Alabama Baby Coalition

A story from a health department that uses
PPOR and FIMR together

Presenter:
Anthony Bondora,
FIMR/Alabama Baby Coalition Coordinator
Mobile County Health Dept.
Data for Local Calculations
2002, 2003, 2004, 2005
 Alabama Baby Coalition, Fetal-Infant Deaths
 Calculated using 4-year combined numbers
because of the small number of cases
 Fetal-Infant Mortality Rate calculations use:

 Live births >500gms and fetal deaths >24 weeks
 (Deaths/live births + fetal deaths >24 wks) times 1,000
PPOR analysis provides the
framework
Mobile County, Alabama
Population 393,585 in 2005
61.6% White
34.6% Black or African-American
3.8% Other or more than one race
Fetal-Infant Mortality Rate – Mobile
County 2002-2005 (All Races)
Total Fetal-Infant Mortality Rate = 8.9
(214/23,293) x 1,000
3.3
(79/23,293) x 1,000
1.9
1.6
2.1
(45/23,293) x 1,000
(38/23,293) x 1,000
(52/23,293) x 1,000
Fetal-Infant Mortality Rate – Mobile
County 2002-2005 (WHITE)
Total Fetal-Infant Mortality Rate = 6.9
(92/13,271) x 1,000
2.7
(36/13,271) x 1,000
1.1
1.5
1.6
(15/13,271) x 1,000
(20/13,271) x 1,000
(21/13,271) x 1,000
Fetal-Infant Mortality Rate – Mobile
County 2002-2005 (BLACK)
Total Fetal-Infant Mortality Rate = 11.9
(119/10,022) x 1,000
4.4
(44/10,022) x 1,000
2.8
1.9
2.8
(28/10,022) x 1,000
(19/10,022) x 1,000
(28/10,022) x 1,000
National External Comparison Group’s
Fetal-Infant Mortality Rate
Total Fetal-Infant Mortality Rate = 5.9
2.2
1.5
1.1
1.0
Excess Mortality by Race for Mobile County 2002-2004
Precon
Mat Care
NB Care
Inf Health
Overall
Mobile/White
2.7
1.1
1.5
1.6
6.9
Reference
2.2
1.5
1.1
1.0
5.9
Excess/White
0.5
-0.4
0.4
0.5
1.0
EXDTH/WHT
7
-5.3
5
7
13
Mobile/Black
4.4
2.8
1.9
2.8
11.9
Reference
2.2
1.5
1.1
1.0
5.9
Excess/Black
2.2
1.3
0.8
1.8
6.0
EXDTH/BLK
22
13
8
18
60
Mobile/Total
3.3
1.9
1.6
2.1
8.9
Reference
2.2
1.5
1.1
1.0
5.9
Excess/Total
1.1
0.4
0.5
1.1
3.0
EXDTH/TOT
26
9
12
26
73
Excess Mortality -- White
0.5
-0.4
0.4
0.5
Excess Mortality -- Black
2.2
1.3
0.8
1.8
Excess Deaths 2002-2005
19%
White (n=13.3)
Black & Other
(n=60.1)
86%
PPOR Trends based on 3-Year
Average (Overall/ Mobile)
12
10
Overall
Preconception
Maternal Care
Newborn Care
Infant Health
8
6
4
2
0
98-00
99-01
00-02
02-05
PPOR Trends based on 3-Year
Average (White/ Mobile)
10
9
8
7
6
5
4
3
2
1
0
Overall
Preconception
Maternal Care
Newborn Care
Infant Health
98-00
99-01
00-02
20022005
PPOR Trends based on 3-Year
Average (Black & Other/ Mobile)
14
12
Overall
Preconception
Maternal Care
Newborn Care
Infant Health
10
8
6
4
2
0
98-00
99-01
00-02
20022005
What Does It All Mean?
Our black IMR was higher than our white IMR.
 We have a lot of low birth weight babies dying.
 The majority of excess deaths (86%) in our
county are of black race.
 Our excess deaths were in the category of
preconceptional health & infant health.
 Black IM rates are increasing in these problem
areas. White levels remain stable.

Mobile County FIMR

Reviews ALL deaths
– Hospital and Clinic records

High refusal rate for maternal interview
--missing data
FIMR Challenges/Barriers
We are not reaching the African American
population in our education efforts.
 We have a very low maternal interview rate.
 We have a lag between infant death and
paperwork of up to 1 year.
 Mobile County obesity rates for FIMR
population =46%: for state =28.7%
 Some mothers have transportation problems
that could extrapolate to FIMR cases.

FIMR Results: Preconception Health
46% of
 22% of
 12% of
 18% of

our cases involved maternal infection.
cases involved maternal smoking.
cases involved alcohol.
cases involved drug abuse.
FIMR Results: Infant Health
51% of our cases were anomolies & infections.
 9% of our cases were SIDS deaths
 Accidents/injuries 20%
 Unspecified 20%

As A Result…
We found excess mortality is related to unsafe
sleep practices.
 We are pushing through legislation to mandate
that hospitals hand out information on safe
sleep practices to all mothers
 There is a need for PSA and Billboards
regarding nutrition, exercise and obesity
