Term Paper on "Prenatal Care and Health Care Access"

Term Paper 32 pages (8616 words) Sources: 17 Style: APA

[EXCERPT] . . . .

prenatal care and health care access on infant death outcomes in five public health districts with the highest and lowest rates of infant deaths in georgia

Infant rate mortality in Georgia is extremely high and is an indicator of the overall poor status of health among women and children in this state. Between 1990 and 2000, it is reported that Georgia was among the states with the highest rate of infant deaths. In 1990 the infant morality rate in Georgia was at 12.4 deaths for each 1,000 live births and decreasing to 8.5 per 1,000 in 1998. The infant death rate among the white population is 6.1 per 1,000 while the African-American population was stated at a much greater rate of 13.5 per 1,000, which is over twice as high as infant death rates among the white population in the state of Georgia. (Georgia Department of Human Resources: Infant Mortality Fact Sheet, 2000)

PURPOSE of STUDY

The purpose of this study is to investigate Infant mortality in African-American women in Georgia for the years 2000-2005 in five public health districts with the highest rates of infant mortality and five public health districts with the lowest infant mortality rates (so we are looking at 10 public health districts total that can be found on the OASIS website) in the state of Georgia).

LITERATURE REVIEW

It is stated by the Georgia Department of Human Resources in the work entitled: "Infant Mortality: Fact Sheet" that the primary cause of infant deaths in the state of Georgia has been found to be low birthweight, or babies who are born weighing 5.5 pounds or less. The second primary cause of infant mortality in the state of Geo

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rgia is premature birth, which is often characterized by low birthweight. Risk factors stated by the Georgia Department of Human Resources include those of:

1) Conception at a young age;

2) Poor health and/or nutritional status of the mother;

3) Some infections including reproductive tract infections and periodontal infections;

4) Substance abuse;

5) Closely-spaced pregnancies;

6) Inadequate prenatal care;

7) Inadequate folic acid intake; and 8) Positioning babies on their stomachs to sleep. (Georgia Department of Human Resources, 2000)

Reduction of infant mortality rates in the state of Georgia during the 1990s was accomplished through improvement of technologies and facilities in the treatment of severely underweight babies and increasing the access to quality prenatal care for women who are pregnant. Finally, raising the concern of the public about reduction of the risks contributing to SIDS has assisted in reducing infant mortality rates in the state of Georgia. While the survival of low birthweight babies is more likely in Georgia due to technological advances there is a great cost in the intensive and extended care necessary for these babies to survive. The Division of Public Health (DPH) in the state of Georgia has focused on combating low birthweight through placing an emphasis on prevention program improvement. The following table lists the infant mortality by health district for black infants during the period 1990-1997 in the state of Georgia.

Infant Mortality by Health Districts, Black Infants 1990-1997

Source: Perinatal Epidemiology, Epidemiology and Prevention Branch, Georgia Division of Public Health, November 1990-1997 Vital Records

The following chart lists the infant mortality by health district for black infants 1990-1997.

Infant Mortality by Health District, Black Infants, 1990-1997

Source: Perinatal Epidemiology, Epidemiology and Prevention Branch, Georgia Division of Public Health, November 1998, Source: 1990-1997 Vital Records

State of Georgia Infant Mortality by Race

1990-1997

Neonatal, Postnatal and Total Infant Mortality

Source: Perinatal Epidemiology, Epidemiology and Prevention Branch, Georgia Division of Public Health, November 1998, Source: 1990-1997 Vital Records

FIVE HEALTH DISTRICTS WITH HIGHEST INFANT MORTALITY RATE

The five health districts in the state of Georgia with the highest infant mortality rate for the years 2000 through 2005 are those shown in the following table.

Five Health District in the State of Georgia with the Highest Infant Mortality Rate

Infant Deaths & Infant Mortality Rate (IMR), All Causes, Race: Black

2000 2001 2002 2003 2004 2005 SELECTED YEARS TOTAL DEATHS DEATHS DEATHS DEATHS DeKalb Health District 83-76 83-70 87-68-467 Crawford 0-0 1-0 0-2-3 Jones 0-0 2-3 1-2-8 Twiggs 0-2 0-3 2-1-8 Columbia 3-2 2-2 2-4-15 Jenkins 1-0 1-1 1-0-4 Screven 3-0 1-3 3-1-11 Chattahoochee 0-1 0-1 0-2-4 Harris 0-2 2-2 0-1-7 Quitman 0-0 1-0 2-1-4 Sumter 1-5 3-3-10 6-28 Calhoun 1-1 1-0 0-3-6 Early 0-2 1-4 3-0-10 Mitchell 6-2 3-4 2-3-20 Worth 1-2 0-0 0-0 3

Source: Oasis (2008)

The infant mortality rate in these health districts is extremely higher than in other Georgia Health Districts throughout the state.

