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Jan. 11, 2013
KANSAS CITY, Kan. As part of an ongoing effort to reduce the incidence rate, the Unified Government here is preparing within the next few months to conduct in-depth reviews of each infant death that occurs in Wyandotte County.
Health department officials earlier this week outlined a timetable for the initiative after Kansas Action for Children announced the agency had received a five-year grant of nearly $300,000 to conduct fetal and infant mortality reviews, or FIMRs.
Funding for the effort is part of a roughly $900,000 initiative through the United Methodist Health Ministry Fund and the Kansas Health Foundation. Kansas Action for Children, a Topeka-based advocacy group, is administering the program.
“This is something I feel very strongly about and have been wanting to do something along these lines for quite some time,” said Terrie Garrison, program manager for the Unified Government family planning/prenatal clinic.
Wyandotte County has about 30 fetal and infant deaths a year.
“We tend to care better for our infants than we do even for our elderly,” she said. “If we are losing babies at that rate, what does that mean for the health of the community?”
As part of the reviews, teams will scrutinize death certificates, autopsy reports and the medical records of mothers. If possible, the data collectors also will interview each mother to learn things such as details regarding her prenatal care and the accessibility of bereavement counseling.
The review teams, which typically include medical professionals, analyze each infant death case studied through the FIMR. Another team then will work to improve community services based on the findings of the reviews.
Kansas City, Mo., has had an infant death review program since 2003, conducted by the Mother & Child Health Coalition through the federal Healthy Start program. Garrison is chair-elect of the coalition board.
Coordinator Mary Jean Brown tracks infant and fetal deaths in 10 Kansas City Zip codes. The coalition officials said they that hope in February to be ready to publish findings from 125 deaths that occurred between 2004 and 2010.
Brown said the top three issues contributing to infant death identified in the reviews mirrored national data: substance abuse problems, weight issues, and lack of access to prenatal care. She said the data also revealed that about one in five of the local mothers had a history of asthma, a much higher rate than among Missouri’s population as a whole.
“If we hadn’t done the data,” Brown said, “we would’ve never known that asthma was in there.”
Brown said Wyandotte County might have different issues than Kansas City, Mo. given the high percentage of black mothers on the Missouri side versus the large Hispanic population on the Kansas side.
“So it’s going to change a little bit,” she predicted, “and that’s what they need to do – ferret it out.”
The announcement of the grant opportunity came at a May meeting of the Kansas Blue Ribbon Panel on Infant Mortality. The foundations announced they would consider grant proposals from the five Kansas counties with highest infant mortality rates and then fund programs in three of the five. The counties with the highest infant mortality rates are Wyandotte, Geary, Saline, Shawnee, and Reno.
Counties submitted proposals in the fall.
Officials are finalizing participation agreements with the other two counties, said Shannon Cotsoradis, the chief executive of Kansas Action for Children. She declined to name the other two counties until they have signed the agreements.
According to the latest statistics from the Kansas Department of Health and Environment, the state’s infant mortality rate decreased slightly in 2011, to 6.2 per 1,000 live births. The 2010 rate was 6.3 per 1,000 live births.
According to the data, which the department released in November, Wyandotte County had a rate of 8.3 infant deaths per 1,000 live births between 2007 and 2011. Its rate for the previous five-year period was 8.5 per 1,000 live births.
Based on 2009 data cited by the Kansas Blue Ribbon Panel on Infant Mortality, Kansas ranked 40th among all the states for overall infant mortality and worst in the nation for deaths of black infants.
In Kansas City, Kan., Garrison said officials could integrate the mortality review findings into work already underway through the “action teams” created under Healthy Communities Wyandotte, a community-wide wellness campaign championed by Mayor Joe Reardon.
For instance, she said, feedback from the mortality reviews could provide additional evidence that certain areas lacks access to healthy foods.
In Kansas City, Mo., Brown said the findings have prompted several moves by the Mother & Child Health Coalition, including distribution of a resource guide that tells women where they can obtain an official pregnancy test. Medicaid does not accept over-the-counter tests as proof of pregnancy. Brown said the coalition also planned to dispatch an intern this month to place safe-sleep literature in pediatricians’ offices.
Pediatrician Michelle Haley, who practices at Children’s Mercy West, has worked on the FIMR initiative in Wyandotte County.
“I think there are a lot of community agencies and resources,” she said. “We are just not using them to the greatest degree, so I think this will kind of push that along.”
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