Rick Majzun, vice president, strategic operations and planning at Children's Hospital, St. Louis, visited a 20 bed hospital in Kenya's Rift Valley as part of his 2011 Eisenhower Fellowship in September 2011. Handout Photo
For babies to survive to their first birthdays, a lot depends on where they are born.
Infant mortality rates in some corners of the United States, including parts of the St. Louis region, compare to Third World countries. In other areas, the low rate of infant deaths resembles Scandinavian countries at the top of the survival curve.
Rick Majzun, a vice president at St. Louis Children’s Hospital, traveled last year to Sweden and Kenya to try to understand why infant death rates vary so widely by geography, and what might be done to reduce the disparities that exist even among St. Louis-area ZIP codes.
“It patently didn’t seem fair,” Majzun said of the reason he chose infant mortality as a topic of research for his 2011 Eisenhower Fellowship, an international exchange program for midcareer professionals.
Infant mortality rates, defined as the number of babies out of every 1,000 who die before turning 1, range from fewer than 2 to more than 175 worldwide.
In Sweden, the rate of infant deaths is under 3. The rate in Kenya is 52. In the U.S., the death rate is 7 out of every 1,000 babies, which means about 30 countries worldwide fare better on infant survival.
But it’s much worse for certain demographics — an average 14 deaths out of 1,000 black infants in the U.S., and as many as 23 in some ZIP codes in St. Louis and other cities.
Majzun visited the two countries to meet with hospital leaders, government officials and health care providers to discuss how children’s hospitals can work in their communities to prevent infant deaths.
“In an era when hospitals are being held accountable for their community’s health, what more can we do?” Majzun said in explaining his focus.
Most births in Kenya have historically taken place in the home. Some hospitals are changing that, while still honoring the tradition by hiring birth attendants who usually work in homes to encourage and help women deliver in the hospital. The program has helped reduce infant mortality rates in some villages.
In Sweden, nurses are assigned to every newborn to help make sure the child meets his or her developmental targets and gets vaccinations. Nurses are compared with their peers and graded on a report card with a goal of improvement through competition, a program Majzun thinks could be applied at Children’s Hospital.
Majzun learned about the social insurance system that gives residents a sense of financial and health security.
“The sense of solidarity and brotherhood is so different there,” he said. “They just take care of each other.”
The Swedish resources made Majzun feel “embarrassed more than proud” of the American health care system, he said.
“Unlike in Sweden, where health care is viewed as a public good, the American system is a fragmented, expensive and wasteful patchwork that produces results that are truly beneath what we are capable of achieving,” Majzun wrote in his postfellowship report. “Once you get into the hospital, we generally do a pretty good job. However, we fail to do enough to keep you from arriving at our doors.”
One in 8 babies in Missouri is born prematurely, costing the state an estimated $500 million a year, according to the March of Dimes. Because the U.S. insurance system reimburses hospitals for expensive treatments, there is no incentive — other than a moral obligation — for hospitals to prevent early births.
“The St. Louis community will spend $1 million for a month of (neonatal intensive) care for a premature baby, and they will do it many, many times this year,” Majzun wrote. “But we don’t have an adequately funded, community-wide approach to reducing the number of late pre-term births.”
The state Legislature created a task force earlier this year to address Missouri’s infant mortality rate. A proposal from the task force is due in 2013 with ideas for policy changes and other strategies to reduce premature births and infant deaths.
Part of the focus will be on increasing access and coverage for preconception care — health concerns specific to women of childbearing age. Because about half of all pregnancies are considered unplanned, preconception medical visits would include screenings for conditions that can raise problems in pregnancy, such as smoking, drinking, high blood pressure, diabetes, obesity and poor nutrition. The woman’s vaccinations should be up-to-date, and any medications she’s taking should also be safe for pregnant women.
Another focus of the task force will be on reversing the rise of elective preterm births, the scheduling of births a couple of weeks before a woman’s due date for nonmedical reasons.
“There is no substitute for the mother’s womb unless the child is in distress,” said Mary Elizabeth Grimes, Missouri state director of the March of Dimes and a member of the task force. “The exponential growth of the child’s brain and other organs are so significant in the last few weeks prior to 39 weeks, that you are really depriving the child from realizing the fullness of their development.”
Majzun said part of the challenge will be explaining to people why they should care about the high prematurity and infant mortality rates in certain parts of the country. Healthy babies turn into healthy and productive adults who contribute to a well-functioning society, he said.
“We need to hold our health care institutions more accountable for the broader health of the communities we serve,” he wrote. “It felt like that accountability was in place in Sweden. Kenya and the United States have a long way to go.”
Comments