatesTarrant County, 1994-2004
20.0
16.0
12.0
Infant Mortality Rate
8.0
4.0
0.0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Year
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By looking at the numbers in a new way, we can
finally understand fetal/infant mortality and its
common causes. Only through understanding can we
take steps to ensure every child gets a chance at
life. -
CityMatCH
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Perinatal Periods of Risk Approach

• Developed by Dr.McCarthy WHO
• Simple Approach
• Strong conceptual basis
• Mobilizes communities
• Prioritizes prevention efforts
• Establish ongoing surveillance
• Used in developing countries

CityMatCH PPOR http//www.citymatch.org/ppor_inde
x.php
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Perinatal Periods of Risk Approach (PPOR)
Age at Death
Fetal Death
Post- neonatal
Neonatal
Birthweight
Maternal Health/ Prematurity
500-1499 g
Maternal Care
Newborn Care
Infant Health
1500 g
CityMatCH PPOR http//www.citymatch.org/ppor_inde
x.php
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Map Connections to Action
Maternal Health/ Prematurity
Preconception Health Health Behaviors Perinatal
Care
Prenatal Care Referral System High Risk OB Care
Maternal Care
Perinatal Management Perinatal System Pediatric
Surgery
Newborn Care
Sleep Position Breast Feeding Injury Prevention
Infant Health
CityMatCH PPOR http//www.citymatch.org/ppor_inde
x.php
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PPOR Phase I Map Gap Analysis

• Examines the four Periods of Risk
• Maternal Health / Prematurity
• Maternal Care
• Newborn Care
• Infant Health
• for various population groups
• Identifies groups and periods of risk with the
  most deaths, highest rates
• Uses comparison groups to estimate excess
  deaths for these groups and periods of risk

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FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC
GROUPS 2001-2003
Maternal Health/Prematurity 3.1
Infant Health 1.7
Newborn Care 1.4
Maternal Care 1.7
Feto-infant mortality per 1,000 live births
fetal deaths
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FETO-INFANT MORTALITY RATES, ALL RACIAL/ETHNIC
GROUPS 2001-2003
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Using Reference Group to Calculate Excess
Feto-infant Mortality
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PPOR - Phase II
Maternal Health/ Prematurity
mortality rate among VLBW babies
VLBW births
Interventions
Preconception Health
Perinatal Care
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PPOR - Phase II
Target Population African-Americans
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Phase II Findings
Overall Excess Mortality among African-American
Women
BW specific mortality 28
BW distribution 72
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To Summarize
Maternal Health/ Prematurity
PPOR-Phase I
PPOR-Phase II
VLBW births
Interventions
Preconception Health
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Revised Case Management Protocol
FIMR
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If you want to travel fast,
travel alone. If you want to travel far,
travel together.
- African Proverb
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ACKNOWLEGEMENT
Micky Moss Moerbe, MPH Dorian Villegas,
MPH Tarrant County Infant Mortality Network
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http//www.tarrantcounty.com/eHealth
Thanks for Listening