INFANT MORTALITY RATE - CONTRIBUTING FACTORS

The work of McDermott, et al. (1999) entitled: "Does Inadequate Prenatal Care Contribute to Growth Retardation among Second-Born African-American Babies" reports a study in which the relation between "adequacy of prenatal care and risk of delivery of full term small-for-gestational-age infants" was explored. Data was obtained from "...materially linked birth certificates for 6,325 African-American women whose first pregnancies ended in single, full live births in Georgia from 1989 through 1992." (McDermott, et al., 1999) McDermott et al. states that babies whose birth weights are less than "the 10th percentile for gestational ages are considered small for gestational age and are at risk of increased morbidity and mortality. However, being small at delivery is likely to affect health primarily if the infant's in utero growth was retarded in some way." (1999) Small Gestational Age has been linked to smoking, insufficient weight gain, and hypertensive disease and the risk of small gestational age is higher in the first pregnancy than in following pregnancies. Mothers who have a history of delivering babies that are SGA are at a higher risk of delivery SGA babies in the future. Genetics plays a role in repeated SGA deliveries and low socioeconomic status and weight loss during pregnancy has also been linked to small gestational age babies. Prenatal care generally includes interventions that address risk factors for SGA including smoking, hypertensive disease, insufficient weight gain and obstetric complications during pregnancy. Researchers state findings that "prenatal care is associated with a reducing in SGA births" (McDermott, et al., 1999) and that prenatal care has the greatest impact on babies born at 40-42 weeks gestation.

The work of Ashman (2005) entitled: "Infant Mortality and Financial Stability" relates that infant mortality "is most heavily determined by the financial stability of a family. The high mortality rate in urban Atlanta, Georgia and the low mortality rate in urban White Plains, New York exemplify the correlation between the financial income and infant mortality in the Untied States. A family's income determines access to good prenatal care." (Ashman, 2005) Ashman relates that a mother's access to prenatal care is the first consideration in seeking a solution to high infant mortality rates because without prenatal care "mothers increase their chances of engaging in unhealthy activities which will affect the health of the baby and of themselves; they increase the risk of having premature infants and of losing an infant to complications during the pregnancy." (Ashman, 2005) the prenatal visit involves weighing the patient, checking blood pressure, testing urine for possible infection and monitoring of the heartbeat of the baby and checking the growth of the baby. Furthermore, "a prenatal health care team administers various tests and gives advice to mothers.

The health care provider discusses healthy eating habits, avoiding unhealthy environments and exercising carefully with the approval of the physician." (Ashman, 2005) Ashman reports that the average costs for prenatal care include hospital costs for a delivery with no complications is approximately $6,400 however, in situations where complications exist a longer hospital stay is required for the infant resulting in "the median treatment cost of delivery averages up to $50,000." (Ashman, 2005) Ashman states that the present "inadequate financial support for mothers and their families in Atlanta results in their dependence on the federal program Medicaid. The federal government and the governments of each state have devised this medical program to pay for medical assistance for individuals and families with low incomes and resources who meet eligibility criteria. Individuals eligible for Medicaid range from pregnant women to children to the elderly." (Ashman, 2005)

Eligible women are able to access this program yet the eligibility requirements in the State of Georgia for pregnant women have undergone changes. Ashman states that under the plan developed by Governor Perdue "pregnant women and infants in households earning $34,040 or more for a family of four would not longer qualify for Medicaid." (Ashman, 2005) Ashman relates that the total eligibility income for a family of four "is barely enough for an expectant mother to survive, much less for an expectant single mother. The government estimates that 12,500 women may lose prenatal care because of their inability to afford the costs of prenatal and maternity services." (Ashman, 2005)

Ashman relates the fact that "the inconsistency of government officials in the state of Georgia affects the aid available to mothers in Atlanta. A solution capable of aiding expectant mothers… READ MORE

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Quoted Instructions for "Prenatal Care and Health Care Access" Assignment:

“

Research Topic/Title:

To Assess The Impact of Prenatal Care And Health Care Access On Infant Death Outcomes In Five Public Health Districts With The Highest And Lowest Rates Of Infant Deaths In Georgia

(Basically, the study will focus on infant mortality in African American women in Georgia for the years 2000-2005 in 5 public health districts with the highest rates of infant mortality and 5 public health districts with the lowest infant mortality rates (so we are looking at 10 public health districts total that can be found on the OASIS website) in the state of Georgia).

