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The conduct of an infant mortality assessment entails identifying and answering an organized array of questions about the factors or determinants that contribute to the risk of an infant death or other adverse pregnancy outcome. Factors that contribute to an infant death occur across a continuum, from preconception, to the time of birth and beyond. Thus, when conducting infant mortality assessments, it is important to examine a wide range of factors and identify those that can be addressed with available resources and technology.

1) What are the causes of death? (Based on the ICD-9 classification)

  • Congenital Anomalies
  • Prematurity associated disorders
  • SIDS
  • Respiratory distress
  • Birth Complications
  • Infections
  • Accidents
  • Hypoxia & Birth Asphyxia
  • Pneumonia

2) When are the deaths taking place (neonatal or postneonatal period)?

  • Are specific causes of death associated with certain ages at death?
  • Is the association between cause of death and age at death changing over time?

3) What are the associated adverse pregnancy outcomes that contribute to infant death?

  • Preterm delivery
  • Low birth weight (<2500 gms) and very low birth weight (<1500gms)
  • Small for gestational age
  • Postterm delivery
  • Macrosomia
  • Congenital malformation and anomalies

4) How do these adverse pregnancy outcomes relate to infant mortality?

  • Are the trends both increasing/decreasing/stable or are they disparate?
  • How does the risk of mortality vary by birth weight and gestational age categories?
  • How have the risks of mortality by these outcomes changed over time?
  • How much of the IMR is explained by these associated adverse outcomes?

5) Are there racial/ethnic disparities in IMRs?

  • How have the racial/ethnic disparities in mortality and associated outcomes changed over time?
  • What risk factors underlie these disparities?

6) What risk factors are associated with a high IMR or an adverse pregnancy outcome?

  • Poverty
  • Lack of health insurance
  • Lack of employment
  • Low education
  • Stress and lack of support
  • Poor access to or inadequate use of prenatal care
  • Smoking
  • Alcohol or substance abuse
  • Poor nutrition
  • Intendedness of pregnancy
  • Unmarried
  • First pregnancy or high parity
  • Short birth interval
  • Age of mother (too young / too old)
  • Low weight gain during pregnancy
  • Medical complications (hypertension, diabetes, etc)
  • Infections
  • Multiple births
  • Inappropriate hospital level for delivery

7) What are the relative risk (RR) and the attributable risk (AR) for these risk factors?

Relative risk is

The incidence of the disease among those with the risk factor    
The incidence of the disease among those without the risk factor

Attributable risk is

(Incidence in total population) – (Incidence in non-exposed group)

8) How does the distribution of these risk factors vary?

  • Over time?
  • By region, county, place?
  • By specific adverse outcomes?

9) Are there successful IM prevention programs in place?

  • How has the impact been demonstrated?
  • Are these programs reaching the appropriate populations?

10) What is the availability of high-risk obstetrical and newborn care (relative to need or indication of need)?


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