Maternal and Child Health Library

MCH Alert: Focus on Infant Mortality is developed by the Maternal and Child Health Library in collaboration with the National Sudden and Unexpected Infant/Child and Pregnancy Loss Resource Center at Georgetown University. This and past issues are available online at http://www.mchlibrary.info/alert/archives.html and http://www.sidscenter.org/alert/archives.html.

January 29, 2010

Special Notice: In an ongoing effort to support state and local maternal and child health programs, the Association of SIDS and Infant Mortality Programs (ASIP) and the Association of Maternal and Child Health Programs (AMCHP) will co-sponsor a series of quarterly webinars to strengthen services related to sudden unexpected infant death, sudden infant death syndrome, infant safe sleep, and bereavement across the United States. Topics will include research, new national initiatives, promising practices, and policy and legislative activities. The first webinar will be held on February 11, 2010, from 3:00 p.m. to 4:30 p.m. EST. Future webinars will be held in April, June, and September. For more information, contact Sandra Frank (ASIP) at sfrank@asip1.org or Jessica Hawkins (AMCHP) at jhawkins@amchp.org

1. TOOLS HELP FETAL AND INFANT MORTALITY REVIEW TEAMS ASSESS CULTURAL AND LINGUISTIC COMPETENCE

The National Center for Cultural Competence (NCCC) has produced a new instrument and a new guide to address the unique functions of fetal and infant mortality review (FIMR) teams. NCCC developed the tools in collaboration with the National FIMR Program, with guidance from a national workgroup of state and local FIMR representatives, and with support from the Health Resources and Services Administration's Maternal and Child Health Bureau. The new tools include the following:

* The Cultural and Linguistic Competence Organizational Assessment Instrument for Fetal and Infant Mortality Review Programs (CLCOA-FIMR) is intended to support FIMRs to (1) plan for and incorporate culturally and linguistically competent policies, structures, and practices in all aspects of their work; (2) enhance the quality of case reviews and action plans within diverse and underserved communities; and (3) promote cultural and linguistic competence as an essential approach in the elimination of disparities and the promotion of health and mental health equity. The CLCOA-FIMR addresses the three core functions of FIMRs: data gathering, case reviews, and community action. The instrument gathers a range of data in four domains (Our World View, Who We Are, What We Do, and How We Work) to help FIMRs identify their strengths and areas for growth. The instrument is available at
http://www11.georgetown.edu/research/gucchd/nccc/documents/FIMR_Assessment.pdf

* A Guide for Using Cultural and Linguistic Competence Organizational Assessment Instrument for Fetal and Infant Mortality Review Programs reviews the benefits to FIMRs of engaging in cultural and linguistic competence self-assessment, discusses the values and principles for self-assessment, and delineates a four-step process for organizational self-assessment. Additional topics include frequently asked questions, definitions, useful steps for making the self-assessment work, and processes for community engagement in self-assessment. The guide is available at http://www11.georgetown.edu/research/gucchd/nccc/documents/FIMR_AssessmentGuide.pdf

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• Between communities, the median outpatient LRI incidence rate was 42 per 100 child-years, while the inpatient rate was 6.3.
• Maternal education predicted inpatient and outpatient LRI risk independently of other factors.
• At the community level, a high proportion of poorly educated adults was more predictive of inpatient and outpatient LRI risk, independent of the presence of other variables.
• For both inpatient and outpatient LRI outcomes, lower maternal education and a higher proportion of adults in a community with less than a 7th-grade education increased the likelihood of inpatient and outpatient LRI in a dose-response manner.
• The absolute LRI risk associated with birth to a less-educated mother was blunted after controlling for the low educational status of the community. Conversely, the protective effect associated with birth to a well-educated mother was substantially reduced if community educational status was low.

• PIH increased from 3.0 percent in 1990-1991 to 3.8 percent in 2003-2004.
• Differences in rates of stillbirth and neonatal mortality between women with and without PIH were greater in 1990-1991 than in 2003-2004. This was true for both first and higher-order births.
• PIH was associated with a higher risk of stillbirth, especially among second and higher-order births, both in the 1990-1991 and the 2003-2004 periods.
• The risk of neonatal death following PIH was also elevated, although the difference between first and higher-order births was less marked.
• Black women had consistently higher mortality rates, and PIH-associated stillbirth was more likely among multiparous black woman compared with multiparous white women.