In the span of just one year, Cincinnati managed to decrease its infant mortality rate (IMR) by over 25 percent, from 13.3 deaths per 1,000 live births in 2012 down to 9.9 in 2013. A recent series of initiatives in the city and county have incorporated and leveraged relevant data in various ways in an effort to combat this critical public health challenge.
Cincinnati has consistently seen infant mortality rates that are more than double the national average of 6.1. While the overall figure in Hamilton County, home to Cincinnati, has been lower than in the city itself, it is still among the worst five urban areas across the United States on this measure.
Enter two recent local programs: the Infant Vitality Surveillance Network and Cradle Cincinnati. The first is a project of the Cincinnati Health Department in partnership with area hospitals and community health centers, while the second is a nascent collaborative endeavor involving leaders both within and outside of government across Hamilton County.
Prior to implementing the Infant Vitality Surveillance Network, Cincinnati was able to break down preexisting infant mortality information to get an IMR specific to each zip code in the city. Separating out the data in this way provided a better understanding of where the problem was concentrated and revealed that the rate was as high as 32.2 infant deaths per 1,000 births in some of these areas.
Armed with this knowledge, the city decided to concentrate the efforts of the Infant Vitality Surveillance Network within the most vulnerable neighborhoods. Since 2007, this targeted undertaking has tracked various indicators and outcomes, such as birth weight and race/ethnicity, among pregnant women in the 18 zip codes with the highest IMRs.
The data compiled has in turn set in motion other initiatives and shaped what they look like. For example, the year-old “First Steps” program revolves around regular messaging to pregnant women, and the issues – such as depression screening and breastfeeding – that are highlighted in this messaging was informed by what the data collected through the network revealed as having a major impact.
First Steps also relies on a database that tracks women throughout their pregnancies and records interventions they get through the program. The information in the database is essential to coordinating services across partners.
The difference in IMR among the women and babies involved in First Steps as compared to the rest of the city is substantial: it is 32 percent lower.
Kelli Kohake, the Chief Operating Officer of the Maternal and Infant Health Division within the Cincinnati Health Department, described future plans to refine and improve these efforts through the use of data. The program will switch from using zip codes to census tracts, which “will hone it down a little bit more distinctly by neighborhood,” Kohake said, since zip codes often cut across areas with widely varying demographics.
The department also intends to integrate neighborhood-specific IMR data and life expectancy data to explore a possible connection between the two, since “infant mortality is often a reflection of the community’s overall health,” according to Kohake.
In these ways, Cincinnati can “further focus public health efforts and interventions for greater impact,” Kohake said.
Cradle Cincinnati, formed in 2013, also relied primarily on data to determine what elements to focus on in the fight against infant mortality. According to Data Director Eric Hall, Cradle Cincinnati first solicited suggestions from the collaborating partners about what behaviors they considered to have the biggest impact on infant mortality.
Then, by assessing which were measurable and looking at data to determine “which of those indicators were present within the children who had actually passed away,” those involved selected birth spacing, smoking, and safe sleep as the three areas in which the initiative aims to change the habits of women in the county.
By using data to zero in on quantifiable risk factors and on at-risk communities, these two efforts are assisting Cincinnati and Hamilton County in making major strides on a difficult undertaking, the fight against infant mortality rate.
Read more about Cradle Cincinnati at http://www.cradlecincinnati.org/ or follow the initiative on Twitter @CradleCincy.