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Current Trends Infant Mortality in a Rural Health District - - Georgia
In 1979, the infant mortality rate (IMR) in a south Georgia health district, a rural, 16-county area covering 5,943 square miles with a population of 249,000, dropped and remained relatively low in 1980, compared with rates during the preceding 5 years (Figure 4). The number of births and deaths for infants born 1974-1978 and 1979-1980 were calculated for three birthweight categories: less than 1,500g, 1,500-2,499g, and 2,500g or greater (Table 1). Although infants with birth weights greater than 2,500g had the lowest mortality rates, they represented 45% of deaths in 1974-1978 and 38% in 1979-1980.
To determine the components of the decline in IMR, a computerized registry of linked birth and infant-death certificates, maintained by the Georgia Department of Human Resources, was used (1). The greatest relative decline in mortality occurred among infants with birth weights 1,500-2,499g and 2,500g or greater. If birthweight-specific neonatal and postneonatal mortality rates* for 1974-1978 had remained unchanged, 69 additional deaths would have been expected in 1979-1980 among infants with known birth weights (Table 2). Nearly two-thirds (43/69) of the difference between observed and expected deaths occurred in the 2,500g or greater birthweight category. For infants 1,500-2,499g and 2,500g or greater, improvements during the neonatal and postneonatal periods were approximately equal, while for smaller infants, improvement was limited to the neonatal period. When specific causes of death were examined for infants 2,500g or greater (Table 3), decreases in deaths due to infections and birth trauma/asphyxia/hypoxia contributed the most to the decline in neonatal deaths, and a decrease in deaths due to infections was the greatest contributor to the decrease in postneonatal deaths.
The IMR declined from 16.0 to 9.1 for white infants and from 30.4 to 19.1 for infants of other races, while the racial composition of births remained constant. The percentage of women delivering infants at high risk for neonatal death did not decrease (2). Ninety-four percent of the decline in mortality was attributable to improved survival within birthweight categories, and 6% to a shift in the birthweight distribution (3). The decrease in IMR was not associated with a parallel increase in admissions to intensive care units for newborns. Reported by JT Holloway, Southeast Health Unit, Waycross, S Zaro, MPH, Family Health Svcs, RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human Resources; Div of Field Services, Epidemiology Program Office, Div of Reproductive Health, Center for Health Promotion and Education, Birth Defects Br, Center for Environmental Health, CDC.
Editorial Note: Most of the recent decline in U.S. neonatal mortality has been attributed to improved survival of infants with birth weights lower than 2,500g (4,5). In this rural health district, where the IMR had been substantially higher than rates in the remainder of Georgia and the nation, most of the decline in infant mortality was due to improved neonatal and postneonatal survival for infants 2,500g or greater at birth. Within this group, decreases in neonatal mortality due to birth trauma/asphyxia/hypoxia may reflect improved intrapartum care, and decreases in neonatal and postneonatal deaths due to infections may reflect improved obstetric and infant care. Changes in IMR accompanied efforts to enhance basic prenatal, intrapartum, and postnatal services for women and infants. In 1975, this health district began a program providing routine prenatal and infant care as a precondition for receiving benefits from a nutrition program for mothers and infants. By 1979, the program was in effect in all 16 counties and enrolled approximately 30% of the district's pregnant women. Additionally, physicians in each county were identified who would offer low-cost obstetric care for high-risk, medically indigent women. However, it is not clear why the sharp drop occurred in 1979. Local and state health officials are conducting further studies to assess the contribution of participation in the supplemental nutrition program and other factors to the decline in infant deaths.
Linking birth and death certificates permits the use of maternal and infant characteristics at birth, particularly birth weight, in describing infant mortality. Analysis of birth weight, period-of-death, and cause-specific mortality rates forms a basis for implementing more appropriate strategies for preventing infant deaths and enhancing the evaluation of these programs.
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