Monday, August 15, 2011

2001-2010 Achievements in Maternal and Infant Health

Well, I'm only about three months behind on this, but the CDC's MMWR (Morbidity and Mortality Weekly Report - most exciting periodical EVAR) published a list of ten great public health achievements between 2001-2010.

Maternal and Infant Health
The past decade has seen significant reductions in the number of infants born with neural tube defects (NTDs) and expansion of screening of newborns for metabolic and other heritable disorders. Mandatory folic acid fortification of cereal grain products labeled as enriched in the United States beginning in 1998 contributed to a 36% reduction in NTDs from 1996 to 2006 and prevented an estimated 10,000 NTD-affected pregnancies in the past decade, resulting in a savings of $4.7 billion in direct costs.
Improvements in technology and endorsement of a uniform newborn-screening panel of diseases have led to earlier life-saving treatment and intervention for at least 3,400 additional newborns each year with selected genetic and endocrine disorders. In 2003, all but four states were screening for only six of these disorders. By April 2011, all states reported screening for at least 26 disorders on an expanded and standardized uniform panel. Newborn screening for hearing loss increased from 46.5% in 1999 to 96.9% in 2008. The percentage of infants not passing their hearing screening who were then diagnosed by an audiologist before age 3 months as either normal or having permanent hearing loss increased from 51.8% in 1999 to 68.1 in 2008.
Quoted from here with citations removed for readability.

So to summarize, in the last 10 years we've made gains in preventing neural tube defects (the best-known disorder in this category is spina bifida) by fortifying grains with folic acid, and we've done a better job screening for diseases at birth, allowing earlier treatment. The data about hearing screening is actually quite surprising to me - I would not have guessed that so recently, there was so much room for improvement. Of all the things you need to catch early! So I was glad to see that.

You know what I would have been gladder to see? Gains in lowering the maternal and infant mortality rates, and gains in prevention of low birth weight and prematurity. Namely, the same gains made from 1900-1999, except that those rates have stabilized and in some cases gone back up. Worse, there are awful, large and growing racial/ethnic disparities in all four of these areas. It's such an insidious process for an overall reduction in mortality/morbidity to disguise a growing disparity. My sense is that we're really far from a wide awareness and acknowledgement of this process (which I bet happens in lots of other areas besides maternal and child health).

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