Please Note:

* Thesis needs to be in APA format

* Focus on African American Population (compare to whites & others)

* Data sets are for the years 2000-2005

* Include a hypothesis, if needed

Sections:

I. Introduction (Suggested topics to include in introduction please, you can also add more info. and change the order of topics)

A. Epidemiology of Infant Mortality in the United States

(What is infant mortality, Why it matters, Infant mortality on national, state (GA.), local level)

1. Prevalence and Distribution on Infant Mortality

a. Age (maternal (teens & adults), neonatal & post neonatal)

b. Geographic Location (Urban & Rural)

(include background info. on the 5 public health districts with the highest rates of infant mortality and the 5 public health district with the lowest in GA., demographics, population age, average income, ethnicity)

c. Social Economic Status (include info on national, state (GA) level, & local level, also include info. on mothers education, income, ethnicity, birth rates & lifestyles)

B. Purpose of Study

a. Literature Review( include hypothesis,

include info. on the state of Georgia,

African American women in GA, Infant

mortality in GA, state rank, etc*****¦)

b. Theoretical Framework (as of now I

think the social cognitive theory

works with this study, please show the

relationship between this theory and the

research topic, & the variables that should

be considered to answer research questions)

C. Preconception Care (In the U.S., in GA. & within

the particular public health districts)

D. Prenatal Care (include info. on the number of

hospitals in each public health district, the

number of physicians in each public health

district, barriers to seeking care, please add

other relevant info.)

E. Access to Health Care (Info. on access to health

care in GA, info. on each public health district,

medical insurance: private, Medicaid, no

insurance at all, barriers to access and anything

else that is important).

F. Reducing Infant Mortality (on a national level, in GA and in particular public health districts, please add other relevant info.)

II. Methodology (include Measure, Procedure, Analysis, also please include the study design, the population to be studied, data collection procedures, the location and time

frame of the study, and how the data will be analyzed)

III. Results (include Findings for Research Question/Topic/Hypothesis, Describe findings as they relate to specific research question or hypothesis. This section should include the results of the study. Tables and figures may be used to describe pertinent findings).

IV. Discussion (Strengths and Limitations, a summary of your results and a discussion of the implications of your findings. Consider your results in terms of health policy, clinical, or public health implications. Your discussion must be supported by pertinent literature).

V. Conclusion (if you need to conserve space or pages the conclusion and recommendations can both go under the discussion)

VI. Recommendations (Consider your results in terms of health policy, clinical or public health implications)

Please include all of the following in the email:

*****¢ Data sets used for each public health district for the years 2000- 2005 (OASIS website)

*****¢ Abstract: Brief summary (250 words or less) of the major components of the study including purpose, method, results and discussion.

*****¢ References: All cited references must be included in the reference list. All references included in the reference list must be cited in the body of the text or tables.

*****¢ Tables- (suggestions for tables to include, you can add more or any tables relevant to research)

o Infant deaths and mortality rates for the five leading causes of infant death by race in GA, 2000 or 2004 or 2005

o Percentage of mothers receiving late or no prenatal care, by race and age in U.S. and GA (pick a year 2000 or 2003 or 2004, whatever you can find data on)

o Infant Mortality rates by education and race/ ethnicity, 2000-2005

o Low Birth Weight and very low birth weight, live birth rates by race/ethnicity, 2000-2005 (Blacks, Whites, American Indian Asian Pacific Islanders, Hispanics)

*****¢ Figures- (suggestions for figures to include, you can add more or any figures relevant to research)

o Infant Mortality Rates in GA. and U.S. 2000-2005

o Infant Mortality Rates by Public Health District in GA., 2000-2005 (can be displayed using the map of GA. and using different colors to represent the 5 public health districts with the highest IMR and the 5 public health districts with the lowest IMR, is it possible for you to use Geographic Information System (GIS) for all the maps)

o Infant Mortality Rates by Race/Ethnicity in GA., 2000-2005 (or pick a year, display African American, Whites, Hispanics, American Indian, Asian/Pacific Islanders)

o Map of GA. with hospitals, active primary care doctors displayed within proximity to public health districts (Geographic Information System (GIS))

o Infant, Neonatal and Post-neonatal mortality rates be race/ ethnicity, 2000-2005 (or pick a year, whatever data you can find for particular year)

o International comparisons of infant mortality rates, United States and selected countries, 2003 or 2004 or 2005

Other sources that might assist with data collection:

*****¢ Online Analytical Statistical Informational System (OASIS-GA, 2000-2005)

*****¢ Pregnancy Risk Assessment Monitoring System(PRAMS-GA, 2000-2005)

*****¢ National Institute of Health (NIH)

*****¢ Office of Minority Health

*****¢ (CDC MMWR)

*****¢ CDC WONDER: infant deaths, linked birth/ death records

*****¢ National Vital Statistics

*****¢ National Center for Health Statistics 2000-2005

*****¢ United Health Foundation- Americans Health Ranking

*****¢ World Health Organization

THANK YOU

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