Multiple deliveries in North Carolina: effects on birth outcomes.

OBJECTIVES: The purpose of this study is to examine the trends in multiple deliveries in North Carolina and assess their effect on the rates of low birth weight, fetal mortality, and infant mortality. METHODS: Using North Carolina vital statistics files, trends in multiple births, categorized by race, maternal age, and birth weight, were examined for the period 1980-1997. A partitioning method was used to estimate the contribution of maternal age distribution and age-specific multiple birth rates to the overall increase in multiple births, and the contribution of the changing multiple birth rate to observed trends in low birth weight and fetal and infant mortality. RESULTS: Between 1980 and 1997, the state's multiple birth rate increased by 40%. Most of the increase was due to a rise in the age-specific multiple birth rates, rather than a shift in the maternal age distribution. The increase in the multiple birth rate accounted for a substantial proportion of the increase in low birth weight among Whites and Blacks. The rise in multiple births also hindered further declines in fetal and infant mortality during this time. CONCLUSIONS: Multiple births are an increasingly important contributor to perinatal outcomes, and warrant greater consideration in research aimed at evaluating trends in low birth weight and infant mortality.

Assessing the public's health: community diagnosis in North Carolina.

The community diagnosis process in North Carolina has evolved over a period of years. It began in 1974 and gained great impetus during and after 1983. It serves to address the "true" health problems of the State's citizenry through the identification and communication of these problems from the local level to the State. In this "bottom-up" planning process, conducted biennially, the State health department prepares 100 county-specific health data books and an accompanying guide that advise local health department personnel on the concepts, methods, and materials of community diagnosis. The data books and guides are presented at a series of workshops to county health department personnel who subsequently analyze the data in the light of their local situations and report back to the State their county's priority health problems and strategies for solving them. This county information is then used by the State health director to determine funding requests to the legislature. In the end, it is hoped that the products of this process serve the ultimate goal of allocating resources according to priorities to meet the documented health needs of North Carolinians. "The Future of Public Health," authored by a committee of the Institute of Medicine, defines a health planning and leadership role for a local health authority that is fundamental to the protection of the community's health. Community diagnosis provides for the kind of needs assessment that is crucial to that role.

Postneonatal deaths in North Carolina, 1959-1963.

PIP: The data presented indicate that the disturbing upward trend in infant mortality in North Carolina has been arrested and possibly reversed during the 1959 through 1963 period. Information obtained from death certificates indicates that infections accounted for slightly more than half (52.4%) of the postneonatal deaths occurring in the study periods. The most common type of infection was influenza and pneumonia, followed by gastroenteritis and colitis, infective and parasitic disease, meningitis, and acute respiratory infections, in that order of frequency. Infections were responsible for a greater percentage of the postneonatal deaths among nonwhite (58.5%) than amon white infants (40.7%). the postneonatal death rate from infections was 13.4 for nonwhite infants and 2.2 for white infants. The next most common cause of postneonatal mortality -- congenital malformations -- was relatively more important in the white race, being responsible for approximately 25% of white deaths and only 6% of nonwhite deaths. I11 defined and unknown causes ranked 3rd in importance, with postneonatal death rates of 3.0 for nonwhite and .4 for white infants. Accidents, wich ranked 4th, were responsible for approximately 10% of the postneonatal deaths in each race. In both races, the risk of postneonatal death was greater in infants born to younger mothers, partiuclarly those under age 20. For the infants of mothers under age 15, the postneonatal death rate was 3 times as high as for those of 20-24 year old mothers. Beginning with age 20, the risk of postneonatal mortality decreases gradually as maternal age increases up to 35 years, when it begins to rise again in the white race. In nonwhite races, the decline continoues to age 40. Infants born to young mothers of nonwhite races suffer relatively higher postneonatal mortality than do their white counterparts. The postneonatal mortality rate is lowest for 1st born infants of both races. Among nonwhites, it is highest for the 2nd born; in the white race, it rises with each successive birth, with the exception of the 5th. Postneonatal mortality among very small white infants (those weighing less thatn 1500 gm at birth) was some 7 times that of infants weighing more than 2500 gm; it was even higher in nonwhite races being nearly 2 1/2 times that of the white group and appoproximately 4 times higher than the rate for nonwhite infants weighing more than 2500 gm at birth. The risk of postneonatal death for nonwhite infants born illegitimately was 1 1/2 times as great for those born in wedlock. Among white infants, the risk was almost twice as great for those born out of wedlock.^ieng